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Category Archives: General

Placenta Encapsulation and Newborn GBS Case Study: Response

On June 29, 2017, the CDC published an article about a case study in Oregon describing a situation wherein a newborn of a woman that had her placenta encapsulated, developed early and late-onset Group B Strep infection. You can read the original article here. The newborn developed early-onset GBS sepsis shortly after birth (before the mother started taking her placenta pills) and was treated for 11 days and then sent home. Several days later the baby was brought to another hospital with symptoms of irritability and later diagnosed with late-onset GBS sepsis. You can read about the difference between early vs late-onset GBS sepsis here. Early-onset sepsis is contracted during the birth process and develops within the first few days. Late-onset can be transmitted during the birth process but also through physical contact by nursing staff, doctors, family members, friends, etc., and develops after the first week.

In this case study, the article’s conclusion, regardless of the fact that baby was already diagnosed with early-onset sepsis and treated, is the late-onset GBS sepsis was contracted secondary to her placenta pills that were tested and confirmed to have been contaminated with GBS.  However, it states that transmission via physical contact with others could not be ruled out. “Although transmission from other colonized household members could not be ruled out, the final diagnosis was late-onset GBS disease attributable to high maternal colonization secondary to consumption of GBS-infected placental tissue.” The mother’s breastmilk was tested and no GBS was found, so ingestion of the pills by the mother could not be the cause of transmission to baby. It is concluded that handling of the contaminated pills increased colonization on the mother and therefore transferred to baby. “Consumption of contaminated placenta capsules might have elevated maternal GBS intestinal and skin colonization, facilitating transfer to the infant.”

The article explains that the company that processed the placenta dehydrates at temperatures ranging from 115-160 degrees F, which is a very wide range and so it is unclear how this specific placenta was processed. According to the CDC article, placental tissue needs to be dehydrated with at least 130 degrees F for 121 mins to reduce bacteria.

Unknown factors in this case study

  • How the placenta was handled/processed, and the sanitation protocol of the equipment by the encapsulation company
  • Could someone else have transmitted GBS to the baby such as a family member, friend, nurse, etc.
  • Could the late-onset sepsis be a recurrence of the original infection that wasn’t completely resolved after treatment
  • Could the mother unknowingly have contaminated the pills herself after bringing them home because she herself was still highly colonized. We know that she had previously been colonized to have transmitted it to baby initially during the birthing process because the baby already had early-onset GBS sepsis

Keep in mind, this is just ONE case study, it is unknown how the placenta pills became contaminated, or how the GBS was transmitted to baby the second time, but we do know that safety protocols, proper sanitation, and eligibility requirements in the encapsulation process is paramount.

My Standards:

  • See my sanitation protocol here
  • I give specific and detailed instructions on how to handle/store placenta after birth until I can pick up, as well as instructions for after you receive your pills. See my instructions/responsibilities of client here
  • I instruct clients they must inform me of any symptoms of infection or diagnosis, during or after birth
  • I dehydrate every placenta at 155-165 degrees F for at least 24 hours and up to 48 hours to ensure complete dehydration
  • I also offer a steaming method of encapsulation before dehydrating, should a client choose this, which is known to be even more effective (aside from proper sanitation/handling and dehydrating at 155-165 degrees F) at killing bacteria, see article here

I am always happy to answer any questions about my process. I pride myself on safe practices and I want my clients to be comfortable and confident with your decision to hire me for placenta services. The safety and health of my clients are top priority.

 

Written by Rebecca Burkett

June 30,2017

Posted in After Birth, General, Placenta Encapsulation.

22 Questions to ask while touring the maternity ward

Here are some questions to ask while touring the maternity ward:

1. What is the Cesarean Rate?
2. What is the Episiotomy Rate?
3. Do you have time limits on how long I can labor before intervention is suggested?
4. Do you automatically administer pitocin after birth? What if I don’t want it?
5. What birthing tools do you provide or allow? (birthing balls, birth stool, shower, tub, birth bars, etc.
6. What is the procedure for IVs when admitted? (Automatically start heplock vs wait until needed)
7. Do you allow women to eat and drink during labor?
8. What is your policy on cord clamping? If I want to delay, will you respect my wishes?
9. Do you allow immediate skin-to-skin before you do your routine checks on baby?
10. What does your routine checks of baby consist of?
11. Do you provide breastfeeding support? Is there a lactation consultant on staff?
12. How many visitors can I have at one time after birth?
13. How many people can I have in the room during the birth?
14. Do you allow women to move around the room freely during labor to help relieve pain?
15. Do you allow different positions for birth other than on my back in the bed? ( Standing up, hands and knees, squatting, etc)
16. Can my baby stay in the room with me at all times?
17. What are your policies on fetal monitoring? (intermittent or continuous) If continuous, is it wireless so I can still move around during labor?
18. What are the maternal and infant mortality rates?
19. If I need a C-Section, can my partner be in the room?
20. If I have a C-Section, do you allow immediate skin-to-skin?
21. Do you have students or residents? If so, how involved are they/could they be in my birth experience? What procedures do you allow them to do?
22. How often do you do vaginal exams?

Posted in General, Hospital Birth, Labor, Pregnancy.

My reflections on reading Born in the USA by Mardsen Wagner

Reading Born in the USA by Mardsen Wagner was very overwhelming and I was surprised by most of his points including the fact that the American Congress of Obstetricians and Gynecologists (ACOG) is not regulated or given responsibility to set the standards it does, the fact that off-label and against-label drug use by doctors is tolerated, why the US does not have regulations or required standards on recording and investigating maternal mortality, and the fact that doctors are surprised and complain about the “litigation crisis” while continuing to put into practice the things that result in litigation.

I have heard of ACOG several times before reading Born in the USA. It has been mentioned in other books and articles I have read as well as brought up in conversations when talking about home birth and specifically water birth. I was under the impression that ACOG was a very important organization that had the responsibility of setting standards for care providers. Much to my surprise, thanks to this book, I know the truth about ACOG. While they are a very important group (to doctors) no government agency has given them the responsibility and right to see such standards and have care providers be reprimanded if they practice against these standards and statements. How did they get so much power? I know there are several care providers out there that don’t agree with the way ACOG does things but they fear speaking out because they do have so much power and fear it would have negative effects on their careers. We need more people like Wagner to speak out with confidence against ACOG in order to overcome this organization that claims to care about the health of our country.

The tolerance of off-label and against-label drug use by doctors such as using Cytotec to induce labor, absolutely blows my mind! How is this even legal? Wagner mentions several studies that have been done that suggest Cytotec is not safe to use for labor induction and it says right on the bottle that this drug should NOT be used on pregnant women. Doctors have been using this drug for years against label and there have been so many cases with negative outcomes, and yet they continue with this practice. We need to make this illegal! I work in real estate doing appraisals for bank loans and for realtors when a house goes up for sale. I was discussing with my boyfriend the other day how ridiculously regulated the real estate market is compared to our health care system, specifically our maternal health care system. There are so many rules, standards, and regulations on how to put together an appraisal on a house and to make sure your appraisal is not misleading and contains 100% accurate information, but yet our doctors and nurses have a very relaxed system and very little accountability.  It’s insane to me that more effort is put into making sure a house sale is legit and fair but yet obstetricians don’t have to or are not being reprimanded for not ensuring women are making informed choices about their health and are giving them drugs without their knowledge that are known to be dangerous and cause adverse effects.

The frustration about the use of Cytotec and the fact that doctors are giving women drugs without informed consent, including Pitocin among others, brings me to my awe that doctors are surprised with this “litigation crisis” and the raises in cost for malpractice insurance. Litigation isn’t just from the use of drugs but from all of the interventions that women feel they have no control over whether it be the doctors and nursing staff don’t tell the woman what they are doing or they impose an intervention on them against their will or without true informed consent. To this day, these care providers are still allowing and suing these practices. They blame their patients for having such high malpractice insurance and need to use some intervention to avoid litigation but it’s those very interventions that the care providers are getting sued for using. If care providers took the time to create a trusting relationship with their patients (clients) and truly gave them informed consent, their patients would not be taking them to court, or at least much less often. They need to allow for better communication and explain all of the benefits and risks of every option, and when there is a negative outcome, they need to be accountable to it and keep open communication with the families about what the possible cause was instead of making it so hard for them to figure out what happened.

When a poor outcome does arise and a mother dies, which sometimes you just can’t avoid, what are the chances that it would accurately reported or recorded at all? According to Ina May Gaskin, the CDC has admitted that maternal deaths are severely underreported. I do not understand why making sure maternal deaths are investigate and accurately reported is not a priority. We have one of the worst maternal mortality rates in the industrialized world and there seems to be no real effort in changing that, at least not from the medical model of care standpoint. They just keep focusing on how the latest technology should prevent negative outcomes but continue to be blind to the fact that using those technologies and continuing to intervene in one of the most natural processes of life, is actually what is causing those outcomes and insane mortality rates. We know that these rates can be much better by just looking at other countries and researching their systems. It makes me so sad that women and families are not respected enough to be worthy of investigation if they die during the childbearing cycle but yet the justice system can spend weeks, months, or even years on other death related events such as murders or even accidental deaths while on the job. Without these deserving investigations on maternal mortality, that should be a no brainer, the maternal health care system will be extremely difficult to improve because we won’t have the data to show where exactly needs improving and how we can make change. Putting in place regulations on reporting and investigation maternal death should be at the top of our health care system’s priority list.

It is ever so clear the need for change in our maternal health care system. Midwives are definitely a necessity in bring about the right change but without concern and dedication from other care providers such as OB/GYNs, the change will be very difficult. We won’t give up though. The need for midwives is growing and the number of midwives is growing. The health care system will be forced to work with us and they will eventually come to realize the need for change. Midwives can and do change the world!

Posted in General, Home Birth, Hospital Birth.