March 13, 2011

We Are Our Kids' First Immune System

One in 4 women have the Group B Streptococcus bacteria naturally occurring in their digestive tracts and/or vaginas.

One in 200 women who test positive for GBS between 35 and 37 weeks of pregnancy and who are not treated with oral antibiotics will transmit GBS to their kid during birth.

One in 50-100 women who test positive for GBS in the birth canal during labor and who do not get an antibiotic IV will transmit GBS to their kid during birth.

One in 3 newborns infected with GBS will require medical treatment for sepsis, meningitis, and/or pneumonia.

So multiplying those numbers together, the chances of a newborn contracting a serious or even fatal infection from GBS are extremely small--at least until the kid is exposed to GBS. At which point, the bacteria pose a significant threat to a newborn's immature immune system.

One of those kids who died within hours of GBS exposure was Josh Jones's son Wren. A year after his son's birth (and death), Josh wrote about his family's devastating story, and the little cascade of seemingly inconsequential misses or occurrences that precipitated their tragedy.

In the intervening year, Jones zeros in on their decision to have a home birth, with non-nurse midwives, and a lack of immediate access to intervention, as their critical failures. If that conclusion rankles home birth advocates, I'm sure Jones--who has a 100% catastrophic result rate with giving birth at home--will not hesitate to take them on.

Reading his experience, and reading up on GBS [which, frankly, I hadn't known or even heard much about] and realizing that any birth, whether at home or in a hospital, involves some set of small but real risks, I kept coming back to one idea: until he develops one of his own, parents are a newborn's immune system. And he is entirely dependent on them to minimize or eliminate the risk of exposure to those things that are likely to cause him serious harm.

When you decide to have a home birth, you end up taking a great deal more responsibility upon yourself, things that are otherwise outsourced to medical professionals and hospital infrastructure. And that includes things like relentless follow-up on test results; vigilant, informed watch for symptoms and unexpected situations; and an acknowledgment that there are still going to be things you don't know you don't know. And so you'd better find them out.

Wren Jones [ via waxy]
Support and resource organization: Group B Strep International []
It was really hard to read this doula's lament after knowing Josh's story: GBS: Giant Bothersome Stumblingblock?? [wonderfullymadebelliesandbabies]


My heart goes out to them.

Administering an IV is fairly straightforward and can be done even in a home birth setting. My son was born in a freestanding birth center - like a home birth but in somebody else's house. I was strep B positive, and the only issue with me getting the IV was that my labor was going so damn fast that it was a race to see what would happen first - the IV would finish or my son would be born. (I should also note that my midwives were both CNMs, and they do not practice solely in a hospital setting.)

These parents have gone through the worst thing you can live through, and I feel for them. I also hope they're suing the shit out of their midwives, because their baby died because their midwives simply did not follow standard protocol.

That is a horribly sad story. Naturally, my heart breaks for that family and for the loss of their beautiful boy.

It's also, frankly, sad that a year after his son's death he is either so angry or so poorly informed that he is choosing to lash out against home birth on the whole rather than focus on what went wrong with his son's birth and his midwife. His post contains a number of mis-statements, for example, it is not at all true that no CNM will attend home birth, and while CPM training is not as standardized or regulated as it could be, if you look into the process of becoming a CPM it is actually not something you can just dial in.

Birth can be dangerous. Both hospital birth and home birth carry unique sets of risks, and clearly hospitals win out in the crisis management department. However, it's a mistake to assume that just because his child would likely have survived if her were born in a hospital, that there aren't other families who have lost children who would have survived if born at home.

I'm not here to push any kool-aid, I just think misinformation doesn't do anyone any good. Amy Tueter's (the OB who runs the Hurt by Homebirth blog) got her own agenda here, and to my mind, her use of personal narratives borders a little to closely on the exploitation of tragedy for my taste. Of course a family who has lost a child wants to have someone to blame. The sad truth is that not all babies live, and that negative outcomes can occur in any setting.

I hate to even have to get into this stuff, because mostly I just keep thinking of the sweet photos of that little boy, and how I felt the first time I held my own son in my arms. I can't even begin to imagine what that loss must feel like, my heart breaks for him.

But that sorrow I feel doesn't make what he is saying true.

@ Andy, you are missing the big problem with homebirth, which is that non- nurse midwives have no standardized body of education and licensing, and no way for parents to really know what their background or beliefs are.

At least with a doctor in a hospital, you know they've met the minimum education requirements of medical school, residency and licensing. Even then there are incompetent doctors, but with them you have the recourse of suing them under their malpractice insurance. Remember that most non-nurse midwives don't carry malpractice insurance and if something goes terribly wrong, you are SOL as far as any financial compensation--which could be huge if you have a permanently disabled child and need money to support them for life.

Homebirth can be a safe option under the right circumstances. The Netherlands and Canada have safe homebirth systems because their midwives have standardized training, are licensed and work in conjunction with doctors to transfer women who risk out of homebirth. But the U.S. does not have such a system and there's no real way for parents to tell if the person they're trusting with the life of their child is competent.

That doesn't mean all midwives in the U.S. are bad, but how are you as a layperson supposed to tell the difference? Look at Josh and Tweeny--educated, intelligent parents with lots of money and they trusted the wrong person and it killed their baby. If they weren't able to spot a bad midwife, how can we expect the average person to do so?

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