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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Pregnancy and exercise are not mutually exclusive.  Yes, pregnancy does require some lifestyle changes as the pregnancy gets farther along like not sleeping on your back, but being pregnant does not relegate you to invalid status.

Exercise and pregnancy go hand in hand. The benefits of exercise during pregnancy are significant.

• Reduced constipation
• Better sleep
• Helps to keep weight gain at appropriate levels
• Increased strength and endurance
• Reduced risk of gestational diabetes
• Reduced risk of high blood pressure
• Helping baby settle into a good position for birth
• More energy
• Stress reduction
• Improved mood

Pregnancy is a perfect time to start exercising regularly if you haven't been working out.  Walking is a great place to start, although you can start with just about anything like having a dance party with your kids, or raking leaves.  Build up gradually until you are working out for at least 30 minutes 5-6 days a week.  If you are already working out, you may want to modify what you do.  For example, if you are doing heavy weight lifting, consider using lighter weights and more reps.  Be mindful of avoiding exercise that puts you at risk of falling such as mountain climbing, or contact sports such as hockey.  Also modify abdominal exercises to reduce the chances of diastasis recti.  

I encourage all the clients I serve to exercise because the benefits are too great to miss out on. Labor and birth require strength and endurance. Regular exercise will go a long way to help with being prepared for the demands of labor and birth. 
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Today, I'm going to rant a little.  One of my personal pet peeves as a midwife is that once it is obvious that someone is pregnant, it is as if they become public property.  Complete strangers suddenly feel as if they have carte blanche to comment about your pregnancy, your choices, your health and so on.  Sometimes they feel that pregnancy entitles them to come over and touch your belly without asking first!  You may get told birth stories whether you want them or not.  

Why does it seem to so many that it's acceptable to comment on a stranger's pregnancy.  Comments like "You look ready to burst", or "I hope your water doesn't break while you are shopping" are often shared when someone sees a pregnant mother.  It's sad that people just can't keep their comments to themselves.  

A large proportion of society seems to have the tact to restrain comments on someone's appearance while with them in person (social media is another matter) unless it's a pregnant mother.  We don't walk up to strangers and tell them how to take care of themselves unless it's a pregnant mother.  We don't tell siblings that their lives are never going to be the same, that they will have to grow up unless they are with a pregnant mother.  We keep our comments to ourselves unless it's about a pregnant mother.

We need to stop making comments, expecting we can pat bellies, and giving unsolicited advice.  What if we kept our mouths shut and didn't share unless asked?  What if we shared a smile with the pregnant mother and went on with our day knowing we made her life easier by smiling instead of assuming we have something to say she wants to hear?

Nausea or morning sickness is a common complaint of pregnancy.  Morning sickness typically resolves by the end of the first trimester, although some Moms can have it their entire pregnancy.  

It is unknown exactly what causes nausea in pregnancy.  It may be caused by elevated progesterone and hCG (human chorionic growth hormone), or swings in blood sugar levels or a nutritional deficiency like low magnesium. During pregnancy, the body becomes very sensitive to swings in blood sugar levels.  When blood sugar levels drop, that can cause feelings of nausea and may lead to vomiting. Since you don't eat while you are sleeping, blood sugar levels are low in the morning (hence the name morning sickness).   A sudden increase in blood sugar levels depending on what you eat may bring on more nausea. Sometimes certain smells, foods or food textures can cause nausea. Whatever the cause is doesn't change the fact that having nausea in pregnancy is not pleasant.

What can be done to prevent or minimize nausea?

• keep blood sugar levels stable.  Having protein and healthy fats every time you eat can help, so can having small, frequent meals or adding in snacks throughout the day.
• Have a protein rich snack right before bed.  This helps keep your blood sugar from dropping as much during the night.
• Try taking 50 mg Vitamin B-6 at bedtime.
• Ginger: tea, candy, ginger ale etc can help calm nausea symptoms.
• Peppermint: smelling peppermint oil, or having peppermint candies may help.
• using an acupressure wristband  or magnetic bracelet specifically for nausea.
• anise or fennel leaf tea first thing in the morning, and chewing on the seeds through the day.
• Probiotics, either a supplement or in fermented foods and yogurt may help.

Nausea in pregnancy can escalate into a problem known as hyperemesis gravidarum.   If you experience any symptoms of hyperemesis gravidarium, contact your midwife or doctor.  The signs of this include

• ceaseless, uncontrollable vomiting
• decreased urine output
• fainting
• weight loss that exceeds 5% of body weight 
• dehydration

Nausea typically peaks around 11 weeks gestation and ends at 14 weeks for the majority of pregnant Moms. My perspective as a midwife is that my clients should not expect morning sickness to be their normal. As part of my midwifery care, I share all these suggestions and more to help reduce or eliminate morning sickness.  I want my clients to feel amazing during their entire pregnancy.


Sources not linked in blog post:
Davis, E (2012). Heart & Hands: A Midwife’s guide to Pregnancy and Birth (5th ed.)  Ten Speed Press
Frye, A. (2007). Understanding Diagnostic Tests in the Childbearing Year (7th ed.). Portland, OR: Labry’s Press
Frye, A. (2008). Holistic Midwifery, Vol 1. Portland, OR: Labry’s Press
Sinclair, C (2004). A Midwife’s Handbook. Elsevier Ltd

What is Hemoglobin?
Hemoglobin is found in your red blood cells.  It is a protein your body makes from iron, and is what holds oxygen to transport it around your body to cells and organs.

How do I get the iron my body needs to make hemoglobin?
Food is the best source of the iron your body needs to make hemoglobin.  Remember being told as a kid you should eat liver?  Well, pregnancy is the time to take that advice.  For those who just can't handle liver (including me), red meat such as beef, buffalo, venison etc are the next best source.  Dark chocolate is a good source too.  The darker the chocolate, the higher the iron content.  Lots of foods have iron, so read labels and do some research online.  Be mindful that calcium will block iron absorption, so if you are needing to increase your hemoglobin, think twice about adding cheese to your hamburger.  On the other hand, Vitamin C will increase iron absorption so you can feel good about enjoying some dark chocolate covered strawberries.  Make sure you have are getting folate since iron needs this as well as Vitamin C to do its job.  If your iron has dropped at around 30 weeks gestation, good job expanding your blood volume!  You have time to get your hemoblogin back up to a healthy level before birth. 

What should my hemoglobin level be?
In the first prat of pregnancy, hemoglobin levels should be 12-15 g/dL.  As your blood volume expands, this number drops, usually by 2 g/dL.  This drop is due to your iron being diluted by the increased amount of blood in your body.  I prefer my clients have a hemoglobin level of at least 11 g/dL before the baby is born.  This will help Mom handle blood loss from birth well and lets baby build iron stores.  Iron transport accross the placenta to your baby is highest in the last 4 weeks of pregnancy.

How will I know if my hemoglobin levels are low? 
You may notice fatigue, brittle nails, pale skin, dizziness, shortness of breath and heart palpitaiton or rapid pulse.  I like to check hemoblogin at around 30 weeks gestation so we can see how much of a change there is, and so there is time to get it back into a healthy range.  

What should I do if my hemoglobin levels are low?
I recommend my clients focus on iron rich food while being mindful that sources of calcium will block absorption and vitamin C will increase absorption.  Depending on what lab work indicates, I sometimes recommend supplemental forms of iron and sometimes Folate to help raise levels.  It takes about 2 weeks before any increases will shop up in labwork, although often clients will notice an increase in energy, or a lower heartbeat after just a few days  of working to raise iron levels.  Depending on how much the level has dropped and how a client is feeling after working to raise levels,  I may check it again around 36-37 weeks gestation.

​Hemoglobin is critical for your baby, and for your body.  I expect hemoglobin to drop in pregnancy, and I actually find it more concerning when the level doesn't drop. Monitored through your pregnancy,  hemoglobin levels are very easy to address with simple changes in diet.
 
               



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