The 43 Year Active Management of Labor Project: What have we learned?

The concept of active management of labor is familiar to most maternity care professionals.  This concept was first demonstrated  at the National Maternity Hospital in Dublin Ireland in the late 1960s.

Defined, active management of labor includes two major components.  The first component is the Organizational Component, which many have stated is the most critical of the two.  The Organizational Component includes prenatal education (which includes patient/family education about the birth process and working with labor), daily physician assessment (assessing labor progress, supportive to patient throughout labor and during the postpartum period), bedside support (emotional and educational support at the bedside by staff), and peer reviews of outcomes (evaluate the effectiveness of the approach and possible process improvement).  The other component, the Medical Component, includes a rigid inclusion criteria (ensure only term, umcomplicated nulliparas are actively managed), strict diagnosis of labor (prevent hospital admission in early labor, decrease cesarean rate), early amniotomy (to assess volume and presence of meconium), frequent cervical exams (detect early dystocia and adequate process), and high-dose oxytocin (to correct dystocia with more effective contractions).  All of this with twelve hours believed to be the maximum safe duration of spontaneous labor.

Interestingly, epidural anesthesia is not a component of the active management of labor routine.  To compound this, there is some conflicting research as to the effect of epidural anesthesia on length of labor, depending on the source.  Over all,  it is well known in the literature that women who have inductions have longer labors and higher cesarean rates.

Taking a look at the state of US maternity care today, with pregnancy outcomes (specifically maternal morbidity/mortality and infant morbidity/mortality) not improving (in fact worsening) and the cesarean rate rising significantly since 1968, it is important to assess use of active management of labor prior to its efficacy.  Many birthing facilities and care providers use some of the components of active management of labor, however several items tend to be overlooked or forgotten in the implementation of the process ~ specifically, prenatal education, bedside emotional and physical support and rigid inclusion criteria.  Therefore, with these vital components not being included, any assessment of the efficacy of active management of labor would be incongruent.   Thus, active management of labor may be misunderstood by care providers and misapplied.

One only has to look as far as the Cochrane Database to obtain a summary of RCTs and evidence-based care.  No longer do we have an excuse that evidence-based maternity care continuing education opportunities are beyond reach.  And in this case, ignorance is not bliss.  Nor is it professional.  Expectant parents look to care providers to do just that ~ give care.  Our organizations charge us with providing best practice and quality care.  Conversations, albeit heated ones, exist about the best practice vs best price conundrum.  How dare we, as a society or as a country, put currency before the health of our women and children.  How can our conscience survive knowing that we compromise care, blaming it on "that's the way we've always done it", "that's what our policy says" or more acidic comments such as "if you don't do this, your baby will die" (when in fact, the baby will not die).

Our maternity care practices in the past 43 years have not yielded better results.  The outcry of those pleading for revolutionary change in maternity care are not those who are aggressive, uneducated radicals uncomfortable with 43 years of rituals.  Many are, in fact,  physicians, midwives, nurses, childbirth educators and doulas.  They are authors, speakers, researchers, university professors.

And they all are asking the same question: What have we learned?


Resources:


Listening to Mothers I & II

Boylan, P.C. Active management of labor: results in Dublin, Houston, London, New Brunswick, Singapore and Valparaiso.  Birth 1989 16: 114-9.

Declercq, E. Macdorman M., Menacker F. Recent trends and patterns in cesarean and vaginal birth after cesarean (VBAC) Deliveries in the US.  Clinical Perinatology 2011 June 38(2) 179-92.

Declercq, E. Macdorman M. Zhang J. Obstetrical intervention and the singleton preterm birth rate in the US 1991-2006. American Journal of Public Health 2010 Nov 100(11) 2241-7.

Declercq, E. Macdorman M., Menacker F. Neonatal mortality risk for repeat cesarean compared to VBAC in the US 1998-2002 birth cohorts.  Maternal and Child Health Journal 2010 Mar 14(2) 147-54.

Florence DJ, Palmer, D. "Therapeutic choices for discomforts of labor" Journal of Perinatal and Neonatal Nursing 2003 Oct-Nov 17(4) 238-49

Impey L. Boylan P. Active management of labor revisited.  British Journal of Obstetrics and Gynecology. 1999 106:183-7.

James D.C. "Routine obstetrical interventions: research agenda for the next decade." Journal of Perinatal and Neonatal Nursing.  2011 Apr-Jun 25(2): 148-52

Nil Nocere

This post is actually a quote from Dutch professor of obstetrics G. Kloosterman:

Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character.  The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine - nil nocere [do no harm].


Kloosterman, G. (1982) "The universal aspects of childbirth: Human birth as a socio-psychosomatic paradigm" Journal of Psychosomatic Obstetrics and Gynecology 1(1) 35-41 page 40.

Free New App for Breastfeeding

Hot off the press is the new LactMed App for iPhones and Androids.


LactMed, part of the National Library of Medicine's (NLM) Toxicology Data Network (TOXNET®), is a database of drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives are provided to those drugs where appropriate. 


All data are derived from the scientific literature and fully referenced. Data are organized into substance-specific records, which provide a summary of the pertinent reported information.


To download this App, go to the iTunes App Store or scan the QR code here below to learn more.

Apple Dumplings ~ from a UK Midwife!

Perhaps the first music video about breastfeeding!

What if......we substituted Childbirth Educator for the word Anesthesiologist?

There was an article that was written recently about the disparity in understanding between maternity health care providers, focusing on anesthesiologist.  In playing with the word anesthesiologist, I wondered what the article would look like if I substituted the word childbirth educator or education.  Here's how it turned out.  What are your thoughts?


********************************************************************

"Childbirth educators are pivotal in so many areas of the hospital, yet their work and expertise are not well understood, especially in labour and delivery settings," said Dr. XXXXXX, XXX Fellow at XXXX  Centre and resident physician at the University of XXXX and lead investigator of the study. "This study is the first-of-its-kind that explores specifically how childbirth educators and their labour and delivery colleagues perceive the childbirth educators role, and the potential impact of these perceptions on interprofessional dynamics and team collaboration in labour and delivery."

The study, co-supervised by Dr. xxx, vice-president of education at St. xxxas Hospital, and Dr. XXXXXXXXXXX  with the XXXXXX  Institute of xxxxx  Hospital and The xxxx Centre, was recently presented at the first International Conference on Faculty Development in the Health Professions in (city)  at  xxxxx  Hospital.

Health providers in the labour and delivery units at two urban teaching hospitals in Toronto were interviewed. Participants (ranging from midwives, nurses and obstetricians, as well as childbirth educators, all with different levels of experience) were asked a series of in-depth questions to determine their understanding of the childbirth educators's role during labour and delivery, the childbirth educators process, and the type and amount of education and training they had received around childbirth education management.

On analysis of the data, a number of important themes emerged: 

• Lack of understanding of the complexity of the childbirth education process during labour and delivery. While midwives, nurses and obstetricians appreciated the role of their childbirth educator colleagues, particularly in the provision of labour pain relief and anesthetics for C-sections, many reported that their understanding of the actual process of childbirth education was limited.
  
  
• Lack of training about childbirth education: Many nurses and midwives received little formal training about the childbirth education process in school or during their clinical placements. Similarly, most obstetricians had very little postgraduate exposure to formal childbirth education training. The study also revealed that opportunities for structured communication between all labour and delivery health professionals (ex. to discuss cases or to debrief after an adverse event) were infrequent and therefore, a missed opportunity for team learning and quality improvement. 
  
• Childbirth educators’ membership in the labour and delivery 'team': Nurses, midwives, obstetricians and other members of the obstetrical team spend countless hours with the patient throughout the entire labouring process. In comparison, the study found that the childbirth educators had less involvement in decision-making processes, even when they could have had useful and important input into a patient's care. The study found that this misunderstanding and the often peripheral position of the childbirth educators on the team, led to isolation of the childbirth education s in their work, which had implications for effective communication, collaboration and the safe delivery of care. 
  
• Imbalances and tensions between health professionals: The study found that some engrained stereotypes and historical tensions were present between different health professions. Instances of hesitation to question other professionals about decisions related to patient care were sometimes borne out of fear, or were due to inadequate training and knowledge. 
  "This study tells us that as health professionals, we have an immense amount of work to do in order to build a culture of true interprofessional teamwork and to provide the necessary training and supports to ensure that we deliver the best possible patient care, " .

World Breastfeeding Week 2011!

The theme of this year's World Breastfeeding Week is "Talk to Me! Breastfeeding a 3D Experience".  When we look at breastfeeding support, we tend to see it in two-dimensions: time (from pre-pregnancy to weaning) and place (the home, community, health care system, etc). But neither has much impact without a THIRD dimension – communication!

Every year, breastfeeding advocates and parents celebrate world wide Breastfeeding Week during August 1-7!
Even with global exclusive breastfeeding rates on the rise, the momentum to promote and continue to promote breastfeeding is a wise decision!

Read more.......

Healthy Babies Are Worth the Wait! New from March of Dimes

Another great resource for childbirth educators and doulas: the first educational stop on the pregnancy journey!

The March of Dimes' new campaign, Healthy Babies are Worth the Wait, informs health professionals and the public about the complications and health risks related to inducing a pregnant woman before 39 weeks gestation.

Through this new campaign, the March of Dimes aims to raise awareness among women and medical providers of the importance of having a full-term birth and allowing for natural labor, if possible.  

For more information and resources related the MOD’s 39 weeks campaign, visit:  http://www.marchofdimes.com/pregnancy/getready_atleast39weeks.html.

Food Guide Pyramid --> My Plate!

If you are viewing this on Facebook, please go to www.childbirthtoday.blogspot.com to see complete blog post.

Out with the old Food Guide Pyramid and in with the new My Plate!

The USDA has created a more user friendly and easier to comprehend way of looking at our nutrition and have replaced the Food Guide Pyramid with the new My Plate graphic.  Designed to help everyone eat better and be healthier, the USDA have also added some great resources to add to your childbirth education class materials or doula client information!

Check it out ~

Daily Food Plan for Moms
Daily Food Planner/Tracker
Moms with Special Nutritional Needs: Allergies, etc.

While not as Baby Friendly as the Surgeon General would like, there is info on nutrition and breastfeeding:

Breastfeeding Nutrition

What about food safety?  Click here

Need more info about nutrition and pregnancy and breastfeeding?  They have great resources too!

Remember, it is NEVER too late to talk to your expectant clients about the impact of dietary changes on the development of their baby(s)!  Even if you begin interacting in the closing weeks of the third trimester, share the My Plate with them.  It may make a world of difference!

Follow up: FDA oks Birth Pools

The FDA has released birth  pools from "detention" and will continue their investigation. For right now, they are NOT classifying them as Medical Devices, which is best for midwifery community and all women seeking a non-medicated birth. 


~ Waterbirth Solutions

10 Simple Truths About Childbirth ~ #5

If you are viewing this on Facebook, please go to www.childbirthtoday.blogspot.com to see entire post.  Thanks!

Many people are followers and few are leaders.  This is true both in childbirth related organizations and society as a whole.  Not only does it apply to "politics" but also how birth is viewed.  

Birth is an organic, normal, natural and physiologic process.  Like other body functions, birth typically does not need intervention.  However, occasionally, like other body functions, intervention is beneficial...in fact necessary for positive outcomes.

Whatever your role in the birthing community ~ care provider or care receiver ~ think twice about being a sheeple....that is, following the crowd.  Doing what has always been done because it appears ok.  The reality is, at the end of the day...or at the cliff's edge, it may appear ok, but it may not be ok!  

Oh, and another thought.  Be careful whom you do follow.

Birth Pool Accessibility Now in Question

If you are a birth professional, you will know how quickly the news about the FDA making accessibility to birth pools in the U.S. harder went viral today (5/26/11) .   The following is  information from long time expert and waterbirth advocate Barbara Harper: 




"In my personal conversations with a woman(Patricia Jahnes) in the "Office of Compliance- Center for Devices and Radiological Health" (that's where they put us) I was told in no uncertain terms that pregnancy is classified as an "illness" and "birth is a medical event" and therefore ANYTHING that is used during this time is considered a "device" and therefore needs approval by the FDA". ! BH


There is a flaw here in their (the Office of Compliance) reasoning.  A huge flaw.  So if one arm of the U.S. government believes that pregnancy is an illness and birth is a medical event and anything that is used during this time is considered a device that needs to be approved by the FDA, then what about Foley catheters used for Foley Inductions rather than for urinary flow?  What about Cytotec that is used frequently but not approved for use during pregnancy and birth?  And what about the inconvenient truth that both the electronic fetal monitors and the Apgar scoring system were never intended to be used in the manner that they are today?


I realize that these may be the difficult and unpopular questions.  However, I also realize that many of a woman's options and choices in pregnancy and childbirth are under attack.  


And therefore since one arm of the U.S. government believes that pregnancy is an illness and birth is a medical event and anything that is used during this time is considered a device that needs to be approved by the FDA, what is the next option/choice to go? 

10 Simple Truths About Childbirth ~ #4

‎"Men fear most what they cannot see" ~ perhaps that is why they fear childbirth? But all they really have to do is....look.


Fear is by far one of the driving forces behind the increase in medical intervention in childbirth.  "Men" meaning humankind, fear what they cannot see.  And since a good visual is not available for what is happening in the uterus and in the most dangerous 4 inches in an infant's life - the journey through the birth canal - then fear takes over.


Yet as much as we intervene in childbirth in the U.S., research continues to show with the rise in intervention rates, the rate of maternal morbidity and mortality/infant morbidity and mortality is still extremely poor.  In fact, 40 other countries have better statistics than the US in spite of the fact that the US spends more money on maternity health care.


But as the quotation says,  perhaps all one has to do is to look and they can "read" a laboring women.


I am not talking about EFMs or vaginal exams.  


I am talking about physical presence, verbal cues and emotional signals from women in labor.  


Study how she moves - left alone, a labor woman moves in perfect syncrony with her body to promote the cardinal movements of the baby: those miraculous movements that the baby initiates as the journey of birth begins.  Not signaled by the mother or caregiver, the baby instinctually knows how to move, bend and extend in order to fit through the tight spaces of the pelvis.  The mother will also move, bend and extend, crouch, squat, stand, sit, kneel, sway, lean and walk as if listening to a birth song...dancing to this song to bring her baby into the world.


Likewise, she may also "sing" along with this birth song...verbalizing as best as she can the effort going into this work.  It may be in the form of talking, moaning, singing, yelling, groaning, or talking in soft, loud or angry tones.  With each phase/stage of labor, her verbalizing changes, signalling the change from one phase to another.  Her verbalizing tries to match the intensity of the contractions and the work her body does.


As her verbalizing changes in intensity, so do her emotions.  From calm and expecting, to intense and working, to fierce and with effort, a laboring woman's emotions also change to match the work she does.  As the contractions become stronger in an effort to push the baby from the uterus to the loving arms on the outside, the emotions (and endorphins) match this strength.  With the protective fierceness that exists down deep in all mothers, a laboring woman expresses her emotions verbally, on her face, in the tone of her words and in her physical actions.


If we as caregivers take the time (albeit precious) to be fully present at a birth and watch with careful eyes the emotions, movement and verbal cues given by laboring mothers, then as we learn what is normal (and what isn't), birth will no longer be a fearful experience.  But we absolutely must know the normal before we can truly deal with the abnormal.  Then our morbidity and mortality statistics will be more reflective of the maternity care we all want to achieve.


While this has spoken more about the fear that caregivers have of birth, I will soon write Simple Truth #4a - about the fear that pregnant women have surrounding birth.  That also must be addressed.

The New Birthsource Lamaze Childbirth Educator Program!

In the spring of 1979, my husband and I sat in a Lamaze Childbirth Education Class in Lompoc, California.  While I was a nurse, normal and natural childbirth was something new to me.  We were taught about crisis intervention and all of the modern technology of the day, but this was totally new.  I was incredibly inspired by our educator, Linda Richardson (I believe that was her last name).  The spark of childbirth education had been ignited.

During the birth of our first daughter in April of '79, I experienced the Lamaze techniques and some of the same feelings we saw in the birth film (reel to reel ~ LOL) "Nan's Class".  As I held my beautiful daughter in my arms, counted her fingers and toes like all new parents, I knew my destiny.  I wanted to be an educator!

Several month later, I called Linda only to find that ALL of the Lamaze Educators in the local area were leaving, as their husbands were all military and it was time for new assignments.  They all helped me complete the educator program, including my own Seminar taught by Harriet Palmer in Fresno.  In August of 1980, I taught my first Lamaze childbirth education class, under the observation of one of the other educators.  I was hooked!  I soon became an LCCE and then a charter FACCE.

When our second daughter arrived in 1986 at Cape Canaveral Hospital in Florida, I had been teaching for seven years and really got an opportunity to "practice what I preached".  Her amazing birth reinforced that normal, natural childbirth was possible, even in a hospital setting; that there were care providers who believed in the power of women and the normalcy of birth!  Her birth strengthened my focus and further dedicated me to education.

During the 31 years since certification, I have taught in many states (as my husband was also in the Air Force), locations (adult schools, colleges, military hospitals, civilian hospitals, churches, and privately).  As I checked the mail yesterday, that same thrill came to me as I opened the envelope from Lamaze International containing the welcome letter and certificate for the new Birthsource Lamaze Childbirth Education Program!

While to many it may just be a natural progression - the sage femme becomes the educators' educator - to me it is an honor and privilege to be an active part of such a respected and prestigious organization that has stood for education, advocacy and maternity reform for so many years.

I guess now I too can say.....Thank you Dr. Lamaze.
And thank you to my daughters, who unknowingly played such an important part of my career!
And to my husband, who stood by me, cheering all the way.

10 Simple Truths About Childbirth ~ #3

I have begun the series "10 Simple Truths About Birth".  You can respond on Facebook, or directly on my blog at www.childbirthtoday.blogspot.com.  

Truth #3:    Many of today’s expectant women are passive, uninformed and fearful

In a discussion several days ago with another seasoned birth professional, we came upon the theory that the reason why so many women present in childbirth class passive, uninformed and fearful is because they may not have had the same type of role models as in the past.  

Rather than strong family members giving birth and being empowered parents, expectant mothers of today are influenced by the media, and the half truths, misinformation and sometimes, out right lies that are told.

When it comes to books, many women are familiar with the main stream books that are trendy and hip but contain, again, misinformation and half truths.  Rather than look for the evidence-based information, they are relying on celebrities and even some of my own maternity/obstetrical colleagues to provide a non-biased view of birth.  Unfortunately, expectant women who rely on these sources lose in the long run.

Likewise, if expectant parents rely on television, they will also lose.  Few if any televised shows about childbirth/breastfeeding present unbiased and/or evidence-based information.  Case in point:  

Please also view this:





And finally, this opinion:





Thank you to American Baby and "Better" for helping to promote the importance of childbirth education classes.   Where do the majority of the expectant parents you know get their information?

10 Simple Truths About Childbirth ~ #2

 Today I begin the series "10 Simple Truths About Birth".  You can respond on Facebook, or directly on my blog at www.childbirthtoday.blogspot.com.

Truth #2:  US maternity care does not practice evidence based care.

The US Maternity Health Care system does, in fact, not practice evidence based care.  A close look at the statistical data on maternal morbidity and mortality/infant morbidity and mortality shows a very bleak picture of our outcomes based on an interventive based care plan.  In fact, in their new initiative, Childbirth Connection states that “the largely healthy and low-risk population of childbearing women and newborns experiences 6 of the 10 most common hospital procedures. One out of three babies is born via cesarean section, the most common operating room procedure in the United States. Best evidence supports more judicious, restrictive use of maternity care procedures, and suggests that overuse is contributing to significant excess harm and costs.´

There is obviously a disparity between evidence based care and the care practices in the US.  But, as Childbirth Connection also asks, how can you make a change if you don’t know what you are aiming for?”  Exactly!

The scope of change will never happen with birth professionals standing at the hospital doors, banging, and yelling “You must change because we say so and because it is right”.  As stated in another “Truth”, hospitals are indeed companies or businesses wanting to make a profit.  Change will not happen necessarily because the literature says that is the thing to do….especially if “what we’ve always done” is working….mirroring the old adage: If it ain’t broke don’t fix it.

It is broken.  Research is beginning to come to the surface about our broken system.  A report issued by the California Pregnancy-Related and Pregnancy Associated Mortality Review shows that deaths from pregnancy-related causes, usually occurring at the time of birth, have risen dramatically in the U.S., in spite of the increased use of technology and the increase in cesarean section rates.  In fact, the study that was released on April 26, 2011 stated that the increase in cesarean sections were a major contributor to the increase in deaths from pregnancy-related causes.

But again, what does evidence based maternity care look like?  What is staffing, what services?  Is there a comprehensive childbirth education program and if so, what do those classes look like, certification?  What about a hospital based doula program?  Again, the Childbirth Connection asks for an essential package to answer these questions and many more.

I especially like Childbirth Connection’s call for a revival and broaden reach of childbirth education through expanded models and innovative teaching modalities.  

This in turn, will foster and promote a true cultural shift in attitudes toward childbearing.

10 Simple Truths About Childbirth ~ #1

    Today I begin the series "10 Simple Truths About Birth".  You can respond on Facebook, or directly on my blog at www.childbirthtoday.blogspot.com.

Truth #1:  Birth is healthy and normal, complications are the exception.

Mother nature says it.  The World Health Organization says it. Many maternity health care professionals such as physicians, midwives, nurses, childbirth educators and doulas say it.

Birth is healthy and normal. 

Anyone can find proof.  See abstracts of journal articles at the website for the US National Library of Medicine/National Institutes of Health or the Cochrane Database.  Read about it in books such as The Official Lamaze Guide: Giving Birth With Confidence, 2^nd Edition.

Interfering with the normal physiological process of labor and birth in the absence of medical necessity increases the risk of complications for mother and baby. So why is nature seen as abnormal and interventions seen as “normal”?  One educator shared on Facebook that it was the media and cultural brainwashing.  Some believe it is the process of accustomization – where we are slowly and methodically lead to believe that intervention is beneficial and good – see my previous blog and video spot from the US television show, "The Doctors".  Sadness was the emotion that came to me as I viewed this.  This was not an instance of misinformation or omit evidence.  What they did on that show was lie about the risks of the use of epidural anesthesia.  How sad.

It is vital that we continue (and in some cases, begin) to teach from a risk/benefit view…evidence-based information…best practice. The Joint Commission requests this practice.

How to do that?  Lamaze has established the Six Health Birth Practices: avoiding medically unnecessary induction of labor, allowing freedom of movement for the laboring woman, providing continuous labor support, avoiding routine interventions and restrictions, encouraging spontaneous pushing in nonsupine positions, and keeping mothers and babies together after birth without restrictions on breastfeeding ~ skin to skin.  Well established documentation of the evidence accompanies these Birth Practices.  Lamaze has partnered with Injoy Video Productions to make professional quality handouts and free videos available to everyone.

Many birth professionals who receive formal training such as physicians and nurses may have never thought of birth as anything else than a crisis waiting to happen. That concept is not taught in the medical schools and nursing schools of the U.S.

Do not be afraid of speaking the truth.  The paradigm shift needs another a kick start.

Questions to Ponder

These are questions I've been wondering about for a while....actually quite a while.

If birth is natural and normal, then why isn't intervention of any kind (with the exception of emergent cesarean) seen as the non-norm?

Why are those who seek natural, healthy, normal birth seen as "odd" or labeled with everything from "crazy" to "granola crunchers"?

If, as the research demonstrates, all medication crosses the placenta and affects the baby, then why are women more fearful of THAT than the few minutes of pain/hour of labor?

The female breasts are put there to nourish a newborn.  Why is these seen as the non-norm?

Why are those who breastfeed their babies seen as "odd" or labeled with everything from "crazy" to "granola crunchers"?

If, as the research demonstrates, breastmilk is THE perfect source of nutrition for babies, then why are women more fearful of THAT than the additives in formula?

Mmm, I see a pattern here.  Do you?

View this...then read that.

View this segment from U.S. television:






Then read this:

http://www.scienceandsensibility.org/?p=2379#respond 


Thanks to Kimmelin Hull for a brilliant rebuttal.  Also read some of the comments if you would like to write the Doctor's TV Show.

Revised US Guides on GBS

In the April 2011 issue of Obstetrics and Gynecology, the American College of Obstetricians and Gynecologists will share the revised guidelines for the prevention/treatment of GBS or Group B Streptococcal Disease.

GBS is a relatively common, asymptomatic bacteria carried by women (approx. 10-30% of expectant mothers) in the vagina or rectum.  If transmitted to newborns (approx 2% of newborns infected), it can cause infections such as sepsis (blood), lungs, brain, or spinal cord.  Nearly 5% of those infected newborns tragically die.  It is important to note that when the guidelines were published in 1996, there has been between 70-80% decrease int he rate of early onset GBS disease.

Summarizing the new CDC (U.S. Centers for Disease Control) guides for GBS, the ACOG Committee Opinion #485 acknowledges the screening between 35-37 weeks of pregnancy and the antibiotic treatment for women with preterm labor or premature rupture of membranes (water breaking).  Updated guides include antibiotic treatment for women plus regimens for women with penicillin allergy, and updated management plans for newborns at risk.

To see the CDC Guidelines or download them as a PDF, click here.

The College of Midwives of Manitoba (Canada) recently updated their Guidelines for Management of Group B Strep.  Click here to see their Guidelines.

Speaking the Truth Often Unpopular But the Right Thing To Do!

I have been a Lamaze Certified Childbirth Educator a long time.  A very long time.  Since 1980.

I have always prided myself in giving the most recent, evidence-based information to my clients, even before it was in vogue and "evidence-based" was a popular term.  My clients had all of their options before them, ready to make choices made with full, unbiased information.  I watched my voice inflection and body language to not give away my (few) biases.  I didn't want to sway them.  It was their birth.

Because I gave the most current, evidence-based information, I was not popular with some.  Mainly because what I spoke was sometimes contrary to "the way we've always done it" or contrary to "our policy".  Even when I would show the professionals telling me those things that the evidence was in their own journals, it didn't seem to matter.  I cannot teach what isn't accurate.  I have to tell the truth.

I have a binder in my office with evidence-based articles.  I have two websites full of the evidence-based information.  I still believe that providing my clients with the current research, evidence-based information and letting them make their informed decisions is the right thing to do.

And I hope I continue to teach and share the research for another 30+ years!