My last blog post was about my health emergency, so please read it to have context for this post.

During my hospitalization and recovery, I learned a few things. I thought I would share them since they can be applied to pregnancy, birth and postpartum.

• You need to advocate for yourself.  
  • I had to advocate to be able to take my thyroid medicine in the middle of the night as I've been doing for years instead of 1 hour before breakfast.  I had to do this multiple times with multiple staff members.
• A sense of humor helps everyone.
  • I joked about mooning people in my hospital gown, and hospital food. Laughing together helped put everyone at ease.
• Recovery takes time.
  • While my emergency happened very quickly, recovery did not.
• Recovery takes longer than we think it should.
  • I was told to allow 6 weeks for recovery. I expected I would be back to normal in two weeks but my body made it very clear it needed 6 weeks and then some.
• Sleep is very healing.
  • I slept for 16 hours a day the first few weeks at home. While there were things I wanted to be doing, my body made it obvious that sleep needed to be a priority.
• Eating nutritious foods and hydrating well help with recovery.
  • Being dehydrated, and living on potato chips is not going to give your body the tools it needs to recover. Your body only has the tools you give it to work with, so give it nutritious food and good hydration.
•  It's okay to ask for help.
  • I don't usually ask for help, but there were so many things I just couldn't do myself. I had to ask for help to get out of bed early on, I needed someone to pick up things that fell to the floor, I needed to have my husband come on my walks because I was so unsteady, and the list goes on.  
• It's okay to have days where you just rest, sleep and eat.
  • I've had to create rest days even though I'm feeling so much better. I have overdone things and needed more rest to compensate for overdoing it. Sometimes it's just been nice to have an easy day and that's okay.

Every single thing listed here applies to pregnancy, birth and postpartum. Be kind to yourself. Give yourself space. Give yourself time. Ask for help, and let people help you. While it can feel like a long time, remember where you are at is temporary and things will get to a new normal.

What is GBS?
Group B Strep (GBS) is anaerobic bacteria that is usually found in the digestive tract. In 10-30% of pregnant women, it can colonize or grow in the vagina.

Why is GBS a concern during pregnancy?
Most women carrying GBS will have no symptoms. Carrying GBS is not harmful to you, but there is a small chance it can affect your baby around the time of birth.

How will I know if I have GBS?
GBS is detected by doing a vaginal swab and running a culture.  The recommendation is to test between 36 to 38 weeks gestation.

If I test positive for GBS, will I still have GBS when my baby is born?
GBS is transient so your status can change.  Up to 33% of women who test positive at 36 weeks may be negative at birth, and up to 10% of women who test negative at 36 weeks may be positive at birth. Without doing a rapid test (which is not the standard of care in the US), GBS status at the time of birth is unknown. For the clients I serve who test positive at 36 weeks, they have the option to repeat the test to see if their status has changed.  

What are the risks of GBS to my baby?
GBS can occasionally cause serious infection in newborns. Many babies come into contact with group B Strep during labor or around birth, and the vast majority will not become ill. Of Moms who test positive for GBS and choose not to have antibiotic treatment, up to 2% of babies born will develop a GBS infection. For Moms who test positive and choose to have antibiotic treatment, the risk of baby being infected drops down to .2 to .4%  If the GBS infection is not treated, babies can become seriously ill. With prompt treatment, most babies will make a full recovery, a small number of babies who are infected die. Early detection of GBS disease is vital so treatment can be started as soon as possible.

The two main types of GBS disease in newborns are:

• Early-onset GBS disease: Occurs within the first week of life and is more common. This is what GBS testing is focusing on preventing.
• Late-onset GBS Disease:Occurs 1 week to 3 months after birth and is less common.

How many babies die from early onset GBS disease?
Two to three babies (4 to 6%) out of 50 babies with early onset GBS disease will die.

What are the symptoms of early-onset GBS infection in newborns?

• Being floppy and unresponsive
• Grunting when breathing, or working hard to breathe when you look at their chest or tummy
• A high or low temperature
• Very fast or slow heart rate
• Very fast or slow breathing
• Crying and inconsolable

The overwhelming majority of babies with early-onset GBS disease are diagnosed within the first hour after birth, which indicates the baby was most likely infected before birth.

What is the treatment for GBS infection in babies?
The treatment for GBS infection in babies depends on the severity of the infection. Antibiotics are the main treatment for GBS infection. Antibiotics do not discriminate between strains of bacteria, so if you get IV antibiotics during labor, or your baby is given antibiotics after birth, I recommend taking probiotics to rebuild a healthy microbiome.

In Summary:
While the risk is low of a newborn getting a GBS infection, there is a risk and I want clients to be aware of that. I don't want any client to have a baby who gets GBS disease. I cannot provide antibiotic therapy, so if that is desired, we will work to transfer care for a hospital birth. I trust that clients are capable of weighing the risks and benefits and making the decision they are comfortable with and is best for their family. I will monitor baby for signs of GBS infection and make sure the client knows what to look for and how to access help if baby needs it.







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What is amniotic fluid?
Amniotic fluid is a water-like substance that surrounds and protects baby during pregnancy as baby grows inside the amniotic sac which is filled with amniotic fluid.

What is amniotic fluid comprised of?
The composition of amniotic fluid changes from early to late gestation. In the first weeks of pregnancy, amniotic fluid comes from both baby and mom and includes water, maternal fluids, and fluid from the amniotic cavity. Around 20 weeks, amniotic fluid is largely produced by baby's urine and lung secretions.​

What does amniotic fluid do?

• ​ Amniotic fluid helps to protect baby from injury by providing cushioning  from bumps and jolts. 
• Amniotic fluid helps to prevent the umbilical cord from getting compressed, which could cut off baby's oxygen supply.
• Baby practices breathing and swallowing amniotic fluid. This helps to develop the lungs and digestive system.
• Amniotic fluid helps to regulate baby's body temperature by keeping it at a constant level.
•  Amniotic fluid contains antibodies that help to protect baby from infection.

What is oligohydramnios and polyhadramnios?
Oligohydramnios is too little amniotic fluid. Polyhydramnios is too much amniotic fluid.  Both of these situations can lead to complications for Mom and baby. As a midwife I evaluate how much amniotic fluid is in the amniotic sac everytime I palpate baby.  If I have questions or concerns, I will recommend an ultrasound to assess just how much amniotic fluid there is.

What about meconium in amniotic fluid?
​Meconium is the first bowel movement of a newborn baby, and it is normally passed after birth. However, if a baby passes meconium before birth, it can be a sign of fetal distress. Meconium can cause problems if the baby breathes it in, which can lead to a condition called Meconium Aspiration Syndrome. Meconium Aspiration Syndrome can cause breathing problems, pneumonia, and other serious health problems.  Meconium Aspiration Syndrome is pretty uncommon. Data shows 15% to 27% of term and post term babies have meconium in the amniotic fluid.  Of those babies, Meconium Aspiration Syndrome occurs 2% to 10% 

Fun facts about amniotic fluid:

• Amniotic fluid has a pH of 7 to 7.5
• Amniotic fluid appears around 12 days or pregnancy when the amniotic sac forms

What is the placenta?
The placenta is an organ that your baby makes during pregnancy. This organ starts forming right after conception. As baby gets bigger so does the placenta. By around 12 weeks of gestation, it is considered "mature" which means it is fully functioning and producing hormones. It attaches to the uterine wall and is what sustains pregnancy. The side baby is on is known as the amnion, and the side that attaches to Mom's uterus is the chorion. 

What does the placenta do?

• It brings oxygen, and nutrients to the baby
• It removes carbon dioxide and other waste products from baby's blood
• It produces hormones including progesterone to sustain pregnancy
• It acts as a filter, filtering out some viruses, and micoorganisms. The placenta does not filter out everything which is why there are cautions about drinking, or exposure to measles if Mom does not have immunity.
• It passess antibodies to baby to help baby's immune system as birth approaches

Can the placenta move?
The placenta does not move from where it attaches to the uterus. The placenta appears to move because the part where it has attached has shifted as a result of the uterus enlarging to make space for baby.  

What can I do to have a healthy placenta?​
The same things that help with a healthy pregnancy, also help you have a healthy placenta.

• Avoid smoking and drinking alcohol.
• Eat a healthy diet.
• Get regular exercise

What concerns are there about placentas?

• How close the placenta is to the cervix. The concern is that part of the placenta may detach as the cervix dilates, leading to excessive bleeding. If the placenta is close to the cervix, checking where it is with ultrasound as pregnancy progresses will assess if it has shifted away from the cervix as the uterus enlarges.
• Placental Abruption: this is when a part or all of the placenta separates from the uterine wall. If this happens before labor, or during birth, it can be very dangerous for mother and baby.
• Placenta Accreta: this is when the placenta has attached by growing through the uterine lining into uterine muscle. This means the placenta will not detach, or detach completely and often requires surgical removal.
• Retained placenta: this is when a portion of the placenta remains attached to the uterine wall even though the rest of the placenta has detached. Any placental tissues that remain in the uterus after birth increases the risk of a uterine infection.

Fun facts about the placenta:

• It is an organ made by the baby.
• Identical twins share the same placenta.
• It is the only organ in your body that your body does not keep.
• The average placenta weighs about  1 lb, and is an average of 10 inches across.

Sources: 
​my.clevelandclinic.org/health/body/22337-placenta