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Splish, Splash: Can Water Births Cause Legionnaires’ Disease in Newborns?

7/25/2017

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Water births are becoming popular not just with the home birth community, but also in birthing centers.  That being said, with several recent cases in Arizona of Legionnaires’ disease in newborns after water births in home tubs, the safety of water births is being questioned.  

What is Legionnaires’ Disease?  Legionnaires’ disease is a bacterial form of pneumonia that is spread through contaminated water.  Symptoms include fever, chills, cough and headaches.  The bacteria is naturally found in fresh water and can contaminate water tanks, hot tubs, cooling towers, and air conditioners.  You can contract it by breathing in the mist that contains the bacteria or aspirating it.  You cannot get it from someone else and most people who are exposed do not get the disease.   However, individuals with poor or immature immune systems, such as newborns, are  particularly susceptible.  

So, what do we know about these two cases in Arizona last year and how did these babies contract Legionnaires’ disease?  In both cases, the infants were delivered at home in a tub where the water had been pre-filled with tap water at a temperature where the bacteria can thrive (77 to 113 degrees F).  Temperatures need to be higher than 140 degrees Fahrenheit to kill these bacteria.   While these incidences are rare, waterborne infections can be serious and fatal especially for a newborn whose immune system is still developing.  

So what do the experts recommend: The American College Of Obstetricians and Gynecologists (ACOG) has found using tubs in the first stage of labor may be associated with shorter labor and decreased use of epidurals (results were not consistent in a 2009 Cochrane systemic review).  However, when it comes time to pushing and actual delivery of the baby, there is concern for increased risks of drowning, infection (cases of Legionella and Pseudomonas bacterial infections have been reported) and umbilical cord avulsion.   While further studies may provide more definitive recommendations in the future, ACOG advises that although the early part of labor may be spent in water, birth of babies should occur "on land."

If you do plan on having a birth immersed in water, ACOG encourages you to use a disposable birthing tub rather than a hot tub. The Arizona Department of Health developed guidelines and resources on how to have a safer water birth and reduce the risk of infection to your baby after those two cases of newborns that had contracted legionella pneumonia.  If you plan on being at a birthing center, make sure to ask what their sanitizing protocols are and what their policy is on cleaning tubs.

Dr. Pam


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Since Your Baby Doesn’t Come with an Owner’s Manual Chapter 3:  The Third Trimester

7/18/2017

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As we enter the latter part of pregnancy, a number of important milestones occur during the third trimester.  The one that patients are often most excited about is their due date (at 40 weeks)!  That being said, anytime after 37 weeks is considered a “full term” pregnancy, so once labor starts beyond that time, it’s “go time”!  Some babies are a little slower to make their grand entry (particularly for first-time moms), though, so don’t be discouraged if it takes a little longer for you.  If it seems to really be taking awhile for you (hello third trimester during the hottest part of summer!), then inductions can be considered at 39 weeks or beyond in most cases.

There are also a number of visit highlights in the third trimester.  At the beginning of the third trimester (28 weeks), we give any mom with an Rh negative blood type a medication called rhogam.  This medication can help prevent formation of maternal antibodies that can attack the growing baby’s blood and cause anemia.  It’s especially important for moms who are planning future pregnancies because if that interaction occurs, it’s often even more significant in later pregnancies (for those who are interested, you can check out our archives for more information on rhogam http://www.tetonobgyn.com/blog/archives/08-2016).  We also offer every mom vaccination for pertussis (whooping cough) between 27-36 weeks.  Maternal vaccination during this time can help provide your baby with protection until he/she starts their vaccination series.  This vaccine has become particularly important as there have been as many as 50,000 cases per year over the last few years, and this number is on the rise, particularly in the 0-3 month age range.

Next, we increase the frequency of your visits.  Instead of every 4 weeks, we now see you every 2 weeks until around 35-36 weeks, and then we see you on a weekly basis until you deliver.  As we begin the weekly visits, we begin checking for cervical dilation, and we also do a test for group B streptococcus (GBS).  Between 15-25% of women are carriers for GBS, and while it’s not harmful to mother’s, babies exposed to the bacteria can develop sepsis, pneumonia, meningitis, heart, GI or kidney problems that can require admission to the neonatal ICU.  Fortunately, mothers who receive antibiotics during labor dramatically decrease the risk for newborn infection with GBS.

Congratulations!  You’ve now entered the home stretch, and your baby is only about 3 months away!  While the third trimester may seem like the longest to many moms-to-be, there’s a lot to do to help you get ready for your new baby.  We generally suggest pre-registering at the hospital where you’re planning to delivery and also taking a tour of the facility.  During that tour, it’s often beneficial to bring your significant other, too, because the last thing you want is to take the “scenic route” to labor and delivery while you’re having contractions.  You may also find it useful to pack a bag of things you’ll need in the hospital (if you’re wondering what to bring, Dr. Pam did a blog with a list in the archives http://www.tetonobgyn.com/blog/archives/08-2016).  Good luck, and remember you’re almost there!  It sounds cheesy, but you’ll be bringing your bundle of joy home with you before you know it!

Dr. Nick
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Can Eating My Placenta Make My Baby Sick?

7/11/2017

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Eating your placenta has become increasingly popular in recent years.  In fact, it's become so popular that we've even been asked to address the topic on a previous blog.  Animals do it, and so do some celebrity moms like January Jones, Kourtney Kardashian and Alicia Silverstone.  Some of them eat it raw, blend it into a smoothie, or have it dehydrated and pulverized into capsules for $250.00.  Those who tout the benefits of placentophagy suggest that other mammals do, so shouldn't we do it?  That being said, it seems likely that there would be some element of hunger induced following delivery if we have truly adapted to eat our placentas (while I've experienced a lot of emotions during lots of deliveries, I can't exactly say hungry is the feeling I get after delivering a placenta). The questions remain, “Is there any benefit to eating your placenta and can it be harmful?"

In 2015, researchers at Northwestern University School of Medicine reviewed 10 published studies on the practice and they found no data to show that consuming the placenta provided any protection against postpartum depression, decreased post-delivery pain, increased energy or increased milk protection. 
Until now, we have been telling patients that whether to eat the placenta or not remains a personal decision and advised caution in circumstances of an active intrauterine infection or meconium (baby poop).  However, a recent case of one Oregon mother and her newborn has the CDC and NIH, among other health-related organizations, strongly discouraging mothers from consuming their placenta.

In 2016, an Oregon mother gave birth to a healthy baby after an uncomplicated pregnancy and delivery.  Shortly after birth, the baby was admitted to the NICU with GBS bacteremia.  This is a fancy way of saying this bacteria was present in the baby's blood stream.  GBS bacteremia is a very serious infection, which is still the leading cause of death in infants as it can be lethal in 5-6% of cases (roughly 1 in 20 cases). As a side note, this is why your ObGyn will test you for carrier status of GBS in the third trimester.  The baby was treated with antibiotics for 11 days and discharged home.  Five days after discharge, the baby was re-admitted with the same blood infection.  While the doctors were trying to figure out how the baby became re-infected, they noticed that the mother was taking placenta pills. As stated earlier, there are many companies that will dehydrate and pulverize your placenta into capsules.  When the researchers examined the pills, they found that the strain of GBS in the pills was the same one that had infected the baby.  Since there is no oversight of the processing of placenta pills, there is no way to know what’s inside the pills and what goes on during the manufacturing process.  Unfortunately, this leaves women and their babies susceptible to infection and possibly other toxins.

With no proven benefits and potentially deadly side effects for newborns, we would strongly caution against ingestion of placenta capsules after delivery and, at this time, are in favor of siding with the CDC and NIH in advising against eating the placenta after delivery.
​

Dr Pam
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