Meeting the Challenge of Infection
Prenatal infection can threaten both mother and baby. The most effective approach a midwife should take will strive for prevention and foster radiant health, which increases overall resistance to disease. Pregnant women should be encouraged to maintain these basic habits:
1. Drink abundant pure water, which provides a medium for removal of metabolic waste. Encourage moms to drink prior to and beyond thirst.
2. Regular fresh-air exercise keeps tissues oxygenated and circulates immunological factors throughout the body. It decreases anxiety, increases energy, and elevates mood. Positive emotions are emerging as one of our most powerful infection fighters.
3. Consistent intake of fresh, minimally processed food, including fiber and ample protein in an easily digested form, is imperative. I emphasize fresh vegetables, whole grains, plant- and sea-based proteins, then fruit, in that order. Delayed intestinal transit time, reduced stomach acids, and diluted enzymes make items like red meat a tough proposition.
4. Top quality supplements, with plenty of vitamin C, bioflavinoids, and minerals, are a must. Ask your client at each visit how she is doing with supplements: Can she swallow them? When does she take them? How many is she taking? Are they staying down? Suggest taking them in the evening, never on an empty stomach, followed by a few bites of food.
5. Intervene early, before a minor infection turns ugly. This requires careful surveillance. Allow plenty of time for prenatal visits. Pay close attention. Get all the details if something doesn't seem right. -Judy Edmunds, condensed and excerpted from "Wholistically Meeting the Challenge of Infection," The Birthkit Issue No. 14, a Midwifery Today publication
Food-Borne Hazards
Certain organisms that exist in food are known to cause late miscarriages, stillbirth and premature labor. The main known dangerous organisms are listeria, a bacteria, and toxoplasma gondii, a parasitic organism. Listeriosis is usually contracted from meat and dairy products, especially soft-ripened cheeses; cook-chilled, ready-to-eat poultry; pate and other cook-chilled meals. The listeria bacteria is unusual in that it can multiply at the temperature of most refrigerators.
Pregnant women should avoid soft-ripened cheeses such as Camembert, Brie, and blue-veined types, whether made from pasteurized or unpasteurized milk. Ready-cooked poultry should be thoroughly heated. Raw foods and cheeses should be stored away from other foods in the refrigerator. Food should not be reheated more than once, and if reheated, should be heated all the way through. Food that is reheated in the microwave should be allowed to stand as directed by the oven manufacturer.
Toxoplasmosis can cause serious or fatal problems to a baby during pregnancy. To avoid them, pregnant women are advised to wear gloves when changing cat litter trays and while gardening; to wash their hands after changing litter, after gardening and after handling raw meat; and to wash fruit and vegetables thoroughly before eating.
Tests for toxoplasmosis can be carried out during pregnancy to find out whether the mother and baby have been infected. Antibiotics are used to combat the organism, and although damage that has been done cannot be reversed, the baby can be protected from further damage. -When a Baby Dies, by Nancy Kohner & Alix Henley, Thorsons, 1997
Listeriosis and Toxoplasmosis
Listeriosis first presents as a mild infection with upper respiratory complaints, fever and nausea, with occasional severe systemic illness. Within a few days, an intrauterine infection develops with fever, a high white blood count and the onset of labor. Listeria may remain in the mother's genital tract for several weeks after birth.
Diagnosis depends on bacterial culture from tissue or body fluid. Blood antibody tests are not widely available.
Early onset of the disease in the newborn produces classic Granulomatosis infantiseptica, a diffuse sepsis with lung, liver and nervous system complications. These babies are most often premature and have congenital pneumonia with a rash and an enlarged liver and spleen. Mortality rate is around 90 percent. Late onset neonatal listeriosis presents as meningitis. Up to 40 percent die. Those that don't frequently have hydrocephalus and mental retardation.
Adult symptoms of toxoplasmosis gondii are mild and cold-like with swollen glands, muscle and joint pain and fatigue. Those with normal immune systems recover rapidly and develop antibodies; those with suppressed immune systems often die. Maternal recovery is excellent and treatment is not usually recommended since the drugs used may be harmful to the fetus. Only the acute infection can be transmitted to the fetus. This may cause hydrocephaly or microcephaly, jaundice, convulsions, vomiting, diarrhea, a rash, fever or hypothermia. Eye problems, the most common symptom, may appear at birth or in the first weeks or months of life. Isolation is not necessary as the organism does not shed.
A modified indirect fluorescent antibody (IFA) test can be done to distinguish acute neonatal infection from passive antibody transfer due to prior maternal infection. A true positive establishes infection. However, 50 percent of newborns with obvious problems may have negative results. If infection occurred at or near term, the baby will be born antibody negative, with antibodies appearing sometime during the neonatal period. -Anne Frye, Understanding Diagnostic Tests in the Childbearing Year 4th ed., 1997.
Reprinted from Midwifery Today E-News (Vol 1 Issue 15, Apr 9, 1999)
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