Science & Sensibility

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Occasional Science & Sensibility contributor Rebecca Dekker of Evidence Based Birth has spent the last month writing a blog article about Group B Strep and it is finally here! In her painstaking but clear review of the evidence on GBS in pregnancy, Rebecca came to the conclusion that universal screening and treatment for GBS is more effective than treating with antibiotics based on risk factors alone. She also found that although “probiotics, chlorhexadine, and garlic have the potential to reduce vaginal and newborn colonization with GBS, we do not have evidence yet to show that these strategies can prevent early GBS infections, since GBS infection usually occurs when GBS gains access to the amniotic fluid and gets into the fetus’s lungs during labor.”

To read Rebecca’s just released article, Group B Strep in Pregnancy: Evidence for Antibiotics and Alternatives in its entirety, click here.

Today, Rebecca joins us on Science & Sensibility to talk about her latest addition to Evidence Based Birth.

Sharon Muza: What inspired you to write this article?

Rebecca Dekker: I received more requests to write about Group B strep than any other topic! Over the past few months, I had weekly, sometimes daily emails and Facebook messages from women—all asking me to provide them with evidence about antibiotics, hibiclens, or garlic for preventing GBS infections. After about the 50th request, I figured I better set aside my other plans and focus on this topic, because it was clearly weighing heavily on many women’s minds! 

SM: What was the most difficult thing about writing this article?

RD: Probably the most difficult thing was sorting through the stacks and stacks of research articles that have been published about Group B strep in pregnancy. This was one of the reasons it took me almost a year of blogging before I decided to dive into group B strep. I knew it would be a monumental task. And it was. But I was fortunate enough to have an expert in GBS who helped point me to the most important or “landmark” studies.

SM: Who was this expert?

RD: I met Dr. Jessica Illuzzi via email earlier this year. She and I had corresponded about a different blog article, and at that time I found her to be incredibly helpful. I knew that in addition to being an OB, Dr. Illuzzi was a research expert in GBS. So I asked her if she would review my article for me. To be honest, I could not have written this article without her guidance. She read my first draft and basically told me that I needed to go back to the drawing board. She encouraged me to dig deeper into the evidence so that I would really understand it. Whenever I had questions about something, she sent me research articles that immediately answered my question. In the end, I knew the article was ready when she said it was a great summary of the state of the science of GBS. 

I was also lucky enough to have 2 other GBS experts give me feedback on the article—a GBS researcher and a microbiologist. And then I have several physicians who faithfully review all of my articles and give great suggestions. I am very grateful to all of them as well!

SM: I know that you usually begin your articles with an exploration of your own biases, in order to tease the bias out of your writing. Did you have any pre-existing biases about GBS? 

RD: To be honest, I actually had no biases up front. I was fortunate to always test negative for GBS myself, and so I never had to struggle with this issue before. I was pretty open-minded to the entire issue. I was open-minded to antibiotics. I was open-minded to hibiclens or other alternatives. I had no personal agenda. I simply wanted to get to the facts. Hopefully this lack of bias will shine through and help people respect the article even more.

 SM: What surprised you most as you wrote this article?

RD: One of the things that surprised me was how people have such different reactions when they read the evidence about GBS. I had several friends preview the article for me. Some of them instantly said, “Oh yeah, that sounds like a really high risk. I’d definitely take the antibiotics to prevent an infection in my newborn.” Others would say, “Really? That’s all? That’s not a very high risk at all. I wouldn’t take antibiotics for that level of risk.” This is a great example of how everyone perceives risk differently. But at least in this article I have been able to put some evidence-based facts out there. Let people interpret the risks as they may. I only ask that they talk with their health care provider before making any decisions!!

 SM: What do you think is the future of GBS evidence?

RD: Ten years from now I am guessing that I could write a very different article. I would like to think that by then we may have a vaccine on the horizon that could prevent both early GBS infections and GBS-related preterm birth. It would also be nice if the rapid test was affordable and widely available by then. I would also LOVE to see some solid research evidence on the use of probiotics for decreasing GBS colonization rates in pregnant women. As far as I know, probiotics for decreasing GBS hasn’t been studied yet in pregnant women, and I think it deserves further inquiry.  

SM:What makes your blog article about GBS different than all the other blog articles out there on this topic?

Rebecca Dekker

RD: I purposefully didn’t look at any of the other GBS blog articles out there until I finished my article. Yesterday, I read through a variety of blog articles (there are a lot!). Most of them were about 90-95% accurate in their facts. A couple of them had serious errors (in particular, I found one blog article that had inaccurate information about hibiclens). Most didn’t list any references, and I could tell that most of the blog authors had used secondary sources (other blogs or summary articles) instead of looking at the research evidence themselves. This can be fine, but sometimes it’s a bit like playing telephone: You just keep repeating the same facts over and over without checking to see if the evidence has changed or if the summary you are parroting was accurate in the first place. I’d like to think that my blog article is a very accurate assessment of the research evidence on GBS in pregnancy—translated into regular language so that women and their family members can understand the evidence. 

SM: What are you going to write about next?

RD: I don’t know!! What would YOU like to see me write about?

SM: I want to thank you Rebecca, for your contributions to Science & Sensibility and for sharing Evidence Based Birth with the world!  I know that these articles take a huge amount of time and you are very diligent and conscientious about researching the literature and providing only the best analysis possible,  and seeking out experts on the topic to help you really be sure that you are offering the best of the best of information.  I always enjoy reading your blog and find it a great source of information for my doula and CBE students and my birth doula clients as well. I know that I speak for all the readers here on Science & Sensibility when I say, keep on keeping on!  Do please let Rebecca know what you would like her to write about next!   

Sharon Muza ACOG, American Academy of Pediatrics, Babies, Childbirth Education, Evidence Based Medicine, Guest Posts, informed Consent, Maternity Care, Medical Interventions, New Research, Newborns, NICU, Push for Your Baby, Research antibiotics, Evidence Based Birth, GBS, group B strep, guest post, informed Consent, newborns, prenatal testing, Rebecca Dekker, research, Sharon Muza, tests in pregnancy

Regular contributor Penny Simkin discusses the research around parents’ singing to their babies in utero and the post birth benefits.  She also shares how birth professionals can encourage clients, patients and students to start this practice during pregnancy.  Part one of this two part series can be found here. – Sharon Muza, Community Manager, Science & Sensibility

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What is the research evidence for postnatal benefits to parents or babies  of singing to the baby before birth?

• Fetuses can sense audio vibrations and rhythms early in pregnancy. Later in pregnancy they hear and distinguish various sounds. (4)
• They recognize their parents’ voices after birth (1)
• Newborns prefer their parents’ voices over the voices of strangers (1)
• Repetitive prenatal reading of one story by one parent every day for weeks results in the newborn’s recognition of and preference for that story. (2)
• Fetuses respond to music by calming, becoming active, changes in FHR (depending on the music) 5,6)
• Premature babies are calmed by calming music. (7)
• Newborns and young babies are calmed by familiar music, as demonstrated by the universal use of lullabies.

Combining these findings, a proposal

In light of all that has been learned about babies, I think we can combine it all into a simple approach to enhance bonding, soothe the baby, empower parents with their own unique tool that no one else, even the experts, can do as well as they. (8) I propose that we who provide care and education for expectant parents urge them to do the following at around 30-32 weeks’ gestation (or earlier or later):

Maia sings to her sister in utero ©Penny Simkin

If parents feel they can’t sing or are too embarrassed to do it, I suggest choosing a poem that has a nice rhythmic meter, and recite that to the baby. I recommend Mother Goose Rhymes or poems in books by AA Milne, such as “When We Were Very Young” and “Now We Are Six;” or Shel Silverstein’s “Where the Sidewalk Ends” and others.

Film clips showing baby’s reactions to familiar songs 

Recent students in my birth class took my suggestion to heart, singing “Las Mañanitas,” from their Mexican culture, to their unborn baby frequently. The dad would lie with his head on the mother’s pregnant belly as they sang. They even videotaped sessions while the mother was having a non-stress test that showed the baby’s heart rate steadying when the dad was singing, and rising when he was not.  We also see the dad singing to their sweet little daughter right after the birth. Though she cries pretty hard when being suctioned and rubbed with blanket, she calms down with his singing.

I’ve just completed a film for children (9). In the film, we see 4 year old Maia singing  ”Twinkle, Twinkle, Little Star” to her baby sister before birth and again right after birth. Neve, her sister, calms down when she hears Maia singing the familiar song.

Enjoy these heartwarming scenes in the video below.

Conclusion

Maia sings to her newborn sister ©Penny Simkin

In conclusion, when parents sing one (or possibly a few) songs repeatedly to their child, before and after birth, it is a once in a lifetime opportunity to build a unique, meaningful and fun connection with their baby. The child already knows and loves the song as sung by his/her parents more than any other song, sung by anyone else. Parents always have their voice with them and can use it to comfort, soothe, and play with their child for years to come. Parents have the opportunity prenatally to give their baby a gift that becomes a gift for them as well.

Singing to the baby before and after birth is a lovely and very special thing to do. Would you consider introducing this ritual to your students, clients and patients?  Have you already done so?  How has it been received?  Do you have any stories about parents who have practiced this connection? Please share in the comments section, I would love to hear about it.  If we all get the word out to expectant families, it could have a very positive impact.

References:

1.  Brazelton B. Cramer B. (1991)The Earliest Relationship: Parents, Infants, and The Drama Of Early Attachment . Da Capo Press Cambridge, MA.
2. De Casper A. 1974, as described in Klaus M, Klaus P, Kennell J. 2000. Your Amazing Newborn. Da Capo Press, Cambridge, MA..
3. Odent M. 1984, Birth Reborn. Pantheon Books: New York
4. Klaus M, Klaus P, Kennell J. 2000, Your Amazing Newborn. Da Capo Press, Cambridge, MA.
5. Verny T, Kelly J. (1982)   The Secret Life of the Unborn Child. Dell: NY
6. Chamberlain D. (2013) Windows to the Womb. North Atlantic Books: Berkeley, CA.
7. Lubitzky R, Mimouri F, Dollberg S, Reifen R, Ashbel G, Mandel D. 2010. Effect of music by Mozart on energy expenditure in growing preterm infants. Pediatrics 126;e24-e28. DOI: 10.1542/peds.2009-0990.
8. Simkin P. (2012) Singing to the baby before and after birth.  International Doula 19(3):30-31
9. Simkin P. (2013) “There’s a Baby: A Children’s Film About New Babies.” PassionflowersProductions: Seattle.

Penny Simkin Babies, Childbirth Education, Guest Posts, Infant Attachment, Newborns, Parenting an Infant Childbirth Education, guest post, Infant Attachment, infants, newborns, Penny Simkin, Singing to baby

Regular contributor Penny Simkin shares her experiences with parents who sing to their baby in utero and then continue after birth and looks at what the research says about this practice in this two part blog piece.  Part two can be found here. Join me in reading about some unique situations that Penny shares as she explores this opportunity for parents to bond with their unborn child.  - Sharon Muza, Science & Sensibility Community Manager.

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People have sung to their babies forever. Every culture has lullabies and children’s songs that are passed down through the generations. New ones are written and shared and the custom goes on –a rich part of the fabric of human civilization. These songs are designed to relax babies, calm their fears, or entertain and amuse them throughout childhood. As we have learned more about the life and capabilities of the fetus, we have realized that the fetus can hear clearly for months before birth, and also can discriminate sounds and develop preferences for some sounds over others. Furthermore, at birth, newborns respond to familiar sounds by becoming calm and orienting toward the source of the sound, and even indicate their preferences for familiar voices and words over the unfamiliar.

Newborn babies prefer their parents’ and other familiar voices over those of strangers (1), and they prefer hearing a story that their mother had read frequently in utero rather than an unfamiliar story or the familiar one read by someone other than their mother (2).  Fetuses hear, remember, have preferences, respond to, and discriminate among differences — in sounds, music, voices.

These exciting findings have inspired educators to advocate prenatal learning through recordings played through a mother’s abdomen (of languages, music, and other things). They have inspired birth activists and baby advocates to provide a safe enriching environment for the fetus. Advocates of prenatal bonding emphasize communication between parent and unborn child as a powerful way to strengthen the bond.

I’d like to offer my take on this phenomenon and urge everyone who works with expectant parents to tell them about some unique and heart-warming benefits of singing or reciting rhymes to their unborn babies.

I think my interest in parents singing to their babies prenatally began in the 1980s when I first read Michel Odent’s book, “Birth Reborn”(3). Odent is a French physician who has always been ahead of his time. He had a unique and original maternity care program at his hospital in Pithiviers, France. His book had a great influence on my understanding of normal birth, and the book is still worth reading today, along with all his subsequent ones. One lovely aspect of his program is particularly relevant to the topic of this blog post. The program included a weekly singing group at the hospital, attended by pregnant women, their partners, families with young babies, the midwives, and Odent himself. The group was led by an opera singer who believed singing to be important for fetuses, babies and those who care for them. Odent’s account inspired me to invite Jamie Shilling, a folk singer who had recently taken my birth class, to bring her guitar and her baby to my classes a half hour early each week and sing with the expectant parents. That went on very successfully for several class series, then the groups decided to combine and carry on in a monthly sing- along for expectant parents and new families, in a private home –Although the groups  eventually disbanded, they provided many parents with opportunities to sing together and connect with their babies and each other in relaxing and peaceful surroundings. A high point during that time was when Michel Odent came to Seattle to give a conference and he agreed to come to one of our sing-alongs. See the photo of Jamie leading the group of expectant and new parents, with Michel Odent and myself participating. He taught us the song, “Little Black Cat” in French.

© Penny Simkin

I couldn’t help but think during those times, how the unborn and new babies must love hearing their parents singing. Seeing the parents caressing the mother’s belly as they sang was heartwarming. That happened  in the mid- 1980s, when much research on the capabilities of the unborn and newborn baby was beginning to be published. Recalling those special gatherings, I have always suggested to my students in childbirth class that they sing to their unborn babies, or play their favorite recorded music, with the thought that the baby will remember it and be soothed by it after birth.

But it was one couple, whom I served as a birth doula, who took my suggestion to another level, and showed me much more about the value of singing to the unborn baby. They were having their second child, hoping for a VBAC. When they discovered that they were having a boy, they decided to give their baby the song, “Here Comes the Sun” and sang it to him often during pregnancy. The VBAC was not possible, and as the cesarean was underway, and the baby boy, crying lustily, was raised for the parents to see, the father began belting out the baby’s song. Though the mother didn’t have a strong voice under the circumstances, she also sang. The baby turned his head, turned his face right toward his father and calmed down while his father sang. Time stopped. As I looked around the operating room, I saw tears appear on the surgical masks.

It’s a moment I’ll never forget, and it was that event that taught me the value, not only of singing prenatally, but also, singing the same song every day. Not only does the baby hear his or her parents’ voices, not only does he or she hear music, but the baby also gets to know one song very well. Familiarity adds another feature to this concept, because we know that fetuses have memory and prefer the familiar. Think for a moment about what this might have meant to our cesarean-born baby –suddenly being removed from the warmth, wetness, and dimness of the womb with its mother’s reassuring heartbeat, into the cold bright noisy operating room. The baby’s transition to extrauterine life is hectic and full of new sensations. He cries reflexively, but perhaps also out of shock and discomfort. Then he hears something familiar – voices and music and the sounds of words that he has heard many times before – something he likes. He calms down, and seeks the source of this familiar song. Everyone present is moved by this gift to the baby from his parents.

I’ve become passionate about this idea as a way to enhance bonding between parents and babies, but also as a unique and very practical measure for soothing a fussing baby or a sick baby who can’t be held or breastfed. Please join me on Thursday, for Part Two on this topic when I will continue the discussion including research evidence that supports this concept: practical suggetions for childbirth professionals to share with expectant parents; and some very endearing film clips of families singing to their babies.

References:

1. Brazelton B. Cramer B. (1991)The Earliest Relationship: Parents, Infants, and The Drama Of Early Attachment . Da Capo Press Cambridge, MA.

2. De Casper A. 1974, as described in Klaus M, Klaus P, Kennell J. 2000. Your Amazing Newborn. Da Capo Press, Cambridge, MA.

3. Odent M. 1984, Birth Reborn. Pantheon Books: New York 

Penny Simkin Cesarean Birth, Childbirth Education, Doula Care, Guest Posts, Infant Attachment, Newborns, Parenting an Infant, Vaginal Birth After Cesarean (VBAC) Childbirth Education, Infant Attachment, Michel Odent, newborns, Penny Simkin, perinatal bonding, Singing to baby

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Holidays are a time when many of us gather with with family and friends, when hearts are open, tables are full, spirits light and oxytocin flows just from being with those we care about and sharing meals and good times. For some families, babies arrive on the holiday to make the day even more special and significant then other years. For health care providers, doctors, nurses, midwives, doulas, birth photographers, lactation consultants and those that work with birthing families, holidays are often times spent away from their own friends and families so they can help women become mothers and see the birth of a family.

I have a clear recollection of being pregnant with my second daughter through the holidays of 2000. Grumpy, crabby, “done” with being pregnant, and very mad that everyone else seemed to be so festive and happy. Hard to make plans for holiday gatherings and meals, unwilling to have people over and not wanting to go elsewhere, I complained my way through each day, surprised like any other fully pregnant 40 weeker, that I would wake up each morning in my bed, “still pregnant.” I agreed to join friends for our traditional sushi rolling party that we did every New Year’s Eve, and pregnant or not, I was going to be rolling and eating sushi. Alas, baby felt like joining the party, and I went into labor New Year’s Eve. A slow labor ramp up seems to be the way my babies come, and I mildly contracted through the night, all New Year’s Day and into that night. As was the case, I seem to go from early labor to transition rather quickly and soon was pushing a baby out into the world in the pre-dawn hours on January 2nd. 01/02/01. Missing 01/01/01 by just a few hours. Missing the tax break and a New Year’s Eve baby by a day. Regardless, a memorable New Year nonetheless for myself and my family.

I sit now waiting for the call to join a client as her birth doula, as other women, clients of mine, tick the hours past the holiday celebrations, very pregnant and wondering if they too, will have a holiday baby.

As a doula for over 10 years, I have attended births on every holiday, my birthday, and my children’s birthdays, as those babies come when they want to, regardless of the plans of those of us on the outside!

I thought I would check in with those women who have given birth on a holiday like July 4th, Valentine’s Day, Christmas, New Year’s, Halloween and others to find out what their experience was like. And also ask those who themselves were born on a holiday, how has it been forever having their birthday associated with a holiday well known by many here in the US.

“I birthed on a holiday!”

Most of the women I spoke to who gave birth on a holiday had gone into labor spontaneously. Several of them had a long labor, for several days, with the baby making their appearance on the holiday. I wondered if they felt that their birth team minded not being with their family on the holiday. Everyone reported that, regardless of home birth or hospital birth, the birth team seemed very present, happy to be there and upbeat about welcoming the new baby. A few hospital birth mothers remarked at how empty and quiet the hospitals were during their births. Discharge seemed to take a bit longer and it was sometimes harder to be seen by a lactation consultant or other specialist. Some babies born on Christmas were given a green and white striped hat instead of the “normal” newborn baby hat after birth.

Many women talk about celebrating their child’s birthday on the original holiday date when the child is young, but as they get older, they have moved the celebration to a day that is not the holiday, so that friends and family are more available to join in the celebration. They shared that others seem “dismayed” that they gave birth on a holiday, expressed regrets for the child’s birth date, as if it was a bad thing.

I recall being at a birth on July 4th, and the baby was born about 30 minutes before the fireworks over the city were to happen.  The midwife and nurses turned off all the lights and we swung the mother’s bed completely toward the wall of windows, and the new family, and staff and I all watched the big fireworks show in silence, baby snuggled at mother’s breast.  I whispered in the baby’s ear later on, “Remember, these fireworks will always be to celebrate *your* special day!”

All the women I spoke to, who birthed on a holiday, made sure to comment and share that they felt it was important to have the baby pick its birth date, and be born when it is ready, even if that is a holiday. They all recognized what Lamaze speaks to when we share information in our Healthy Birth Practice, Let Labor Begin On Its Own.

The women all stated that they wanted to be sure that their child, born on a holiday, would always feel special and have celebrated, and not have their child’s birthday get lost in the shuffle of holiday celebrations.

“I was born on a holiday!”

I spoke with women who themselves were born on a holiday and they shared what it was like to have to share their birthday with a holiday that everyone was celebrating.  The folks who were born on Christmas or New Year’s shared that they frequently felt like their birthday got “overlooked” or “short shrift” in the celebrations of the season.  As a child, they often had to express their frustrations and share that they  needed their families to make their birthdays special, “If I was born in August, would you wrap my birthday gifts in Christmas wrapping?” said one woman.  Gifts often said “Merry Christmas and Happy Birthday.” One woman, born on New Year’s Day remarked; “At least I wasn’t born on Christmas!”

Many women who are born on other holidays, like Halloween or 4th of July, share that it was great fun growing up with that birthday date, and continues to be fun into adulthood.  One woman shared that being born on April Fool’s Day was not fun, and she got pranked a lot with empty boxes wrapped as presents and other jokes.  Not something she has enjoyed, and she shared; “I felt like my birthday was always a joke!”

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“I worked with birthing women on a holiday!”

I also spoke with health care providers, who shared that they enjoyed working on holidays, that facilities were often quiet, and low key, and the birthing families that they work with seemed extra appreciative of their support on the holiday.  They often wear a little something special to make things more festive, a Santa hat, or Halloween headband or an American flag on July 4th.  Sometimes, hospitals put something special on the meal tray, a flower or decorated cookie.  They are glad to be helping in any way they can.

Conclusion

I think that family and friends, and even the public makes a lot of comments to pregnant women who may find themselves likely birthing on a holiday, adding an extra layer of stress for these women, to what can already be a time period raw with emotion at the end of pregnancy. I am glad that these women are treated well by care providers.  None of the women who responded to my small, unscientific survey said that they felt pressure to induce to avoid a holiday birth date.

I think that as educators, we can stress that babies come when they come, and recognize the additional pressures that women may feel to birth or avoid birthing on a holiday date. We can provide tips on coping with holiday celebrations and plans when “very pregnant” and honor the emotions that some of the women may be experiencing.  Reassuring women that their babies know when to be born and helping them to prepare for however things unfold is a gift we can give to our students and clients.

Have you birthed on a holiday?  Were you born on a holiday?  Do you support birthing women and frequently work on a holiday.  Please share your experiences with all the readers in the comments and let us know what your experience was.  Is anyone waiting on a baby now? Do you expect to get called to a birth? Are you working in a hospital?  On call? Finally, a huge thank you to all the professionals who give up their holidays to support the new babies coming into the world.

Sharon Muza Babies, Childbirth Education, Healthy Birth Practices, Newborns, Science & Sensibility Childbirth Education, doulas, Healthy Birth Practices, Holidays, L&D Nurses, lactation consultants, midwives, newborns, obstetricians, Sharon Muza

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evilpeacock/3285516649/

Injoy Birth and Parenting Education is offering a free webinar titled “Secrets of a Postpartum Doula: Newborn Care and Soothing Techniques” taught by  Kimberly Bepler, IBCLC.

This webinar is scheduled for December 6, 2012, 1:30 pm (EST).  Some of the objectives of this webinar are to present:

• The latest evidence in newborn care
• Tips on teaching parents how to keep their babies happy and fulfill their innate needs
• Ways educators can become more baby-friendly and promote breastfeeding, while still supporting parents and giving them the competence (and confidence) to do their best
• New options for the care of infants

If you are a professional who works with expecting and new parents and their newborns in the classroom, or one on one, you may want to consider registering for this webinar event.  Learning effective methods of presenting evidence based information and interesting learning techniques is something that we all can brush oup on, no matter how long we have been working with new families.

Please consider joining the webinar and hearing what Kimberly will be sharing.

Click to to register and for more information. Please contact Injoy for all questions about this webinar.  Thank you.

Sharon Muza Babies, Childbirth Education, Continuing Education, Infant Attachment, Newborns, Parenting an Infant, Webinars Childbirth Education, Continuing Education, Injoy, newborns, Parenting an Infant, Webinars