pregnancy Archives | Doulas of Baltimore

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RSV Vaccine during Pregnancy | The Evidence

We all want to keep our newborn babies safe. When looking at common illnesses, RSV is a frequent concern amongst new parents. The latest recommendation? Recieve the RSV Vaccine during pregnancy. If your doctor has made this suggestion you may be curious how it works. Let’s take a look at what RSV is and what you can do before your baby is even born to protect them from it.

What Is Respiratory Syncytial Virus (RSV)?

Respiratory syncytial virus (RSV) is a leading cause of hospitalization in infants, responsible for 58,000–80,000 annual hospitalizations in children under 5 in the U.S. Babies under 6 months are especially vulnerable, as RSV can lead to severe lung infections like bronchiolitis and pneumonia. We’ve done a deep dive on the specifics of RSV in babies, you can check that out here!

It’s important to remember that while RSV is dangerous for infants and the immunocompromised, it can present as a common cold in healthy individuals. This means even if someone’s only symptom is a runny nose, they could spread the illness.

How does getting the RSV vaccine during pregnancy work?

The Abrysvo vaccine, approved by the FDA and recommended by the CDC, is given to pregnant individuals between 32 and 36 weeks of gestation. It works by transferring protective antibodies to the fetus, providing passive immunity that shields infants during their most vulnerable early months.

Is it safe and effective?

Yes! Clinical trials show impressive results:

81.8% efficacy against severe RSV within the first 90 days of life.
69.4% efficacy through 6 months of age.

Safety data from over 7,000 participants revealed no significant risks to pregnant individuals or babies. The most commonly seen side effects are mild such as injection site pain or fatigue and they were reported to be short-lived.

What else should I know about the RSV Vaccine during Pregnancy?

Timing: CDC recommends vaccination at 32–36 weeks, ideally before RSV season (typically fall/winter).

Who should get it? Most pregnancies without contraindications. This could be something such as an allergy to the vaccine’s components.

Alternative option: For those unable to receive the vaccine, there is an option that can be given to infants post-birth.

The American Academy of Pediatrics (AAP) and World Health Organization (WHO) endorse RSV vaccination during pregnancy as a safe, effective way to reduce infant complications due to RSV.

Take Action

The most important thing you can do when considering healthcare decisions is to talk to your trusted healthcare provider. You can practice using the BRAIN acronym during your prenatal visit by asking the following questions:

Benefits – What are the benefits of recieving the RSV vaccine during pregnancy?
Risks – What are the known risks? What are the risks of RSV to a newborn?
Alternatives – What alternatives do I have?
Intuition – What am I feeling now that I know the science-based answers to my questions?
Nothing – What happens if I do nothing about RSV?

By vaccinating during pregnancy, you’re offering your baby a strong first defense against a potentially serious illness.

Group B Strep: What is GBS?

Pregnancy

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.

Birth Classes | 3 Ways Independent Curriculums Stand Out

Childbirth Education

There are pros and cons for all the birth classes on the market. Depending on what you are looking for from a class, many of the mainstream birth classes can be unappealing.

You may feel like taking a childbirth series is one more thing to do before your baby arrives, but this is one thing that could make an incredible difference to your birth experience.

Childbirth education classes share information that is not just about the physiological birth process. They also dive into the myriad of options that could be present at the birth of your child. If you pick a quality class, it is about much more than that.

Most parents are asking their providers for recommendations of where to attend, and for many, that means signing up for the hospital’s class. Childbirth classes are all different!

We want to share why choosing an independent professional childbirth education class could be one of the best things you do for you and your baby.

1) All The Options for Birth Classes

Because our childbirth classes are taught outside of the hospital, our instructors are free to share all options and not only those that support hospital policy. As independent instructors we focus on sharing information, explaining the many options available during labor and birth, and the various scenarios that may arise. This way our students feel informed and prepared to enter their own experience.

Our goal is getting you the knowledge for the type of birth that you desire.

Are you looking for a low intervention birth?

Maybe you’re curious about epidurals?

Have you considered what to do before you get an epidural?

We give easy-to-understand knowledge, and tools to help you bring your plan to life, and, if necessary, help to navigate the unexpected.

2) Specialized Birth Educators

Once you decide to take a childbirth class , why not rest assured your instructor is someone connected and knowledgeable about birth in your area. To be a childbirth educator with Doulas of Baltimore, years of study, hundreds of hours teaching, and first-hand experience helping families in labor are what make the difference.

The nuance of birth is such that there is no pattern that everyone will follow. However, a new kind of skill develops which your teacher is happy to share with class attendees. It may be silly to say, but that ability is having trust and confidence in birth. When you know what is possible, and learn the necessary skills to discuss needs and wishes with your care providers, you increase the potential for an excellent birth experience.

3) Partners Enjoy Independent Birth Classes

There’s a stereotype that non-pregnant partners are uninterested in attending or participating in birth classes. We find birth partners engaged in our classes and happy to feel more confident when class has ended!

We do not shove you into a classroom with grainy videos of birth from the 1970s. A screen is never the focus of the class. We endeavor to make our time together result in you having more confidence about your child’s birth. And more confident about how to interact with one another during your baby’s birth.

Need more information? Read testimonials from former students and please to reach out with any questions. If you are ready to get started – head straight to our class registration page!

Top Positions to Try During Labor

Childbirth Education

Our top positions to try during labor? Childbirth is a process that can last a varied amount of time based on many factors. During labor, the birthing person might need to try a variety of different comfort measures. Even moving between each of these positions can help ease discomfort and be a welcome distraction. We’ve put together a guide on some of our top recommendations complete with variations and things for a support person to consider.

Positions for laboring in bed

This photo is property of Lamaze International.

Throne

Description: Throne position is a secret weapon of doulas everywhere! This position utilizes the movement of hospital beds to get the laboring person into a comfortable position for resting or waiting. This one is easy to remember, since the very idea of the position is in the name. We’ll be putting our birthing individual on a “throne”.

How to Get There (hospital bed): Have the birthing person sit in the bed. Using the controls on the hospital bed, raise the back up between 45 and 90 degrees. Have the birthing person lean forward for the initial adjustment and lean back to raise or lower the back to a comfortable position. Drop the lower part of the bed all the way to create a “throne”. The goal is a seated position.

Especially Helpful for: After an epidural or medication! This position is perfect for when you’re waiting for dilation but are comfortable enough with medication on board to rest. This is also helpful for getting baby to descend by letting gravity work its magic.

Variations: While this can be great for medicated births, this seated position is also excellent for non-medicated births in other spaces. One notable variation is sitting backwards on the toilet! Since our pelvic floors are trained to relax on the toilet to allow us to use the bathroom, often we’ll use this position to move dilation along. Note: this position can get intense very quickly as baby descends, make sure someone is nearby to help the birthing person off the toilet quickly if needed.

Side Lying

Description: As the name suggests, this position is very simply lying to the side for the birthing person. Another resting position, this helps take the pressure off of the pelvis and back for the birthing individual. We highly recommend a pillow or two between the legs. This one doubles as an excellent pushing position! The top leg can be held by the individual, their birthing partner, a nurse, or a doula to allow the pelvis to open in a more comfortable position.

How to Get There: Simply turn gently to one side or the other! To keep labor moving, a great idea is to move from one side to the other periodically.

Especially Helpful for: This is a great position for early labor, resting after an epidural, or while waiting for pushing urges to emerge.

Variations: Adding a peanut ball or a stack of pillows that brings the upper knee facing upwards is a surefire way to help with dilation and progression of labor. This position is well-loved by our clients who choose medication as it allows them to rest well while laboring down. This can also be used for an unmedicated birth but, just as with the throne position on the toilet, it can get intense very quickly. Ensure someone is nearby in case a shift needs to happen quickly.

Hands and Knees

Description: Put those arms and legs to work! Laboring on all fours is an excellent way to open the pelvis. This position also could be great for getting baby oxygen and some physicians recommend it for easier positioning of monitors.

How to Get There: Very simply put, this position is fairly simple to get into! In the bed, rotate a little bit at a time with some support on one or both sides. Have someone nearby to move pillows or blankets as needed until the birthing person is in position.

Especially Helpful for: Active laboring! This position is a very active one and gives the birthing person the sensation of doing something instead of being swept away by laboring. Note: this one can get tiring! This is a great position to prepare or “train” ahead of time by lifting light weights or doing movements that strengthen the arms.

Variations: Lean over something to give your arms a rest! Our best suggestions are a stack of pillows, a birthing ball, or the back of the hospital bed. This position could also translate well to water if choosing hydrotherapy with the birthing person leaning over the side of the pool or bath.

Positions for out of the bed

Partner Supported

Description: Lean on me! Standing can get tiring but letting gravity do its job can be very helpful. Enter: partner support! Whether you lean on someone standing in front of you, behind you, or use a bedsheet or rebozo, getting support from someone else can make standing or squatting much easier.

How to Get There: For partner-supported sitting, simply have the partner stand in front of or behind the birthing person to support. It may be helpful for the partner to have their back supported against the wall.

Especially Helpful for: Taking a break from walking or while a contraction is happening.

Variations: Use a bedsheet or rebozo under the birthing person’s arms to offer extra support that is easier to manage for the partner.

Hands and Knees Redux

Description: This position is a great one to do outside of the bed as well! Enjoy all the same benefits of hands and knees in the bed but with more freedom of movement.

How to Get There: Simply sit on the floor swinging legs around and using support to evenly distribute weight onto both hands and knees. Consider putting down a yoga mat or folded up blanket to support the knees and soften the surface.

Especially Helpful for: Active laboring and hip squeezes!

Variations: Lean over a birthing ball or chair to ease the strain on wrists.

Birth is not a one-size-fits-all and your comfort is a top priority. When practicing these positions, take note of what feels comfortable and what feels like too big of a stretch. Remind yourself and your birthing partner that what feels good outside of labor may change very quickly and vice versa. Stay in tune with your body as labor progresses and move naturally. Your body is wise!

Early Labor | What Should I Do?

Childbirth Education, Doulas of Baltimore, Pregnancy

Early labor can often leave us with the question of, “When do I head to the hospital?”. Clever reminders like “511” remind us that contractions should be 5 minutes apart and 1 minute long for 1 full hour before you head in. As doulas, we are huge advocates for distraction through early labor. Often, when you focus on distractions you’re able to discern when you can’t ignore labor anymore.

When your pregnancy is healthy and labor is going normally, we love to encourage clients to try to make their contractions go away. True labor won’t stop just because you put your feet up! In addition to staying hydrated, eating nourishing food that feels good to you, and laying down for a bit, here are a few of our favorite ways to enjoy a distraction during early labor.

Schedule an Appointment

An excellent way to relax and distract yourself is to get yourself to a self-care appointment. Book a pedicure, a prenatal massage, or find a salon near you that does blow outs. These appointments are wonderful for distraction but they also help create a flow of oxytocin in your body. Oxytocin is a wonderful pain relief and also calming hormone and it can be stimulated by skin-to-skin contact. Be sure you’re in contact with your birth team and consider having someone else drive (just in case!)

Warm Shower or Bath

The warmth of a shower or bath can ease tension and relax your muscles, helping you stay comfortable as early labor progresses. Water has a calming effect and can provide gentle relief, especially for back pain or cramps. Sitting or standing under a warm shower allows the heat to target your back and abdomen, while a bath can create a more immersive, weightless experience that helps you relax between contractions.

Safety Note: Be sure to keep the water at a comfortable, warm temperature (not hot) and stay hydrated if you’re soaking for a while.

Movement and Gentle Exercise

Moving around can be surprisingly effective in early labor. Gentle stretches, walking, a prenatal yoga video, or using a yoga ball can help release muscle tension, encourage a more optimal baby position, and may even help labor progress. Slow dancing with a partner or swaying your hips in a figure-eight motion can bring comfort and connection, grounding you through each contraction.

Tip: If you have a yoga or birth ball, sit and gently rock your hips, move them in a figure 8 motion, or bounce lightly to ease any pressure in your lower back or hips.

Create a Calming Environment

A soothing environment can make a big difference in how you feel. Dim the lights, play calming music or sounds, and use soft, cozy blankets or a favorite pillow. Try lighting a candle that has a soothing scent to create a spa-like atmosphere if you’re interested in aromatherapy. Choose things that bring you comfort and help you feel safe.

Tip: Make a playlist with a mix of calming and upbeat songs. The calming ones can help you relax, while the upbeat tracks can lift your mood if you’re feeling restless.

Mindful Distractions

Early labor is the perfect time to engage in activities that keep your mind occupied without draining your energy. Simple activities like reading a favorite book, watching a comforting movie, or doing a craft project can keep your focus off contractions while still allowing you to relax. Some people enjoy adult coloring books, knitting, or easy puzzles that bring a sense of calm.

Tip: Make a list of short, enjoyable tasks you can do easily and stop anytime, so you’re prepared with options if labor progresses quickly or you start needing to focus more on your contractions.

These techniques can help you stay comfortable and relaxed at home as labor begins. Remember, there’s no right or wrong way to experience early labor; do what feels best for you. Take things one contraction at a time, stay connected to your body, and know that each step brings you closer to meeting your baby.

Unsure if it’s really labor? Check out our blog “Am I actually in labor?”