what make a hb midwife "not safe" to you? - Page 4

[kathrineg]

This is absolutely not true. Ecoli now makes up a larger percentage of infections because babies no longer die from GBS as frequently. That does not mean that the same number of babies die---they don't. It means that when they do die, it's more likely to be from something other than GBS.

If you can find a reliable source that says that there are the same number of deaths now that there were in, say, the 60s, I'd love to see it. This is literally a matter of life and death and it's important that we get it right.

Originally Posted by mwherbs 

So now thanks to intrapartum antibiotics ecoli and antibiotic resistant ecoli and other infections are now the leading cause of death. So although gbs deaths are down there are the same amout of deaths due to infections. Balancing vaginal flora should be the primary approach. Trouble is GBS is considered to be normal flora, by most medical folks cus 1/5-1/3 of the birthing population are colonized. Peroxide producing lactobacillus has been show to be good at colonizing the vagina and is healthier than GBS

As for oxygen the resuscitation protocols have changed for the majority of resuscitations room air is recommended for use. Part of this is that they have figured out through pulse ox that newborns transition they dont have high oxygen levels to start with. Also they dont know exactly when 90-100% oxygen becomes dammaging . So although I have carried oxygen for years I am less and less likely to turn it on.
The simplest way to make midwifery safer is to legalize it in every state and to allow those midwives to carry and use what is considered normal meds not that they should have to use them but so they could if need be.

[mwherbs]

I hope this is trimmed enough, there is a similar data set published from Taiwan, title below. The cdc info is saying 77% coverage and saying that is why gbs still exists and the very early studies when they were treating risk factors only, and remember preterm was a major risk factor set, that pretem and very early preterm had increased ecoli and antibiotic resistant ecoli

J Perinatol. 2011 Apr 28.
Early-onset neonatal sepsis: rate and organism pattern between 2003 and 2008.
Sgro M, Shah PS, Campbell D, Tenuta A, Shivananda S, Lee SK.
Source
1] Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada [2] Department of Pediatrics, St Michael's Hospital, Toronto, Canada [3] Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, Canada.

Comparisons of incidence rate, demographics and causative organisms were carried out between earlier cohort (2003 to 2005) and later cohort (2006 to 2008).Result:A total of 405 infants had positive blood and/or cerebral spinal fluid cultures over the study period. The EONS rate was 6.8/1000 admissions (n=24969) in the earlier cohort compared with 6.2/1000 admissions (n=37484) in the later cohort (P=0.36). Rate of clinical chorioamnionitis was higher in the later cohort (38 vs 26%; P=0.02). For term infants, coagulase-negative Staphylococcus (CONS) (2.4/1000) followed by group B Streptococcus (GBS) (1.9/1000) were the most common organisms identified. For preterm infants, CONS (2.5/1000) followed by Escherichia coli (2.6/1000) were the most common organisms identified. There was a significant reduction in GBS EONS over time (P<0.01) and a trend toward an increase in other organisms.Conclusion:Although the rate of EONS among neonates admitted to NICUs has not changed, the pattern of infection has changed over the past 6 years. With the increased use of prophylactic antibiotics to mothers, careful surveillance of the changing trend of bacterial organisms among neonates is warranted.Journal of Perinatology advance online publication, 28 April 2011; doi:10.1038/jp.2011.40.

PMID: 21527901 [PubMed - as supplied by publisher]


Pediatr Neonatol. 2011 Apr;52(2):78-84. Epub 2011 Mar 16.
The changing face of early-onset neonatal sepsis after the implementation of a maternal group B Streptococcus screening and intrapartum prophylaxis policy--a study in one medical center.
Lin CY, Hsu CH, Huang FY, Chang JH, Hung HY, Kao HA, Peng CC, Jim WT, Chi H, Chiu NC, Chang TY, Chen CY, Chen CP.
Source
Division of Neonatology, Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.

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And in the Netherlands they have reported decrease in GBS but increase in late onset infections...
Neonatology. 2010;97(1):22-8. Epub 2009 Jul 2.
Long-term trends in the epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents.
van den Hoogen A, Gerards LJ, Verboon-Maciolek MA, Fleer A, Krediet TG.
Source
Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands.
Abstract
BACKGROUND:
In an era with increased maternal antibiotic use, patterns in early- and late-onset sepsis and antibiotic susceptibility may have changed.
OBJECTIVES:
To identify longitudinal trends in causative microorganisms for neonatal sepsis and analyze antibiotic susceptibility of all blood isolates of infants with sepsis.

METHODS:
Early- and late-onset sepsis cases from 29 years (1978-2006) were studied retrospectively, in five clusters of 5 years (period I-V) and one cluster of 4 years (period VI), including antibiotic susceptibility profiles of blood isolates during the years 1999-2006.
CONCLUSIONS:
The incidence of early-onset sepsis mainly caused by GBS decreased. In contrast, the incidence of late-onset sepsis, predominantly caused by CONS, increased significantly. The incidence of fungal and yeast infections remained low. The majority of CONS blood isolates were susceptible for first-generation cephalosporins.

Copyright 2009 S. Karger AG, Basel.

Comment in
Neonatology. 2010;97(1):29-30.
PMID: 19571584 [PubMed - indexed for MEDLINE]

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And there is this free full text article in Pediatrics look specifically at table #1 you will see numbers of infections and organisms... Note that although GBS declines in number others greatly increase
Like gram positive ecoli starting at 3 and increasing to13, gram negative ecoli starting at 15 and increasing to 71.

http://pediatrics.aappublications.org/content/125/5/e1031.long

[mwherbs]

There are additional concerns with antibiotic exposures. Like the association with pregnancy exposure to antibiotics and asthma. Also notice what flora arises greater amounts of bacteroides colonization is associated with IBS... Since there is also an increase in the expression of gluten intolerance since the 1950's there may very well be a link between antibiotic exposures and gut damage/flora chages that usher in this type of intolerance.

[Alenushka]

link to the study please.

Association is not the same as cause.

[mwherbs]

There are some studies on infant flora they show place a birth as well as differrences in flora for c-section compared to vaginal birth. They are not included in this list this is just a few on links between asthma, eczema and antibiotics.


Am J Epidemiol. 2011 Feb 1;173(3):310-8. Epub 2010 Dec 29.
Antibiotic exposure by 6 months and asthma and allergy at 6 years: Findings in a cohort of 1,401 US children.
Risnes KR, Belanger K, Murk W, Bracken MB.
Source
Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale University Schools of Public Health and Medicine, New Haven, Connecticut, USA.
Erratum in
Am J Epidemiol. 2011 Jun 15;173(12):1475.
Am J Epidemiol. 2011 Apr 1;173(7):846.
Abstract
Many studies have reported that antibiotic use may be associated with increased risk of childhood asthma. Respiratory tract infections in small children may be difficult to distinguish from early symptoms of asthma, and studies may have been confounded by "protopathic" bias, where antibiotics are used to treat early symptoms of asthma. These analyses of a cohort including 1,401 US children assess the association between antibiotic use within the first 6 months of life and asthma and allergy at 6 years of age between 2003 and 2007. Antibiotic exposure was associated with increased risk of asthma (adjusted odds ratio = 1.52, 95% confidence interval (CI): 1.07, 2.16). The odds ratio if asthma was first diagnosed after 3 years of age was 1.66 (95% CI: 0.99, 2.79) and, in children with no history of lower respiratory infection in the first year of life, the odds ratio was 1.66 (95% CI: 1.12, 3.46). The adverse effect of antibiotics was particularly strong in children with no family history of asthma (odds ratio = 1.89, 95% CI: 1.00, 3.58) (P(interaction) = 0.03). The odds ratio for a positive allergy blood or skin test was 1.59 (95% CI: 1.10, 2.28). The results show that early antibiotic use was associated with asthma and allergy at 6 years of age, and that protopathic bias was unlikely to account for the main findings.

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A little older....
http://pediatrics.aappublications.org/content/123/3/1003.long

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This is a review....
Birth Defects Res B Dev Reprod Toxicol. 2008 Dec;83(6):547-60.
Early-life environment, developmental immunotoxicology, and the risk of pediatric allergic disease including asthma.
Dietert RR, Zelikoff JT.
Source
Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA. [e-mail]
Abstract
Skipping some>>>>>>>>>>>>>>). Because novel immune maturation events occur in early life, and the pregnancy state itself imposes certain restrictions on immune functional development, the period from mid-gestation until 2 years after birth is one of particular concern relative to DIT and AD-A. Several prenatal-perinatal risk factors have been identified as contributing to a DIT-mediated immune dysfunction and increased risk of AD. These include maternal smoking, environmental tobacco smoke, diesel exhaust and traffic-related particles, heavy metals, antibiotics, environmental estrogens and other endocrine disruptors, and alcohol. Diet and microbial exposure also significantly influence immune maturation and risk of allergy. This review considers (1) the critical developmental windows of vulnerability for the immune system that appear to be targets for risk of AD, (2) a model in which the immune system of the DIT-affected infant exhibits immune dysfunction skewed toward AD, and (3) the lack of allergy-relevant safety testing of drugs and chemicals that could identify DIT hazards and minimize problematic exposure of pregnant women and children.

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Int J Occup Med Environ Health. 2006;19(1):70-6.
The prenatal use of antibiotics and the development of allergic disease in one year old infants. A preliminary study.
Jedrychowski W, Gałaś A, Whyatt R, Perera F.
Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland. [e-mail]

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BJOG. 2006 Jul;113(7):758-65.
Could peripartum antibiotics have delayed health consequences for the infant?
Bedford Russell AR, Murch SH.
Source
Heart of England NHS Trust, Birmingham, UK.
Abstract
Antibiotics are increasingly prescribed in the peripartum period, for both maternal and fetal indications. Their effective use undoubtedly reduces the incidence of specific invasive infections in the newborn, such as group B streptococcal septicaemia. However, the total burden of infectious neonatal disease may not be reduced, particularly if broad-spectrum agents are used, as the pattern of infections has been shown to alter to allow dominance of previously uncommon organisms. This area has been relatively understudied, and there are almost no studies of long-term outcome. Recent findings suggest that such long-term data should be sought. First, there is evidence that organisms initially colonising the gut at birth may establish chronic persistence in many children, in contrast to prompt clearance if first encountered in later infancy, childhood or adulthood. Second, there is a rapidly advancing basic scientific data showing that individual members of the gut flora specifically induce gene activation within the host, modulating mucosal and systemic immune function and having an additional impact on metabolic programming. We thus review the published data on the impact of perinatal antibiotic regimens upon composition of the flora and later health outcomes in young children and summarise the recent scientific findings on the potential importance of gut flora composition on immune tolerance and metabolism.

PMID: 16827757 

[Honey693]

If a midwive won't give me an answer to what happened at your worst birth I'm out of there.  I realise bad things can happen in any birth and I want to know how my midwife/OB/family practitioner is going to handle them.