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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    May 27
    2008

    No Breaking of Waters - Birth

    Archived User
    A friend of mine just had her baby.  The baby was born with the amnio sac intact (homebirth with midwife).  I thought this was great and healthy for the baby.  When I asked my doctor about this, he said that he does not like this since there is a risk to a prolapsed cord.  I know that care givers have different views on birth practices.  What is your view on this?   Also, I have read that it is best not to cut the cord until it stops pulsating while breastfeeding the baby (Bradley).  It seems like doctors rush the process and go and get the placenta right away.  One friend of mine had hemmoraging after that.  She felt that it might have been from the doctor going in and manually taking out the placenta.  What is your view on that?  Thank you so much for answering my questions.
    Archived User
    I just saw my doctor again and he said that he likes to break the bag of waters early incase there is maconium and to reduce risk to baby.  I asked him at how many cm's he likes to do that.  He said around 3-4 cm.  My first daughter, my bag of waters did not break until 10 cm.  I told that doctor my concern was risk of infection and being GBS positive.  He felt that the antibiotics were strong enough to prevent that.  He said that since I don't want the bag of waters ruptured early, he won't do it.  At least he is willing to offer that, but I am not too crazy about his ideas.  What do you think about his view on this?
    Henci Goer

    A friend of mine just had her baby.  The baby was born with the amnio sac intact (homebirth with midwife).  I thought this was great and healthy for the baby.  When I asked my doctor about this, he said that he does not like this since there is a risk to a prolapsed cord.  I know that care givers have different views on birth practices.  What is your view on this?   Also, I have read that it is best not to cut the cord until it stops pulsating while breastfeeding the baby (Bradley).  It seems like doctors rush the process and go and get the placenta right away.  One friend of mine had hemmoraging after that.  She felt that it might have been from the doctor going in and manually taking out the placenta.  What is your view on that?  Thank you so much for answering my questions.

    Let's take this point by point.

    • Umbilical cord prolapse: (For background's sake, umbilical cord prolapse is when the umbilical cord comes down ahead of the baby. The concern is that with prolapse, the cord can get pinched between the baby's head and the mother's pelvis during contractions.) The umbilical cord is inside the amniotic sac. If the bag is intact, there is no risk of cord prolapse. The only time there is a risk is when membranes are ruptured and the head is still high in the pelvis. Once the head settles against the pelvic opening, it is like an egg in an egg cup. The cord cannot get past it. In other words, this doctor has it exactly backwards. The real risk is when someone breaks the bag of waters early in labor before the head has descended.
    • Early cord clamping: I don't know as you have to have the baby at the breast before clamping and cutting the umbilical cord, but clamping the cord before circulation through it stops can deprive the baby of  as much as 40% of its blood supply by trapping it in the placenta. Studies show this can cause short- and long-term (months) complications, some of them serious. (See end of post for references.) It's a testament to how well the birth process is designed that most babies manage to tolerate this. If you think about it rationally for a moment you will see that early cord clamping interferes with a natural sequence that happens with all mammals when they give birth and that for this reason, routine early clamping has to be bad. That goes double for a baby who is slow to start breathing. So long as the cord is pulsing, baby is getting oxygen from the mother.
    • Umbilical cord traction/manual placental removal: It has become common practice to pull on the umbilical cord to remove the placenta once it thought to have detached in the belief that doing so reduces bleeding. This is part of a package of routine interventions with this goal in mind called Active Management of Third Stage--a package, by the way, that does not include early cord clamping. I don't have time to go into all the problems with this approach. I've written a whole chapter on it for the new edition of Obstetric Myths Vs. Research Realities,  but suffice it to say that one potential problem is the impatient OB who thinks "Why hang around waiting? Let's just get the thing out" who then causes a hemorrhage because the placenta wasn't ready to detach. Of course, when a woman is already bleeding heavily, the doc will want to get the placenta out so that the uterus can clamp down. Your friend, quite understandably under the circumstances, may have gotten the sequence reversed.  

    -- Henci

    Hutton EK, Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. Jama 2007;297(11):1241-52.

    CONTEXT: With few exceptions, the umbilical cord of every newborn is clamped and cut at birth, yet the optimal timing for this intervention remains controversial. OBJECTIVE: To compare the potential benefits and harms of late vs early cord clamping in term infants. DATA SOURCES: Search of 6 electronic databases (on November 15, 2006, starting from the beginning of each): the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Neonatal Group trials register, the Cochrane library, MEDLINE, EMBASE, and CINHAL; hand search of secondary references in relevant studies; and contact of investigators about relevant published research. STUDY SELECTION: Controlled trials comparing late vs early cord clamping following birth in infants born at 37 or more weeks' gestation. DATA EXTRACTION: Two reviewers independently assessed eligibility and quality of trials and extracted data for outcomes of interest: infant hematologic status; iron status; and risk of adverse events such as jaundice, polycythemia, and respiratory distress. DATA SYNTHESIS: The meta-analysis included 15 controlled trials (1912 newborns). Late cord clamping was delayed for at least 2 minutes (n = 1001 newborns), while early clamping in most trials (n = 911 newborns) was performed immediately after birth. Benefits over ages 2 to 6 months associated with late cord clamping include improved hematologic status measured as hematocrit (weighted mean difference [WMD], 3.70%; 95% confidence interval [CI], 2.00%-5.40%); iron status as measured by ferritin concentration (WMD, 17.89; 95% CI, 16.58-19.21) and stored iron (WMD, 19.90; 95% CI, 7.67-32.13); and a clinically important reduction in the risk of anemia (relative risk (RR), 0.53; 95% CI, 0.40-0.70). Neonates with late clamping were at increased risk of experiencing asymptomatic polycythemia (7 studies [403 neonates]: RR, 3.82; 95% CI, 1.11-13.21; 2 high-quality studies only [281 infants]: RR, 3.91; 95% CI, 1.00-15.36). CONCLUSIONS: Delaying clamping of the umbilical cord in full-term neonates for a minimum of 2 minutes following birth is beneficial to the newborn, extending into infancy. Although there was an increase in polycythemia among infants in whom cord clamping was delayed, this condition appeared to be benign.

    Rabe H, Reynolds G, Diaz-Rossello J. A systematic review and meta-analysis of a brief delay in clamping the umbilical cord of preterm infants. Neonatology 2007;93(2):138-44.

    BACKGROUND: The optimal timing of clamping the umbilical cord in preterm infants at birth is the subject of continuing debate. Objective: To investigate the effects of a brief delay in cord clamping on the outcome of babies born prematurely. METHODS: A retrospective meta-analysis of randomised trials in preterm infants was conducted. Data were collected from published studies identified by a structured literature search in EMBASE, PubMed, CINAHL and the Cochrane Library. All infants born below 37 weeks gestation and enrolled into a randomised study of delayed cord clamping (30 s or more) versus immediate cord clamping (less than 20 s) after birth were included. Systematic search and analysis of the data were done according to the methodology of the Cochrane collaboration. RESULTS: Ten studies describing a total of 454 preterm infants were identified which met the inclusion and assessment criteria. Major benefits of the intervention were higher circulating blood volume during the first 24 h of life, less need for blood transfusions (p = 0.004) and less incidence of intraventricular hemorrhage (p = 0.002). CONCLUSIONS: The procedure of a delayed cord clamping time of at least 30 s is safe to use and does not compromise the preterm infant in the initial post-partum adaptation phase. (c) 2007 S. Karger AG, Basel

    Henci Goer
    Posted By n/a on 05/28/2008 2:33 PM
    I just saw my doctor again and he said that he likes to break the bag of waters early incase there is maconium and to reduce risk to baby.  I asked him at how many cm's he likes to do that.  He said around 3-4 cm.  My first daughter, my bag of waters did not break until 10 cm.  I told that doctor my concern was risk of infection and being GBS positive.  He felt that the antibiotics were strong enough to prevent that.  He said that since I don't want the bag of waters ruptured early, he won't do it.  At least he is willing to offer that, but I am not too crazy about his ideas.  What do you think about his view on this?


    I'm sorry, but I think he isn't making any sense. The usual rationale for routine early amniotomy (breaking the bag of water also called artificial rupture of membranes or AROM) is that it will speed up labor, which will supposedly reduce the cesarean surgery rate. This has been shot down by the reseaerch. Amniotomy has little, if any, effect on labor progress and looks like it may increase the cesarean rate. (See below.) In any case, it certainly doesn't decrease it.

    In so far as meconium goes, some studies suggest that amniotomy increases the incidence of abnormal fetal heart rate episodes. In other words, rupturing might cause sufficient distress that it could precipitate meconium passage. And some obstetricians are sufficiently concerned about undiluted, thick  meconium that when membranes are ruptured and there is meconium, they will insert a catheter into the womb and run in saline solution.

    Early amniotomy also opens the door for umbilical cord prolapse and infection. This brings us to your ob's argument that rupturing membranes is OK because any increased risk of infection will be counterbalanced by taking antibiotics. This is absurd. Why on earth would he want to increase the baby's risk in the first place by performing a procedure that has no benefits? 

    It sounds to me like you are dealing with a case of "You can always find a reason to do something you want to do," which raises the issue of what other questionable procedures and practices does your ob engage in? I recommend you download a copy of "Having a Baby? Ten Questions to Ask" off the Coalition for Improving Maternity Services website and check your ob out further. If you don't like what you hear, go to "Choosing a Caregiver" on the Childbirth Connection website and see if you can find someone whose philosophy and practices are more in line with what the research evidence says is optimal care. 

    -- Henci

    Smyth R, Alldred S, Markham C. Amniotomy for shortening spontaneous labour. Cochrane Database Syst Rev 2007(4):CD006167.

    BACKGROUND: Intentional artificial rupture of the amniotic membranes during labour, sometimes called amniotomy or 'breaking of the waters', is one of the most commonly performed procedures in modern obstetric and midwifery practice. The primary aim of amniotomy is to speed up contractions and, therefore, shorten the length of labour. However, there are concerns regarding unintended adverse effects on the woman and baby. OBJECTIVES: To determine the effectiveness and safety of amniotomy alone for (1) routinely shortening all labours that start spontaneously, and (2) shortening labours that have started spontaneously, but have become prolonged. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 March 2007). SELECTION CRITERIA: Randomised controlled trials comparing amniotomy alone versus intention to preserve the membranes. We excluded quasi-randomised trials. DATA COLLECTION AND ANALYSIS: Two authors assessed identified studies for inclusion. Both authors extracted data. Primary analysis was by intention to treat. MAIN RESULTS: We have included 14 studies in this review, involving 4893 women. There was no evidence of any statistical difference in length of first stage of labour (weighted mean difference -20.43 minutes, 95% confidence interval (CI) -95.93 to 55.06), maternal satisfaction with childbirth experience (standardised mean difference 0.27, 95% CI -0.49 to 1.04) or low Apgar score less than seven at five minutes (RR 0.55, 95% CI 0.29 to 1.05). Amniotomy was associated with an increased risk of delivery by caesarean section compared to women in the control group, although the difference was not statistically significant (RR 1.26, 95% CI 0.98 to 1.62).There was no consistency between papers regarding the timing of amniotomy during labour in terms of cervical dilatation. AUTHORS' CONCLUSIONS: On the basis of the findings of this review, we cannot recommend that amniotomy should be introduced routinely as part of standard labour management and care. We do recommend that the evidence presented in this review should be made available to women offered an amniotomy and may be useful as a foundation for discussion and any resulting decisions made between women and their caregivers.

      

    Archived User
    Thank you Henci for the information.  I am already 37 wks and I found this web-site while being very far along.  I have been very nervous about this doctor.  I just don't want anything that could cause an unneccesary "C".  This doctor comes up with some odd ideas that seem to not go in line with the research out there even though he says that same about my info.  It is too late for me to find someone else.  I sure wish I could!  I have GBS and it wasn't for that, I would have a homebirth.  What things should I be on the watch for with getting antibiotics for GBS?  I am afraid of being hooked up and then doomed to my doctor's odd ideas.  I have to be one up on him and be an advocate for my own birth. I don't want to get under sway of his odd ideas.  What can be done about the GBS which my test said that I had a high amount?  Thank you so much for the journal articles.  That is good to combat my doctor.  Journal articles is the only thing that will get through to him!
    Henci Goer

    You can have GBS and have a home birth. You just need a midwife who can give you the IV antibiotics.

    But to answer your question, one big problem with IV antibiotics is thrush, a yeast infection. You can get this vaginally or on your nipples, in which case it can be passed to the baby. Some recommend taking probiotics to reduce this probability. Thrush of the nipples makes them very sore and bright red as if they were sunburned. A lactation consultant should be able to diagnose it and tell you what to do next.

    Also, prophylactic antibiotics are not perfect. Even with IV antibiotics, if I were you, I would refuse any procedure that increased the risk of exposing the baby to the microbe. This would include stripping membranes, breaking the bag of waters, and internal monitoring, and I would keep vaginal exams to a minimum. The glove may be sterile, but the examining fingers sweep the microbe from the vaginal opening where it mostly lives (it originates in the intestines) and deposit it on the cervix. Since the likelihood of GBS is related to time from exposure, I certainly wouldn't have any vaginal exams until I was well established in an active labor pattern.

    Finally, if you are worried about having an avoidable c/section, you really should download "Having a baby? Ten questions to ask" from the CIMS website. If nothing else, find out your ob's cesarean rate. If it is much higher than 15%, then staying with this doctor means you are rolling dice that are loaded against you. Numerous studies have shown that rates lower than this can be achieved safely in the general population of women. Yes, it is difficult to find another provider this late if the one you have doesn't measure up, but you don't know what can be done until you try. The doulas and childbirth educators are likely to know who are the doctors and midwives (hospital or home) who practice physiologic care.

    If you really are stuck with your care provider, then avoid induction of labor and epidural analgesia. Both of these are major triggers in the cascade of interventions. Insist on intermittent monitoring of the fetal heart rate, not continuous electronic monitoring. Stay up and around in labor. Hire a doula for the emotional and physical support. Except in case of emergency, find out the advantages and disadvantages of any proposed medical intervention and the pros and cons of all your other options, including doing nothing. Insist, too, on time alone with your partner to consider what you want to do. You don't want to have a chip on your shoulder, and you can catch more flies with honey, but also remember that it is your birth, your body, and your baby and that you are paying your doctor and the hospital staff to care for you. 

    -- Henci 

    Archived User
    Thank you Henci for the information.  I had GBS with my previous pregnancy which was for twins.  I had slight GBS.  My labor was very short, so I only had antibiotics for one hour but still my babies had thrush.  It was not fun.  I am not sure if it affects babies nursing and pain for them, but it was a lot of pain for me!  With this pregnancy, the test showed a high amount of GBS which concerns me.  Should I take the probiotics before birth or after I have the antibiotics?  I did buy some strong acidolpholis that I planned on taking after birth.  I have heard that 4 hrs. is the time needed to be on antibiotics.  That is a long time!  I will not go to the hospital though until my bag of waters rupture or I am in very strong contractions.  I told the doctor that I do not want any rupturing of the membranes.  Thank you so much for all of the helpful infomation. 
    Henci Goer

    I cannot advise you about probiotics other than to say that some midwives recommend them when taking antibiotics. My feeling is they are unlikely to do harm and might be of some help and aren't unreasonably expensive, so why not? I do not know whether you should start them beforehand. Perhaps the store where you buy them can tell you.You are correct that to reach peak effectiveness, you should have a dose of intravenous antibiotic at least 4 hrs before birth.

    -- Henci

    Archived User
    Probiotics are certainly good to take.

    FWIW, there is a LOT you can do to prevent GBS and antibiotics.


    This was compiled from different sources so forgive me if someone here is quoted!

    GBS= Group B Streptococcus, a bacteria found in the genital, urinary,
    and/or digestive tracts of some women. It comes and goes.
    This 'germ' is one of several related species, including strains of
    Group A Strep that is the germ usually responsible for what we
    commonly call 'Strep Throat'.

    A woman can be a carrier of Group B Strep without having any
    symptoms. The concern with this bug is that when baby passes through
    vagina during birth, s/he will be exposed to it, and could possibly
    get an infection. Because babies have such immature immune systems,
    the fear is that newborns are at risk to die from this infection--and
    this does happen very occasionally.

    Because of that risk, docs like to treat women with antibiotics to
    kill the GBS: some give antibiotic pills during the final weeks of
    pregnancy, then also give IV antibiotics during labor. There are
    variations on this theme--and there are 2 problems with this: one is
    that the antibiotics do not always work; some babies get infected
    anyway. The other is that due to all this antibiotic use, docs are
    creating supergerms that are resistant to antibiotics. Yes, there
    are now fewer GBS infections in newborns, but now there are MORE
    infections with antibiotic-resistant strains of e.coli. There are
    also long term negative effects of antibiotics on the health of
    mothers and babies both, including thrush/yeast, GERD and other
    digestive issues, other things.

    If your baby is at least 37wks along, and/or at least 5lbs, and is
    otherwise healthy in general, the risk of infection is very low.
    VERY VERY LOW. And we will never eliminate risk in birth or life; if
    you intend to UC then you had better be prepared to face life and
    death decisions. In my opinion, GBS testing and especially the use
    of antibiotics is solely a way that docs try to reduce one risk only
    to create a few more risks. Yes, GBS may kill a few babies per
    10,000. FAr better that, than to create more superbugs who will kill
    a high % of those who come in contact with them!
    ***
    Extremely few full term otherwise normal/healthy babies (37wks or more) who weigh more than 5lbs will get an infection, EVEN if the mother is a GBS or e. coli carrier, and even if mom did not take antibiotics. Even fewer babies who are born at home will get infected (with a healthy mom and a planned homebirth), than those born in the hospital--well, duh, home is just healthier for the family in so many ways. However, if your baby has any symptoms then do get medical help since GBS is known at times to kill newborns in just a matter of hours without antibiotics.

    There are numerous reasons to avoid antibiotics for any condition, and any person no matter what their age, etc! Tons of research on the dangers of antibiotic overuse is now out there--they are so dangerous to us and to life! However, tho I do not recommend antibiotics for pregnant women with GBS, it is true that for women who get abx (antibiotics), there are fewer babies who get infected w/GBS. Just to correct an assumption--I have only just been updating my research on this for my client info files. Some babies get infected even if mom had abx during labor; and of those w/no abx for mom, no more babies die than when the mom did get abx. Just so you also know that if you don't take abx, your baby has no greater chance of dying from the infection, just a slightly higher chance of getting an infection in the first place...still, we are talking extremely low numbers here.

    The approach to reducing or eliminating GBS (or E. coli, yeast, or gardnerella....) in your vagina is 2-fold: one is to try to kill the unwanted critturs; the other is to make your system UNfriendly to pathogens and VERY friendly to beneficial organisms. So, we can use herbs, abx, other stuff to try to kill some of the pathogens...but they will just come back if we don't also re-introduce the beneficials and make our bodies more acceptable to their health. Remember that what you think of as 'your own body' is actually composed of countless types and numbers of other microscopic organisms--some are needed for our bodies to function, some are more or less 'neutral', some hurt us if they get too numerous.

    The vagina and urinary tract in a healthy woman is fairly acid by nature, whereas the blood, for instance, is just about neutral pH...and the digestive tract is even more acidic...we have varying 'pH environments' within our bodies. And guess what, the beneficial organisms thrive in an acidic environment. You've heard of ACIDOPHILUS...ACID ophilus...yep, this is a brew of freeze-dried ACID loving and acid CREATING organisms mainly in the lactobacillus family that also grows in yogurt, tempeh, some other cultured foods. Interestingly and sensibly enough, acid loving organisms give off acidic by-products, which helps them to create and maintain a sufficiently acid environment to thrive.

    GBS, e. coli, yeast, gardnerella on the other hand, are ALKALINE ('base') loving critturs. It is believed by an increasing number of 'natural health oriented practitioners' that it is our widespread over consumption of sugars and refined carbs (white rice, white flour, etc) that has helped promote more alkaline conditions in the urinary tracts and vaginas of women. Along with this, is the vast overuse of antibiotics, which kill off the pathogens AND the beneficials in our bodies...harming digestion and absorption of nutrients, changing pH, other stuff. This in turn has made it easier for the alkaline loving organisms to thrive, harder for the acid lovers to thrive.

    So, while it can be helpful to use such things as goldenseal to kill the pathogens, and echinacea to boost the immune system, these things will not help unless we also replace the beneficials and then help them to live by re-establishing the properly acidic pH of vagina and urinary tract. And so:

    Acidophilus tabs inserted nightly, high into the vagina can help, as can eating PLAIN, high quality yogurt every day (a tablespoonful or 2, a couple times a day is sufficient). Or yogurt sex, yep, use plain yogurt as a 'lube' on your insertable 'toy' of choice...and have fun! I personally like Dannon because it has no seaweed or other thickeners; it's just milk, milk powder, and lactobacillus orgs. Even the organic brands contain lots of additives--they may be 'natural additives' but for this purpose, you want the yogurt very plain.

    Drinking vinegar... eating unsweetened pickles, vinegar and oil salad dressing, or just a tablespoon or 2, a couple times a day will help acidify generally BUT, vinegar is among the few acid substances that remains acid in the body. Citrus fruits, etc, only make the body produce alkaline for digestion...neutralizing the acidic property of those foods. Mild vinegar douching can also help--1/4 cup in a quart of water, gentle douche.

    Reduce intake of sugars and refined carbs--this means ALL sugars, not just 'table sugar'...dextrose, maltose, corn syrup, maple syrup, dried fruits...read labels. If you have a strong sugar craving then you may be protein deficient, mildly depressed, and/or you may have a lot of yeast/other pathogens in there, demanding their favorite feast!

    You can also take one clove of garlic as due date approaches, and peel it; insert into vagina at night, take it out in the morning. this helps kill pathogens without harming beneficials. Do this every other night for about 2weeks. Can be alternated w/acidophilus.

    Get a cranberry extract pill: cranberries have a substance whose name I forget that actually prevents pathogens from attaching to our mucus membranes. Also, eating cranberries, blueberries, raspberries, will help this way as well.

    You can even do a gentle douche of plain sterile water in early labor, if waters are intact. It has been studied--this 'plain rinsing' can wash out colonies of the undesirables, thus reducing the chance of GBS transmission to your baby. The more colonies of pathogens inside you, the greater the chance your baby will pick it up on the way out; the fewer the colonies in there, the less chances.
    ***
    Signs of neonatal GBS infection:

    Respiratory distress: grunting with each breath (not 'humming', as some babes normally do, but definite grunts with every breath). Breathing is effortful, not easy, rate of breaths per minute will likely be greater than 60. Retractions: you will see the baby's belly retract (like when you suck in your gut) deeply enough for his/her ribs to stick out, also with every breath. It is normal for some babies to have little variations in their breathing that pass momentarily or pretty soon--we are talking about constant things here. Some newborns also breathe fairly rapidly for the first few days (transient tachypnea of newborns)...this is fine if they have none of the above symptoms, JUST a breathing rate above 60per minute. But that should resolve to 40-60per min within a few days, or it could indicate some problem even if not GBS.

    Color--may or may not be an indicator, but any blueness that goes beyond fingertips/nailbeds (which can be normal) is a suspicious, if baby seems to be warm enough. Yes, possibly pallor (looking white/pale) but color doesn't always change w/infection in any way.

    Lethargy--too sleepy to eat, nursing poorly/weakly. Some newborns might sleep 4-6 hrs or so in the first 12-24hrs of life. Never let them sleep more than 6hrs; wake em up thoroughly to nurse, to avoid low blood sugar. And this need should pass off soon, with baby waking to nurse every 1-4hrs normally...some babies might sleep as much as 4-6hrs ONCE in 24hrs even in earliest days/weeks, but most will want to nurse every 1-3 hrs, even if they immediately go back to sleep again.

    Fever--esp above 100 (farenheit..not sure what that is, in celcius). Any temp (even below 100) that does not resolve in 24hrs is suspect. or, temp below 97.

    Also, check this research
    http://www.cochrane.org/reviews/en/ab000115.html
    Archived User

    Henci,

    I ended up having my baby on 6/23.  I got to the hospital when I was 7 cm.   The doctor wanted me to have my bag of waters broken, but I declined that.  The sac remained completely intact.  The baby would have been born in the bag of waters, but the doctor ruptured it as the baby was coming out.  I had about 3 hrs. of IV Penicillin.  When baby was born, he suckled very poorly.  Even in the hospital, he suckled very poorly.  My milk was definitely present.  Baby never expressed right and I got engorged and baby got dehydrated losing 12% of his weight.  I didn't get the right lactation help and as a result, my milk supply really dropped.  I should have been expressing at engorgement to preserve my milk supply.  Now I am supplementing with a SNS tube and pumping around the clock trying to get my supply back up until hopefully baby will suckle more consistently.  It has been very hisheartening.  I so wanted to normal breastfeed this baby. I nursed my first two children with no problems.  My twins prior to this baby had a simliar problem which never ironed out and I nursed them for 2 yrs. on the SNS due to them being hooked on it. 

    My question is, could the IV antibiotics could have weakened the baby to where he could not suck consistently?  I was very weak myself after birth.  With my twins, I had only 1 hr. of antibiotic.  I didn't feel as much weakness, and my twins seemed to suck better than this baby.   I did not have antibiotic with my two pregnancies where I had successful nursing.  If IV antibiotics could have caused this problem, if you know of the journal article stating that, I would like that link.  Also, if you know of a link to a journal article regarding the risks of breaking the bag of waters to prevent meconium problems, I would like that. 

    Thank you so much!

    Archived User
    P.S.  Maria,  could you please post any links that you have regarding problems associated with antibiotic use for Group B Strep that you mentioned - GERD, long term affects to mother and baby, digestive disorders, etc...  I would be interested in what info you have found on that.  Thanks!
    Henci Goer
    Posted By n/a on 08/12/2008 1:23 PM

    Henci,

    I ended up having my baby on 6/23.  I got to the hospital when I was 7 cm.   The doctor wanted me to have my bag of waters broken, but I declined that.  The sac remained completely intact.  The baby would have been born in the bag of waters, but the doctor ruptured it as the baby was coming out.  I had about 3 hrs. of IV Penicillin.  When baby was born, he suckled very poorly.  Even in the hospital, he suckled very poorly.  My milk was definitely present.  Baby never expressed right and I got engorged and baby got dehydrated losing 12% of his weight.  I didn't get the right lactation help and as a result, my milk supply really dropped.  I should have been expressing at engorgement to preserve my milk supply.  Now I am supplementing with a SNS tube and pumping around the clock trying to get my supply back up until hopefully baby will suckle more consistently.  It has been very hisheartening.  I so wanted to normal breastfeed this baby. I nursed my first two children with no problems.  My twins prior to this baby had a simliar problem which never ironed out and I nursed them for 2 yrs. on the SNS due to them being hooked on it. 

    My question is, could the IV antibiotics could have weakened the baby to where he could not suck consistently?  I was very weak myself after birth.  With my twins, I had only 1 hr. of antibiotic.  I didn't feel as much weakness, and my twins seemed to suck better than this baby.   I did not have antibiotic with my two pregnancies where I had successful nursing.  If IV antibiotics could have caused this problem, if you know of the journal article stating that, I would like that link.  Also, if you know of a link to a journal article regarding the risks of breaking the bag of waters to prevent meconium problems, I would like that. 

    Thank you so much!


    I'm happy that the birth went well and sorry that you are having breastfeeding difficulties. I am not aware of any reason why antibiotics would lead to poor suck unless the baby developed thrush, which feels like you have burned your mouth on pizza. It's a common problem because the antibiotics kill off the harmless bacteria too, allowing for things like thrush (is thrush a yeast or a fungal infection?) to set up housekeeping. But if that was the case, you would probably have thrush in your nipples, and you would know it because it makes nipples very sore and tender. The other possibility is that your baby was given bottles and is bottle hooked. Are you working with a lactation consultant? She should be able to help you diagnose feeding problems and suggest remedies. And as frustrating as it must be, the bottom line is you know you can make this work because you did it with the twins.

    Turning to your second question, breaking the bag of waters isn't to prevent meconium problems; it's to see if there is meconium in the amniotic fluid. But rupturing membranes for this purpose doesn't do any good and may do harm. On the one hand, research has established that there are no benefits to suctioning out meconium at birth in a vigorous baby. (We don't have any trials looking at it in nonvigorous newborns, so for all we know, it doesn't help them either.)  Meanwhile, some studies have looked at running a tube into the uterus and infusing saline in women with meconium and ruptured membranes in hopes of diluting the meconium. This raises the interesting picture of a dr in one room rupturing membranes to see if there is meconium while next door another dr is infusing saline to try and put the fluid back. As for harms, rupturing membranes opens a route for infection, not something you want to do in a GBS+ mom if  you can help it. Welcome to the Alice Through the Looking Glass logic of conventional obstetric management! 

    Vain NE, Szyld EG, Prudent LM, et al. Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: Multicentre, randomised controlled trial. Lancet 2004;364(9434):597-602.

    -- Henci


    All Times America/New_York

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