Tag Archive | infection

What to Do When your Bag of Waters Breaks

It is common to be in labor without your water breaking. Actually, only thirty percent of women experience their water breaking before the start of labor.

What Is My Bag of Waters?

The bag of waters—or amniotic sac—is a bag or “membrane filled with fluid that surrounds your baby in your uterus during pregnancy.” The bag of waters is very important to your baby’s health. The fluid protects your baby and gives your baby room to move around. The bag itself protects your baby from infections that may get into your vagina.

Is it urine or is it amniotic fluid? If you are leaking, it can be difficult to determine if your membranes are leaking or if it is urine. In most cases, it is probably urine. There are several ways to tell the difference, but there is no definite answer. When in doubt, smell it! Urine has a distinct smell and color. You will leak urine when your bladder is full, when coughing , sneezing or laughing; even when you are exercising. Only 3 percent of pregnant women will go into premature labor (before 37 weeks) as a result of ruptured membranes.

In most cases your membranes will rupture as you are nearing the end of your pregnancy, and this is definitely one of the early signs of labor. If your water does break in public, and you have visions of a huge gush of water running all over the floor, then you have probably been watching too many movies. It is most likely going to occur as a slow trickle, or at most, a small gush of fluid of colorless and odorless amniotic fluid. Call your healthcare provider if your water breaks and the fluid is green or brown. This is an indication that your baby had a bowel movement in utero.

What Should You Do When Your Water Breaks

First, don’t panic! Follow the instructions your healthcare provider discussed with you if and when your water breaks. Immediately after your water breaks, know that nothing should be placed in your vagina at this point. This will help prevent infection.
•Wear a maxi pads, not tampons, to keep the amniotic fluid from wetting your clothes
Keep your vaginal area clean
When you go to the bathroom, be sure to wipe from front to back
Sexual intercourse is officially off-limits

Call your healthcare Provider immediately if:

Your due date is more than 3 weeks away from today
•The water is green, or yellow, or brown, or has a bad smell
•You have a history of genital herpes, whether or not you have any herpes sores right now
•You have a history of Group B strep infection (“GBS positive”)
•You don’t know if you have GBS or not
•Your baby is not in the head-down position, or you’ve been told it is very high in your pelvis
•You have had a very quick labor in the past, or feel rectal pressure now
•You are worried.
•If you feel something in your vagina, or see any of the umbilical cord at the vaginal opening, get medical help immediately

Call your health care provider within a few hours if:
•Your due date is within the next 3 weeks and
• You are not in labor and the fluid is clear, pink, or has white flecks in it
• Your baby is in the head-down position
•Some health care providers will want you to come in to the office to confirm that the bag of waters has broken and listen to the baby’s heartbeat as soon as you notice that the bag of waters has broken. Others will suggest you stay home for several hours to wait for labor to start.

What Do I Do Until Labor Starts?

Most women will go into labor within 48 hours. If you are waiting for labor to start and your bag of waters has broken:
• Put on a clean pad
•Do not put anything in your vagina
•Drink plenty of liquids—a cup of water or juice each hour you are awake
•Get some rest
•Take a shower
•If there is any change in your baby’s movements, call your health care provider right away

Check your temperature with a thermometer every 4 hours—call right away if your temperature goes above 99.6.

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Group B Strep in Pregnancy: Frequently Asked Questions

1. What is Group B Strep (GBS)?
GBS is one of many common bacteria that live in the human body without causing harm in healthy people. GBS develops in the intestine from time-to-time, so sometimes it is present and sometimes it is not. Group B Strep or GBS can be found in the intestine, rectum, and vagina in about 2 of every 10 pregnant women near the time of birth. GBS is NOT a sexually transmitted disease, and it does not cause discharge, or itching. Unfortunately, it can cause a bladder/urinary tract infection.

2. How Does GBS Cause Infection?
At the time of birth, babies are exposed to the GBS bacteria if it is present in the vagina, which can result in pneumonia or a blood infection. Full-term babies who are born to moms who carry GBS in the vagina at the time of birth have a 1 in 200 chance of getting sick from GBS during the first few days after being born. Occasionally, moms can also get a postpartum infection in the uterus.

3. How Do You Know if You Have GBS?
Around your 35th to 36th week, during a regular prenatal visit, your healthcare provider will collect a sample by touching the outer part of your vagina and just inside the anus with a sterile Q-tip. If GBS grows in the culture that is sent to the lab from that Q-tip sample, your provider will make a note in your chart, and you will be notified at your next prenatal visit that you are GBS positive, The GBS protocol for a positive culture will be discussed at your next visit with your healthcare provider and the expectations of care when you are in labor.

4. How Can Infection from GBS Be Prevented if My Culture is Positive?
If your GBS culture is positive within 4 to 5 weeks before you give birth, your healthcare provider will recommend that you receive antibiotics during labor. GBS is very sensitive to antibiotics (penicillin or penicillin family) and is easily removed from the vagina. A few intravenous doses given up to 4 hours before birth almost always prevents your baby from picking up the bacteria during the birth. It is important to remember that GBS is typically not harmful to you or your baby before you are in labor.

5. Do You Have to Wait for Labor to Take the Antibiotics?
Although GBS is easy to remove from the vagina, it is not easy to remove from the intestine where it lives normally and without harm to you. Although GBS is not dangerous to you or your baby before birth, if you take antibiotics before you are in labor, GBS will return to the vagina from the intestine, as soon as you stop taking the medication. Therefore, it is best to take penicillin during labor when it can best help you and your baby. The one exception is that, occasionally, GBS can cause a urinary tract infection during pregnancy. If you get a urinary tract infection, it should be treated at the time it is diagnosed, and then you should receive antibiotics again when you are in labor.

6. How Will We Know if Your Baby Is Infected?
Babies who get sick from infection with GBS almost always do so in the first 24 hours after birth. Symptoms include difficulty with breathing (including grunting or having poor color), problems maintaining temperature (too cold or too hot), or extreme sleepiness that interferes with nursing.

7. What Is the Treatment for a Baby with GBS Infection?
If the infection is caught early and your baby is full-term, most babies will completely recover with intravenous antibiotic treatment. Of the babies who get sick, about one in six can have serious complications. Some very seriously ill babies will die. In the large majority of cases if you carry GBS in the vagina at the time of birth and if you are given intravenous antibiotics in labor, the risk of your baby getting sick is 1 in 4,000.

8. What If You Are Allergic to Penicillin?
Penicillin or a penicillin-type medication is the antibiotic recommended for preventing GBS infection. Women who carry GBS at the time of birth and who are allergic to penicillin can receive different antibiotics during labor. Be sure to tell your healthcare provider if you are allergic to penicillin and what symptoms you had when you got that allergic reaction. If your penicillin allergy is mild, you will be offered one type of antibiotic, and if it is severe, you will be offered a different one.

Provided by Angel J. Miller, MSN, CNM

What is Mastitis? Cause, Treatment and Prevention

Mastitis occurs when bacteria enter your breast through a break or crack in the skin of your nipple or through the opening to the milk ducts in your nipple. Bacteria from your skin’s surface and baby’s mouth enter the milk duct and can multiply — leading to pain, redness and swelling of the breast as infection progresses.

Mastitis is often caused by Staphylococcus aereus and Escherichia coli bacteria. It is an unwelcome guest, especially to first time moms who have a difficult enough time trying to establish a breastfeeding routine with their baby. It is also unwelcome to those of you who have already experienced cracked nipples, have thin or sensitive skin, engorgement or a weakened immune system. Mastitis is often preceded by engorgement, plugged milk ducts or cracked and bleeding nipples.

Symptoms of mastitis include:
• A red, sore spot or “hot spot” on your breast
• Breast tenderness or warmth to the touch
• Swelling of the breast
• General malaise, or feeling ill
• Overall, flu-like symptoms
• Fever of 101 degrees F or 38.3 C or greater
• Red lines following the troubled milk duct’s path

Because many healthcare providers will prescribe antibiotics, it is up to the mother to find, in addition to the antibiotics, other remedies and comfort measures to help shorten the episode of mastitis, ease the pain and help to continue to breastfeed your baby.

Self-care remedies. Resting, continuing breast-feeding and drinking extra fluids can help your body overcome the breast infection. If you are prescribed an antibiotic, the course of therapy will usually be ten to fourteen days of antibiotics. Even though you may feel better after 48 to 72 hours of taking the antibiotics, be sure to finish the antibiotic regimen to ensure your breast infection is resolved.

To relieve your pain and discomfort:
• Maintain your breastfeeding routine-Yes; you can still breastfeed your baby with a breast infection. It is safe for you and for your baby. It is also recommended by the La Leche League to continue breastfeeding on the affected breast through mastitis to help shorten the episode of the infection and avoid abscesses. Mastitis need never be the reason to discontinue breastfeeding your baby
• Avoid prolonged engorgement before breastfeeding your baby. The mother needs to reduce the fullness as much as possible at each feeding to ease the inflammation and expel any milk plugs that may be present. Some babies may be reluctant to breastfeed on the infected breast because of elevated sodium content in the milk. If the baby cannot be persuaded to nurse, the mother needs to express milk to keep her breast soft.
• Use different positions to breastfeed your baby; sometimes the same position causes pressure points on a certain area of the breast, thus causing a plugged duct which can lead to mastitis. Be sure you are in a good and comfortable position before your baby latches on
• Drink plenty of fluids! Did I mention this before? This is important enough to repeat!
• If it is too painful to breastfeed on the affected breast and/or your breast is too sore to have babe latch on, you can pump and hand expressing your milk
• If you have difficulty emptying a portion of your breast, apply warm compresses to your breasts, take a warm shower, or kneel in your tub filled with warm water and submerge your breasts before breastfeeding your baby or pumping
• Wear a good supportive bra
• While waiting for the antibiotics to take affect, take a mild pain reliever such as acetaminophen (Tylenol, others) or ibuprofen (Motrin, Advil, others)

Minimize your chances of getting mastitis by fully draining the milk from your breast while breastfeeding. Allow your baby to completely empty one breast before switching to the other breast during feeding. If your baby nurses only a few minutes on the second breast, or not at all, start breastfeeding on that breast at your next feeding.

Alternate the breast you offer first at each feeding, and change the position you use to breastfeed from one feeding to the next. Make sure your babe latches on properly before each feeding. If your baby is not latched on properly, break the suction with your finger. If baby fusses a few seconds, that is okay. This is better than you developing cracked nipples that can lead to mastitis.

Finally, do not let your baby use you as a pacifier. Babies enjoy sucking and often find comfort in suckling at the breast even when they are not hungry.

Breastfeeding your baby is the most fulfilling action in the mother-infant bonding process. It should be pain free and fulfilling.

by Angel J. Miller, MSN, CNM

Excerpts from Mayoclinic.com on Breastfeeding problems; La Leche League (lll.org)

Importance of Oral Health During Pregnancy

“Why do my gums bleed so much and so easily?” Oral health is a key component of overall optimal health and wellbeing across a person’s lifespan. During the course of pregnancy, it is very important to obtain treatment for your oral health and it IS safe throughout pregnancy. It is very surprising to find out that 22% of U.S. women reported they never accessed oral health care prior to becoming pregnant, and less than one third of pregnant moms visited their dentist in the postpartum period (between 2 to 9 months postpartum) following the birth of their babies. These statistics were obtained in a 2004 study. Surprising? Yes. Can it be prevented? Absolutely!

Why is oral health so important, especially during pregnancy? The many physiological changes that a woman’s body undergoes during pregnancy can have an undesirable affect on her overall oral health and good oral hygiene. The many hormonal changes that occur in pregnancy can increase the risk of the pregnant mom to be more susceptible to oral infections, such as periodontal disease, and can reduce the body’s ability to repair soft tissues in the mouth. In addition, “pregnancy gingivitis” or mild inflammation of the gums occurs in approximately 60% to 75% of pregnant women. If this condition is left untreated, it can lead to periodonitis, which can lead to bone and tooth loss. Periodontal disease has been associated with cardiovascular disease, stroke, poor diabetes control and adverse birth outcomes. The pain that results from oral disease can also harm nutritional intake and affect a pregnant woman’s self esteem.

While oral health is important to a women’s overall health, her oral health is also important in its relationship to the health of her unborn child. Studies have shown an association between periodontal disease and adverse birth outcomes such as low birth weight, preterm birth and gestational diabetes. More importantly, transmission of bacteria from the mother to her baby is the primary way that children first acquire the disease that causes cavities. Evidence suggests that most infants and most children acquire caries-causing bacteria from their mothers. Cavity-causing bacteria is passed through saliva via activities like sharing utensils, wiping off the baby’s pacifier in the mother’s mouth, and testing food before feeding to your baby. The healthier mom’s mouth, and the longer the initial transmission of bacteria is delayed, the more likely children are to establish and maintain good oral health.

Tips to help promote oral health:
• To help prevent or control tooth decay, brush your teeth with fluoridated tooth paste twice/day, and FLOSS DAILY
• Eat fruit, veggies, whole grain products and dairy products. Limit foods containing sugar to meal times only (watch those carbs!!)
• Drink plenty of water or low-fat/skim milk. AVOID carbonated beverages
• Choose fruit rather than fruit juice to meet the recommended daily intake of fruit (and will have less sugar)
• Obtain necessary oral treatment ideally before pregnancy. Those who have bleeding gums or cavities, should visit a dentist as soon as possible
• Diagnosis (including necessary dental x-rays) and treatment can be provided throughout pregnancy; however, the period between weeks 14 and 20 weeks of pregnancy is the best time to receive treatment.• Delaying necessary treatment could result in significant risk to the mother and indirectly to her baby

If you are dealing with morning sickness or frequent nausea, especially in the first trimester, here are some tips:
• Eat small amounts of nutritious foods throughout the day: the 6 small meals a day rule is important throughout pregnancy, but especially for dealing with nausea
• Chew sugarless or xylitol gum (causes bacteria to lose the ability to adhere to the tooth, stunting the cavity causing process) after meals.
• Rinse your mouth with water and a teaspoon of baking soda (sodium bicarbonate) after vomiting to neutralize acid
• Gently brush teeth with fluoridated toothpaste twice a day to prevent damage to demineralized tooth surfaces
• If you can’t brush your teeth because you feel sick, rinse your mouth with water or a mouth rinse that has fluoride

For mom:
• Maintain good oral health
• Limit foods containing sugar to meal times only (watch sugar intake overall)
• Avoid saliva-sharing behavior, including:
Sharing spoons or other utensils
Cleaning a dropped pacifier or toy by putting it in your mouth

For Baby:
• After the first tooth erupts, wipe your baby’s teeth after feeding with a soft cloth or soft-bristled toothbrush
• Avoid putting your baby to bed with a bottle or sippy cup containing anything other than water
• Ask your baby’s healthcare provider about your baby’s oral health status
• Schedule your baby’s first dental visit for between ages 6 and 12 months

Promoting oral health during pregnancy is the solution to achieving overall health and well-being for pregnant women, their babies and families. Visit your dentist regularly and maintain good oral hygiene.

Article by Jessie Buerlein, MSW, Project Mgr, presented by Angel J. Miller, MSN, CNM
Quickening, Summer 2009. Volume 40, Number 3
Official Newsletter of the American College of Nurse Midwives

Submitted by the Improving Perinatal and Infant Oral Health Project, a joint effort of the American Academy of Pediatric Dentistry and the Children’s Dental Health Project. For more info please visit http://www.cdhp.org