Group B Strep Prevention Protocol

I have known Brenda Parrish for a couple of decades. We met online and did not meet in real life until a year or so ago at a breastfeeding rally. She had just recently moved from south Georgia to the metro area. She is a fabulous home birth certified professional midwife. I in fact am awaiting a birth with her to happen soon. Here is her protocol for women to kill the GBS bacteria that sometimes lives within us- in fact some say 40% of women have it at any given time. It is not dangerous unless you are giving birth when it is present. If the baby picks it up once your water breaks, it can be fatal to the newborn. Ironically the only baby I have ever been the doula for who went to the NICU with GBS+ status was a mom who had tested negative! But here is her wonderful protocol that has proven to be very effective in her home birth moms!

brenda

 

Sometimes being forced to think “out of the box” leads to accidental discoveries that end up being quite important.  Such has always been the case of midwives who are open to alternative remedies, especially when the medical alternatives tend to have unwanted side effects.

GBS (group beta strep) is the most common cause of sepsis and meningitis in newborns and can cause newborn pneumonia.  Many people carry GBS in their bodies but do not become ill.  Because it can be present and not cause problems, many women are colonized and do not know it.  A baby can become colonized if the mothers is colonized in the rectum or vagina at birth.  This normally happens during labor or birth.  The standard of care is for mothers who test positive to GBS to receive intravenous antibiotics every 4 hours during labor to help prevent the baby from becoming sick.

Many CPMs (Certified Professional Midwives) do not have access to the recommended intravenous antibiotics to treat GBS.  So we have always looked for alternative ways to reduce the colonization in expectant mothers who have tested positive.  For many years, I have encouraged women to insert a peeled clove of garlic vaginally at bedtime-either one week on and one week off or every other evening  until delivery. (a cheesecloth packet holding the clove is an easy way to get it out.) We followup with the use of Hibiclens disinfectant solution to rinse the outmost vaginal canal and perineum during labor.  While this has actually served me well for many years, I’m sure it is not the most pleasant experience for the mothers.

Several years ago, a study was presented at a MANA (Midwives Alliance of North America) Conference detailing the use of a specific probiotic to actually keep GBS bacteria in check or significantly reduce the colonization, thus increasing the number of mothers who would test negative.  The product was FemDophilus and it contained a strain of good bacteria called L. Rhamnosus.  This made such good sense to me.  If we could help moms to simply naturally control GBS colonization without the use of antibiotics, it was a win-win situation, because even though the antibiotic normally works pretty well, it is not without side effects for both mother and baby.  If we could do something that had only GOOD side effects, how much better would that be?

I looked around for this product and didn’t find it right away but after reading a few labels, I realized Jarrow made yet another formula called “Jarro-Dophilus EPS” which was readily available locally and also had a significant amount of the desired L. Rhamnosus.  So, a little over two years ago I began to strongly recommend that all the clients in my care take this probiotic formula daily as a preventative to GBS.

jarrow

In that period of time, until recently, I had not had a SINGLE mother test positive.  Recently I had one mother who was positive with her first pregnancy test positive again.  I have not questioned her yet as to how closely she followed the protocol.  Another mom was in her fourth pregnancy and had never tested positive before so she did not take the probiotic on a regular basis.  The third was an expectant mom who transferred to my care one week before we ran the GBS lab and had earlier tested positive in a urine culture so she is very highly colonized and one week was not a sufficient amount of time to make much difference to her digestive tract.  So, that’s a pretty good track record.

My protocol is this:

New client in the first trimester-no previous GBS history and no UTIs–just take one of the EPS formula probiotic a day.

New client in the first trimester-previous positive GBS or a positive urine culture–take three probiotics a day for a week, then 2 a day for a week, then one for the balance of pregnancy.

Late transfer-3 probiotic a day for a week, 2 a day for a week, then 1 a day for the balance of pregnancy.

Once I question the mom who tested positive recently that had a previous positive GBS in her other pregnancy, I may tweak that protocol in the future to stay on three a day for a longer period of time.

But so far, this probiotic is having very good success. Nice side effect is several moms have mentioned that is also seems to be helping them with regularity.

 

Brenda Parrish, CPM, CLC is a homebirth midwife who currently lives in Marietta and serves metro-Atlanta area mothers in their quest for a natural birth.  Originally from south Georgia, she served women there for many years before relocating her practice.  Her first primary “catch” was the late in life “surprise” baby born to her former preceptor, 18 years ago.  Many babies later, she is still enjoying her midwifery career.  She is a mother to three grown children and “Nana” to seven delightful grandchildren.  She loves music and singing (used to work in a recording studio and in a traveling music group), photography and scrapbooking, crafts, sewing and good food.

Traditional  Birth Services, LLC

http://traditionalbirthservices.com

Charlotte Sanchez another home birth midwife has offered her suggestion for probiotic use. I thought I would share this as well- She recommends this probiotic due to the higher level of good bacteria. You can see this one is for vaginal health specifically and has 50 billion organisms per capsules.

ultimate flora