Originally Posted by tiredmidwife
You're mistaken about the MRSA protocols for carriers who don't have active infections, at least when it comes to birth. Look up MRSA on labor and delivery -- it's a huge deal.
NUMEROUS people carry it in their nasal passages, and never end up with a boil/abcess.
But Bluesparks has said that her family has had numerous infections, including a current one and past "horrible ones."
I just don't get it. . . .I mean seriously- they may have patients who have had MRSA who are wearing t-shirt, sleeveless shirts, shorts, skirts, etc. and sitting on and touching their equipment. They have NO IDEA.
But birth is not just about sitting around with dry, intact skin showing, right? Blood, sweat, tears, mucus, feces, urine, vomit... I've seen it all, been splashed by it all, and had all of it get on my equipment at births (and I am careful, believe me). And I've never but never gotten through a water birth without getting wet... with water that has blood, urine, sweat, vaginal mucus, amniotic fluid, and sometimes feces in it. So... a little different from someone sitting in my office in her t-shirt.
I'm not really sure what birth centers and we home birth midwives can do/should do with known MRSA, but I am pretty sure that we shouldn't make light of it and blow it off. That's how the hospitals got into the trouble they're in.
First of all, I have TRIED looking it up, and the little information that I have found is either inconclusive, or conflicting.
Second of all, I was responding in part to this particular situation, and in part to homebirth and birth center births and MRSA in general.
Third, to my knowledge, blood, tears, feces, urine and vomit are not typical modes of spreading MRSA. And assuming these are of concern, wouldn't the ever present media panic over transmission of blood borne diseases mean we would have heard more of an outcry over this? Wouldn't doctors be warning people who have had MRSA to make sure no one touches ANY of their bodily fluids for risk of contracting MRSA? If the worry is about any bodily fluid, then is breastmilk a concern as well? Sweat, and mucus ARE known, and typical means of transmission- and these things are UNAVOIDABLE in life in general, not just in birth. Which means the very clients, building, and equipment they are attempting to protect may have already been exposed and contaminated. It is not like bluesparks67 failed to disclose it early on- she has been in their office for the entire pregnancy! If you are worried about community acquired MRSA spreading to your facility, then you need to know the status of individuals before they even walk through your door! What if a carrier sneezes or sweats in your building, on your furniture, etc.? Did bluesparks67 or any of her family members ever sneeze or sweat while they were in the office? It is entirely possible that they have clientele that are asymptomatic carriers, or are having issues with MRSA, and don't know what they are dealing with OR they know and did not disclose for any number of reasons (including being told that at this point, community acquired MRSA is EVERYWHERE!) and impossible to avoid. I guess my point is, if they were SO concerned, it would seem like they are shutting the barn door after the horse has run off! That is my problem with this situation. MRSA has been around since 1961- so now, at 32 weeks of this woman's pregnancy, in 2011. you are going to say, "Oh shit! We should be worried about this?" It is one thing for the average person to be misinformed about the protocols, but quite another for midwives and birthing centers to not have a clear grasp, and a standing policy regarding MRSA in place at this point! There is no excuse to be doing a 180 at this time! To me, it indicates a complete lack of knowledge and preparation for dealing with what you say is a very serious concern when birthing!
I am not suggesting to blow it off, and I am not suggesting to make light of it. I am just questioning the efficacy of the decision these midwives had made at this point.
I'd LOVE to see some real, peer reviewed studies on MRSA and birth, and I'm sure if the midwives had approached bluesparks67 with such studies, and talked to her like she was a reasonable human being, her reaction would have been different. But it doesn't seem as though they did! It doesn't seem as though they had given this much thought when she first came to them and disclosed her prior MRSA status. It seems like a FEAR reaction.
In THIS case, there is an active infection in the family, and you are criticizing bluesparks67 for not disclosing the infection. It does not seem as though she was given a CHANCE to disclose the infection on her own (which made her angry), it does seem like her daughter's doctor may have violated her privacy (which made her angry), and it also seems as though the birth center midwives may need to do a LOT more planning about how do deal with MRSA positive patient (which has made her frustrated). It is unclear, because we are only getting one side of the story here, but it truly seems as though these midwives did not have a good grasp on MRSA and birth, and/or did not do a good job of communicating their boundaries with regards to MRSA. Was the issue that there is an active MRSA infection in the household (which is what I assume), and if so, was bluesparks67 informed that this would risk her out of birthing there when she disclosed her MRSA status? Or is the issue due to her MRSA positive status in the past, and the prior infections in the family? If the second, why was it not a big deal earlier, but is now at 32 weeks? And if she only had a history of past MRSA infections, and not a current outbreak in her household, would she have been okay then to birth in their birth center? If no, then why did they continue to see her up until 32 weeks?
Is MRSA something that is omnipresent, and thus once a carrier, always a carrier? Or can you be "cured"? How long do you (or your household) need to be infection free to be considered "clear"? Because I have never found a definitive answer to this question...
I guess my final question is: does treating previously positive MRSA patients (or their families) like pariahs actually reduce the spread of MRSA? I understand trying to protect your clientele, but I am unsure if the tactics thus employed by this particular birth center are in any way truly effective.