Posts Tagged ‘labor and delivery’

What you need to know about GBS

Wednesday, July 5th, 2017

pregnant woman with doctorDuring your last trimester of pregnancy, you will get a test for group B strep (also called GBS). GBS is a common type of bacteria that can cause infection. Usually GBS is not serious for adults, but it can hurt newborns. It is important to get this test and know the results, so that you can protect your baby.

Who is at risk for GBS?

Many people carry GBS—in fact about 1 in 4 (25%) of pregnant women are carriers.  GBS bacteria naturally live in the intestines and the urinary and genital tracts. As an adult, you can’t get it from food, water or things you touch. You can’t catch it from another person, and you can’t get it from having sex. GBS in adults usually doesn’t have any symptoms. But sometimes it can cause minor infections, like a bladder or urinary tract infection (UTI).

However, when you are pregnant, if you have a GBS infection, it can be passed to your newborn during labor and delivery and it can make your baby very sick.

Testing and treatment for GBS

You prenatal care provider will test you for GBS at 35 to 37 weeks. The test is a simple swab of your vagina and rectum. If the results are positive, then you have GBS. Antibiotics can treat GBS but you must get them during labor and delivery. Your provider will give you the antibiotic through an IV. Treatment with antibiotics helps prevent your baby from getting the infection.

Penicillin is the best antibiotic for most women, but if you’re allergic to penicillin, your can get a different medicine.

It is not helpful to get treatment for GBS earlier in your pregnancy. The bacteria can return quickly, so you could have it again by the time you go into labor.

If you have GBS, remind your providers at the hospital when you go to have your baby. This way, you can be treated quickly. Treatment works best when it begins at least 4 hours before childbirth.

If you have GBS and you’re having a scheduled c-section before labor starts and before your water breaks, you probably don’t need antibiotics.

What are the chances I can pass GBS to my baby?

If you have GBS during childbirth and it’s not treated, there is a 1 to 2 in 100 chance (1 to 2 percent) that your baby will get the infection. The chances are higher if you have any of these risk factors:

  • Your baby is premature. This means your baby is born before 37 weeks of pregnancy.
  • Your water breaks (also called ruptured membranes) 18 hours or more before you have your baby.
  • You have a fever (100.4 F or higher) during labor.
  • You’ve already had a baby with a GBS infection.
  • You had a UTI during your pregnancy that was caused by GBS.

You can read more about GBS on our website.

Have questions? Send them to AskUs@marchofdimes.org.

You’re pregnant. Should you have a doula help you?

Monday, September 21st, 2015

pregnant woman smilingA doula can provide significant support to you and your partner throughout your journey to parenthood. Last week we talked about what a doula is and the support services they provide for pregnant women during pregnancy, labor, delivery and postpartum. If you are considering working with a doula, we want to help you make an informed decision.

Research has shown that continuous support from a doula may:

• Decrease the use of pain medications during labor and delivery
• Reduce the need for Pitocin, a labor-inducing drug
• Decrease the incidence of C-sections and the use of forceps
• Result in shorter labor and delivery with fewer complications
• Allow moms and partners to feel supported

In addition, women who had continuous support from doulas gave birth to babies who were less likely to have low five-minute Apgar scores.

Is there anything a doula can’t do?

A doula can be a great addition to your care team, however a doula cannot provide medical advice or replace your health care provider.

What about your partner?

A doula will not replace your partner. In fact, a doula can support your partner or family member to become as involved in the birth process as you desire. A doula can help teach your partner how to comfort and support you during the birth process.

Where can you find a doula?

• To find a certified doula near you, use DONA’s online locator or visit Doulamatch.net.
• Ask your health care provider or child birth instructor for a referral or information on how to find a doula.
• Contact your local hospital or health department for a referral.
• Ask your social network or health care team about free or low cost doula services. Insurance coverage for doula fees vary by plan. Some doulas offer free services and many communities offer volunteer doula programs supported by federal and city funds.

Have any questions? email or text us at AskUs@marchofdimes.org.

What is a doula?

Monday, September 14th, 2015

mom-with-newborn-in-hospitalA doula is a trained and experienced professional who provides physical, emotional and informational support to a pregnant woman and her partner. A doula provides care for moms-to-be during pregnancy, labor, delivery, and the postpartum period. She also helps women carry out their birth plans so that they have a positive childbirth and postpartum experience.  The word “doula” comes from the ancient Greek meaning “a woman who serves.”

There are different kinds of doulas:

A birth doula understands the birthing process and the emotional needs of a woman in labor. If you are pregnant, a birth doula will help you develop a birth plan and assist in carrying out your plans during labor and delivery.

Your relationship with your doula will start with one or more meetings during your pregnancy. Once you start your contractions, she will stay with you throughout your labor to provide physical comfort, emotional support and help as you make informed decisions.

A postpartum doula can provide you with education, companionship and support after your baby is born. She can assist with newborn care, meal preparation, light household tidying and can help your family adjust to your newest addition. She will also be able to offer evidence-based (scientifically proven) information on feeding, soothing, coping skills and emotional and physical recovery from your labor and delivery.

A bereavement doula is a newer form of support. Although DONA does not offer a bereavement doula training program, many doulas are able to find other programs in their communities and online to receive certification. A bereavement doula can provide assistance, support, resources and referrals to families who are experiencing the loss of their baby.

A doula that provides bereavement support may be known by a different title, such as a Baby Loss Family Advisor. These professionals have been trained to help you navigate through the difficult days – from the moment you hear the news to preparing for the hospital experience and for when you return home.

Many birth and postpartum doulas are trained and certified through DONA International, toLabor, and CAPPA.

Now that you know what a doula is, tune in next week to learn if you should consider having one help you.

Have questions? Text or email us at AskUs@marchofdimes.org.

 

Join our Twitter chat on pregnancy

Monday, August 25th, 2014

Pregnancy chatAre you pregnant? Do you have questions about pregnancy? Join us on Thursday, August 28th at 2pm EDT for a Twitter chat and get your questions answered.

We will be joining the National Institute of Child Health and Human development (@NICHD_NIH) and the Federal Drug Administration Office of Women’s Health (@FDAWomen) to discuss:

• common pregnancy myths
• how to reduce health problems during pregnancy
• how long your pregnancy should last
• important info about labor and delivery

Jump in the conversation any time to ask questions or tell us your story.  Follow #pregnancychat.

We hope to see you then!

If you have questions, feel free to email us at AskUs@marchofdimes.org.

Click here to read more News Moms Need blog posts on: pregnancy, pre-pregnancy, infant and child care, help for your child with delays or disabilities, and other hot topics.

Updated guidelines for water birth

Monday, April 7th, 2014

Water birth is the process of giving birth in a tub of warm water.  A few weeks ago the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) released a joint committee opinion regarding laboring and delivering in water. In it they state that “Undergoing the early stages of labor in a birthing pool may offer some advantages to pregnant women. However, underwater delivery has no proven benefit to women or babies and may even pose a risk of serious health problems for the newborn.”

It is important to understand that the committee does make a distinction between laboring in water and delivering in water.  They acknowledge that there may be some benefits to being in the water during the early stages of labor. For women who have uncomplicated pregnancies, laboring in water may result in decreased pain, reduced use of anesthesia, and shorter labors. However there is no evidence that immersion in water during the first stage of labor otherwise improves perinatal outcomes. And being immersed in water during the first stage of labor should not prevent appropriate maternal and fetal monitoring.

However, the committee did express concerns about a woman actually delivering her baby in water. They found that “the safety and efficacy of immersion in water during the second stage of labor [delivery] have not been established, and immersion in water during the second stage of labor has not been associated with maternal or fetal benefit.”

After reviewing studies on water births they found a risk of severe complications in the newborn, including
•    maternal and neonatal infections, particularly with ruptured membranes;
•    difficulties in newborn temperature regulation;
•    umbilical cord rupture while the newborn infant is lifted or maneuvered through and from the underwater pool at delivery, which leads to serious hemorrhage and shock; and
•    respiratory distress that results from tub-water aspiration (drowning or near drowning).

While these complications of water birth may be rare, they are very serious. Until more thorough studies are done and the benefits of delivering in water to both mother and baby have been proven, both ACOG and AAP suggest that deliveries in water should be done in a research setting with mothers being fully informed about the potential risks and benefits.

Medications for pain relief

Monday, December 2nd, 2013

iv-bagWhen it comes to managing labor pain, some expecting moms prefer to deal with the pain of childbirth naturally, using breathing and relaxation techniques. Others decide from the start to use pain medication to help manage labor pain. One option for pain meds during labor is to use narcotics (also called analgesics or opioids).

Narcotics affect the whole nervous system, instead of just one area. They are given through an intravenous (IV) catheter (a small tube that is inserted into a vein) or by injecting the medicine into the butt or thigh muscle. The medication lowers pain and makes it easier to rest.

Narcotics can be given anytime during labor, but work best during early labor when the cervix isn’t fully dilated. Sometimes, you may be able to control your own pain relief by pushing a button that releases a fixed amount of medicine through the IV tube and into your body. Pain relief begins within minutes. You remain conscious throughout labor and into delivery. Pain relief can last between 2 and 6 hours, depending on how it’s given.

As with most things, there are pros and cons to using narcotics.
Pros –
• Narcotics lessen your pain and take effect quickly.
• They help you rest without causing muscle weakness or lowering your ability to push.
• In some cases, you can control how much medication you use during labor.
• Narcotics can be used with other pain medications like an epidural or spinal block.

Cons –
• Narcotics may leave you feeling sleepy.
• They may cause nausea.
• If too much medication is used, it can temporarily slow down breathing for both mom and baby.
• The medication cannot be given right before delivery because it may slow the baby’s breathing and heart rate at birth.

Midwifery – What does a midwife do?

Tuesday, October 8th, 2013

midwifeThis is National Midwifery Week, created by the American College of Nurse Midwives to celebrate and recognize midwives and midwife-led care.

A certified nurse-midwife is a registered nurse with advanced, specialized training and experience in taking care of pregnant women and delivering babies. Certified nurse-midwives are licensed to provide care before, during and after delivery.

There are several different types of midwives, each holding different certifications based on their education and/or experience. Certified nurse-midwives (CNMs) and certified midwives (CMs) attend approximately 93% of all midwife-attended births in the United States, and as of 2010 they are required to have a master’s degree in order to practice midwifery.

Midwifery care fits well with the services provided by obstetrician/gynecologists (OB/GYNs), who are experts in high risk, medical complications and surgery. By working with OB/GYNs, midwives can ensure that a specialist is available if a high-risk condition should arise during pregnancy or labor and delivery.

Once your baby is here, a midwife can assist with questions about breastfeeding (it’s not as easy as you think.) Midwives can provide you with health care in the postpartum period and between pregnancies at well woman visits. They can provide pain medications, birth control, screenings and vaccinations. They treat women from the teen years through menopause.

Here is a link to more information about midwives from the American College of Nurse Midwives.

Who will delivery your baby?

Tuesday, September 3rd, 2013

baby arrivesGetting early and regular prenatal care is very important for having a healthy pregnancy and baby. The first step in getting prenatal care is to choose your prenatal care provider. This is the medical professional who will care for you during your pregnancy. You have options, so think about it. Will one make you feel more comfortable or confident?

You can choose either a doctor (physician) or midwife to take care of you during your pregnancy and to deliver your baby.
• An obstetrician (OB) is a doctor who specializes in the care of women during pregnancy, childbirth and recuperation from delivery. About 8 in 10 pregnant women choose obstetricians.
• A family practice doctor is a doctor with training in all aspects of health care for every member of the family. A family practice doctor can be your health care provider before, during and after your pregnancy, and your baby’s doctor, too.
• A certified nurse-midwife is a registered nurse with advanced, specialized training and experience in taking care of pregnant women and delivering babies. Certified nurse-midwives are licensed to provide care before, during and after delivery.
• A maternal-fetal medicine specialist is an obstetrician with special training in the care of women who have high-risk pregnancies. If you have risk factors that could complicate your pregnancy, your prenatal care provider may refer you to a maternal-fetal medicine specialist.

It’s important to choose a health care provider who makes you feel comfortable and listens to you. Click on this link for a list of questions to consider when making this decision.

Study shows we can reduce unnecessary early deliveries

Tuesday, April 9th, 2013

A study published today in Obstetrics & Gynecology shows that hospital-based quality improvement programs across many states can be remarkably effective at reducing early elective deliveries of babies.

The rate of elective early term deliveries (i.e., inductions of labor and Cesarean sections without a medical reason) in a group of 25 participating hospitals fell significantly from 27.8 percent to 4.8 percent during the one-year project period, an 83 percent decline.

The March of Dimes, which partly funded the study, calls the findings good news, because babies delivered before full-term are at increased risk of serious health problems and death in their first year of life.

“This quality improvement program demonstrates that we can create a change in medical culture to prevent unneeded early deliveries and give many more babies a healthy start in life,” says Bryan T. Oshiro, MD, of Loma Linda University School of Medicine and lead author of the study.

“Reducing unnecessary early deliveries to less than five percent in these hospitals means that more babies stayed in the womb longer, which is so important for their growth and development,” says Edward R.B. McCabe, MD, medical director of the March of Dimes. “This project saw a decrease in the proportion of babies born at 37 and 38 weeks and a corresponding increase in the 39-41 week range during the one-year period studied. Additional studies, perhaps over a longer period of time, could clarify whether such quality improvement programs can also bring down a hospital’s overall preterm birth rate.”

This was the first project of a collaborative with perinatal quality improvement advocates from state health departments, academic health centers, public and private hospitals, and March of Dimes chapters from the five most populous states in the country: California, Florida, Illinois, New York, and Texas. These five states account for an estimated 38 percent of all births in the United States.

The March of Dimes urges hospitals, health care providers, and patients to follow the American College of Obstetricians and Gynecologists guidelines that if a pregnancy is healthy, to wait for labor to begin on its own. The final weeks of pregnancy are crucial to a baby’s health because many vital organs, including the brain and lungs, are still developing.

“A Multistate Quality Improvement Program to Decrease Elective Deliveries Before 39 Weeks,” by Dr. Oshiro and others, appears in the April 8 online edition of Obstetrics & Gynecology, Vol. 121, No. 5, May 2013.

What is the breech position?

Friday, April 5th, 2013

Dr. Siobhan Dolan discusses the breech position in the new March of Dimes book, healthy mom, healthy baby.

“Babies typically move into a head-down position during the last month or so of pregnancy. But some don’t, meaning that when labor starts, they are positioned to be born feet-first or buttocks-first. This is called the breech position. Having a breech baby is most likely to happen when a woman goes into labor early, has had previous pregnancies, is pregnant with more than one baby, has a condition in which there is too little fluid in the amniotic sac, or has problems or abnormalities with the uterus or placenta. Sometimes it happens for no identifiable reason.

“If your baby is breech, your provider may recommend a procedure called an external cephalic version. In this procedure, a provider places his or her hands on your belly and tries to move the baby into a head-down position from the outside of your body. This can be uncomfortable, and it may not work. Sometimes a “version,” as it is often called, is attempted more than once. Delivering a breech baby vaginally is risky, especially for mothers having their first delivery, so if your baby can’t be moved out of the breech position, your provider will likely recommend a c-section.”

Learn more about healthy mom, healthy baby, read excerpts from the book, even order a copy at this link.