The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
|
If you know any birth attendants who are still practicing premature clamping and cutting of the cord, encourage them to watch this video of a grand rounds with Dr. Nicholas Fogelson at USC. It's got lots of research and an open-minded perspective. |
Genital Herpes and
Pregnancy: Preventing Neonatal Transmission (Archived Web Conference)
CME/CE [Medscape registration is free]
Release Date: February 16, 2005; Valid for credit through February
16, 2006
Cesarean Section Appropriate in Women With Active Genital HSV [Medscape registration is free]
"Other risk factors for neonatal HSV were first-episode infection, isolation of HSV from the cervix, HSV-1 vs. HSV-2 isolation, invasive monitoring, delivery before 38 weeks, and maternal age younger than 21 years."
This means that women with a long-standing HSV infection not cultured
from the cervix who carry to term are at lowest risk for passing on neonatal
herpes to their baby, even with an active lesion. However, it seems
clear that suppression therapy is a big win for women with a history of
herpes.
Suspected
cases of neonatal herpes require prompt treatment
Antiviral treatment curtails virus and enhances normalcy at 1 year.
The
acquisition of herpes simplex virus during pregnancy.
Brown ZA, Selke S, Zeh J, Kopelman J, Maslow A, Ashley RL, Watts DH,
Berry S, Herd M, Corey L
N Engl J Med 1997 Aug 21;337(8):509-15
The chance of asymptomatic shedding at any one time is about 2%, half of which occurs within 7 days of an outbreak. Young age and recent acquisition of genital herpes were identified as risk factors for asymptomatic shedding of HSV during pregnancy.
Neonates delivered vaginally during a recurrent episode have an infection
risk of only 1% to 4%. So the risk of infection for an asymptomatic
woman is less than 0.02% to 0.08% on average, and even less than that for
older women who did not acquire herpes recently.
HERPES AND PREGNANCY from herpes.com
A
double-blind, randomized, placebo-controlled trial of acyclovir in late
pregnancy for the reduction of herpes simplex virus shedding and cesarean
delivery.
Watts DH, Brown ZA, Money D, Selke S, Huang ML, Sacks SL, Corey L.
Am J Obstet Gynecol. 2003 Mar;188(3):836-43.
CONCLUSION: Acyclovir significantly reduced, but did not eliminate, herpes simplex virus lesions and detection in late pregnancy.
[See Related
Articles for most recent studies]
Hale, T. (1996) Medications and Mother's Milk, 5th ed.:
Acyclovir (Zovirax)
Approved by the AAP for use in breastfeeding mothers.....Percutaneous
absorption following topical application indicates poor systemic absorption,
with undetectable plasma levels....Acyclovir levels in breastmilk are reported
to be 0.6 to 4.1 times the maternal plasma levels, Maximum ingested dose
was calculated to be 1500 mcg/day assuming 750ml milk intake. This level
produced no overt side effects in one infant. In another study, doses of
800 mg five times a day produced milk levels from 4.16 to 5.81 mg/L (total
infant ingestion per day=0.73 mg/kg/day). .......Toxicities associated
with acyclovir are few and usually minor.......Acyclovir therapy in neonates
is common and produces few toxicities. Calculated intake by infant would
be less than 1 mg/day.
The medication recommended here (zovirax) I need to tell all of you
about. It works ok when taken orally in pill form but not in the cream
form that you rub on a herpes outbreak. I was pretty shocked about this
myself but my son works at a drug co. and this is the information they
got. It was hush, hush like don't tell to many people ( hah like no one
will be looking) but it truly doesn't work in that form and they keep making
lots of money off of it. So for what it is worth don't use the cream!
I beg to differ. The study that I was in was with the cream only. I
have used the cream and find it works really well. I don't know what source
the pharmacists had but I have been using it for 15 years and think the
cream is great.
A Complete
Holistic Treatment Protocol for Herpes Viruses
Our local chiropractor/nutritionist says she's had great results in
her practice using an herb from the Amazon called tayuya. It will
shorten outbreaks from a week to 2-3 days. Many patients say if they
take it at the first tingle it prevents the outbreak completely.
She carries it under the name DermH3.
Our local naturopath recommends:
* acupuncture to increase immunity (working to support remission with
the liver divergent meridian; can also use carrot oil on Liver DM points)
* tinctures of echinacea, siberian ginseng and reishi mushroom combined
1-2 droppersful every 2 hours; vitamin C and zinc to body's tolerance;
lots of fluids to flush the system
* frequent topical application of melissa essential oil (it is not
cheap and not so easy to find, but very effective); diluted manuka or tea
tree oil as a less ideal substitute.
* lemon balm (melissa) tea, also chamomile tea, hops, passionflower,
st. john's wort...tension tamer. teas that calm the nerves. I've heard
some people using chamomile tea bags topically too.
* taking a warm bath in any of the above herbs; also baking soda. essential
oils are good in the bath for calmative and therapeutic effects.
* abstaining entirely from sugar, chocolate, caffeine, dairy, alcohol,
hot/spicy food, anything processed
* avoiding sex, biking, and other topical irritants and avoiding all
forms of stress which further antagonizes the nervous system
* lots of sleep and rest
I would recommend L-lysine 1500mg per day until symptoms are gone and
then maintain 500mg per day.
The CNM who was my preceptor has shared the following guidelines re
herpes with me: 1000 mg lysine every 2 hours plus 1000 mg vit C on day
one of the outbreak, then 1000 mg twice a day till the sores are gone.
What about weaning from the acyclovir onto a maintenance dose of Lysine
though? I have a friend that gets severe oral herpes that was pretty chronic
with worsening during any stress. She now takes about 500 mg a day regularly
and has had no further outbreaks in the past two years.
There is an excellent write up in Christine Northrup's book "Womens
Bodies, Womens Wisdom". Lots of alternatives to acyclovir: 1) Garlic -
12 tabs @ outbreak onset then 4 tabs q 4-6 hours; 4 tabs a day for prophylaxis
2) Vitamin C (1000mg) & Bioflavinoids QD 3) L Lysine 500mg TID.
Antiherpes
virus activity of extracts from the medicinal plant Geranium sanguineum
L.
Serkedjieva J, Ivancheva S.
J Ethnopharmacol. 1999 Jan;64(1):59-68.
It can therefore be concluded that quantitative proof exists in vivo that H-Away effectively and safely inhibits HSV2 (genital herpes).
Enhancement
of anti-herpetic activity of antisense phosphorothioate oligonucleotides
5' end modified with geraniol.
Shoji Y, Ishige H, Tamura N, Iwatani W, Norimatsu M, Shimada J, Mizushima
Y.
J Drug Target. 1998;5(4):261-73.
Conclusion: the anti-viral constituent geraniol in H-Away is able to
penetrate into cell membranes to safely inactivate HSV1 (cold sores,
fever blisters).
Cold
Sore Relief™ (Formerly Herpilyn®) from Enzymatic
Therapy contains lemon balm leaf extract.
These products contain glycyrrhizinic acid, which has anti-ulcerous,
anti-viral and anti-inflammatory induction, stopping viral growth (barrier
effect).
What happened to the research a few years ago that showed that infants
of women with long term herpes were immune to herpes and that vaginal birth
was safe, period?
Article in the Summer '95 Birth Gazette about the active herpes mode
of delivery debate? It's in Medical Media Watch, on page 35 (Vol 11 No
3).
The US docs vetoed vag births. Here is an article from the Family Practitioner's
Journal:
Physicians Continue to Disagree About Vaginal
Delivery and Herpes
I've met midwives who've done stuff with spray-on bandage coverings
for the lesions. Worked fine.
In addition to the spray-on bandage, I've heard of nail polish used
successfully to cover lesions.
The problem with nail polish/spray on bandage to cover herpes lesion is that there is frequently cervical shed of the virus in addition to the local lesion.
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