Tag Archive for: newborn

Group B Strep: What is GBS?

If you’re pregnant it’s likely you’ve heard of Group B Strep (GBS), probably as one of the required tests for pregnant individuals. What is it and why does it matter? While GBS is common, (1 in 4 pregnant individuals have it present!) if left untreated it can pose serious health risks. Today we’re taking a look at what GBS is, treatments and testing, and the bottom line so you can make informed and empowered decisions for you and your baby.

What Is Group B Strep (GBS)?

GBS is a common bacterium (Streptococcus agalactiae) that naturally exists and is typically harmless in adults. It resides in the digestive, urinary, and reproductive systems. While the bacteria may be present (colonization) it often doesn’t lead to infection.

If a bacteria has colonized, it simply exists. It’s when it gets out of control that it can cause infection in the body. Even if one is asymptomatic, infection could be present and is very dangerous for newborns which is why testing is so important. An estimated 20-25% of pregnant individuals have GBS present.

Remember: levels can vary over time.

Why Is Group B Strep a Concern During Pregnancy?

Risks to the Pregnant Person:
Those who have GBS present generally are unaffected. Rarely, they can encounter complications such as Urinary Tract Infections (UTIs), infection of the amniotic fluid or infection of the uterus once the baby has arrived. 

Risks to the Baby:
The risks of GBS are generally for the baby. Transmission of the bacteria to the baby during childbirth can lead to early-onset (first week) or late-onset (weeks 1–3) disease. Complications from contracting this bacteria include sepsis, pneumonia, meningitis, long-term disabilities, or even mortality.

Though this can sound scary, please keep in mind that these are rare complications, only affecting 1 or 2 babies out of 100 if the laboring person doesn’t receive antibiotics during labor. Though rare, it’s vital to understand the facts.

Risk Factors for Transmission:
Your baby may be at a higher risk for contracting GBS if you experience preterm labor, prolonged rupture of membranes (greater than 18 hours), a fever during labor, or a prior GBS-positive baby. Your baby is also at risk if you test positive on your routine GBS testing.

How Is GBS Tested for in the United States?

The United States takes a broad approach to testing using a Universal Testing model that requires a routine vaginal/rectal swab at 36–38 weeks. This will typically be done at your OBGYN or Midwife’s office. This swab is then cultured and evaluated to determine if GBS bacteria are present. If yes, the results will be communicated to you along with options for treating and intervention.

This testing is done between 36-38 weeks to ensure accuracy (remember, this bacteria varies in levels present) and avoid overuse of antibiotics.

Urine testing can also detect GBS earlier in pregnancy. Typically a positive result won’t prompt any action by your care provider but if heavy colonization is indicated, this could require antibiotics during pregnancy.

You might be surprised to find that countries around the world vary in their approaches. Canada, for instance, aligns with the US perspective of Universal Testing whereas Nordic countries such as Sweden and EU countries such as the UK prefer a Risk-Based approach where testing is only done if requested or indicated. Regardless, it’s important to ask questions and follow the recommendations of your trusted healthcare provider.

What Are the Options If I Test Positive for GBS?

Intrapartum Antibiotics:
The gold standard for care is IV penicillin administered during labor at least 4 hours before delivery. This helps ensure efficacy of the antibiotic prior to baby passing through the birth canal. The timing is important!

Special Scenarios:
If labor is rapid it can limit the efficacy of the antibiotics. Antibiotics will still be given but baby will likely be monitored more closely. In the event of a Cesarean section delivery, antibiotics won’t be needed if labor hasn’t begun and your water hasn’t broken.

What Else Should I Know About Group B Strep?

Prevention Strategies: There are no preventative measures that can be taken to eliminate GBS bacteria in the body. This bacteria occurs naturally. Once detected, prompt antibiotic treatment reduces neonatal risk by ~80%.

Newborn Care: It’s important to monitor the baby for fever, lethargy (difficult to wake), or breathing struggles. These can all be signs of infection and should be addressed as soon as possible by a medical provider. The baby’s pediatrician should be the first call. Antibiotics are the standard treatment.

Postpartum Care: Mind the birthing person’s temperature and symptoms alongside baby’s, paying attention to any changes and seeking care if they’re noted.

Emotional Support: Addressing parental anxiety and connecting with support groups.

Future Pregnancies: Retesting will be required for all subsequent pregnancies, however, a positive test isn’t a guarantee. Group B Strep can be a transient bacteria that recedes, eliminating the risk to the birthing person and their baby.

Are There Myths About GBS?

Yes! There are many myths about GBS that can feel scary or leave you feeling confused. The main ones are:

GBS is not a sexually transmitted infection. It is a naturally-occurring bacteria that exists within the body and a common one, at that.

Antibiotics during labor do not harm the baby. While it is true that the antibiotics could have a small impact on baby’s microbiome, these effects have not been studied at length. Preliminary studies with limited data suggest that the impact is short-term and the effects can be mitigated to some degree by choosing to breast or chestfeed.

Positive status doesn’t guarantee infant infection! Even if you do test positive and aren’t able to recieve antibiotics quickly the number of newborns that get sick from GBS are few. While the illness is a very serious one and shouldn’t be taken lightly, it is still rare.

No proven remedies are known to exist besides antibiotics during labor. There are many online suggestions such as Hibiclens or Garlic to change the bacteria levels. There are no scientific studies to prove any of the alternatives work to keep your baby safe.

Wrapping it all up

If you’ve found yourself here because you have tested positive for GBS, don’t panic. Remember, GBS is a bacteria that naturally exists within the body. There is nothing you could do that would change that. If you test positive for GBS at your routine screening, remember that it is manageable with proactive care.

Antibiotics reduce both neonatal and postpartum risks for baby and parent and can be simply administered during labor.

As with everything, remember to ask questions and follow the guidance of your medical care provider. With early intervention, proper treatment, and consistent care you and your baby will not experience any ill effects from GBS.

New Parents | Planning for Your New Normal

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New Parents, your life will never be normal again.

Ok, that’s not entirely true. You will settle into a new normal but when a baby is born, life as you know it comes to an end. That can sound daunting! How will you make sure your new baby is cared for, your home is tended to, your work keeps going? When new parents are settling into a new normal it will take work. With some skilled planning and a willingness to shift when needed, you’ll find yourself in a groove before too long.

 

End of New Parents Leave

Usually once a baby has arrived one or both parents will get some amount of leave from their job. Circumstances look different for each employer. Explore what options you and/or your partner have for parental leave once your baby has arrived. How long can you take? When preparing to return to work, consider what will make it easiest including a hybrid or virtual work schedule for a period of time or even permanently. Explore these options and what they will look like with your employer.

New Caregiver

New parents transitioning to a new caregiver will take some effort but with planning it can be as smooth as possible. Ensure your new caregiver has adequate bottles and pumped milk or formula available to feed the baby. Pack their bag well with extra diapers, wipes, outfits, and anything else they may need. Discuss any circumstances unique to your family that your new caregiver may need to understand (is your baby on medication? Do they need to be fed a certain way? etc.) Communication is key to make transitioning to a new caregiver as easy as possible.

Balancing Home/Work

A new baby will always change the dynamics in a house. Consider how to make the transition easier for yourself as new parents, your pets, big siblings, and extended family members. Identify how your household tasks are currently split. Who takes out the trash? What about cooking meals? Who does the dishes? Consider a chart or writing out a schedule for when these things occur and think about planning to prepare food ahead of time while you ease into your new routine.

 

Babies change your life in the blink of an eye and it can feel overwhelming going through all the changes that you will face. With an open mind, lots of communication, and a plan ready, going back to work will feel challenging but not impossible. 

 

Need some extra help? Check out our Free Ultimate Postpartum Planning Guide!

The Witching Hour: The Scariest Time of Day for New Parents

Nearly every parent can recall a moment during those early weeks of their baby’s life, when their sweet, innocent little bundle of joy seemed more like a terrifying little monster. This scary time is often referred to as the “Witching Hour”, derived from folklore to mean the time of day when the ghosts, monsters, and demons were said to have appeared. 

Like the term ‘morning sickness’ (which frequently happens far more often than just the morning), the phrase ‘witching hour’ is also a misnomer. Your newborn may spend well more than 60 minutes in this seemingly inconsolable state. Particularly during this time of year, when the sun sets earlier, it is not uncommon for the witching hour to include the hours leading up to and immediately following sunset. 

So what then IS the witching hour?  

The witching hour is a period of excessive fussiness, crying, irritability, and/or sleeplessness, sometimes spanning several hours, often occurring during the late afternoon into evening. It is extremely common for newborns, particularly in weeks 2-4 of their lives, to exhibit this behavior but can (unfortunately) extend for weeks. 

What causes the witching hour in newborns?

Overstimulation

It’s the end of another long and grueling day; you’ve been bombarded by noises, lights, sounds, textures, smells, and other external stimuli for hours on end. It’s enough to make adults want to retreat to their happy place! Now, consider a newborn, only weeks into this journey that is life, experiencing all of these same stimuli. This is why the number one cause of the ‘witching hour’ can be attributed simply to overstimulation. As humans, when we are overwhelmed by external stimuli, it is difficult for our mind and body to rest – overstimulation leads to being overtired too.

Gastrointestinal Discomforts

Your baby’s GI system is also brand new, working hard to learn how to suck, swallow, and digest milk, absorb nutrients, and pass gas and stool. It can be expected that this immaturity can contribute to increased gas (and the ensuing fussiness and discomfort), particularly after a full day of feedings. It’s also not unusual for excess gas and discomfort to compound throughout the day. 

Hunger

A baby’s nutritional needs change throughout the course of the day. It is not uncommon for babies to appear more hungry during the late afternoon and evening hours. This is partially a biological response for breastfed babies in that breastmilk production and supply tends to be at the lowest during this time of day. Babies who are bottle fed may exhibit hunger cues even after finishing their usual portion of milk. 

Tricks & Treats: What can we do to help our baby through the witching hour?

Reduce stimulus 

If you have taken DOB’s Baby 101 workshop, you have likely learned about Dr. Harvey Karp and his 5 S’s; Swaddle, Sway, Side-lying, Suck, and Shhh (or Sound). Combining these five activities can help to reduce external stimuli and, hopefully, encourage baby to close their eyes. A favorite trick for our postpartum doulas is taking baby, swaddled and with a pacifier, into the bathroom, turning off the lights and turning on the exhaust fan! And baby-wearing can be a treat for the whole family. Putting baby in an inward-facing wrap or carrier is a great tool to get through this time, too.

Encourage burps and toots

Encouraging baby to burp and pass gas frequently throughout the day can help alleviate fussiness and bloating in the evenings. Whether breast or bottle feeding, burping baby mid-feeding is always a good idea. Giving baby time to lay and move their limbs can also aid in teaching them how to release gas as well. Ultimately, time and maturity are the only true ‘fix’. 

Feed frequently

While we can’t eliminate baby’s desire to feed frequently in the evenings, sometimes preemptively increasing afternoon feedings can help. This may mean waking more frequently for shorter durations between feedings (2-2.5 hours maximum would be our recommendation). Or increasing the amount or duration at the last feeding session prior to the anticipated witching hour time frame. Cluster feeding, especially in the evenings, is very normal for breastfed babies in anticipation of a growth spurt. Again, this is an instance where time may be the only solution.

Is there a way to eliminate the witching hour?

While it can be difficult to accommodate for every family, one of the benefits of this time of year is the earlier sunsets.  If their witching hour is around 5 pm, ensuring they have a quality late afternoon nap may help. Take advantage of the darkness to push baby’s bedtime back a bit. If baby seems cranky, irritable or inconsolable by 7:30 pm every night, aiming to have them settled and to sleep by 7 pm could help (and mean you might get a few minutes of peace!).

While we can not guarantee that these tips and tricks will work every time with every baby, we can assure you that you are not alone, and ultimately, this time will pass. 

Ways to Help Your Older Child Adjust to the New Baby

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Welcoming a baby into your family is a joy, but a joy that can come with worry. If you’re expecting baby number two, you might be worried about how your older child will adjust to a new sibling. Jealousy is a natural emotion for kids, especially during the ages when they are particularly attached to their parents. They’ll notice you are taking time to care for baby and that people are excited about baby. But, there are still ways that you can help your older child adjust. 

How can I help my older child adjust to a new baby? 

One of the ways that parents can help older children adjust to a new baby is by involving siblings in newborn care, to the extent that they want to be involved. If they are a little older, they might want to help with feeding or bathing. If they’re younger, you can have them get a pacifier and put it in baby’s mouth (gently) or get a diaper. 

Especially for toddlers, it can be helpful for parents to acknowledge the difference between them and the baby. You might find yourself telling the older child to wait while you feed baby or change a diaper. On occasion, you can tell baby that they have to wait while you do something with your older child. You can also remind your older child that they are a big kid and doing something or have something that baby can’t. Emphasizing that they are special can help with feelings of jealousy. 

How do I keep my older child from feeling overwhelmed when baby comes?

 Having a baby can throw everyone’s schedules off, from sleep to meals. One tip to help your older child adjust to a new baby is by keeping their schedule as consistent as possible. If they go to daycare three days a week, keep them at daycare even if you or your partner are home with baby. 

Babies do need a lot of attention, which can create feelings of jealousy in your older child or that there is a certain level of unpredictability. When you feed your baby and do need to devote attention solely to baby, it can help to find something calm and special that the older child can do. While you are trying to have a calm moment for feeding, you can let your older child watch a special show or read a book. 

How can friends and relatives help my older child adjust to a new baby? 

One of the easiest things friends and relatives can do to help your older child or children adjust to baby is acknowledge the sibling first. When they come over to meet baby, have visitors prioritize the sibling. It is so easy for everyone to get excited about the new baby, and your other child can notice this excitement. Have friends and family ask the older sibling if they want to introduce baby or share something special about their new sibling. 

If you have someone who can help you during the postpartum period–whether it is a doula, a family member or friend–you have a great opportunity to prioritize each child on their own. They can take care of baby so that you have quality time with the older sibling. Or, they can take care of the older sibling so you can either rest or take care of baby. 

How to Install a Baby Car Seat Safely

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Installing a car seat safely is one of the most important things to do before baby arrives. In fact, you can’t leave the hospital without a car seat. Choosing and installing a car seat that best fits your vehicle and lifestyle can seem daunting; that’s why our own Child Passenger Safety Technician (CPST) is here to help. Here are six steps to ensure your baby’s car seat is safely installed. 

Be Prepared

If you are a first-time parent, you’ve probably never installed a car seat before. And even if you have other children, you may not be familiar with your new car seat’s installation procedures. To install your car seat safely, read both the entirety of your car seat manual and the portions of your vehicle owner’s manual that pertains to child restraints. We recommend that you install your seat by your 36th week of pregnancy.

Accessories Can Be Dangerous

It might be tempting to use aftermarket accessories for your car seat or car. Don’t. Use only manufactured approved items that come in the box with your car seat (infant inserts, strap covers, etc.). This includes cozy winter inserts like the J.J. Cole Bundle Me, which are not approved for use in car seats. 

Don’t Leave Baby in the Car Seat

Avoid keeping baby in the car seat more than absolutely necessary. A car seat is designed to keep baby snug and safe, but limits baby’s movement. Even if baby fell asleep in the car seat or you want to keep baby in the car seat at a restaurant or indoors, consider babywearing or a stroller with a bassinet instead. 

Ensure Proper Use of the Car Seat

Straps should come through the slot just below baby’s shoulders, be snug enough that you can not pinch any slack at the collarbone or hips and chest clip should be even with baby’s armpits. Never loosen car seat straps or unbuckle the chest clip or crotch buckle unless you are removing the baby from the seat.

Consult a Child Passenger Safety Technician to Install the Car Seat Safely

Before baby arrives, schedule an appointment with a certified Child Passenger Safety Technician (CPST). A CPST is qualified and trained to make sure that your car seat is installed correctly and can help you install a baby car seat safely.

As a Doulas of Baltimore client, you may schedule your Car Seat Concierge appointment for $100. What’s included in our car seat concierge service:

  • Initial consultation to discuss your feature and brand preferences, budget, and lifestyle factors
  • Assistance in selecting the best car seat for your child 90-minute personalized car seat installation appointment with up to 2 seat(s) in up to 2 vehicle(s) 
  • 12 months of industry professional phone/email support as your child grows to ensure your confident in your child’s car seat safety

 

Contact us to learn more.