Anemia in Pregnancy - Prevention and Treatment

Many of the pregnant women I work with are concerned about anemia. They want to know whether they’re getting enough iron in their diets, and whether they should be supplementing.

Physiologic “anemia” in pregnancy is healthy and natural.  Increased amounts of iron are needed to make additional red blood cells for your developing baby, and for your body’s preparation for blood loss at delivery. Anemia also results from the dilution of red blood cells as the fluid volume expands to nearly double the amount normally present before you were pregnant. It is evidenced by a gradual 2 gram drop in hemoglobin by the seventh month, followed by a gradual return to prepregnancy levels by 3-4 weeks postpartum. Iron stores (ferritin levels) also tend to drop.

While iron deficiency anemia is the most common type, it’s important to note that anemia can be caused by a number of factors. Also, vitality is a great gauge of well-being. If your hemoglobin is a little below normal but your iron stores are fine and you feel fit and healthy, you need not worry. Just make sure your diet is rich in foods high in iron and vitamin C.

Symptoms of Anemia

If you are truly anemic, you may experience the following symptoms.

• Extreme exhaustion and weakness

• Shortness of breath

• Heart palpitations

• Dizziness or faintness

• Headaches

• Irritability

• Poor concentration and confusion

• Feeling weary and run down with a lowered resistance to infection

• Poor appetite and unusual cravings for non-food items
  
  

Iron Deficiency Anemia is Common

Whether or not you have the above symptoms, you are smart to be paying attention. The formation of additional red blood cells for both momma and baby, coupled with their dilution by increased fluid in the circulation, can often lead to iron deficiency anemia during pregnancy. It can be especially aggravated by:

• A diet low in iron both before and/or during pregnancy

• Severe nausea and vomiting

• Being pregnant with multiple fetuses

• Closely spaced pregnancies

• Alcohol or drug addiction

• Severe or chronic infection

• Significant blood loss

• More serious medical conditions

Treatment Options for Anemia in Pregnancy

Untreated anemia in pregnancy that becomes severe may increase the risk of harm to your baby. You may be more susceptible to infection, less likely to handle the stress of labor, the normal blood loss at delivery, and the needed healing during the postpartum period.

Treating iron deficiency anemia can be tricky because many sources of iron are not easily absorbed into your system and some products like coffee, soda, black tea, dairy foods, bran, antacids, calcium and magnesium supplements, and certain medications actually inhibit iron absorption. However, careful attention to diet and use of natural easily assimilated forms of iron have produced excellent results without the detrimental side effects of the commonly prescribed ferrous sulfate.

Ferrous sulfate is not only poorly absorbed, but also very constipating, can cause indigestion, black tarry stools, skin rashes, and is said to be hard on the digestive tract, liver and kidneys. Too much ferrous sulfate has been associated with serious complications and can produce the same deficiency state that it was prescribed to correct.

There are a number of ways anemia in pregnancy can be addressed without ferrous sulfate. I recommend combining several of the suggestions below to increase your chances of successfully increasing your hemoglobin and keeping it at a healthy level.

High-Iron Diet

Get as much iron you can from your daily diet. Good food sources for iron (as well as other needed nutrients) include:

• Organ meats like beef or chicken liver

• Red meat and poultry

• Shrimp, oysters and clams

• Egg yolk

• Dark green vegetables like spinach (ideally boiled briefly to increase absorption), watercress, alfalfa, parsley, seaweed, collards, kale, turnip and dandelion greens

• Seaweeds (kelp and dulse/kombu)

• Beets and fresh raw beet juice

• Jerusalem artichokes

• Fermented soy like tempeh

• Legumes like red beans, chickpeas, lentils and split peas

• Whole grains and fortified cereals

• Blackstrap molasses

• Seeds and nuts

• Dried unsulphured fruits fruits like raisins, apricots, cherries, black mission figs and prunes

• Black cherries and pomegranate

• Prune juice

• Carob powder

• Brewers yeast

To further enhance iron absorption, eat iron-rich foods with foods high in vitamin C. For example, fresh organic uncooked grapefruit, oranges, vegetable or tomato juice, strawberries, blackberries, raspberries, mango, cantaloupe, papaya, tomato, red or green pepper, cabbage, broccoli, cauliflower, and leafy greens. Regular exercise will also help with absorption, as will cooking in cast iron.

Herbs and Tonics

Choose one or two of the following natural sources of iron to prevent iron deficiency, or alternate between a few.

Vegetarian Iron Tonic - Mix 1 Tbsp blackstrap molasses, 1 Tbsp brewers yeast, 1 Tbsp wheat germ, 1 Tbsp canola or coconut oil, and 4 oz orange, grapefruit or pomegranate juice. If you like warm drinks, try 2 Tbsp blackstrap in 1 cut hot water with fresh lemon juice. Drink 1-3 times daily.

Fresh Juice - Fresh beets and apples make a yummy absorbable, iron-rich juice. Drink 2 cups twice daily. You can add  1/2 to 1 ounce wheat grass juice, ½ cup of fresh parsley and/or other green leafies (except raw spinach) to boost the iron content.

Wheat Grass - Take no more than one ounce per day. If causes stomach upset, half the dose or add it to beet, carrot or other vegetable juice for the first week then take the full ounce by itself or in the vegetable juice.

Herbal Infusion - Steep up to 1 large handful of dried nettle leaf and/or red raspberry leaf in a quart of boiling water for at least 4 hours. For increased iron, you can add a pinch of dandelion root and/or a pinch of yellow dock root. Strain, and drink several times throughout the day. You can add a splash of  lemon or lime juice, fresh mint, 1-2 Tbsp of blackstrap molasses or a dash of honey to taste.

Capsules - Take 3-4 capsules of freeze dried nettles or 8 capsules of seaweed daily.

Tinctures - For prevention, take a dropperful of yellow dock root or dandelion root tincture in orange juice. For treatment, take up to three dropperfuls 1-3 times daily.

Liquid Chlorophyll - Take 1-3 Tbsp per day depending on your individual requirements.

If You Decide to Take an Iron Supplement

If an iron supplement is needed, I recommend taking a non-sulfate whole food variety like ferrous gluconate or fumarate combined with vitamin C. 30-60 mg of elemental iron daily should suffice for those with normal iron stores, while higher doses may be needed if your iron stores are depleted. Your dose should be adjusted according to your lab results and individual needs. Take your supplemental iron daily until 2-4 months postpartum.

Find the best supplements that have gone through my thorough screening process at the Holistic Apothecary.

For optimal absorption, it is best to spread supplemental iron intake out over the course of the day to avoid stressing your system with the unabsorbed portions. Do not take with dairy foods, caffeine or soda with phosphates. Be sure to take it between meals on an empty stomach with 500 mg of vitamin C and bioflavonoids

Although it can take a few months to correct iron deficiency anemia, you should start to see an improvement in the lab values within two weeks of treatment. If not, try a different combination of natural iron sources. If there is still no improvement after another 2-4 weeks, your anemia may not be related to low iron and a more thorough medical evaluation is needed. If you are feeling overwhelmed, or do not even know what questions to ask, I can help you! You can just schedule a consultation with me here.

Check out my number one international best selling book Natural Birth Secrets and my online course - an online version of how I have helped thousands in my local practice. Both resources are unique, but each provide an in depth, one-of-a-kind holistic approach created by me, a seasoned nurse midwife of over two decades, who has seen everything!

Preparing for Pregnancy

There are so many things to consider when preparing for pregnancy

Every momma wants to give her baby the best possible start in life. Preparing for pregnancy will enhance your own health for fertility success, and set yourself up to provide a healthy environment for your baby.

But, where do you start? Taking a natural, holistic approach to preparing for pregnancy includes optimizing your diet, supplements, physical movement and state-of-mind. This is a less invasive, less expensive, and much healthier approach for both momma and baby before even considering the standard fertility treatments.

Eating for a Healthy Pregnancy

When preparing for pregnancy, it’s best to eat a wide variety of fresh, whole, plant-based foods and adequate protein. Your plate should be beautiful and colorful with plenty of varied vegetables, fruits, whole grains, beans, some nuts and seeds, seasoned with fresh herbs and spices. Look for:

• Organic. Free of chemical fertilizers and pesticides that can damage fetal development, this is the best option for produce. Use the Dirty Dozen as a basic guide. These foods are to be either eaten organic or avoided.

• Local. Choosing local typically means the food is at the peak of freshness, grown in your locality, maintaining more nutritional integrity.

• Colorful. The various colors of fruits and vegetable provides differing nutrients. Make sure you’re eating a full spectrum of color to get a well-rounded diet.

• Unprocessed. Chemical additives, preservatives, artificial sweeteners, food coloring and genetic modification can all negatively affect your health and your baby’s. If it comes in packaging, it’s probably not the best option.

• Sugar-free. Sugar is damaging to you and your baby’s cells, and disrupts gut flora; it negatively impacts your pregnancy, and how you feel physically and emotionally. Sugar is found in almost all processed food. Look out for marketing tricks, like using four or five different types of sweeteners so manufacturers don’t have to list it as the first ingredient. Stick with natural sugars like in fruit, and if you must add a sweetener, a tad of pure raw honey or maple syrup is better.

• Gluten-Free &/or Dairy-Free. Most women feel best when they are gluten-free. Try removing it from your diet for a week and see if you feel better in your mind and body, gain more energy or clarity. Many also feel better off cow dairy, but tolerate goat or sheep dairy products. Try a different week without it and note how you feel.

• Hormone & Antibiotic-Free. Whenever possible, select the highest-quality organic meats and animal products, including wild fish from non polluted waters. If the animal food you’re eating was treated with hormones and antibiotics, your body and baby will be affected by that. And consider that most farm animals are fed genetically modified (GMO) corn and feed that is highly sprayed with pesticides. Animals who are free to move in the sunshine and graze in the green pastures, as they did for thousands of years before the modernization of the farming industry, produce the healthiest meat, diary and eggs for human consumption.

• Healthy fats. Your body needs plenty of high-quality fat, especially when preparing for pregnancy. Ideally, you should be eating wild Alaskan or Norwegian salmon at least twice per week as well as healthy oils. Use extra virgin olive oil on cold foods (like for salad dressing) and light sautéing, and coconut oil or organic grass-fed butter for cooking at higher temperatures.

• Hydration. Don’t forget to drink plenty of fresh spring or filtered water throughout the day. Work your way up to half your body weight in ounces. For example, if you weigh 150 pounds drink 75 ounces of water daily.

Preparing for Pregnancy with Supplements

In a perfect world, we would get all the nutrients we need from our food. But, with today’s industrialization of food and depleted soils, that has become virtually impossible. Additionally, the standard American diet is really empty of needed nutrition and even those of us with the best intentions do not eat all of what is needed for the health of ourselves or our pregnancies. The supplements you need when preparing for pregnancy will depend on your specific situation. Chat with me to find the best supplements for your body.

However, there are a few supplements that every woman should take daily. I take them myself and recommend them to all my clients. Following this supplement protocol has blessed me with feeling wonderfully vital and rarely getting sick - even when a bug is going around my house.

So what’s my supplement magic? I take whole food organic supplements from trusted, high quality, professional grade companies, including:

• A multivitamin/mineral combination

• Methylated folate in B complex

• Calcium, magnesium, and D complex

• Omega three fatty acids

• Herbal iron depending on your iron stores

• Mega-Probiotics that are colon and urogenital specific for 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 by category (listed in the prenatal section), and the products will be shipped directly to your home or work within a few days.

For more details on food and supplements for pregnancy check out my Natural Birth Secrets book, and in even greater depth, my online course.

Exercise for a Healthy Pregnancy and Beyond

Movement is another important aspect of preparing for pregnancy. Not only will a strong, agile and flexible body provide a safer prenatal home for baby, it will help you avoid aches and pains along the way, reduce inner stress, help in labor and even postpartum recovery. The right exercise can also get your body ready to ease your baby into a perfect birthing position.

Ultimately, the best exercise is that which you enjoy, so you stick with it. Vary activities that you love, and incorporate it into your life so it doesn’t feel stressful. Here are some types of movement to consider:

• Walking. This is a great place to start if you’re someone who currently isn’t getting much exercise. Begin with a leisurely 15-minute walk every day, and build up to 45-60 minutes at a faster pace.

• Yoga. Yoga will not only strengthen your body and make you more flexible, it’s been known to decrease stress and enhance your overall well-being as well. There are tremendous health benefits to regular yoga practice. There are even fertility yoga classes out there, designed with just this topic in mind! I teach private yoga classes, including yoga workshops for pregnancy and labor, as well as postpartum - which can be done locally or on Skype.

• Dance. Dancing is such a great way to keep healthy and active! It is so much fun, and is a direct path to feeling awesome without realizing you are also getting a fabulous workout. It relieves stress, helps you feel and move emotions, and creates happy for you, and for your baby; your stress hormones as well as your happy love hormones pass through the placenta to baby....and both are contagious to those around you. Dancing also helps you tap into your sensual or sassy sexy, which is beneficial in pregnancy, labor and life! Dancing in labor uses gravity and asymmetrical movements to ease baby down and out through a wider birth canal. Start by taking dance classes, but you can also just turn on the music regularly and dance like no one is watching. I give group and private healing movement workshops - called Femme!, which is a wonderful experience for both men and women.

• Weight-training. If you are not called to yoga or dance, back, arm, leg and core exercises help align your body and are great preparation for the uneven weight of pregnancy. Squatting helps prepare for delivery.

• Pilates. Pilates has a strong emphasis on core conditioning and is also great for mommas-to-be.

• Swim. It gets you outside, connected to nature and immersed in healing waters that soothes the soul. Swimming and water aerobics are also great ways to be active. In advancing pregnancy, it relieves common aches and discomforts, and pregnant women love the sense of weightlessness they feel in water.

If you’re someone who currently has an intense workout regimen and are having trouble conceiving, consider dialing it back to a lower intensity. Otherwise, moderately moving your body and being active each day is the way to go.

Tapping into Mindfulness and Joy

Reducing inner stress and living in joy are central to preparing for pregnancy. Inner stress can actually prevent pregnancy. Many of us recognize that we have grown out of alignment with our true natural being and it's time to get back to our original design.... get back in touch with the cyclic nature of our human bodies, our minds, our hearts and our spirits. The thoughts we think and the perspective we carry while preparing for pregnancy are incredibly influential.

Find ways to slow down, unplug and enjoy the journey. Make sure you are well rested, and getting 7-8 hours of sleep each night. Practice saying “no” to anything that doesn’t bring you calm and pleasure during this time. Explore ways to bring joy back into the things that aren’t optional. Stay as much as possible in the present moment, one moment, one breath at a time; practicing mindfulness - anchoring into what is going on around you and the sensations within you in the now transforms your life and will benefit your labor immensely. Consider a daily practice of mediation, journaling, and creating any form of art to help your body keep in a calm and joyful state. Decide to live a glorious life; dress and treat yourself like the goddess you are. Focus on what you have to be grateful for and all the blessings in your life. Connect more in community with those you love, and those who inspire you. Clear your body of trapped emotional pain, trauma and internal stress, and transform self limiting beliefs and thought patterns with Clarity Breathwork. Turn negative thoughts into positive affirmations, for example: My body is strong and healthy for pregnancy or I am the perfect age to become a mother; empowering uplifting thoughts are usually the opposite of, and more true than the false stories we typically tell ourselves.

Acupuncture is a great way to relax and has the added bonus of hormone regulation and improved ovarian function. Many women who had some initial trouble conceiving often get pregnant after receiving acupuncture by a practitioner with expertise in fertility; I have seen it used in conjunction with routine infertility treatments, and have seen successful pregnancies even after several IVF attempts failed.

We’ve discussed a lot of lifestyle factors here. Some might be big changes for you. Don’t let them overwhelm you. I’m a huge fan of the 80-20 rule. Spend 80% of your efforts on achieving optimal habits and allow yourself the freedom to enjoy the other 20% without guilt.

Fertility Awareness

Learn the signs of fertility so you can make sure you have intercourse during the small window of time when you are likely to conceive, you get the most accurate estimation of pregnancy dating, and you will even know when you are pregnant before you can take a pregnancy test. This is key, and will also provide helpful information as to causes of difficulties should you need professional guidance. I cover this in more detail in my Natural Birth Secrets book.

For further inspiration and optimal health during, birth and after pregnancy, please make sure to click here to take my online Love Your Birth course, so you can ROCK your journey wherever and however you plan to give birth.

Things You May Find At Your Midwife's Office

The list below shares with you 15 wonderful things you may find during prenatal care visits with midwives, especially those who practice in relatively small group private practices, out of hospital - in free standing birthing centers and home settings across the United States. Other countries may have slightly different models, but authentic midwifery practice shares many common core philosophies of care, so I suspect there would not be much difference.  They are:

1. Time – as in actual time for connecting and developing a relationship with your midwife; so that you can ask your questions and speak about your concerns. Time for the midwife to ask you the questions she needs to make assessments about your health and wellbeing, so she can best guide and support you.

2. Continuity of care - the midwife (or one of the 1-2 partners, if in a small group practice) you see during your prenatal visits will most likely be the midwife who attends your birth.

3. A big heart - your midwife will give you every ounce of her heartfelt knowledge, expertise and care for you and your baby. You may just feel so close with your midwife after a while, she is like your best big sister or wise friend, and her office is a safe space for you to share, laugh, or cry about anything.

4. Education - your midwife will teach you and your loved ones about your body, what’s happening, what to expect along your childbearing journey, and what you can do to make it easier, healthier, more positive. This includes diagrams and models of pregnant moms and babies, placentas, umbilical cords, membranes and pelvises. Your midwife might just have a mirror for anatomy lessons of your own body if you are interested....like in seeing your cervix.

5. Tea and healthy snacks for everyone.

6. Inspirational quotes, affirmations and art about pregnancy, giving birth, breastfeeding, baby wearing and parenting.

7. Pictures of graduates on the wall and/or in photo albums.

8. A collection of thank you notes and birth stories (I call them love letters) in collages and/or scrapbooks.

9. Midwifery and holistic health text/reference books and a lending library of books and movies on pregnancy, natural childbirth, breastfeeding and newborn care.

10. Enough seating arrangements for the whole family and even some friends, as well as toys and books for the little ones.

11. Hands - your midwife’s hands are skillful both in their assessment AND the supportive touch they offer.

12. Tools - all the supplies and knowledge of how to use them, that could possibly needed for your journey. These include equipment such as blood pressure cuff and stethoscope, fetoscope, Doppler and gel for checking baby’s heart rate, scale, measuring tape for assessing the height and growth of your uterus, and lab supplies for checking your blood, urine, screening for infection and pap smear AND so much more! If she uses an exam table, the stirrups will be covered with oven mitts, and it will probably have a nice comfortable and decorative sheet and pillow on it, with a stool for climbing up and down or for the little ones to be involved.

13. A boutique, where you can buy needed items like supplements and natural remedies, books, affirmation cards, birth kits, and rent a birth tub.

14. Office and birth assistants - your midwife may also have students, apprentices, and even have a doula or two to choose from; she may have space to host childbirth classes, pregnancy and postpartum support groups, prenatal and postpartum yoga, parenting groups and all sorts of relevant helpful workshops and community events.

15. Needed medical and midwifery knowledge and clinical skills; and she will also be familiar with and use a variety of holistic, alternative and natural modalities that can help you during and after pregnancy, birth and beyond.

As you go about choosing your midwife and planning for your birth, you might want to ask yourself what is important for you from the above list. Does your midwife or obstetrician offer some of these things, or what you feel you want and need?  Start writing down your questions and your preferences now in a journal, so when you meet her - you have them handy. 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. It will guide you get clear on what you really want, and make informed decisions given all your available options.

My Two Books Pre-launched #1 Bestsellers

I have some exciting news to share with you! I have officially published my first two books on Amazon today...and they both became #1 International Bestsellers! The titles are below. 

I am forever grateful of your support and would love for you to share this with any of your friends or family that you think would enjoy this as well! 

Trauma Release Formula: The Revolutionary Step by Step Program for Eliminating Effects of Childhood Abuse, Trauma, Emotional Pain and Crippling Inner Stress, to Living in Joy without Drugs or Therapy Kindle Edition 

by Anne Margolis CNM, MSN, Yoga Teacher, Clarity Breathwork Practitioner (Author)

If you’ve experienced intense stress, emotional pain or any type of trauma, this program is a must - it represents true hope that saved my life and the lives of countless others. Once you know the key that unlocks the emotional pain, suffering, your ongoing personal life, work and relationship issues, and ongoing stress related physical symptoms and illness, and how to unlock it all, you experience such a powerful healing. 

For the last 22 years I have worked as a holistic nurse midwife, then with the added expertise as a yoga teacher, advanced grad and volunteer staff of Mama Gena’s School of Womanly Arts, and Clarity Breathwork practitioner. I have shared the most intimate experiences with women and their families as they move through young adulthood through and beyond menopause, and as they have their babies. I have held space for the huge powerful transformation of birth – that involves challenging situations of extreme intensity and vulnerability, pain of all degrees, facing enormous fears head on, surrendering to a process far greater than all of us…as well as great joy, love, and miracles. There is no pain – physical or emotional – that scares me – I am comfortable with it all; I have either felt it myself, heard about it, witnessed it, and helped others move through and heal from it. Over many years, the women in my practice, their partners, extended families and friends have shared with me and sought my guidance for their deepest darkest sufferings.

I would say just about everyone has baggage, past trauma of some sort, emotional pain and inner stress that is part of being human. Or it comes out as physical problems. Even if there is no apparent history of physical, sexual or verbal abuse unfortunately occurring at staggering rates (beyond 1:3 what is reported), most -people tell me they are one or more of the following:

Natural Birth Secrets: An Insiders Guide How To Give Birth Holistically, Healthfully and Safely, and Love the Experience! Kindle Edition

by Anne Margolis CNM, MSN, Yoga Teacher, Clarity Breathwork Practitioner (Author)

A Doctor and Midwife Recommended, Guide For Pregnancy To Postpartum Bliss Whether Birthing At Home, Hospital or Birth Center- even if this is not your first baby! 

This is a unique approach on how to have a deeply positive, empowered, and joyful journey through pregnancy, birth, and becoming a mom postpartum. Whether you have visions of a cozy home water birth, giving birth in a birth center free of pain meds and intervention, or a hospital birth with the latest technology and emergency care access just in case, this is the ultimate pregnancy to postpartum training so you can be prepared from an emotional, physical, and spiritual perspective to relax into birth and momma-hood with excitement and ease.

This comprehensive training will help you find your center and feel balanced, strong, relaxed, and calm within yourself during this special rite of passage into momma-hood- in the midst of all the chaos of life along the way. It will help you tune into your deepest desires and create joy and pleasure in your pregnancy, birth, an life as a mom - to take you and your family higher.

I’ve taken everything I’ve learned, trained and supported thousands of women, babies and their families with for over twenty years in my private practice locally and around the world, to create this book and do my part in improving maternity and newborn care and experiences, by empowering women and their families to speak up. These are my insiders secrets to increase your likelihood of avoiding high rates of risky medical and surgical interventions, serious complications including birth trauma for you and your baby, and having the birth of your dreams.

- stressed out, worried and anxious,

- overwhelmed, overworked and depleted, burned out, taking care of everyone but themselves

- filled with resentment, anger, rage

- irritable, cranky, and reactive

- unhappy, uninspired, unfulfilled, sad or downright depressed – do not feel joy

- addicted to harmful habits and do not do much to take care of themselves

- embarrassed or ashamed by some part of their body or not liking the way they look

- struggling with eating disorders,

- stuck and can’t make decisions

- disconnected from themselves and others

- shut down, powerless without a voice

- longing for something more and better, but don’t even know what they want, or thinking something outside of them will rescue them and make them happy

- plagued with self loathing, self doubt, not feeling valued, worthy or good enough, like a failure

- filled with shame, blame or a sense of being wrong

- lonely and isolated – without community, or even within their circle of friends and family

- sensually and sexually shut down and turned off

- troubled by relationship issues (immediate, extended, friends and/or professional)

- battling  career and work problems

- suffering with ongoing physical symptoms or chronic health conditions from body aches and pains, to migraines, intestinal issues, acid reflux, trouble sleeping, high blood pressure, heart disease, autoimmune disorders, cancer …the list goes on. If you can relate or have some of these feelings or issues, you are in the right place.

I want to thank my mentor Mike Koenigs for guiding me to prelaunch two books on my two passions for helping people!!! Both are available on Amazon already! Will be released on kindle in March and paperback in April!! 

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.

Microbirth

Starring Martin Blaser, Maria Gloria, Dominguez Bello, Rodney Dietert

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.

Hibiclens Antiseptic/Antimicrobial Skin Liquid Soap, 32 Fluid Ounce

Hibiclens

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)! I am thrilled to announce that you get a $20 Off with code: ANNE20 at checkout - if you purchase here.

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