Group B Streptococcus (GBS)

June 16th, 2010 § 0 comments § permalink

I’m working on my protocol for GBS, so of course, the books are coming out and I’m doing extra-intense research on this. I know what I would do in this situation (I wouldn’t test—I would just take good care of myself, eat well, and possibly get on immune supporting herbs), but figuring out what to put in a protocol, and what to recommend to a client who had a urine culture come back GBS + (which means she is more highly colonized) is a little bit trickier. :/ I just can’t believe that routine prophylactic antibiotics for all GBS+ moms is the right answer.

Some interesting things have come to light already. Mothers in a study who had developed antibodies to GBS, and passed them to their newborns via the placenta had babies who didn’t get sick, whereas other mothers who didn’t have antibodies and didn’t pass them to their newborns had their newborns get sick. I’m not sure it will be that cut-and-dry once I read the entire study and get all the details, but it is interesting, nevertheless. I also discovered that there is work being done on a vaccine for GBS in its final stages, and it is looking promising (not that I or any of my mothers would be interested in a vaccine).

Anyway, I’m planning to do a post that compiles all my research into a (hopefully!) easy-to-digest version that is still good and informative. Stay tuned!

"Before Moses Delivered Israel…

June 13th, 2010 § 0 comments § permalink

Shiphra and Puah delivered Moses.” (Yes, I realize that it was God who delivered Israel from their bondage in Egypt—not Moses, who was just the instrument God chose to use. Likewise, Christian midwives recognize that it is truly God who brings forth babies from their mothers’ wombs—we are just the instruments He uses sometimes!)

So says my t-shirt, given to me by a midwife friend. I’ve received many comments on it when I wear it. I have come to realize that most people, however, even Christians, don’t know about Shiphra and Puah—unless they are midwives themselves—so I decided to do a post on them and midwifery in ancient Egypt.

Although its not certain that Shiphra and Puah actually delivered Moses, they were recognized as “the Hebrew midwives” or “midwives to the Hebrews”. Historical sources are not clear on whether they were Hebrews themselves, or whether they were Egyptian midwives assigned to deliver the Hebrews babies. Either way, the Hebrew Scriptures, and Josephus, a Jewish historian, speak highly of them. Below is an excerpt from a paper I wrote on the history of midwifery, entitled “Created to Give Birth”.

Midwifery in Ancient Egypt
In Hebrew, or biblical culture, children were considered one of the greatest blessings, and an inability to conceive and have children was viewed as a curse. Indeed, “fruitfulness” was a command from Yahweh, the Lord, to the people of God: “Be fruitful, and multiply, and fill the earth and subdue it.”10 (Emphasis mine.) A similar attitude toward children is also seen in the ancient Egyptian culture. A large family was an honor to parents, and especially to the father, the head of the household. Even though the Egyptians were prolific, and childless couples were expected to adopt to make up for their lack, they were not as fruitful as the Hebrews. At this time, the Hebrews were enslaved to the  Egyptians, and the Pharoah was afraid they would rise up against his kingdom, along with an enemy nation, and overthrow him because of their great number. To limit their numbers, Pharaoh ordered Puah and Shiphrah to kill any boy babies when they attended the women in travail and saw them on the birth stools or “stones”. Josephus, Jewish historian, records that Pharaoh’s order was to Egyptian midwives, because Pharaoh would not presume that Hebrew midwives would obey his order. Risking the wrath of Pharaoh, Puah and Shiphrah spared the Hebrew boys because they feared God. When called to account for their disregard of the Pharaoh’s command, Puah and Shiprah said that, unlike the Egyptian women, the Hebrew women birthed quickly, before the midwives could arrive. Because the midwives feared God, He dealt well with them and blessed them with families. These midwives not having families of their own challenges the common assumption that all midwives in ancient times were older women with children of their own, or even beyond childbearing age. Pharaoh’s mention of the “stool” or “stones” is important, because it gives us knowledge about the birth position commonly used by the Hebrews. In her book, Birth Chairs, Midwives and Medicine, Amanda Carson Banks explains, “The first external, material objects used [as birth chairs] were birth stones and stools. Birth stones were two pieces of roughly shaped rock placed slightly apart so as to create a makeshift seat or stool with an opening in the middle on which the mother sat or kneeled.” The birth stool was also an accepted birth position for Egyptian women. The Egyptian hieroglyphic for birth is a depiction of a woman giving birth seated on two stones, or a low birth stool. According to Dr. Wegner, an archeologist from the University of Pennsylvania, Egyptologists have long known that the standard form of childbirth in ancient Egypt was for the woman to give birth squatting on two mud bricks. Squatting has the double benefit of opening the pelvis, and using the force of gravity to bring the baby down. Egyptian women were commonly attended by two midwives—one attending to the mother, and the other to the newborn baby, in accordance with Egyptian religious beliefs.

Babies puncture, Membranes rupture

June 8th, 2010 § 0 comments § permalink

Why is it sometimes difficult to determine if a mother’s water bag (amniotic sac) is intact, or broken (“ruptured”)?

If a client has a big “pop” or “splash”, and gets all wet and soaked, then her water is broken, especially if she keeps leaking, right? If those things don’t happen, then it’s not.

If only it were so simple…here are a few case studies to demonstrate my meaning.

Case Study #1
A client is laboring in hands-and-knees, and is in active labor. Her midwife is with her. During a contraction, she suddenly says that her water broke. It soaks through her clothes, and she proceeds to keep leaking. Obviously her water is broken.

A few hours later, her midwife checks her to see what progress she has made, and discovers a bulgy bag of water—the membranes are still very much intact. What happened?

Case Study #2
A client comes in saying her water broke at home, and it made a puddle on the floor, smelled clean and fresh, and took a few towels to clean it up. She kept leaking for several hours, and then stopped. Her midwife checked her a few hours later—membranes are still intact. What happened?

Case Study #3
A client says she thinks her water is broken, but she’s not sure. It broke with a pretty obvious sound, but she didn’t keep leaking afterwards. She got pretty wet at the time, though. Her midwife did a Nitrazine test (pH paper to test for the highly alkaline amniotic fluid) that was pretty positive, and they decided to give her all night to see if she would go into labor on her own. Nothing much happened. Her midwife repeated the Nitrazine test in the morning, and it was negative. They did a sterile exam, and there was a very thin membrane in front of the baby’s head, and when the mother had a Braxton Hicks contraction, it bulged slightly. Intact membranes! How did that happen?

When the membranes rupture or the “water breaks”, there are a couple ways that can happen. First, there is the classic “water breaking” with the water bag breaking at the cervix with a pop or gush, and a large quantity of fluid gushing out. Second, is the “slow leak”, where there is a break in the bag of waters (usually up high) that causes slow leaking and little gushes with fetal movement or contractions. The third main way it can break (but rarely), is for fluid to leak between the two layers (the amnion and the chorion) and for only the chorion, the outer layer, to rupture—this causes the fluid trapped between the two layers to leak out. Usually with this last kind of rupture, the mother won’t continue to leak once the fluid leaks out initially.

So it can be trickier than you would think. 🙂 Why is it so important to determine for sure whether or not a mother’s membranes are intact?

If a mother’s water is truly broken, there is a risk of infection (Varney’s Midwifery says from 1.6-29% risk of infection depending on a lot of different factors) that isn’t a problem with the membranes are intact. An intact amniotic sack, for the most part, seals the baby in a sterile environment which protects the baby and the mother from infection.Also, if the membranes are broken, you really don’t want to do any vaginal exams until active labor has begun, because the risk of infection goes up by a good amount 24 hours after the first vaginal exam. Additionally, there is a greater chance of infection if the mother is GBS positive, but that’s a discussion and topic for another day…

Basically, I realized through the last few times I’ve faced having to determine the status of membranes, I’ve learned that it’s not nearly as straightforward as I thought it was!