Postpartum Depression: Ending The Stigma

Postpartum Depression: Ending the Stigma

Guest Contributor: Haley Rolff

"The exact rate of postpartum depression is unknown because there are so many undiagnosed cases.  In the US, it’s estimated that up to 80% of women who give birth will experience some form of it, whether it’s the “baby blues” or a more severe type of postpartum depression (American Pregnancy Association). There are 4 million live births a year which means that 3.2 million women are at risk! This is before taking into account the women who have experienced stillbirths (about 24,000 happen each year in the US) and miscarriages (which happens between 660,000 and 880,000 times a year in the US) (CDC, Mayo Clinic).

As for clinical postpartum depression, specifically, about 900,000 cases are diagnosed each year (Postpartum Progress). Medical experts estimate that, when taking undiagnosed cases into account, that number could be twice as large!

Why are there so many undiagnosed cases? After conducting research and going through over 250 interviews (with moms, dads, and postpartum specialists) a team of students at Northwestern University speculate that the culture around postpartum lifestyle in the US may be a major factor.

When asked whose health came first (between the mom’s health or the baby’s health) the universal response of parents was the baby’s health. Moms think that the baby’s health comes first so much so that many of them don’t eat enough, rest enough, or practice enough self-care. Instead, they overexert themselves trying to obtain the “perfect motherhood” which many characterize with impossibly high standards in terms of the state of a mom’s baby, home, and over-all image.

Let’s start with the standards around the baby. It begins with the baby shower, where the mom receives stylish onesies, blankets, and tiny socks for her baby, who, not only is too young to enjoy its ‘gifts,’ but will quickly outgrow most of it. Those things then turn into more clutter for a mom to worry about.

Beyond the culture around the baby’s style, moms are most worried about their baby’s health. They also feel pressure to spend as much time as possible holding and interacting with her infant for the good of its development (an overwhelming message that is constantly pitched on parent blogs and other social media). Moms then feel incredibly guilty if her baby cries excessively, have issues feeding, or get sick because they see it as a sign of failure as a mom. In reality, these problems are normal and actually shared by most parents.

On Facebook, Pinterest, and Instagram, however, no one posts about these problems which make them seem uncommon and a sign of bad parenting. Parents on Facebook mostly post about the positives. Why would you want to update your friends, family, and coworkers about the fact that your infant isn’t taking to breastfeeding, or is causing you to suffer from sleep deprivation? It’s easier to post cute pictures of infants’ moments of joy and pretend that life is always blissful. Moms on Pinterest post about incredible DIY baby projects, intricate baby fashion, and picture perfect homes. They don’t post about the house getting messy when parenting gets super demanding, or the sweatpants they throw on when they don’t have time to choose a stylish new mom outfit (which is much more common). Instagram is where celebrity moms and fitness-bloggers-turned-moms post their rapid postpartum recovery: somehow they get a six pack a month after giving birth, and their makeup is always perfect. In reality, the postpartum recovery process takes a while and each body has different needs and fitness restrictions.

All of this culminates into unrealistic standards for motherhood. According to the interviews, many moms who looked back on past pregnancies admitted to buying into some of these standards and regretted the toll it took on their own well-being (some interviewees revealed that they had undiagnosed postpartum mental illnesses).

Not only do these standards play a role in damaging the well-being of many moms, but it also plays a role in creating a stigma around postpartum mental illnesses, by constantly plugging that motherhood is an overall joyful experience. Although some people (even celebrities like Chrissy Teigen) are starting to talk about their experiences with postpartum depression, it is still vastly overshadowed and stigmatized by much of the media, or simply downplayed to “baby blues” which invalidates those who actually have clinical postpartum depression.

If you or a mom you know may be suffering from a form of postpartum depression, seek help from a doctor, (midwife), or a support group. Talking to people and sharing experiences is the only way to end the stigma, because it normalizes what has been wrongfully projected as obscure and shameful: mental illness. More importantly, it provides moms the support they need. Every mother deserves to be healthy, and every baby deserves a healthy mother.

Bundles of Health, a startup born out of Northwestern University, aims to give new moms better care postpartum. The company offers a curated selection of the most useful gifts to include in a baby registry. Instead of onesies, blankets, and socks, Bundles of Health allows family and friends to gift the mom-to-be a month of housecleaning, food delivery, or a postpartum doula. To add to your Amazon, Babylist, MyRegistry, or Target registry, click here. Help your loved ones give you the gift of health and happiness, time and peace of mind!

Check out Mayo Clinic’s description of postpartum depression signs, symptoms, and advice here: http://www.mayoclinic.org/diseases-conditions/postpartum-depression/basics/symptoms/con-20029130 "

For Postpartum Mommas Worldwide

Whether it's banishing postpartum depression, healing birth trauma, or balancing me time, I'm an expert in postpartum care and can help you, no matter where you live. I've went through it all personally and professionally. I know postpartum blues, depression and anxiety well, and have helped thousands of women through what I call the "Forgotten 4th Trimester," to prevent or overcome postpartum depression and anxiety in a wholesome, effective and lasting way.  When you are struggling with feeling overwhelmed, exhaustion, mild to moderate feelings of depression or anxiety, newborn care or breastfeeding challenges, or finding a sustainable new momma rhythm, I can help you with personalized guidance for your unique situation.

Chic and Practical Clothing for The Working Pregnant and Breastfeeding Mama

Mothers. We all have them. And most of them have sacrificed the entire rest of their lives to make sure that we are well fed, have clothes on our backs, and are pointed towards a bright future. However, that doesn't necessarily mean that this is the end of their careers and dreams. One may wonder just exactly how it is possible to balance the heavy needs of raising a newborn infant and thrive in the workplace. Well, Yoko Shimada, mother of 2 beautiful children and mother of maternity and nursing fashion line Mitera has just the answers.

Having been immersed in the world of public health in a plethora of countries for the greater part of her career life, the fashion industry was and is the last place that one would expect Yoko to enter and thrive in, including Yoko herself. Yoko, with 15 plus years of experience in helping start and implement global health programs across the world, not only realized the lack of suitable clothing options to raise a baby while holding down and thriving at work, but also took the initiative to create one.

After having her second child in 2013, Yoko started to bring the idea of Mitera to life. It all began when she actually had a dress made to accommodate her breastfeeding practices while at work. With the need to pump for her daughter at her office with a notable absence of a proper facility to do so, Yoko knew that it was time for a change.

With society constantly placing unspoken pressures and expectations on mothers to breastfeed in order to raise their babies in the healthiest manner, the first months and even year, postpartum proves to be a difficult stage. Creating Mitera was a way for Yoko to take a stand against these unpractical circumstances that new mothers are faced with in their personal and professional lives.

The dresses and apparel designed by Mitera are created with these struggles in mind. For example, these chic, stylish, and practical articles of clothing provide easy yet discreet access for feeding or pumping. With both the concerns of the mother and baby in mind, Mitera's goal is not only to help smooth women’s transition into motherhood but also to honor the process of creating and bringing life into this world and celebrate the woman, the nurturer - the unique, beautiful, determined, multifaceted woman who gives all she has, while still remaining who she is.

While undergoing the journey of starting and growing her fashion company, Yoko has remained focused on lifting the women up as they embark on this major transition into motherhood and helping, in her own little way, to shatter the notion that pregnancy and becoming a mother is akin to taking a career break, a set-back, a penalty, or a weakness. There are many successful women out there, who, when they become moms, have a bit of an identity crisis because it seems like they can’t continue their own paths, like they have to give themselves up for the baby.

It was no different for Yoko. Through Mitera, she wants to help give these women - working moms and stay-at-home moms alike their strength and self-confidence back, to feel even more connected to their bodies and self and to be empowered with this new gift of motherhood. Mitera celebrates and supports women all around the world throughout their motherhood journeys and as they become better versions of themselves through the incredible experience of motherhood.  

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3 Ways to Improve Your Chances of a Healthy Childbirth

Are you looking to have a healthy, deeply positive birth that stems from having a healthy pregnancy?

Here are three ways of improving your chances of a healthy childbirth.

With any pregnancy, your hope and deepest desire as a mother is to birth a healthy and beautiful baby, whether you are birthing in the hospital, a freestanding birthing center, or at home.

With our increasingly health conscious society, home birthing is more and more becoming a viable option for many mothers.

Some of the keys to a healthy and wholesome natural birth that you LOVE no matter how it unfolds, are to be well prepared and to ensure that your choices are respected so that you’d be treated with unique focus and care.

My online Love Your Birth course will not only help you prepare for having optimal health in pregnancy and beyond, but will also help you to hone in on your own inner calm, joy and strength, as well as empower you with ways to speak your voice, and ideally avoid unnecessary interventions, medications or surgery.

You have the most active role to play in birthing your baby, and there are definitely a few things that you can do to encourage a healthy pregnancy and birth. Pay close attention to yourself and your needs on ALL levels; make a commitment to take the best care of your total health and well-being, and to nourish your body, mind, and spirit. You only have one of each!

1. A Healthy Physical Well-Being

Whether you’re pregnant or not, there are almost an infinite number of benefits that come with eating fresh, nutritious, and colorful foods and with exercising regularly. I provide some practical guidelines to help every mother with eating healthfully.

Getting the right amount of fruits, vegetables, proteins, and healthy fats each and every single day can be confusing, overwhelming, and difficult at times. Therefore, I recommend adding supplements to your healthy eating so that you and your baby get the amount of nutrients you both need during this special time.

Exercising throughout all of the trimesters as well as beyond pregnancy creates numerous benefits for YOU and your unborn BABY. Healthy pregnant women are capable, fit rockstars, and exercise will help you to feed that spirit of strength and vibrancy.

If you engage in regular exercise that you enjoy, you will have a more comfortable pregnancy and be less prone to injury. You’ll be more capable of assuming positions that allow for easier active birthing, and so more likely to have a shorter, easier labor. You’ll also have a quicker recovery, and your body will bounce back faster postpartum.

You may notice more relief from various discomforts like constipation, bloating, swelling, and backaches. You will feel more relaxed, and notice an overall sense of well-being and energy, even when fatigued.

Being active helps maintain healthy weight gain in pregnancy, stabilize blood sugar levels, and prevent complications like obesity and gestational diabetes.

If you’ve exercised consistently throughout your pregnancy, your baby is more likely to have higher Apgar scores, will transition better outside the womb, and will even have better cognitive skills in early childhood. Studies have also shown that your baby will be leaner at birth (making him or her easier to push out), and will be less prone to childhood obesity.

If you are already a healthy, active woman, I encourage you to continue doing the type of exercise you love now that you are pregnant. There are, of course, some exceptions like extreme and contact sports.

Make it fun! Get 30-45 minutes of moderate, varied exercise most days of the week whilst remaining in tune to your body’s needs. This can include muscle toning and strengthening workouts as well as stretching, aerobics, and dance.

Some types of yoga satisfy all of the above requirements and is a particularly useful form of exercise because it marries movement and breath. It’s a wonderful way to feel more calm, focused, and grounded which are essential tools for labor and mamahood.

If you have never exercised before, you can start by taking brisk walks, joining a prenatal yoga, fitness or dance class, or learning how to swim laps.

Vary it up and listen to your body, modify your exercise as needed, and maintain a healthy, varied whole food diet with good hydration.

2. Reduce Your Stress

Life has always been stressful, and inner stress is definitely not the feeling you want shadowing your pregnancy, your baby’s birth, or your mama-hood.

Take some quiet time with yourself (and baby) to determine what kind of perspective you’re operating from as well as what kind of state of mind you want to impart on your child from as early on as the womb.

Spending energy on the things you can’t change - which is literally most of life - leads to pointless angst and worry.

Adopt an attitude of surrender and acceptance for the things over which you have no power. (It is not easy to embrace this reframed way of thinking, but well worth your efforts! And, this should not discourage action if it can and does need to be taken.)

Instead, focus on what you can change: yourself. You can change and control your attitude, perspective, reactions, choices, and behaviors. This involves a deep and personal look at the thoughts and emotions you host. This takes work. However, it leads to growth that is beyond rewarding and transformative.

Cultivate a spiritual awareness and connection to the magnificent soul within you as it relates to the infinite. Believe that everything happens for your ultimate benefit and growth, even if you don't understand why.

Listen to your heart and gut and live from a place in which what you think, feel, say, and do are in harmony.

Get adequate rest by going to bed at a similar time each night, ideally before 11:00 pm, and aim for 7-8 hours of sleep or more.

Take breaks throughout the day and at least one half an hour power nap in the afternoon. You can also assume a restorative yoga pose like savasana by closing your eyes and quietly focusing only on your breathing. This kind of technique can be equivalent to 2 hours of sleep for your body.

Learn about breath awareness, relaxation techniques, and meditation to activate your own relaxation response.

Beware of over-scheduling yourself. Don’t be afraid to ask family and friends for assistance, and consider hiring help. Cut down on the non-essential burdens in your life, especially if you feel overwhelmed.

This is all easier said than done, so let your days be filled with what’s most important to you and let go of the things that really don’t matter. LIVE your life; don’t rush through it.

Monotask rather than multitask! Try to focus on doing one thing at a time with your full attention, and make a conscious decision to do fewer tasks each day. Unplug daily by limiting your phone and internet use as well as your screen time.  This will not only help you feel better but also allow you to accomplish more, by doing less.

Schedule downtime and guard it fiercely. Do whatever you want as long as it's restful and restorative and has nothing to do with work, chores, being online or running errands.

Spend quiet time each day to connect to your baby. Talk to your baby. Sing to your baby. Play beautiful music to your baby. Your baby relaxes when you do, and your baby hears and loves these precious moments.

3. A Healthy, Supportive Environment

This may be last on the list but please don’t take for granted the value that a fiercely loving support system and environment brings to your pregnancy and childbirth. Uncomfortable, stressful, or even inauthentic surroundings, for example, can surreptitiously raise the discomfort and tension in your body and mindset.

A destructive and harmful environment can be just as toxic to your system as any processed or chemically-altered food. Being mindful of your environment can help support your steps for enhancing your well-being.

In finding the right support system, you’ll be adding tremendous value to your experience like finding other like-minded women and partnering with a midwife or doctor that you trust, admire, and whose primary concern is you and your baby.

Women have supported women in community living since the beginning of time. It takes a village to raise a child as well as a new parent.

Today, even more importantly, I encourage mamas to create a fortress of positivity around themselves. Hang out with calming, positive, uplifting, empowering, and inspiring people as much as possible. If you do not know any, you can create your own tribe of like-minded mamas - they are out there.

Seek out other women who have a similar outlook regarding holistic health and wellness in pregnancy, labor, birth, breastfeeding, and parenting. Make friends at prenatal yoga class, childbirth class, pregnancy and postpartum support groups, attachment parenting, babywearing groups, and La Leche League meetings.

If you do not have these resources in your area, create your own. Host a Positive Birth Movement circle, movie screening, or a book reading. Organize a community Blessingway/mother-blessing, a Red Tent event, or a pregnancy day retreat. Create a gathering of pregnant mamas and invite a prenatal henna artist or massage therapist. Do belly casting/art with each other - you name it! Connect with others on social media - the childbearing and yoga communities are so wonderfully supportive.

Each one of these tips stands on its own with tremendous value. However, when you combine your healthy eating and exercise habits with your low-stress lifestyle and supportive community, there’s no question you’ll love your healthier pregnancy and life even more.

Eating well and exercising regularly will not only keep you and your baby healthy but your baby will also be in tune and benefit immensely from the great amount of energy and positivity that you feel. 

Every expectant mother has a right to glowing peace and a radiant tranquility.

If you haven’t already, download my free Healthy Pregnancy eBook. In it, I go into detail about everything here, including supplements and breathing techniques. You’ll find plenty more tips based on holistic and science-based practices.

And, don’t be shy to join our community! Having others to relate to and lean on is crucial in those times when you feel overwhelmed as well as during those moments when you feel impossibly joyful.

Want to connect with like-minded women supporting each other through their natural birthing journey? Join our Facebook community which is open to all active and previous clients, those who have had consultations, and who have taken my online course or other classes

Journey From Hospital To Home, Victim to Empowered, Fear To Confidence & Loving Birth

Newborn exam on parent's bed, so they can be close to baby, watch and learn.

The truth is that there are things one can do to prepare both physically and emotionally. And there are things one can do to ensure the best possible outcome for mother and baby. Pregnant women are not passive victims to their bodies. I learned these things from women like Pauline Nardella, Childbirth Educator, Anne Margolis, Certified Nurse Midwife and the filmmakers Ricki Lake and Abby Epstein who made “The Business of Being Born”.

For every woman there are specifics that stand out in their prenatal care. I did not have to be subjected to constant pelvic exams, since most of the time, there was no medical need for it. When my midwife had to determine if the baby was head down she respectfully offered me options; an exam or sonogram. Until that point, I had always been told to undress from the waist down. Never asked. Never aware I had choices. I also learned that women are suggestive when pregnant. This is not because we are suffering from “pregnancy brain” or any other one of those derogatory descriptions of a woman expecting. We are suggestive in this condition by nature because it assists in the birthing process. A pregnant woman can be told she can bond with her unborn baby and therefore she can. A pregnant woman can be told that the contractions are surges, or simply a tight feeling and therefore they are endurable or even pain free. 

Being suggestive is critical to the birthing process and being exposed to fear in a suggestive state puts women on a dangerous path toward labor. This is why numbing drugs are so critical in an optionless system, not just to medicate the pain, but to numb a women’s fear and even the fear of fear. My homebirth midwife asked me questions about my pregnancy. She asked questions about my life situation and my concerns. She let me speak and she listened. I was an active participant in the prenatal check-ups to determine the well-being of my baby. She did not overwhelm me, and with each visit she provided simple handouts of things to do or assist me in my pregnancy. I did not feel pressure to do everything (like walk a mile a day, drink a gallon of raspberry leaf tea and do 1000 kegel muscle exercises while sitting in traffic) but to do what I could and even without doing anything at all, my body knows what to do. Women do not “fail” to give birth. This truth was reaffirmed in my Hypnobirthing class. My body and my baby know what to do. We follow nature. Despite this, the moment my water broke, I felt fear. “I am not ready”, I thought. At nearly 42 weeks I should have felt ready. But I still could not let my thoughts go. Did I practice enough with the tapes? Do I have the stamina? Am I going to fail to progress like I did in the hospital with my daughter? Can I take the pain without meds? 

The first contraction was powerful. It took me by surprise. This is where my prenatal care began to demonstrate its effect on me. Instead of thinking “OW!” I thought “WOW! My body is strong.” Holding on to that thought, I went from contractions every 10 minutes to every 5 in less than an hour. Apparently positive thinking and relaxation does have an effect on the cervix. The “proof” was now in action. I actually did not plan in advance the positive affirmations I would use, but once in labor, I no longer referred to them as contractions but as waves because they were not isolated to my uterus. I felt them from the tips of my toes to the top of my head. I called my midwife to let her know the contractions were coming strong and quickly.

My husband ran around preparing the bath and trying to figure out why the heat wasn’t working that cold February night. My 2-year-old woke up looking for me. “The baby is coming?” If someone told me she was going to wake up and pine for me before our babysitter arrived, mid-transition it would have scared me. I cuddled with her and tried to put her back to bed as my husband stopped between errands to hold my hand. My midwife had the wisdom that I should prepare and inform my daughter with videos and a homebirth children’s book. She was a little afraid but more excited mostly because I was not afraid. I did not know I had the strength to care for my daughter and my labor at the same time. At my first birth my husband could not be out of my reach for two seconds. I needed his strength to get through the 20 hours of pain.

Without any rubs this time, I made it one wave at a time. I realized that the waves only lasted for about one minute or so and at this point the endorphins kicked in and the calm between lasted for three or more. It felt utterly divine so I focused on this. Since I was so suggestive, all I had to do from my practice was say the word “relax” and I was completely weightless, and floating. I did not mind the contractions as much simply because the strength of them and my thoughts were instigating this blissful relaxation. My midwife had not yet arrived as my cervix reached 10 cm, and my husband and neighbor had just completed filling the tub. I went back into my head since I did not expect to be in the bath alone and I got scared. 

My Midwife and Doula arrived just before I felt the need to push. I let her know I was scared and she asked me of what. And I said of being alone. My husband was with me, the babysitter arrived and so did my caretakers. She only needed to say “You are not alone” and I was not alone. In the warmth of the tub, my husband was holding me, sharing our strength to birth our son. In the timelessness of following nature, I remember my midwife’s words as I fell into what seemed like a trance. She said, “Go with your body”, after I announced the urge to push. And I did. She said, “Open your pelvis and let the baby through.” And I did. She said, “Push past the burning ring.” And I did! My son was nearly 10 pounds. We brought him into this world without fear, and after only three hours of labor and 15 minutes of pushing, he arrived into our arms with a feeling of love that cannot be described. Perhaps it was the Oxytocin I heard so much about. Still, the experience was life changing. It gave me strength through the turbulent changes of the first weeks of post-partum and a feeling of empowerment that I can carry with me through life. This story of trust, birth and love has bonded us immediately as a family and I have no doubt this birth story will continue to shape our lives.

Love, Ruthie

Let Me Help You Create The Happiest Birth Experience Of Your Life...

Photo by Megan Hancock Photography

Whether you're a first time or experienced momma,

Or a midwife, doula, or birth professional guiding mommas..

Regardless if you are planning a birth at home, a hospital, a birth center or need a cesarean section, or if you are taking another childbirth education class…

You Really Can Create The Delivery Of Your Dreams.

And have a blissful birth wherever you are.

More Precious Than A Wedding...A Birth Should Be A Celebration!

Let me show you how to…

• Understand the sensations of your body and connect your intuition with how your body is communicating and leading you towards what to do during labor

• Tap into your inner calm to deeply relax yourself,letting go of busy, stressful and fearful thoughts on demand for the health of baby

• Speak your truth from your heart in a way that deepens your relationships, sets clear boundaries, and has people listen to you and support you before, during and after pregnancy

• Trust yourself, connect with your body wisdom and communicate with baby in belly

• Connect with natural time and sync your body and mind up with your unique biological clock for ease from pregnancy to postpartum

• Reprogram negative patterns, stories, and beliefs that undermine your confidence, strength and self trust so you can rock your birth

Physicians and midwives around the world recommend my teachings to their pregnant clients and many Doulas across the country learn the secrets of blissful birthing from me to supplement their Doula Training & Certification process!

To learn more, visit:  LOVE YOUR BIRTH Online Childbirth Course!

It is based on my years of experience, as a midwife and yoga teacher, helping thousands of women tap into their calm and live and birth from a place of grounded relaxation and joy. 

It’s wonderful alone, a great refresher or adjunct to any other course!

“Forget your childbirth class, and take steps to your most empowering experience. If you are thinking about conception, pregnant, or love someone who is, take it from me that her wisdom is life-changing.
Yours in the truth
”

— Kelly Brogan, MD

Welcome to my Online Health Dispensary

HEALTHY LIVING FOR HEALTHY WOMEN

My online dispensary is a convenient way for you to purchase my hand-picked, professional-grade, whole food supplements and other natural health products. Ordering is simple, and the products will be shipped directly to your home or work within a few days.

Click here to enter my dispensary at Fullscript.

I have listed my recommended prenatal and postpartum supplements in the PRENATAL SUPPORT and POSTPARTUM/BREASTFEEDING section, but you can search their catalog for other supplements and natural remedies as well.

You can also access your personalized prescriptions and dosage instructions for the products that have been recommended for you after a consultation.

Open an account - registration is free!

Group B Strep: What Does it Mean for Me and my Baby?

Group B Strep: What Does it Mean for Me and my Baby?

Group B Streptococcus, otherwise known as GBS or Group B Strep, is a normally occurring bacteria that lives in the lower intestines of human beings - from babies to the elderly.  It's a hot topic in the world of having babies, and there are no easy answers. I encourage educating yourself, weighing the risks and benefits of each option regarding testing, prevention and treatment, and deciding what is best for you and your baby.

Around 10-30% of pregnant women are colonized with the bacteria, depending on the population studied - but about 25% are reported to have vaginal GBS in the US. When there is a large amount of GBS in the colon and rectal areas, it can come forward to the vaginal and urinary tracts.

If detected vaginally in a non-pregnant woman, there is nothing wrong, and no need for treatment. The main concern is if a pregnant women has it in labor, and baby is exposed to the vaginal bacteria after the 'bag of water' breaks (during pregnancy, the baby is encased and protected in a double layered membranous sac of amniotic fluid, in lay terms referred to as the bag of water).

Although the vast majority of pregnant women with vaginal GBS have healthy babies, half are simply colonized - test positive for it but stay healthy, and about one in 200 babies in the US who are exposed to it during childbirth, can get infectious illness. GBS infection can become very severe or life threatening for about 1-2% of these babies, which is thankfully rare, but potentially devastating for those who are affected. 

Every human life matters, and I take those 1 or 2 babies per a thousand very seriously, as would any parent of a very gravely ill newborn.

I’ve collected some information for you below. I hope that this bite-sized chunk will save you from endless searching on the internet. Take note, that if you are in any doubt, please consult me, your midwife or doctor.

After a positive GBS test, don’t let anyone pressure or scare you out of having a free-standing birth center or home birth, if that’s what you want. GBS can easily be managed in the out-of-hospital setting. And know you do have options and can speak up on how the issue is dealt with; even though there is a standard of care that is strictly upheld in the US, there are different standards in other Westernized countries like the UK, that might just make more sense for you.

Risks During Pregnancy

Serious complications in pregnant women are rare. Complications of GBS can lead to urinary tract infection in women, but often the positive test results are actually from vaginal discharge, even if a ‘clean catch’ culture was obtained. In my practice, I found that out early on, after sending women with persistent GBS on clean catch urine culture tests, to a wonderful local urologist; she found them all to be negative for GBS in the urine using a sterile straight catheter specimen, and said there was no urinary infection to treat.

In the United States, GBS is routinely managed in the United States according to the Center For Disease Control (CDC) guidelines. It is tested for between the 35th and 37th week of pregnancy, by taking a Q-tip like swab from the vagina and rectal area, and sending it to a lab. This is currently the best time for obtaining results closest to the onset of labor.  It takes several days to get results, which are allegedly valid for 5 weeks. Current testing is not completely predictive, as tests can yield different results at different times because GBS can come and go intermittently. A mom can test negative in late pregnancy, but actually be positive for GBS if tested in labor. Likewise, but less commonly, a mom can test positive in late pregnancy, and test negative for GBS in labor. There is a new home GBS test in the UK called Strepelle that gives accurate results 3 days from receipt of the sample - but it is not without controversy. Unfortunately at this time, there are no reliable, widely available, cost effective, rapid test available during labor - which would at least address this issue. 

In other countries like the United Kingdom, women are not routinely tested in pregnancy for group B strep, according to recommendations by The National Institute of Health and Care Excellence; this is because they determined that evidence of the effectiveness of routine GBS testing in all pregnant women remains uncertain. Per guidelines of the Royal College of Obstetricians and Gynecologists, pregnant women are treated with antibiotics in labor only if there are risk factors - such as signs of infection like fever in labor, a prolonged time between 'water breaking' and birth, or if a preterm baby is expected.  Until 2002, in the United States, GBS in pregnancy was managed this way as well. The change in American obstetrical practice guidelines was based on analysis of some large studies around that time, even though there are limitations to the quality of those clinical trials, as is common with research; one major bias that concerns integrative, holistically minded practitioners, which most of the mainstream medical world discounts, is that this research is largely funded by for profit pharmaceutical companies who manufacture the antibiotics.  Today, in the US, all women who test positive for GBS during the late third trimester screen are given IV antibiotics in labor. That is a lot of healthy women and babies exposed to antibiotics when the risk of serious infection in newborn babies is rare. Additionally, most cases of group B strep in term newborns occur after screened pregnant women tested negative. 

Care Recommendations, Alternatives and Issues

The current standard of practice in the USA is based on the guidelines published by The Center For Disease Control and Prevention (CDC), which dictates that antibiotics are to be given during labor, to all women who tested positive for GBS in current pregnancy. This is hospital routine, and is based on the interpretation of the available research, indicating that IV antibiotics in labor significantly lowers the chance of infection in babies from 1 in 200 to 1 in 4000. But antibiotics can have serious side-effects. Many healthy moms in my practice don't want routine IV antibiotics, even though they can be given both in the home and freestanding birth center settings. It feels too medical for them; they are worried about it interfering with their ability to have a beautiful natural birth, have valid concerns about the consequences of the antibiotics and feel their risks do not outweigh potential benefits. Some pregnant moms do want the standard treatment, as they are more concerned with GBS than a few doses of intravenous antibiotics, and do not feel the IV in labor will hinder them or their birth dreams. 

If you do want the IV antibiotics, know you can still move around during the infusion, and be in the tub or shower if the access site is covered properly. I was gifted with a home IV pole on wheels, by a family in my practice. We had previously hung the IV on whatever we found in the house - like a door hook or hanger on a curtain rod (once antlers on a wall-mounted moose head did the trick); or when she needed to walk, someone would personally hold it up, and follow her around with it. You also don't need to be attached to an IV the entire labor and birth, but can have a saline lock, also known as a hep-lock. This is an IV catheter that's inserted into your vein, used only for the 15-30 minutes it takes for the medication to infuse; it is then disconnected from the access portal, so you are not attached to the IV tubing, pole and solution bag in between doses for the majority of your labor.

One reported side-effect of IV antibiotics in women is a harmless rash. Another potential annoying but treatable consequence is a vaginal yeast infection, which can lead to thrush in baby's mouth and on your nipples, and make breastfeeding painful for you until it resolves. A far more serious but fortunately very rare side-effect is Anaphylaxis, an allergic reaction which can be life-threatening, but most often managed effectively with medication. What concerns us most is the effect antibiotics can have on us and our little ones.  

Microbiome disruption is the disturbance of the intestinal tract balance of normal flora in babies (and mothers). More research is needed, but a recent Harvard magazine article tells us that this can cause life-long complications in infants. It also ups the antibiotic resistance in adults and infants, another life-long consequence and can lead to other serious infections for them both.  The award-winning chilling documentary MICROBIRTH, delves deeply into the microbiome - the trillions of bacteria that live on and in us that could be critical for human health.

Chlorhexidine gluconate vaginal wash is commonly used in Europe for pregnant women who have been diagnosed with Group B Strep. Some studies have shown that the treatment of GBS using Chlorhexidine is safe, cheap, and as effective as antibiotics, without negative side-effects. Other studies suggest Chlorhexidine reduces GBS colonization, but not GBS infection in newborns. It is known in the US as Hibiclens, and is available over the counter without a prescription. It needs to be diluted and there are several effective protocols in pregnancy or during labor. It is not natural. It's a potent antiseptic and does disrupt the vaginal flora, which can hopefully be restored with vaginal probiotics; but it doesn't travel through the body and cross over to the baby like the IV antibiotics do. While it prevents the baby from exposure to GBS, it also does not allow exposure to the healthy vaginal bacteria during birth. But many moms in my practice prefer this to IV antibiotics in labor. I have tested its efficacy in my practice. After its use, I get back a culture swab negative for GBS, and have had no cases of newborn infection.  Chlorhexidine for GBS is increasing in the US, mostly in out-of -hospital settings.

Another treatment in late pregnancy that has been used especially among out-of-hospital midwives is a vaginal antibiotic.  Research is sparse, but suggests possible effectiveness. There is currently only one medication that apparently works, if the strain of GBS is not resistant to it, called Clindamycin; its IV use in labor is an alternative within the CDC guidelines, if mom is allergic to the drug of choice.  When testing for GBS, it’s sensitivity to the various antibiotics can also be tested. There is a small study, done by a colleague of mine, on its effectiveness to reduce GBS infection in newborns of moms who had tested positive for GBS in pregnancy. My relatively large homebirth practice was included in her research, as for years, I had been offering this option to pregnant women who tested positive for the bacteria. The option includes a Hibiclens daily wash protocol, other recommendations for prevention of recurrence and weekly GBS follow-up testing. The study demonstrated that this treatment was effective in the vast majority of women without any known complications; but it is only one small retrospective study, not a large, gold-standard, randomized clinical trial. I am still impressed by the negative follow up testing in my practice, and that no baby in my care, after this treatment had GBS infection or other problems. It is also not natural. It is an antibiotic medication, but with more of a local vaginal affect. Moms who have follow up cultures negative for GBS, feel better about declining the IV antibiotics in labor, especially if there are no risk factors. But it also disrupts the healthy balance of bacteria in the vagina, can similarly cause yeast and thrush, and contribute to the issue of disease causing bacteria developing resistance to the antibiotic. 

Both of these treatments are easily accessible and thus convenient for home births, as well as birth center and hospital births. You can be empowered and learn to administer them yourself, once you have the supplies. It is important to know that Hibiclens or vaginal Clindamycin are NOT standard of care in the US, and they are not recognized to date by the medical world as a valid treatment to prevent GBS infection in babies. Women who chose either option are educated on the symptoms to watch for, advised to inform their pediatrician, and have the baby evaluated in 1-2 days. I also tell women who opt for either Hibiclens or vaginal Clindamycin, that they would be considered untreated for GBS and given antibiotics if transferred to the hospital - unless they refuse. Although you have the option to decline IV antibiotics in the hospital, disturbingly, it can get nasty if they are not supportive, involve social services or you are reported to the child protection agency and investigated for child abuse and negligence. Do discuss your plans with your provider and setting in advance, to avoid problems. 

Although I prefer natural remedies when they are effective, unfortunately in my 22 years of midwifery practice, I have yet to find one that works once GBS is detected; and I have had numerous moms who have used just about all of them, then have a positive GBS test on follow-up. There is forever a place in my heart, for a naturopathic mom who declined antibiotics and Hibiclens, and her severely ill newborn with GBS infection - the outcome was tragic. She tested positive for GBS repeatedly despite using the best of the best of protocols of natural remedies. What baffled all of us was there were no risk factors; it was a relatively short beautiful healthy birth with no interventions, water broke on its own during pushing. Yes, countless babies of moms treated naturally did not get sick even though follow up cultures were still positive for GBS. But the one case was enough for me. There is currently insufficient evidence of the effectiveness of any natural treatment remedy for preventing GBS infection in newborns. Holistic care includes all modalities, and sometimes there is a role for medication. When a pregnant mom tests positive for GBS, I discuss the issue, give her literature to read, present her with the pros and cons of all the options, from doing nothing to the alternative modalities, to IV antibiotics in labor, and honor her informed decision. Some want to use the UK’s risk factor protocol and decline GBS testing during pregnancy, and I respect their informed choice. 

It must be said, however, that no treatment is 100%. Cases are still reported in the medical literature where babies were infected with GBS after any treatment - including IV antibiotics, even though IV antibiotics have significantly reduced the incidence and severity of GBS illness in babies according to the research to date. I therefore recommend to keep a close eye on your newborn if you carry GBS, regardless of treatment. If any symptoms present themselves, consult your pediatrician immediately.  

Symptoms To Look Out For (Scary But Rare)

Early onset GBS occurs within the first week of life, most commonly within hours after birth. Signs and symptoms include: Lethargy; irritability; poor feeding; very slow or fast heart rate; abnormally high or low temperature; difficulty breathing such as flaring of the nostrils or grunting noises; too fast or slow breathing rate; blueness of the skin of baby's trunk, and/or pale or grey appearance. 

Late onset GBS occurs in 1/3 of babies with GBS infectious illness but is uncommon - effecting about 0.3 per 1000 babies, mostly who are premature. It can happen anywhere between the first week and 3 months postpartum; but it is rare after one month of life. Unfortunately there is no known prevention and like early onset GBS infection, can occur even when mom tested negative in pregnancy. An otherwise healthy baby can become critically ill within hours. Symptoms of late onset GBS are the same as early onset infection, but can also include: having a high-pitched, inconsolable cry, whimpering or moaning sounds; blank staring or trance-like expression; appearing floppy and listless; having an involuntary stiff body or jerking movements; not moving an arm or leg; excess sleeping and difficulty arousing; tense or bulging fontanelle (soft spot on baby's head); turning away from bright light; blotchy, tender skin; projectile vomiting; pus and red skin at base of umbilical cord or at any puncture site (from internal monitor).

Lets Talk Prevention!

Supplements during pregnancy can’t completely prevent GBS, but I highly advise taking them regardless, as I have had tremendous success with lowering the vaginal GBS rates in pregnant women who take the specific daily probiotic I recommend. Many of my colleagues report similar success with these probiotics. There is finally a small but growing amount of actual research - studies documenting the effectiveness of certain strains of probiotics to reduce the incidence of GBS. Probiotics are also safe and have many other health benefits. The other whole prenatal vitamins and minerals I recommend supplement a healthy diet with nutrients that enhance health and immunity.

You can lower the risk of infection also by minimizing exposure. You can try to lower the amount of GBS in your vagina, with natural remedies, such as in Dr Aviva Romm's protocol - even though there is no guarantee. If you have GBS in a healthy pregnancy and labor, you certainly can decline or limit vaginal exams, invasive procedures like internal fetal monitoring and having your bag of water broken artificially. If your bag of water has definitely broken before or early in labor, you can use natural remedies to gently stimulate labor and lessen the time it takes to birth. Some studies suggest that water birth can possibly help prevent GBS infection, because of less interventions and invasive procedures, as well as the bacteria being diluted or washed away, so baby is exposed to less of it.

Research is on the horizon regarding a vaccine for both early and late onset GBS infectious illness - which sparks an entirely different debate, as well as more accurate and available rapid testing in labor. There is much to be done to decrease risk and rates of preterm birth. But, my hope is for more research demonstrating prevention with probiotics in pregnancy, holistic modalities to improve immunity against infection, and the benefits of out-of-hospital midwifery care in terms of reducing newborn GBS infections. My dream is that there is widespread cessation of routine medical interventions in normal childbirth - one of the main pillars of authentic midwifery care. If there were more midwife-led birthing centers, out-of-hospital and home birthing for the low risk healthy population, according to evidence based NICES recommendations, this would decrease the rates of invasive procedures and hospital exposure to pathogens - especially resistant ones, that all increase risk of infection. And hopefully this would result in a major reduction of serious GBS illness in babies.

Can I Still Give Birth in a Birthing Center or Have a Home Birth?

Of course! And you might be better off doing so specifically in terms of GBS, by having a provider who honors your choices, possibly lessening infection risk by having a water birth, avoiding routine invasive procedures, as well as exposure to bacteria and infectious illnesses that are common in hospitals. Again, testing positive for GBS in pregnancy does not risk you out of either. Even the the usual protocol in the US to administer antibiotics by means of an IV, can be done at home or birth center with licensed midwives, which is good news!

If you are a carrier of GBS and experiencing a healthy pregnancy, I hope that you now feel confident that a home or birth center birth is still possible and actually a wonderful idea. I hope you have a better perspective about the issue, and feel more educated and empowered to make an informed decision about how you want to deal with it. Know you have alternative options to consider and most importantly do what you can in terms of prevention. Definitely take top quality prenatal supplements and probiotics!

I have a holistic approach to life, including healing after pregnancy and birthing. Nothing replaces abdominal toning and exercise for restoring muscle strength and tone - which I encourage for all mamas as soon as they feel up to it postpartum. Nothing replaces touch, slow deep abdominal breathing, and a 'love your postpartum body' perspective that I promote.  But I have found many mamas simply feel comforted by this support garment, especially early postpartum and temporarily as needed....to be used without forfeiting abdominal toning and strengthening exercise, breathing well and touch. I have found Bellefit supportive garments to help like they use belly binding around the world such as in Indonesia. They do aid in early postpartum healing and provide support many mamas feel comforted by. I deal with human beings and the reality is many postpartum mom's struggle with body image, feel frustrated that getting back to themselves takes longer than expected. Being into holistic health and healing includes being sensitive to real human struggles - the mind, body, heart and soul of each person and their unique situation. Having helped countless women with these issues after having a baby as a midwife, I have found many still love that binding and feel better with this support, and ability to fit into their pre-pregnancy clothes comfortably and sooner than they would if they went through a C-section or natural childbirth recovery without it - especially when they have to dress up and fit into a certain favorite outfit for a special occasion or wedding not long after having a baby. For more info on the Bellefit girdle, check out my blog about it here. Have a Great Postpartum Recovery (with a little help from Bellefit)!

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