The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
This brief but well-referenced post analyzes cesarean rates relative to differences in maternal diagnoses or pregnancy complexity. On average, the likelihood of cesarean delivery for an individual woman varied between 19 and 48 percent across hospitals.”
Birth attendants often claim that their high cesarean rate is due to their clientele - that they provide care for a lot of high-risk clients. This analysis shows that:
Among lower risk women, likelihood of cesarean delivery varied between 8 and 32 percent across hospitals.
Among higher risk women, likelihood of cesarean delivery varied between 56 and 92 percent across hospitals.
Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics.
This shows that practice variation in cesarean rates is real, substantive, and not just a reflection of the mother’s risk level.
Tips for Choosing a Care Provider - great overview! from Henci Goer
Women who are scheduled for GBS testing should insert a clove of garlic
that has been peeled but not cut into their vagina at bedtime. Remove
and throw away in the a.m. Garlic cloves are a natural and potent
antibiotic. The routine is done at bedtime because the taste of the
garlic goes to the mouth right away and is better ignored overnight than
the daytime. Doing this for 3 nights before the swab will put them
in the neg. camp.
A summary of alternative treatments:
1) Reduce the vaginal colonization by correcting the vaginal pH.
2) Boost the overall immune system with echniaces, astragalus, garlic, vit. C, etc. This further reduces vaginal colonization and increases the antibodies that get passed through to the baby, thus increasing the baby's immune response if the baby is exposed.
You really have to do something to change the woman's flora over all.
Intestines are the reservoir so some of the things for prevention would
be similar to preventing UTI wipe front to back, cotton underwear, throw
away the thongs, eat live culture yogurt( Nancy's brand in the west,
or home made), sour dough bread, fermented foods and aged natural cheeses...also
I would instill the vagina with plain live culture yogurt. If the woman
doesn't use milk or milk products then the other fermented foods and buy
some lactobacillus caps and open them up to instill along with taking them
orally. Other considerations-- is there any cross contamination
during sex- anal sex or penis in area of rectum before entering the vaginal
area.... probably should use other positions until after pregnancy.
effect of vaginal lactobacilli on group B streptococci] [Article in
Acikgoz ZC, Gamberzade S, Gocer S, Ceylan P.
Mikrobiyol Bul. 2005 Jan;39(1):17-23.
Neonatal group B streptococcal (GBS) infections are one of the important
health problems because of their high mortality and morbidity rates in
certain countries. There are some preventive approaches, including perinatal
antibiotic therapy against these infections. Recently, vaccination with
conjugated GBS polysaccharides has also been practised. In this study,
the in vitro inhibitory effects of 51 lactobacilli (of them 50 were purified
from vaginal swabs, 1 from a commercial vaginal tablet) on five GBS (4
clinical isolates and 1 standard strain) were investigated by sandwich
plate technique and deferred antagonism well technique. Ten clinical isolates
(20%) and the drug-purified Lactobacilli expressed pronounced inhibitory
effects on growth of GBS. All of the inhibitory isolates and 10 randomly
selected non-inhibitory isolates were identified by API 50CHL kit (BioMeriex,
France). Seven (70%) of the inhibitory clinical isolates were Lactobacillus
rhamnosus. The inhibitory isolates had higher acid production than the
non-inhibitory ones (p < 0.05), and pH-adjustment destroyed their inhibitory
effects entirely. If these results could be applied in vivo, it could be
postulated that administration of certain lactobacilli as probiotics via
an appropriate regimen may be a safe, physiological and cheaper alternative
for prevention of neonatal GBS infections.
One of our senior midwives recommends what she calls "yogurt sex", i.e.
using yogurt as a lubricant for sex - it's a great way of applying yogurt
I don't know of any research addressing Hibiclens or hexidine use prenatally. All that I've seen is about using it during the birth.
The studies were based on the information that Strep is very vulnerable to chlorhex compounds and a weak solution of Hibiclens/ hexidine kills it rapidly (almost instantly) without harming normal vaginal flora. When a vaginal rinse/douche was done at admission to hospital for labor -- and repeated every six hours if needed until birth -- the incidence of newborn colonization was decreased.
But since the wash/douch was only for the vaginal perineal area, the women were still likely GBS carriers (rectal, intestinal etc.). A vaginal rinse can't affect strep carriage in other regions.
Hexidine is supposed to have a residual effect for "about two days (if i remember right), so a prenatal rinse might reduce carriage for a very short time, but strep will start regrowth pretty quickly. Using a rinse twice weekly probably isn't frequent enough to have much affect.
And a vaginal rinse isn't enough anyway. If mom has a heavy growth, the intestinal system is a likely reservoir. Washing the vagina won't prevent daily reinfection from the bowels.
I've been intrigued with prenatal efforts to knock out strep. I've even suggested an experiment of doing one vaginal rinse/douche, repeated one time at 48 hours, to drop the vaginal strep growth, COMBINED WITH a vaginal and intestinal "reseeding program" using live lactobacilli cultures orally and vaginally to create an environment less hospitable to strep regrowth. I know of a some women who have done this and retested GBS negative -- and remained negative as long as they continued with the yogurt/lactobacilli regime.
But these are EXPERIMENTS! And the aim is to retest and watch for conversion from positive to negative or back again.
I think a program of repeated hexidine douches is going to be ineffective because it doesn't address recolonization or the intestinal flora. I'm also concerned about safety in pregnancy! I'd strongly caution against longterm or multiple exposures. Chlorhexidine compounds are absorbed through the mucus membranes. Hexidine can be found in the blood stream after vaginal administration.
The amount found after using a diluted solution for one or two exposures in labor is negligible. And the baby is born soon anyway.
But using it in longterm pregnancy -- -- is a different issue.
If a woman used it twice a week for two weeks -- four exposures? -- that's more than I'd like to see.
first -- it's not frequent enough to keep strep down (it would need to be done every 48 hours or so).
second -- I would worry about exposure levels with repeated douches/rinses (14 days = 7 exposures). This seems unhealthy and unwise.
third -- it doesn't address the intestinal flora, which will rapidly infect the peri-anal area and migrate to the vagina.
fourth -- some women have "weak" growths of strep and some have heavy, strong ones. For some women, a simple adjustment of diet or vaginal pH may help her body combat and eliminate strep. But some women need the big guns of antibiotics in labor.
[NOTE - When using essential oils on a tampon, you may want to dilute (some sources say to a 1% concentration! to prevent irritation of the delicate vaginal tissues) them with an organic vegetable oil, such as olive oil, or some people recommend soaking the tampon in olive oil first, then rolling in tea tree oil. Insert a fresh tampon for 1/2 - 2 hours twice daily for 2 weeks until re-test or birth.]
On my ladies with heavy colonization I use EHB by NF Formulas given over a 10 day period (6 caps per day), and Tea tree oil vaginal suppositories 3 to 4 x daily for that time. This can be done on a small size tampon or a cotton ball, whichever is more comfortable for Mom. I have seen heavy colonization completely cleared with this treatment, but have no scientific studies to support it. [NOTE - EHB contains goldenseal, which may cause uterine contractions, so don't use it before 37 weeks and consulting with your healthcare provider.]
I re-tested at two weeks after positive culture (3 to 4 days after last
EHB taken), two weeks after that (2 1/2 weeks after first positive culture),
and on one occasion I tested again 2 1/2 weeks later (5 weeks after positive
culture) because of a prolonged ROM with no labor.
I would like to share with you a case I had last year. Mother's culture at 36 weeks yielded a result of 2+ colonization, which was the same at 38 weeks. I had her take 500mg Vitamin C every 4 waking hours, 1 EHB (NF Formulas) capsule every 4 waking hours, Propolis 4x daily, and she inserted a tampon soaked in 2% Tea Tree oil solution 2%Tea Tree essential oil, 98% Olive oil). She left the tampon in for 4 hours each day for 6 days. Culture at 39 weeks was negative for GBS. She had a long labor, a high leak for 72 hours, then a rapid active phase and 2nd stage, healthy baby, normal placenta, and normal recovery.
I have become a believer in Tea Tree oil for a variety of infections,
though in this case I believe it acted synergistically with the other natural
therapies the mother used. I have used it as a spray on throat infections,
as well as for vaginal yeast, trichomonas, and gardnerella, all with great
success. I do not see much about Tea Tree oil in midwifery literature,
but it may well be worth a try for other GBS+ moms who are averse to standard
by Standard Brands. The midwife I spoke to uses it in this way: For
a positive GBS culture, 3 caps, 3 times a day for a week, then reculture.
If negative, no more Congaplex. If positive, 1 cap a day until the end
of pregnancy. She said she has just done a case history study and found
that it works very well for GBS. If you are having a hospital birth, you
might have a difficult time working with your OB in getting recultured,
using natural medicines, etc. She says that this works very well for midwife-assisted
The herbal protocol I recommend is as follows (it works for GBS, trichamonas, or chlamydia):
Add 1/2 teaspoon goldenseal tincture to 2 cups body temperature spring water. Add this to a douche bag and douche once a day for a week. Also take 500 mg. golden seal (or 1/4 tsp. tincture) orally TID. Then, use a lactobacillus implant daily for 2 weeks (a gelatin capsule of high quality lactobacillus inserted vaginally once or twice a day works well). [NOTE - Goldenseal may cause premature labor.]
It is important to teach women how to douche properly. The bathtub with a towel to lie on is a good place to do it. She can put some pillows under her hips to elevate them. Make sure the tip of the douche is NOT inserted into the cervix. Have her undo the douche clip until the air is out of the line and reclip. As she slowly lets the fluid out, she should hold her labia closed with the fingers of one hand. This allows the vaginal tissues to expand and the fluid to wash over all the mucosa. As she holds her labia closed, her vaginal mucosa will balloon out. Some fluid will run out anyway, but keeping as much in as possible for at least a few minutes is recommended.
Be sure to reculture after the two weeks are up to make sure the GBS is gone. Then occasional douching, oral goldenseal tincture, and vaginal acidophillus is recommended so she doesn't recolonize. I don't have a definite routine on that. [NOTE - Goldenseal may cause premature labor.]
If the pregnant woman chooses to use antibiotics, this is what was recommended to me by a University of California at Davis perinatologist: Amoxycillin 500 mg. Q4, beginning as soon as labor begins. The routine hospital protocol is IV ampicillin 2 grams, then 1 gram Q4 during labor, but I do not do IVs at home.
We have had very good results with a few drops of lavender oil in warm
water douche. I have women do it weekly from 37 weeks it also eliminates
the goopy eyes seen in some newborns. [Ed: Check with your care provider
about the advisability of this treatment.]
The whole prophylactic antibiotic thing is getting really hairy with
the proliferation of "superbugs" , antibiotic resistant strains which are
increasing rapidly. I think this is really scary stuff and we need to figure
out what we're going to do. The more we use the antibiotics, the quicker
the new strains develop. But b strep can be pretty scary, too. Time to
explore immune enhancers and things like echinacea vaginal washes (which
I think work great) and won't get us into "super trouble".
I have been wondering about this forever. I know of diluted bleach water
douching, echinacea (both po and douche) and garlic intravaginally. What
else do people use as an alternative treatment prior to labor, or as preventative
measure for at risk, but negative, client?? What effect, if any, would
the peroxide treatment for BV we recently discussed have, anyone tried?
Looking for thoughts and experiences.
I often have patients who refuse to take antibiotics ( for whoever asked, I am a licensed naturopathic physician in the state of Oregon and certain antibiotics are in my formulary and scope of practice) . I certainly can understand the wish not to take antibiotics as I myself do not take them. I firmly believe we are seeing the effects of overuse/abuse of these substances. However strep is a bad bug, I know of one situation where a newborn developed a fever, the doc decided to wait and observe this baby for 12 hours, the baby died - from strep.
I have also used clindomycin vaginal suppositories, boric acid capsules
inserted vaginally, and herbal douches ( the best is hot yarrow for 5 days).
Since these herbal preparations (echinacea is antibacterial so it may also
work) are not "proven" I would offer herbal douches to a patient who refused
antibiotics and then retest in a week.
I am very confident with the herb Oregon Grape root--in glycerin base for babies--for fighting staph and strep infections or suspected infections. I used this herb alone for treating my daughter for scarlet fever. Although her infection was not of the terrible strains we heard of in days of yore which were extremely deadly, she was sick for two weeks, lethargic, fever, low energy, red bumpy rash. She came out fine and then got chicken pox one week later which we treated with anti viral, immune enhancing herbs and lots of colloidal minerals to boost her depleted system. I have also used Oregon Grape for many other strep conditions in my own children and recommended it to many other parents for the same. Results are great. My newest daughter had a mild eye infection and plugged tear duct at birth. She took two drops of Oregon Grape two times a day and the infection and duct cleared rapidly--Our FP stated the eye would very likely take months to clear.
We are going on nine years of parenting, we have three kids who have
never been on any type of antibiotic or other medication for any condition.
My confidence with herbs grows daily. When conditions are acute we really
push the herbs--sometimes taking the drops every hour or half hour until
something changes or breaks, then reducing to a few times a day for a few
days beyond the acute stages.
Speaking of research that midwives could do . . .
I would love to see serial GBS cultures done with women who have had a positive culture and are using natural remedies to reduce colonization.
Antibiotics do appear to help (for the time being, at least), but it
would seem a safer thing all around to reduce the colonization, whether
or not the woman chooses to take an intrapartum course of antibiotics.
This is what I have found in 41 deliveries with GBS testing. +GBS at 36 wks:
hospital births (for other reasons) with antibiotics: 2 (no complications of GBS) HBs coincided with receiving results so no time to do any natural remedies & chose no abx in labor: 2 (no complications of GBS) HBs with wks to do natural remedies & retest 3 (no complications of GBS) 1 - chose no abx 1 - chose abx but no time to give it, fast labor 1 - chose abx and I gave 2 gm ampicillin IV x2 in labor Natural remedies used: hydrogen peroxide douche 1/day garlic/golden seal douche 1/day 3 gm vit C with bioflavinoids/day 1 woman took colloidal silver, also Results of retests: 1 - went from abundant to moderate (this is the one who took colloidal silver) 2 - remained abundantSomeone mentioned using acidophilus and I will try this next time to see results. Other natural remedies that work, I would love to hear about.
My personal theory is that the great increase in positive GBS status
must be a reflection of something we are doing different (such as
eating meat from GBS+ animals and/or increased number of 3rd world immigrants
contributing their "normal" GBS flora to the general populations, etc.).
So i suggested that each of these moms take a 10 day course of Mega Dophilus
(?sp -- a liquid, refrigerated, high concentration form of acidophilus)
and Echinacea (standard 250mgm blend of e.purpura & e.augustifolia
extract, b.i.d.) while eliminating meat and poultry products and raw fish
(sushi) from their diet and being re-cultured. Both were negative the next
time and delivered at home without any IP risk factors (prolonged ROM,
fever, etc.) and no sequela for the babe. Of course i know that 2 cases
does NOT a study make, but i'm interested in keeping a record of these
occurrences if other midwives might be interested in helping to test out
the theory (that GBS+ status could be reversed). Certainly this would be
a much less expensive and risky treatment modality than IV antibiotics
(with its risks of resistance, allergy, extend hospital time, etc.).
I often wondered about Echinacea and or Golden seal. Are you talking
about dilutions of tincture or powder or what? What might your dilution
be? Have you considered Tea tree oil. With the essential oil information
that was recently posted on the list it seems that these would be reasonable
to try as well. Someone mentioned H202, Golden seal/ garlic, and Vit. C.
Has anyone tried essential oils diluted with anything but distilled water,
i.e. H2O2, witch hazel, saline???
It's been shown that, while echinacea does increase the overall white blood cell count for a short time, after a couple of weeks, it doesn't seem to do much. I would limit using echinacea for only when there is a threat to the immune system, rather than constantly, and only use it for two weeks max at a time. Also, I prefer to use a good tincture of echinacea-including all parts of the plant, and preferably more than one variety. Herb Pharm makes an excellent one, with all organic ingredients, including organic alcohol as it's base, and the Master Herbalist there really knows his stuff.
Oh, and two other immune system builders that can be used regularly that I have personally found very helpful in our family:
Nutribiotic Grapefruit Seed Extract-has antibiotic, antifungal, antiviral properties. It's VERY potent and bitter tasting, it's also a pretty heavy oil. You can get it at most health food stores, in a small squeeze dropper bottle. I recommend one or two drops a day mixed well in a small amount of some citrus juice (orange, grapefruit, or lemonade seem to work well-the sweetness and tartness counteracts the bitterness of the grapefruit seed extract). You have to mix it and down it immediately, or it all goes to the bottom again. If there is an illness, you can increase that to 7-15 drops a day. It can also be used externally, mixed about half and half with a little olive oil, for infections, bug bites, yeast infections, herpes (can burn, but it seems to help clear it up), ear infections, etc.
I also highly recommend, and use regularly myself, Super Blue Green
Algae (aphanozimonen flos aqua-whew, what a mouthful) from Upper Klamath
Lake in Oregon, for a strong immune system.
Here is the herbal regimen that we use for both gardnerella and Group B Strep. As with all herbs, sometimes it works and sometimes it don't.
Echinacea Tincture - qd
Infusion (with cinnamon) - tampon vaginally, tid (with one time being overnight).
Drink (Brew 3 sticks in 1 pint water)
Acidophilus 6-8 caps qd
6-8 caps qd
Vitamin E 400 IU daily
Nasturtium Blossom Tincture
1 dropper tid
*** A good diet is extremely important.
During labor with ROM Echinacea every 1/2 - 1 hour
I have had no luck with echineacea & vit. C, any one else?
Sources for alternative treatment supplies:
GY-NA-TREN includes MEGADOPHILUS dairy-free capsules for oral use, and inserts for vaginal application. [From Natren]
Over the years, there have been other products called Fem-Dophilus or
Pro-Femm from Jarrow Formulas, but I can't find them anymore.
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