Strep B!!!!

I have a theory about strep B.


With all of the treatments and preventative therapies out there, from diet to Hibiclens washes, I find it very interesting that strep b remains a serious fear for many practitioners.

How it is that 33% of women are colonized at term, and that 1-2% of their babies will be affected by this. And that 25% of these babies are premature. (This is a quote from the CDC's strategy paper. ) But 100% of women who test positive for Strep B or who have risk factors during labor: a fever of 100.4 or over, membranes ruptured longer than 18 hours, a previous baby with strep b or labor before 37 weeks, are treated with antibiotics during labor.

I inform my clients about strep b and give them the choice to be cultured, or not. They choose to be treated with antibiotics or not. Most opt out of the culture and all have opted out of the antibiotics. In over 20 years I have never had a baby with a strep b infection. Here is my theory:

The strep bacteria reside on the outside of the woman's genitalia and on the anus. When culturing a woman, this is where the culture is collected from. So if the bacteria always live there how is it that they wind up on the amniotic sac inside of the uterus? I think that care providers put it there. During the last month of the pregnancy, how common is it to have a routine check of the cervix at every visit. Could it be possible that the examiner's fingers are collecting the bacteria (especially if it is colonized) and inoculating the cervix and the amniotic sac with this bacteria. Here it has a wonderful environment to grow and to cause the chorio-amnionitis and amnionitis and uterine infection, and baby infection that is so troubling in ob care today.

When mom is in labor, then the checking continues. If the prenatal cervical exams didn't make sure that the bacteria was in the cervix, the labor exams will.

You might ask, "What about intercourse?" Well, I believe that in most situations, the man isn't putting his fingers, or his penis in the cervix, and is not touching the baby's presenting part, or the amniotic sac, or the inside of the os at all. There is also a lot of cleansing fluids and mucous involved with intercourse that are lacking during a cervical exam.

This has prompted me to make sure that in my practice, since I do not know the strep b status of any of my clients, to not do prenatal cervical exams, and to limit the exams in labor to none, or one. I think that this one practice has accounted for the zero strep b infected babies I have had in my service. I may be just a dumb midwife, but this bit of common sense feels very sensible and right.

Stay out of her cervix. There is nothing gained by prenatal cervical exams and during labor, they are more than annoying to the woman anyway. Women have been having babies for thousands of years without anyone checking them. The women I serve like to tell me what to do and I love it when they say they feel like pushing and I say, just follow your body, do what it tells you to do. They love not being checked and given permission to push.

I do check some moms. If they really want me to. But if they don't ask, I don't offer. It simply isn't necessary, and I believe that it is spreading bacteria that is harmful to the baby and the uterus.

I believe that the birth process is a life giving process, not a life threatening process and if left alone will culminate in a healthy and safe arrival of the newborn. I am dedicated to NOT interfere with it in even seemingly harmless ways. One of these ways is the cervical exam. More ways to follow on this blog.

Cynthia