GAS Infections (Group A Streptococcus) In Pregnancy

GAS Infections (Group A Streptococcus) In Pregnancy

GAS Infections (Group A Streptococcus) In Pregnancy

What is a GAS infection?
Group A Streptococcus is a bacterium which may be present in the throat, on the skin or within the anogenital tract (Anogenital tract name for the area including both the anus and genital tract which includes the external and internal sex organs in men and women). Although it can cause many infections some people carry Group A Streptococcus without any symptoms being observed.

GAS infections are spread through:
• close contact between individuals, through direct contact with mucus from the nose or throat of a person infected with the bacteria even if they have no symptoms of infection.
• contaminated objects

Group A Streptococcus (GAS Infections) have had peaks over recent years and there is currently an increase in cases, especially in children and young people. Children under the age of 4 are a big contributor in transmitting infections due to their close proximity to other children and adults.

Children often rely on adults for their hygiene, health & feeding needs, and therefore if you work with children, already have children in the home or have small children as part of your wider family network, then the infection risk increases.

Why am I at more Risk In Pregnancy?
Pregnancy reduces the body’s immune system and therefore it is much easier for you to acquire the infection.
Children are considered are a common source of infection transmission due to their higher rates of GAS infections in the throat.

* Hand washing. It is one of the most effective ways to protect against germs which cause infection and illness
* Covering your mouth and nose with a tissue when you cough or sneeze will prevent mucus droplets to become airborne and enable any germs to be disposed of.
* Avoid sharing bedding and eating utensils as viral and bacterial infections can be transmitted by direct contact as well as through mucus.

Good hand hygiene is the first step in avoiding GAS infections Knowing when to wash our hands and how to wash our hands is the key to protecting ourselves or reducing our risk of infection and illness!

Signs & Symptoms of illness associate with GAS infections
** Tonsillitis & Pharyngitis – sore throat, difficulty swallowing, red swollen tonsils.

** Impetigo – fluid filled blisters, itchy rash, breaks on the skin.

** Cellulitis – redness or swelling on areas on the skin which are warm to touch, pain in the affected area, pus/abscess in the affected area.

** Pneumonia – dry cough, wheezing, nausea/vomiting, aching muscles, chest pain.

When should I get help?

If you have an illness which is left untreated, such as those listed above, it can quickly develop into a severe infection called Sepsis. Sepsis requires early diagnosis and antibiotic treatment.
Signs of Sepsis include:
• High Temperature (38.0꙳C)
• Headache
• Chills and shivering
• Fast heartbeat (over 100 beats per minute)
• Severe Abdominal Pain
• Fast breathing, breathlessness
• Extreme sleepiness

Reducing Your Risk

In the Antenatal period
• Wash your hands with soap and water frequently as well as before/ after using the lavatory or changing pads
• Wash the vaginal area from front to back.
• Don’t share eating utensils, bedding or towels
• Avoid close contact with nose and mouth mucus, especially from children, example kissing – kiss on the forehead instead.

Following Birth
• Washing hands with soap and water before/ after using the lavatory and when changing sanitary towels.
• Contamination of the perineum can occur when a woman has a sore throat or upper respiratory infection as the organism may be transferred from the throat or nose via her hands to her perineum. Washing hands before/ after using the lavatory or changing sanitary towels.
• Keep wound areas clean

You MAY BE at an increased risk if you have:
1. A raised BMI (>30)
2. Impaired immunity
3. Anemia
4. Increased vaginal discharge
5. History of pelvic or GBS infections
6. Had any antenatal Invasive procedures such as amniocentesis
7. GAS in contacts or other close family members – especially children
8. You work in close contact with children
9. Minority ethnic groups
10. Diabetics
11. Your waters have broken for over 24 hours.
12. Vaginal trauma/ Caesarean section/ wound issues
13. Any retained placenta following delivery

This information is not for diagnostic purposes but rather to provide information for you to seek further advice and assessment especially if you feel may have any signs or symptoms of illness.
If you feel this is so please contact your GP or Midwife

Caesarean Section – Part 2: What will happen If I CHOOSE or NEED this procedure

Caesarean Section – Part 2: What will happen If I CHOOSE or NEED this procedure

Having spoken to many women about their birth choices, one of the issues they experience time and again is actually not knowing or understanding what happens when they need to have or choose to have a caesarean section! This isn’t from the point of the actual procedure, because almost all the women have some awareness that the baby is coming out of their tummy rather than their nether regions! No, this is from the perspective of when they have made the decision – what happens next?

Emergency Caesarean

If you have laboured and at some point during your labour it is discussed with you to opt for a caesarean section, there are a lot of decisions and small changes that take place to get you ready to meet your baby. As this is often a bit of rush, mainly because of the need to deliver the baby, often women feel they haven’t had all the necessary information.

So, following this discussion (including any risks and benefits to you and baby), the midwife will offer to help you change into a hospital gown. This is so there is free access to your back to permit an anaesthetist to perform a procedure called a spinal anaesthetic. However, you will only need this if you haven’t already got a form of pain relief called an epidural. If you have this, then this is used and converted to a spinal administer the medication for the caesarean.

If you haven’t got an epidural, this is usually done in the theatre (this procedure is covered in another blog).
You will, in most cases, be asked to have a catheter inserted into your urethra (where you pee). This is to empty your bladder and keep it empty so that the bladder doesn’t fill. The reason this is important is because if your bladder is full it rises just above the bony part of your pelvis at the front (called the symphysis pubis) and it is possible that the sharp scalpel can cut the bladder if it is full. Some hospitals will empty the bladder using a catheter which is not left in place, and if you have a preference you can ask for either if it is important to you. In addition you will be read a list of risks for the procedure of the caesarean and asked to sign a consent form. You will also be fitted for a pair of compression stockings which will be put on for you, and given an ant-acid to remove any acid from the stomach.

In an emergency it feels very scary and fast paced to get to theatre. In some cases there may not be time to do any spinal and as such you may need to have a general anaesthetic (where you are put to sleep for the procedure). But this is avoided as much as possible and so you can meet your baby as soon as possible.
An elective Caesarean Section

If you have decided to choose to have your baby by caesarean section it is often referred to as an elective caesarean section. At around 37 weeks you will be given a date for your caesarean, usually by your obstetrician or via your midwife, which will also require another date (slightly earlier) for something called a pre-op. This ‘pre-op’ is to a pre-operative appointment in which you will be asked to attend to go through what happens on the day of your caesarean. At this appointment the staff will take bloods, go through your notes with you, discuss the consent form (which you will be asked to sign on the day of your caesarean section) and in some cases you will be given an antacid tablet for you to take on the morning of your caesarean before you arrive at the hospital. The staff will go through when you should last eat and drink the night before and give you any information in relation to your individual needs.

On the Day

You will be asked to come in and shown to your bed on the ward. This may or may not be where you will be after your caesarean. You will be given a gown and some compression stockings (unless the hospital use an electric device which effectively inflates and deflates acting similar to the stockings) and talked through the procedure of the spinal anaesthetic. You will meet the anaesthetist and the Obstetrician performing the caesarean section. They will repeat all the information to make sure you are happy and if not already signed, ask you to sign the consent form for the procedure (there are variances in different regions and this pertains to the UK – it may be different in other countries, in which case I would love to know what these are).

Your partner will be given a set of scrubs (a top and bottom usually worn in theatre). I would advise that partners don’t wear anything except underwear under these as it can get hot in the theatres with all the people and lights and is often the reason partners faint!

It is possible to have a playlist playing in theatre, so ask at your pre-op appointment or on the day if this is important to you.

When it is your time, you and your partner will be escorted to theatre. You will also need to take clothes for your baby and possibly a nappy. I would recommend not taking your best outfit or the outfit you want to show your baby off in as baby may pee on this or there may be a bit of fluid/blood that could get onto them. Your partner may be asked to sit outside the theatre until after the spinal has been put into your back and is working. You will be supported by your midwife, but if you would like your partner to hold your hand, just ask. I have been in many different hospitals whereby both of these are carried out (again variances in regions).

If you would like have skin to skin with your baby in the theatre, let the staff know at this point. In some areas they don’t do this, and often it is because of risk of something happening such as you as the mum not being able to move much to make sure the baby is able to breath through the nostrils, however, show your awareness and ask your partner to make sure the baby’s head is turned to the side and keep a watch. Sometimes women can feel sick and ask that the partner perform skin to skin (it is their baby too). Either way, get this crucial part of building baby’s immune system started and request this to happen – optimise your birth.

Back to having the spinal in ….., you will then be assisted to lay flat on your back and tilted slightly to the left side on the theatre bed. There will be lots of staff – a couple of nurses, your midwife, perhaps a student midwife, the anaesthetist, a health care assistant, and two doctors. So before everyone enters the room you can ask the midwife to catheterise you (which is usual in elective caesarean sections – although you can ask to have an in/out catheter performed). Once this is complete, you will have surgical fluid rubbed across your abdomen with a sponge to remove any bacteria and keep the procedure sterile. When dry a drape will be applied. And then the doctors will check that you can’t feel anything. Once this is confirmed they will begin.

The caesarean should feel sensations of pushing and pulling but no pain. In a few moments your baby will emerge. Usually once the baby is born, the time is recorded and the baby is placed either into a sterile drape over a cot or handed to the midwife. The baby is then taken to a specific area to be dried, have the cord shortened using cord clamps – and if your partner would like to cut the cord this can be done here which is similar to cutting the cord in a non-operative delivery. Then the nappy is put on. If you have opted to have vitamin K by injection, this may well be given here. Although I used to wait until in recovery when the baby was feeding (feeding stimulates endorphins which are natural pain relief hormones for baby, so it is kinder to give the injection at this time). Then the baby will be left unwrapped and given to you under the drape for skin to skin, or your partner to go under the scrubs for skin to skin.

At this time the doctors will deliver your placenta and stitch up the areas. When finished you will be transferred to another bed and moved to the recovery room to continue observations and so you can feed your baby.
Once the recovery nurse is happy that your observations (blood pressure, temperature, heart rate, respiratory rate) are all stable, you will be transferred to the ward. Your baby can remain in skin to skin even at this point. This is important because skin to skin helps to regulate the baby’s temperature, heart rate and breathing and kick starts their immune system from the microscopic bacteria on your skin. Baby’s who are born vaginally have this kick start from bacteria in the vagina.

Over the next few hours you may notice that your baby seems a bit mucusy because the fluid in the lungs hasn’t been squeezed out like a baby that has been born vaginally, and it is important to reassure you that this is normal and happens in almost all baby’s born by caesarean section.

Please be aware there will be regional/geographical differences in this

If you would like to discuss your birth options, create a bespoke birth plan, or book onto my birth preparation package contact me using my email [email protected] or visit my facebook page @naturalpregnancyandbirth

Caesarean Section: Part 1

Caesarean Section: Part 1

April is Caesarean Section Month

So I thought I would do a series of blogs to help you understand a little bit more about your body and perhaps help you to make any decisions about the type of birth that is right for you.

So where do we start?

Well, let me ask you a question – If I asked you ‘How would you like to give birth to your baby?’. Would you have an answer for me? An answer which is based on your understanding of your genetic history and your body – Or would your answer be that which I typically hear all the time –

‘Whatever the Dr says is best, I just want what is best for me and my baby’

I have worked as a midwife in the theatres supporting women and their partners to welcome their babies into the world for elective as well as emergency caesarean sections. As a community midwife I have supported women who have opted to have a caesarean birth over vaginal delivery for reasons unique to them. Fundamentally, the important aspects for women and their partners is information and knowledge. Many women don’t know that it is a choice, but they don’t also know that there are certain times when the choice becomes necessity due to a cascade of medical interventions!

The World Health Organisation (2015) states Caesarean sections are effective in saving maternal and infant lives, but only when they are required for medically indicated reasons.

They recommend caesarean rates should be at population level, however rates above 10% is NOT associated with reductions in maternal and newborn mortality rates. However, it is important to note here that these figures are in consideration of when there are medically presented issues where the mother and or baby risk and do not take into account the psychological impact of issues such as Post Traumatic Stress Disorder (PTSD), tokophobia (an extreme fear of giving birth) or previous abuse.

While a caesarean section can be an essential and lifesaving surgery, it can put women and babies at unnecessary risk of short- and long-term health problems if performed when there is not medical need. To put this in context, in the UK many regions average a caesarean section rate of 30%, with some reaching 50%. So, even if you are planning to have a vaginal birth, it may be a possibility that you could end up with a caesarean section.

Therefore, women need information and to plan for the birth they want, which MUST include OPTIONS when your baby or your body decides not to follow natures plan! Women plan for everything else like a wedding – so with so much at stake, why don’t women plan for birth?

So, with this in mind let me ask you another question –

Do you know how labour works and what parts of the body you need to ensure successful birth?

This may seem a strange set of questions, but there is more to it than hormones and contractions. You may find that there is something preventing you having a vaginal birth so you may not ‘choose’ to have a caesarean section, it is more that is has been chosen for you – which may bring fear of the procedure or the unknown of the procedure.

You may find you have one of the four ‘true’ pelvis’ (Stables & Ranking, 2010). YES that is right – pelvis’ can be shaped differently (See below).
In the UK pelvic imagery isn’t something we use to determine the shape in women having their first baby, or for a woman having a second or subsequent baby seeking VBAC (vaginal birth after caesarean section) who may then go on to have another caesarean section if vaginal birth doesn’t occur.

Then there is the uterus itself – there are deviations such as bicornate uterus or uterine bands which may prevent you having a vaginal birth.

In addition you may have a placenta which lies low in the uterus covering the internal part of the cervix (the opening where baby comes through and referred to by midwives and obstetricians as the OS) which also means you will need to have a caesarean section.

So you see – you may not have a choice, due to some of these factors. However, If you opt to have a caesarean section, it is important to remember that labour is controlled by hormones, so obviously these hormones won’t play a part in the labour itself, and this can include to initiate milk if you wish to breastfeed.

There are things you can do to prepare for this – which I advise all my clients from 37 weeks. This is called milk harvesting and collects colostrum which you can feed to your baby and which will help you in the early days following your baby’s birth.

You may have reasons other than physical ones to have a caesarean section such as a previous traumatic delivery, so you want to avoid a vaginal delivery. Sometimes, it is due to past experiences that you are worried will bring things up for you and which you want to avoid.

I have helped many women overcome these issues using treatments through complementary therapies such as hypnotherapy for PTSD symptoms and pain management, as well as managing anxiety and fear of surgery, so they feel they have choices.

If you would like to find out more about my packages please contact me via email at: [email protected] or alternatively join my free private Facebook Community, the link is here, I would love to see you there.

How to Maximise your Chances of Conception

How to Maximise your Chances of Conception

Top 5 Things to consider when trying to CONCEIVE.

CONCEPTION is it really as simple as Women have eggs and Men have sperm … and all they need to do is meet up and “hey presto …… a positive pregnancy test”

NO! Absolute NOT.

So what seems to be the problem?

Well, unfortunately, in our medical world women are being conditioned into thinking their bodies are defunct, no good, unable to get pregnant, stay pregnant and then actually give birth having gone through this already very stressful journey!!

There are some really key factors that every woman should know about fertility and becoming pregnant. These are:
1. Know your menstruation and what happens during the month and whether you are actually Ovulating
2. Nutrition and supplements – what are you feeding your body and does this support you in your journey to parenthood
3. Find a fertility coach – those who have had coaches specific to their fertility have had enormous and invaluable emotional support & focus to navigate the additional stress and strain that conditioned infertility can have on a woman and their relationships.
4. Acupuncture is a complementary therapy which can help to balance the body from the inside out with an established body of evidence to support its use in fertility, conception and when embarking on Assisted Reproduction Therapies (ART) such as IUI and IVF.
5. Hypnotherapy. Alongside fertility coaching and acupuncture this therapy really connects the mind to the body helping to reduce stress and dive deep into the emotional abyss that contains all the elements which may be preventing pregnancy without you actually realising.

So lets take each of these things one by one:

Every month a woman will tend to ride the menstruation and ovulation rollercoaster. Hormones are a big player here and when all is well you will have a period and then ovulate (release an egg). And if your timing is right, you will have made love to your partner and the sperm will have fertilised the egg. A couple of weeks later you will miss your period and take a pregnancy test which will confirm you are pregnant.

So what can be the issues with ovulation and menstruation?

Well, first and foremost are you actually having a period? If not then there is no lining in the womb (uterus) to enable the fertilised egg to implant. If you have got to this stage then are you ovulating? Is the ovary releasing an egg to be fertilised?

When there are physical diagnosis, this doesn’t necessarily mean that you can’t get pregnant – it means your body is out of balance somewhere. Diagnosis can be fore example, medical tests which indicate high FSH levels, endometriosis, PCOS, Issues with the thyroid, digestive system. Some women are actually made to feel too old and therefore their body clock is ticking which deems their body incapable to naturally conceiving. Some women have had a baby before but are now struggling to conceive.

In addition, could it be that the sperm quality or motility a potential barrier? Are you a same sex couple looking at ART, and attempts are failing on transfer?

So many variables it may be that there may be more than one. But the good news is that it is possible to identify and work in this area to understand what is happing each month.

Nutrition & Supplements:

We live in a society where diet is full of processed foods. We don’t really understand the micro/macro nutrients our bodies need in order to function to the best of its ability.

One of the most important parts of the diet is to take from foods or supplements the nutrients our bodies need but can’t make or can’t get enough. This is why all adults should take a vitamin D supplement and in addition those trying to conceive – folic acid.

However, did you know that our diets have omega 6’s in them. Omega 6 is required for the body but if you have too much it can lead to inflammation in the body and create a harder membrane around our cells making it very difficult for the cells to pass things in and out of themselves that they need. To overcome this your Omega6 should be balanced with your Omega3 in a 3:1 ration. There is growing evidence which supports the use of Omega3 in fertility and conception. I use this Omega3 with my clients following a blind dry blood spot test to determine initial parameters which we then retest (again blinded) to see and understand how the body reacts when the Omega’s are balanced.

There is also gut health to improved the microbiome and optimise absorption of the nutrients and all of these are vital to enhancing the environment ready to conceive a baby.

A Fertility Coach:

Helps to support those struggling to conceive, through the emotional times of the month when your period appears – YET AGAIN, or when there are life stressors which impact on you emotionally, be it family, work, partner or another cycle of ARTs when your emotions are at an all time high and your positivity at an all time low.
You may worry about loss if you have experienced miscarriage or stillbirth. You may have taken on board the worries of healthcare professionals relating to your age, You may not be able to look to the future due to the journey so far. You may wonder if you will ever be able to conceive or if there has been a life disruption or disharmony that you need to talk through to help you relax and bring back positivity.

Just having someone to work through the issues, understand and be empathetic to your situation and help guide you through it which aligns to your way of doing things. Supporting your emotional and mental wellbeing.


This is a recognised therapy which uses fine needles which are inserted into points on the body. Each point is located on an energy channel (also called meridians) to establish Qi (pronounced ‘chee’). Qi may need to be balanced so when using the points the needles cause the body to react by sending natural endorphins to the site allowing the body to self-heal and reinstate natural balance within the body.

There is a wealth of studies and research material which underpins and supports the use of acupuncture in the area of women’s health and especially fertility and conception. I use acupuncture in my practice to enhance the parenthood journey and alleviate many issues in the body which present as pain and disharmony.


What it is not – it is NOT about you NOT being in control!. Many people, when hypnotherapy is suggested, think of the days of people being on stage succumbing to the tasks the hypnotherapist tells them to do – to make an example or fool out of them.

WHAT IT IS – It is a therapy which helps you to obtain a very deep state of relaxation and engage your subconscious mind (where all your thoughts and habits are contained) and to work with part of your mental wellbeing to help you deal with the emotions you experience and process the things that are stopping your body conceiving.

This may not sound logical but your thinking brain only engages 5% of what happens in a day – everything else is done subconsciously. If you imagine your body like a computer and your brain like the processing centre which continually does all the background checks regardless of what your do. For example, lets say you intend to drive to somewhere, half way through your drive you realise you have taken the route you take every day to work/school/visit a friend or relative. Well that is because your brain has stored the route in your subconscious. You may also not remember the exact details of this journey on this day. This is because you are in a trance and your body operates in auto-pilot.

So why is this important to know. Well because if you have unprocessed emotional and mental wellbeing issues, your body will respond to these on a subconscious level. For example, if you have had the seed that your body clock is ticking and you are advancing past 35 you may think you can’t conceive. Add on the career you have built and the doubt you will be able to manage being a parent with a career and what happens? Well there is evidence to suggest that your body will subconsciously stop you conceiving by using your hormones to prevent ovulation or by contracting the fallopian tubes to prevent fertilisation. Your body is amazing and it is important that you don’t underestimate it.

Why Work with ME?

As a trained midwife, I am able to fully support and immerse myself in your world. I understand the physical, emotional and mental toll this has on you and for you. The fear, the grief, the blame, the shame and the longing to be a parent.

I understand how the physical body works and adapts from menstruation and conception, through pregnancy and loss all the way through to birth and trauma. This allows me to support you on a deeper level. I work with you through my coaching and hypnotherapy training to employ my refined skills in this area. Teaching you what is happening and empowering you to be strong and positive through your journey.

If you are close enough to me I also perform acupuncture, but can also advise on what working with an acupuncturist in your area can bring to your journey

email: [email protected] for further information or to book a 1-2-1 discovery call.

Women need to plan for pregnancy like they are planning their wedding!

Women need to plan for pregnancy like they are planning their wedding!

Why should you prepare for pregnancy?

Many couples have contacted me with issues around conceiving and fertility – none of whom have considered their diet and lifestyle and how this is a major factor in optimising conception, and something I will soon be offering advice and treatment on.

But for now, as a community midwife I meet women who have come to my clinic to let me know they are pregnant. Some of these women have tried for months to get pregnant, others have just started trying to conceive. However, it always strikes me that very few women prepare their body to enhance their pregnancy and reduce their risks and anxieties around growing a human being. This process is very intricate and complex.

Much like planning a major event in your life, much time and attention to detail will be required. If you think of a wedding or a holiday – we don’t just find ourselves suddenly in these situations, we carefully consider venue, transport, clothing, pre-preparation, diet etc etc. So why do women not apply the same consideration to pregnancy?

Initially planning should include folic acid which is a type of B Vitamin. This helps with the production and maintenance of cells in your body and supporting a pregnancy. I rarely find a woman who has commenced the minimum recommended dose of folic acid pre-pregnancy. The majority of women, I would estimate to be around 95% or more think about it or commence it once they have a positive diagnosis of pregnancy through a pregnancy test. For those requiring a higher dose of 5mg, which requires a prescription from your GP and is recommended if you have any of the following:

• BMI above 35
• had a previous pregnancy and the baby has had a neural tube defect
• are taking anti-epileptic medication
• are diabetic
• you or the biological father have a neural tube condition or a family history of neural tube condition

Many women meet their midwife at around 6-10 weeks of pregnancy. Folic acid is only required for the first 12 weeks, therefore it is possible that the benefits of taking folic acid have been missed!

Research shows taking the correct dose of folic acid can significantly reduce neural tube defects (NTD) which are defects of the brain, spine, or spinal cord. These are formed in the first month of pregnancy, often before women are aware they are pregnant, hence the importance of preparing for pregnancy.

Spina bifida and anencephaly are the two most common NTDs, although there are others. With Spina bifida, the baby’s spinal column doesn’t close completely usually resulting in nerve damage causing some paralysis of the legs. In anencephaly, most of the brain and skull do not develop. These are usually permanent and non-curable.

Your diet can contribute to folic acid intake, however, it is unlikely you will be able to consume the recommended minimum daily requirement, let alone the higher dose. But preparing well for pregnancy and increasing foods which contain folic acid will help to reduce the chance of your baby having a NTD. These foods include:

• The legumes
• whole grains
• fruits (particularly citrus)
• vegetables (especially asparagus, brussels sprouts, and dark leafy greens)
• breakfast cereals fortified with folic acid.

So please, please ladies, plan to take your folic acid 🙂

Pin It on Pinterest