How to Plan, Have, and Rock Your VBAC

How to Plan, Have, and Rock Your VBAC

Photo by @senhoritasfotografia

Didn’t think you could have a successful VBAC or vaginal birth after Cesarean? Keep reading to discover what’s possible for you.

If you’re a momma who has previously undergone a C-section birth, I want you to know that having a vaginal birth in the future is totally possible.

VBACs are more attainable and beneficial than you might think. While C-sections are absolutely appropriate in life-threatening situations, they do not (and, should not) have to become a routine.

There are some practical steps you can take to not only determine if VBAC is right for you, but also prepare for having a deeply positive vaginal birth experience that will have you feeling empowered in your own capabilities.

Hopefully, these practical tips give you the confidence to know that you too can have a wonderful VBAC.

How to Research When Planning a Successful VBAC

Why do You Want Your VBAC?

The first step, in any major decision, really, is to know and believe that you have a voice.

Take full responsibility for your pregnancy, and do not surrender it to others, especially to your health care provider and the hospital.

Don’t simply assume that a doctor or midwife knows what’s best for you. Only you can truly understand what you’re feeling and experiencing physically, emotionally, and spiritually.

Don’t skip this first step or even take it lightly. It’s the most important step and sets up the foundation for the rest of your VBAC journey.

So, how do you get started with your foundation? Ask yourself this simple (albeit, difficult) question, “What do I want, and why?”

This is your opportunity to educate and empower yourself.

The more you know, the more likely you are to make better decisions. The more you know about yourself, the more likely you are to make more harmonious decisions that coincide with who you are.

This is feeding your soul, your deepest truth!

Know the Real Pros and Cons of Both a VBAC and a Cesarean Section

The next step includes understanding the nature of both VBACs and C-section birth. Then, you should probably tackle their pros and cons.

A Cesarean section (or C-section) is a major abdominal operation in which the baby is delivered through a surgical incision in the mother’s abdomen and uterus while under anesthesia.

This is usually an epidural or spinal anesthesia, inserted via a needle and catheter into the space around your spinal cord, which attempts to numb you from the waist down. General anesthesia is medication given so you are completely out. Depending on the situation, you may be given such a high dose, you will need a tube inserted into your airway so that a machine can breath for you. It is is more often the method of choice in severe emergencies where time is of the essence.

While being a life-saving surgery, C-sections are meant to only be performed in cases of serious complications and emergency in which the mother and/or baby are in real danger.

Another advantage of repeat cesarean is that, if planned, it can take less of an emotional toll for some moms. A mom, for example, who’s very anxious about a past emergency or planned vaginal birth that did not work out, is extremely afraid of vaginal birth, or has a history of unresolved sexual abuse trauma can feel reassured by her perceived sense of predictability and controlled surgical procedure in having a C-section.

The trouble with C-sections is that they are, nowadays, becoming more and more commonplace, putting moms and babies at a significantly increased risk of poor physical and psychological health.

In fact, the USA is ranked among the highest in the world for cesarean sections at 30% and counting. In my area, some hospitals have a 40-50% C-section rate.

This is a lot considering the fact that C-sections are supposed to be rare! It is unacceptable, malpractice, and explains our country’s horrid outcome stats. We rank near the bottom as compared to other developed countries in terms of mothers and babies becoming seriously ill or dying during or soon after childbirth.

We have soaring rates of birth trauma for both mother and baby, which significantly impacts their lives in the short and long term. My cesarean section rate is 5% which is comparable to most homebirth midwives, within the ideal range of percentage rates of performed Cesareans.

Here’s the scary long list of risks that come with having a cesarean section: injuries to other organs during surgery, bowel obstruction, infection, hemorrhaging, having an emergency hysterectomy, blood clots, stroke, and maternal death.

You also run the risk of having pain if the anesthetic doesn’t work completely.

There’s prolonged, more intense pain postpartum, a longer hospital stay, readmission to the hospital, an upsetting or emotionally traumatic birth experience, less early contact and connection with the baby, depression and mental health problems, low self-esteem, relationship issues, difficulty functioning and doing usual daily activities postpartum, chronic pelvic pain from scar tissue, problems with and discontinuing breastfeeding - along with the associated risks to mom and baby of not breastfeeding.

There can be accidental cuts to the baby during the surgery,  lung and breathing problems, including asthma for the baby. There could be future reproductive health problems like reduced fertility, infertility, negative feelings about childbirth and having another baby, higher risk for life-threatening complications in future pregnancies, including placenta previa, accreta or abruption, ectopic pregnancy, mild separation to frank rupture of previous uterine scar, fetal malformation or central nervous system injury, stillbirth and newborn death. The baby could also be born prematurely or with a low birth weight.

(Whoo!)

VBAC, or vaginal birth after Cesarean, on the other hand, is exactly what it sounds like. Having had a C-section in the past doesn’t mean that you’re required to have C-sections for every subsequent birth.

In fact, when all is well and healthy, the benefits of having a VBAC are quite numerous and significant. The risks of repeat cesarean birth far outweigh the risks of VBAC.

First of all, avoiding major surgery is a crucial health benefit in and of itself - it avoids all of the above-mentioned risks of cesarean. Almost all other surgeries that were once major are now done laparoscopically with much smaller incisions to minimize risk.

Also, you significantly increase the chances of having a more positive birth and postpartum experience. Healing and recovery are much easier, and there are fewer chances of enduring postpartum depression and emotional birth trauma. There are shorter hospital stays, fewer readmissions, and the increased opportunity for earlier and more prolonged contact and bonding with your baby. There’s more likely to be success with breastfeeding, especially after a natural birth.

But, as with everything, there are risks with a VBAC. The main risk of concern is the partial or complete separation of your previous surgery’s scar that may or may not have any impact on you or your baby. The numbers are about 2 in every 1,000 VBACs, but this risk doesn’t have any effect on the health of the mother or baby, as it refers to partial or slight disruption of the prior incision without clinical significance.

A significant uterine rupture which would, in this case, be a life-threatening risk is actually even less likely to happen. These numbers are less than 1%.

There are also risks of some vaginal pain or tearing that takes a few weeks or few months to fully heal (a much shorter time than it takes for for the cesarean wound to heal), a slight increase in urinary and rarely anal incontinence, and birth injury to baby from the uncommon complication of shoulder dystocia.

As a midwife, I fully support a momma’s choice to have a VBAC. But, there are many important reasons why you could find yourself in a condition to have either a scheduled or an unplanned repeat C-section birth.

For example, your baby may be in a transverse position (lying in the uterus across your abdomen), or you may be nearing your term and have placenta previa - especially if the placenta is completely or partially covering your cervix. Read up on these situations to further understand what truly are indications for undergoing a C-section.

Once you’ve learned and weighed the pros and cons of both a VBAC and a C-section, complement your research with the knowledge and experience of your trusted doctor and/or midwife.

Find the Right Health Provider for You

After you’ve gathered your information and have made a few decisions as to what you’d like to do, it’s time to find the provider that will work with you toward your vision of a successful vaginal birth.

Ask various providers their VBAC rates as compared to their repeat Cesarean rates. This is important—look for, of course, the providers with whom their VBAC rates are higher than the repeat C-sections. They should not have a VBAC rate lower than 70-80%, if you want to maximize your chances of vaginal birth.

If you’re planning on having the birth of your baby in a hospital, then you can equally research your local hospitals and get their VBAC rates as well, gauging in the same way.

It is worth mentioning that a natural birth gives you your highest chances of having a successful vaginal birth after Cesarean. Just know that while many wonderful obstetricians have high rates of VBAC, they are highly skilled surgeons who specialize in higher risk complications.

They can look for them, diagnose and treat them medically and/or surgically. Going to a surgeon and having a natural vaginal birth may be extremely challenging in many cases.

Most midwives whether they practice in or outside of hospitals have some of the best VBAC to repeat C-section ratios. You might have to dig a little deeper in your research, however, to find midwives who practice in-hospital. Sometimes, their hands are tied by limiting obstetrical or hospital policies and malpractice insurance companies. But they still tend to have higher VBAC rates than most OB/GYNs.

Related article: Can All Women Have a Homebirth?

Prepare to Rock Your VBAC

How to Deal with Emotional Trauma From Previous Cesarean?

Now, that you’ve done your research and you’ve decided that you’re going to have a VBAC, it’s time to prepare yourself, mind, body, and spirit.

This is particularly important if you’ve previously had a traumatic experience with a C-section birth.

There are actually therapists whose specialty is to help women overcome the trauma of the last upsetting unplanned cesarean birth.

Photo by midwife @lindseymeehleis after her VBAC

That is what I do for the women in my local practice and online via Skype or Zoom for the global community. I work with you not only to heal, but also help you to approach your next childbirth experience with positivity, confidence and joy. Also, that is a main focus of my comprehensive online course, Love Your Birth, in addition to helping you achieve optimal health of the mind, the heart, the body, and spirit along the entire journey from pregnancy to birth and mamahood.

I have personally found the most effective form of trauma healing to be: Clarity Breathwork - it is so much more powerful than most any other modality, including medication and talk therapy alone. I tried just about anything, and nothing worked. I had such profound healing using Clarity Breathwork, I became a practitioner who provides private and group Clarity Breathwork sessions and assists at larger workshops, to help others experience the huge healing and transformation I did and witnessed in so many others. Additional incredibly effective methods of trauma healing include Somatic Experience and Organic Intelligence.

My goal is to create for you the springboard you need to heal fully, then create for yourself the deeply connected, positive, and empowering experience that childbirth truly can be.

Your VBAC Community

Another very important component to preparing for your VBAC is to gather around you a community of women who are on the same wavelength as you in terms of mindset and experience.

It is actually easier than you think to find women who’ve gone through what you’re going through, given the high rates of cesarean birth in our country.

Do a bit of research on ICAN, a nonprofit organization whose goal it is to educate and support women through their Cesarean recovery. They also seek to support families in their communities advocating for vaginal births after Cesareans.

This is a time to work closely with your midwife or obstetrician on bringing to life the successful birth you’ve envisioned for yourself.

Make your needs and goals very clear (your midwife or I can even help you to hone in on what those needs and goals might be), so that all you have to focus on is delivering your baby when the time comes.

Surround Yourself with Positivity and Joy

Lastly, be on the lookout for positive VBAC stories of healing, beauty, and empowerment to encourage you. We always seem to envision these horrific and traumatic scenes when it comes to birth.

Fill your mind with positive birth stories, and what’s possible for you instead of what you fear might happen.

I have collected my favorite resources for mamas in my course. It contains 200 of the best supplies, books and movies I use personally and professionally with my clients, family, and friends. Even diving into a fraction of this list will have you feeling empowered and prepared for conception, pregnancy, postpartum and parenting!

Draw, journal, meditate, visualize, play sensual music and let yourself freestyle dance to it—these things help you to heighten and easily tap into the intuitive, feminine self. This is your heart and gut, your truth, your wisdom, the part of you that knows what you most deeply desire and the part of you that knows exactly how to give birth.

With easier access to this huge part of your being, you will more easily determine what it is that you want and need. This creates more confidence and assuredness in the decisions that you make, no matter what the rest of the world might be telling you.

Now that you know where to begin, take responsibility for your pregnancy and childbirth. This is the most empowering thing you can do for you and your baby. It is also the healthiest, and will bring you a deep sense of inner peace and joy.

You’ll find that there are actually many resources and communities that can help you to have the kind of birth that you envision for yourself.

Know what you want and why you want it. Find healthcare providers as well as other women who support you in your decisions and who can help you on your journey. Hire a doula and learn why this is so important especially if you are planning a VBAC and you do not have that kind of calm mothering support for the big day.

A woman’s childbirth is her own and she should have the freedom to experience the full power of what she is capable of.

A glowing vaginal birth after Cesarean is possible for every momma.

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Your many questions may be more common than you think! Subscribe to my monthly Ask the Midwife Newsletter where I answer common questions in written or video format.

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).

Photo by Megan Hancock Photography

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

Whether you're a first time or experienced momma, planning a VBAC

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

Happy Birth On The Farm...Except For The Cat

Dearest Baby James Barry (formerly known as Boop),

You are 22 hours old. You are slumbering next to me on the bed. You are a little miracle and a little marvel. I am relishing this time. Midwife Anne has banished me from stairs, and I am glad.  We spent the day in bed together, you and I, and will do the same tomorrow. What a gift.

Your arrival was not so different from what I imagined and hoped for. Still it is a miracle! Your big sister Elaine June arrived two weeks after her estimated due date. So I did not expect you to come on yours. Still, one gets antsy. The days rolled by. 

(Part of why I thought this is because I had dreamt you were a girl.  But you are a boy, and we're so very thrilled that you are who you are! Your dad and sister both thought you were a boy all along.) 

Anyway, on Monday night, I got out my cello. We stretched around it together, you huddled in front of course, and I played "Happy Birthday" to give you the idea, and some Bach suites, and "The Swan," then "Happy Birthday" again before I put it away.  

Tuesday went by with more “no baby yet” comments from one and all. On Wednesday night EJ said, “I want Boop to be born on Thursday!” I agreed.

I had assumed that my labor would begin at night, since that's what happened with EJ. Thus, each awakening morning brought disappointment as I realized, yet again, NBY—No Baby Yet. Yet...as I ate my breakfast yesterday morning, I felt a cramp. Just the same kind of cramp I'd felt in early labor 4 years before...

I told Dave, and felt hopeful. But I was well aware that some women have contractions for days before their babe is born. At 7:30 a.m. I realized that your Grandma Sheena was about to leave for work. I called her off, even though I wasn't sure this was the day. She commenced to work from home. The contractions slowed. Dave went to work; I took EJ to school. The pains returned and were somewhat regular, though, every 20 minutes or so. I left a message for Anne, and called Sheena with a disappointing “no news yet” message. Back at the farm I went on a walk, and the contractions slowed down. It was a nice walk up past the pump house and around to the garden where I pulled a few weeds with the crew. I finally saw the log cabin. I returned and called Sheena again with more non-news.

Dave came home early from work. We had an appointment with Anne, set for 1 p.m.  I didn't want to drive there myself so long after the due date, especially with contractions! In fact I hoped we'd soon be birthing at home. But the contractions kept petering out, only to come back after a while, only to slow down again. Nothing seemed certain.

Your dad and I picked EJ up from preschool and she ate a packed lunch by the gazebo on the river. The contractions were back, and fairly regularly so, 10-15 minutes apart. I spoke with Anne and all agreed that we should head home. I looked at my early labor list...made a frittata, moved some stuff around, and wondered when I should call Jean (your Grandma Sheena) to come be with EJ. We didn't want a crowd here waiting for things to get moving, as that would surely slow it all down. But the contractions started to be dependable. We called Jean around 2:45 p.m.  

Grandma Sheena was here by 4 p.m. and took EJ down to the lake. We were timing my contractions, which were coming 7 minutes apart, then 5, then 7. Anne said she'd like to be heading here when they were 4-6 minutes apart, but she could come anytime. Dave and I were torn: we didn't want a house full of folks just waiting too soon...a watched pot doesn't boil! But our friends had just had an accidental unassisted birth since it went so fast!  The contractions got closer together, and Anne was on her way.

Then, of course, the contractions slowed, 6-12 minutes apart. Nancy, Anne's assistant and a wonderful doula, arrived and suggested a long walk. EJ and Sheena came up from the lake, and got ready for yogurt and a bath. I don't know if she ever ate dinner! Anne came, and your dad and I left.  

Up around the farm we walked, through the gardens and the flower area. I had to tell your dad not to pull weeds. We'd stop now and then when I had a contraction, though they did seem further apart. As we descended the hill, there were dark clouds and Dave wanted to hurry. Um, no, I could not hurry! The contractions, though spaced out more, were starting to really hurt. We got home and EJ was excited. I set up a bed on the couch for her and Sheena. EJ wanted my attention and I was trying to give it to her, but the contractions were regular now, and hurting more and more. A movie distracted EJ. I finally realized I needed to settle in upstairs.

We decided to birth in Elaine June's room. She had agreed to this months ago and we'd spoken of it often. Mizoo cat kept attacking poor Anne, as had been his tradition since the home visit.  She set up all of her instruments on a sterile field which he promptly hopped upon between attacks on her.  Dave finally had to trap him downstairs in the bathroom. Patient Anne and Nancy had tried hard to bear with him, but the bugger was relentless. A couple of days later EJ coined the phrase “attackive” to describe him. (He's not like that with everyone; I don't understand! And by the time you're reading this, James, Mizoo is likely to be a mellow old dude, or remembered as such.  Funny, these felines!)

The contractions were closer and more painful but I had yet to have the bloody show or broken water or anything that felt productive. I called Dave at last and moved onto my knees in the bedroom. (I had been pacing the hall, and swaying low with the contractions.) Finally I peed and found some bloody mucous. I don't think it was long after that, that I started pushing, and soon enough the water broke. I was glad things were moving on. Nancy kept checking your heartbeat; it was always good and strong. Thank you for reassuring me, sweet James!

Oh, my, I certainly had forgotten the pain! Through each contraction I would remember: breathe low and slow through the pain, stay loose and open, and—the hard one for me—do nothing extra.  It took a long time for me to give in and Do Nothing Extra.  Between each contraction I wanted to give directions on where to find things, what I wanted to drink, that I didn't care if the yoga mat got bloody, etc.  At least, before I finally got myself to shut up, I was able to tell Nancy where to find an empty trash can, as I sensed that I was going to puke. They suggested the green bowl I had there for the placenta.  But it's so dear to me and I didn't want to throw up in it!

Nancy came through, transition came on, I threw up, and at last realized that I had to stop talking and save every ounce of energy to push you out. It was agony for a while. But I pushed with all my might, knowing that I had prolonged EJ's birth by pushing with half-strength for hours. During those most painful contractions I shuddered and moaned, I prayed, and I begged you to please come down, Baby Boop, please come down now. Anne said she enjoyed hearing the horses and sounds of the farm as I labored. I heard nothing, only felt as you slowly descended. All of this time, on my knees, I was squeezing and clawing your dear Dad. He managed to hold my hands, hold a hot water bottle on my back, and massage me all at once, or so it seemed. Anne and Nancy massaged too; it felt so good and eased some of the pain.  

You were low; it was time to wake EJ. I heard her crying before Sheena brought her in. I couldn't talk. She came in crying for me, wanting to snuggle and hold my hair. After trying to calm her, Sheena took her away. Anne said “you can't force these things” and I knew she was right. All along I had known it might not work to have your sister there. I was sad, but I knew I had to let that go and move on and get you born, dear James!

Breathe, low and slow, through the pain. Stay loose and open. Do nothing extra. James, this time I was so grateful to actually feel relief, even briefly, between the contractions. EJ's birth was back labor and there was pain even between. With you there was brief, blessed rest in those middle moments. At one point I asked for the birth stool. I had the idea that squatting might make you come faster. It was awful, though--I felt so unsteady. I remember crying “I hate this stool!” and everyone scrambling to help me turn back to your father, return to my knees, and keep pushing you, and pulling and pawing your dear dad...

The door opened, and Sheena came in, carrying a quiet Elaine June. Dave opened his arms and she crawled in. I even managed, between pains, to tell her I was so glad she was here. So glad, so grateful! She watched, quietly, with the occasional “I love you Mommy, you can do it Mommy” escaping her thumb-stuffed mouth.  

I knew you were low, James, that you were close. But I also knew it could still be a long time. The pain, though fierce, was now somehow bearable. I shuddered with dread as each contraction came on, but I knew you were coming. Anne held a warm, oiled cloth under me and I pressed into it. Your head was there, with hair. The “ring of fire” stung, but it meant you were so close. I pressed into that warmth, and you came closer each time. But how close? Finally, finally Anne said your head was coming out. Then it was out. Then, with a last surge that took my breath away, you slipped right out behind me. I'm crying even now writing about it, dear baby boy. You came out to tears and joy. I asked “boy or girl?” Anne replied, “I'm not telling!”

I was still on my knees.  Anne passed you in between my legs and I carefully picked up wonderful, slimy you. I thought you were a boy, and checked to be sure. Then I said “it's James Barry Llewellyn!” and held you for your Daddy, sister, and grandma to see. And I held you to me.

Elaine June said “I have a baby brother!”  (She wanted you to be a boy), and/or “just like I wanted”...the truth is I'm not sure. She was thrilled and could not wait to kiss you. (She had been watching birth videos for months and was not alarmed by my screeches nor your sliminess.) Your Daddy said that, when you were born, she gave him “the biggest hug she has ever given anyone”. (That is a big hug, James.) Later, to me, she said, “Mommy, remember when Boop was born, how I gave you so many kisses?!”  

I felt very unsteady and shivery, and wanted to birth the placenta. Anne and Nancy had me lay down and I held you to my chest, baby boy. The placenta came and Anne asked who wanted to cut the cord. I knew your dad didn't. I asked Sheena, and she and Anne asked if EJ wanted to.  She did. Dave asked me, “are you sure?” I said, “she loves scissors!” Anne helped your proud big sister cut the cord. You latched on a little but were really just exploring. We had to get up.

Nancy helped keep me steady for a short shower. As I left, I heard your Daddy say, “he has the beginnings of a beak!”, then he and Sheena discussing your Morrison nose! I went to bed and you were brought to me, dear Baby James. Such a marvel! Such tiny apricot ears and long wrinkly fingers...you were just inside of me, and now here you were!!! Your fingernails were like daggers, we'd have to clip them soon. Your fingers were so dinosaur like—wide at the bottom and pointy at the top, wrinkly and peely. You latched on. Anne stitched me and cleaned me up some more. As she did I held you under a towel. When it was lifted it revealed what Nancy said was the biggest meconium poop she'd ever seen! We laughed briefly about James and The Giant Poop, while Nancy patiently and tirelessly cleaned us both.

Your sister came to bed -- “I want to kiss my baby brother!  I want Boop!” she said. We told her she had to be gentle on the bed. She was. She kissed you, and has been kissing you ever since. We said goodnight to her many, many times. Sheena kept bringing her down with the ploy of a movie. But that didn't hold. After 10 or 20 minutes we'd hear thumpthumpthump “I want my baby brother!” and she'd come up, climb on the bed, and kiss you and pat you and call you Baby Boop, Baby Brother, Baby James, and kiss you some more. That night she gave you her wee stuffed rooster that she had chosen for you before you were born. It's been your companion ever since.

Now you are 8 days old.  

The day after your birth Granny Annie and Aunt Suzanne came to meet you.  We all marveled at your purple, waxy peely feet and hands, your dear little ears, your masculine nose.  “His nose has salt on it!” proclaimed EJ, seeing the little white hormone zits.  I think her favorite Baby James miracle is that even your big toes are little; she mentions it daily.  She calls you Baby Brother, Baby James, Boop,  JamesBarryLlewellyn, JamesyJames, JamesyWamesy, and, most of all, Cute, as a name.  “I'm going to call him Cute, because he's cute.”  “I want to kiss Cute!”  She comforts you when I change your diapers, loves to hold you and kiss you and pat you.  She brings me water when I nurse and a burp cloth when you're done eating.  She is constantly talking about when she's older and what she'll do with you, just you: “When I'm thirteen and a half I can take Cute to Big Truck Day all by myself!”, etc and so on.  When Elaine June is asked about your birth, she tells people three things: she watched movies all night, she saw you born, and she got to cut the cord.  

Between movies on your birthday night, your dad helped Elaine June and Sheena blow up blue balloons and put them under the frog outside, so everyone coming to the farm on Friday would know you were here.  That first day we just stared and stared at you.  Dave was bemused that, like me, youbarely have any eyebrows—no hint of his uni-brow.  (“You'd think that would be dominant”, said he.)  I kept wondering how you could be so frog-like and yet so furry, all at the same time.  Your frogginess faded in just a few days as you slowly uncurled into our world.  Now you are peeling off the waxy layer left from inside of me, ever expanding.  You are still so sweetly soft and fuzzy; Daddy calls you James the Giant Peach.  Every day you change and grow.

You were born on Thursday night.  Friday EJ slept at Sheena and Poppy's.  Saturday I was nervous about when she'd crawl in bed with us and what would transpire.  But then, and each night since, it's been fine.  I got up to pee that night, and when I came back, I saw three dear souls, all curled in their own way on our bed.  Between you and EJ there was an empty space just for me, the missing piece in our family slumber puzzle.  Such a sweet, blessed gift.

You sleep most of the time, these days.  You've been merciful at night and somehow seem patient even when poopy or hungry.  If a cry can seem polite, yours does.  When you awake, your Daddy and EJ and I look at you and talk to you and marvel and wonderful, captivating you.  You do seem to smile.  You are strong, lifting your head and even pushing up from your belly.  Both Anne and the pediatrician have proclaimed you “perfect”, which of course we knew already.  

We welcome you, we celebrate you, we thank God for you, Baby James, and we love you with all our hearts.  

Sincerely, sincerely yours, dear James...

Your Mom, and also your Dad and sister too.  And Batchy and Mizoo

---

Photo by Megan Hancock Photography

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

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

Birth Story - Sacred, Sensual, & Laughing Baby Out

My second son Ojiah was born... During the pregnancy I needed guidance accepting the change that this was bringing to my life. From conception, Ojiah has been asking for my evolution as a person, spiritually and actively. While researching ecstatic and orgasmic birth, I found Suni Krall's book Sacred Birthing. My first birth was amazing and I needed to know I could have another wonderful birth (that I hadn't used up my great birth reserves, so to speak) This book, most of all, helped me with affirmations, visualizations, and meditations. I practiced mindful meditation, stating my intentions towards a healthy baby and a spiritually high, painless birth. 

The early evening of Dec 12th, I was feeling restless and hungry. I had been having pre-labor sensations for a couple of weeks and felt ripe and ready. Jack and I put our son Sedge to bed, then made love. Labor came on instantly--what a pleasant surprise! I had dribbling of water from my yoni and nice strong contractions. We both laid down in bed and tried to get some rest.

Jack's body was propped up on some pillows and I was lying on his chest; he was so solid, strong, and warm.

I focused on my breathing and closed my eyes. The waves of sensation with each rush manifested in my breathing rate and I was both concentrating on and allowing relaxation through the surges of intensity. As the waves started to come on stronger andmore often, I felt the need to get up. I also needed to empty my bowels. The rushes became stronger and this seemed to be happening quickly. I began to moan and groan to release any pain. I sought out the most comfortable positions which was kneeling on the floor, knees splayed, my upper body propped up on the couch, a stool or a birthing ball. 

Timing of when to call the midwife is tricky when you become so immersed in the present, but Jack was making me aware of the obvious--things were progressing--it was time to call Anne. When she and her assistant Nancy arrived, they were so gentle and respectful. Any concerns about having toentertain or having my energy pulled away from myself quickly diminished. They were immediately present and 'holding the space'. Jack's touch was amazing, connected, and strong. To complement that, Nancy's touch was soft, warm, and reassuring. Making noises during rushes really moved them through me. At one point, I remember feeling a gentle sadness washing over me and I announced it was going to manifest itself as a cry. Jack was so supportive as he sat with me and Nancy respectfully paused in the process of checking my temperature. Everyone present allowed this feeling to express. It was very calm and fleeting, and felt almost like singing. It was a gentle weeping, like a breeze through a willow, and it was over, no specific thoughts were involved--just total feeling. 

As things began to get more intense, Anne wisely suggested a shower, which was revitalizing. As the close of the birth was approaching, I began to fear that our two year old son, Sedge, would wake up and be needy when the baby needed us most. We had originally planned to call someone to be with him. Though this didn't feel right in the moment, I feared having the flow broken if Sedge became scared and needed something I just couldn't give. Jack kept talking me through this, reassuring me that it was ALL OK. Walking, squatting, bending, moaning were all part of the progression, and the pressure began to feel heavier. I felt the need to push. Anne checked me and said I was not ready--I needed to open more. Certain visualizations came into my being at this time: the opening of flowers and an affirmation from Sacred Birthing -- "I wish to envision my birth as an ultimate high". I also remembered from Spiritual Midwifery about connecting in with your man. We had smooched plenty earlier and I know this had helped me. I turned toward Jack and looked into his eyes and acknowledged and held that connection I felt. It was deep and loving and freeing and joyous, and out bubbled a laugh; it felt GREAT..... "ah hah!" I allowed the laughs to keep on coming and thought about the words "I wish to envision my birth as an ultimate high," and I was getting high! I don't remember any pain at that time. I was completely lifted above it all... it felt REALLY good. Laughing transcended me. I'm not sure how long this went on. There's no linear grasp on time, but I know that it was a prevalent gift in my birthing experience.  

Sedge began waking up then, and Jack went into the bedroom to be with him and talk about what was going on with mama. I clearly remember the 'last laugh'. It started to arise naturally and then was caught in my throat by a strong rush. I knew it was time for inward quiet. Transition. I sat on my birthing ball and felt deep calm. I was fully opened. I felt Ojiah moving lower and lower with the next contractions and deeper grunts came out of me. All I wanted to do was walk around and squat on the rush. Sedge and Jack came out of the bedroom. Sedge gave me a hug, then he and Jack sat on the couch, while I sat on the birthing stool facing them and resting my upper body on Jack's lap, hugging him whenever the intensity of feeling came on. Sedge was not just there, he was completely supportive. At one point this pure, wise little being rested his hand on my arm. A gesture that was fully present and not at all needy. He was aware of the magic and sacredness of the space and moment.

Anne and Nancy had me on a birthing stool that was the perfect height to really get a squat. During the pushing I alternated between sitting on it and getting up onto it to get a deeper squat. Anne made lovely suggestions during this time to walk, go under the shower, and listen to music. I didn't think I was grounded enough to choose or enjoy music, but I trusted Anne and agreed to it. She took out her CD of women birthing songs from around the world. I pushed and called out with a will of strength so primal and raw.  I was actually tuned in and encouraged by the tribal music. It was ancestral. My beautiful baby boy was born. He was so gentle and peaceful and welcome.

Bringing me back to that moment swells my heart to a great capacity. It is a beautiful and awesome initiation into the countless moments of the real and perfect harmonies of parenting. Thank you for allowing me the opportunity to share my story.

Shannon

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

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

Photo by Megan Hancock Photography

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

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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