Preggie Pals
Common Bacterial Infections in Pregnancy

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Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.
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DOCTOR JAN PENVOSE-YI: You may have noticed signs of an infection in your pregnancy or you may hope to prevent future infections. How infections diagnosed and treated in pregnancy? And can these infections post risk to mom or baby? I’m Doctor Jan Penvose-Yi , board certified OBGYN and today we are discussing common infections in pregnancy. This is Preggie Pals.

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STEPHANIE GLOVER: Welcome to Preggie Pals, broadcasting from the birth education centre of San Diego. Preggie Pals is your online on-the-go support group for expecting parents, and those hoping to become pregnant. I’m your host, Stephanie Glover. Thanks to all of our loyal listeners who have joined the Preggie Pals club.

Our members get special episodes, bonus content after each new show plus special give aways and discounts. See our website for more information. Another way for you to stay connected is by downloading our free Preggie Pals app available in the Android, iTunes and Windows marketplaces. Sunny our producer is now going to give us some information about the virtual panelist program.

SUNNY GAULT: Yes. So, our virtual panellist program is for everyone out there that you may not be able to make in into the studio or perhaps you live further away. And it’s a great way for you guys to participate in the conversation. So, I’m going to be posting some stuff online through our Facebook account.

There’s Twitter as well. I’ll be using #preggiepalsvp, the VP stands for virtual panellist. I’ll ask you guys some questions, some of the same questions our panellist in the studio are talking about. It’s another great way for you to ask our expert questions. So, we usually try to post these questions in advance prior to the taping to give you guys an opportunity to be part of our conversation. So, there you go

STEPHANIE GLOVER: Great. Thank you Sunny

SUNNY GAULT: Yep

STEPHANIE GLOVER: So we’ll go ahead and go around the table and introduce ourselves here. Again I’m Stephanie Glover. I’m thirty two. I am a stay at home mom, host of Preggie Pals and a trans childbirth educator. No due date but I do have two little girls. Gretchen is three and Lydia is almost fifteen months. My first was a caesarean and my second a VBAC

AMY DUGAN: Oh hi. Hi guys it’s Amy Dugan here. My name is Amy Dugan. I’m thirty three years old. I am a home school and stay at home mom. And I have two little girls, one and a half and five and a half and no due date because I am not currently expecting a child

KRISTEN STRATON: Hi I’m Kristen Straton. I am a birth and postpartum doula. I’m also the mother of three ages five, three and sixteen months

SUNNY GAULT: And I’m Sunny. I’m producing today’s show but I’m also the owner of new mommy media which produces this show as well as parent savers, the boob group and twin talks. I have four kids of my own, they are all under age four, four and under I guess I should say. And my oldest is four, my middle guy is two and then I have twin girls who are about to turn one

STEPHANIE GLOVER: Awesome. Thank you. And Doctor Jan Penvose-Yi, we’ll go ahead and include you in the introductions since you’re also a mommy. If you could tell us just a little bit about your family

DOCTOR JAN PENVOSE-YI: I’ve got three kids I love and my oldest, Abigail is fifteen. And Catherine is ten and Ethan is six years old. Keeping me on my toes

STEPHANIE GLOVER: Great. Thank you

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STEPHANIE GLOVER: Today we’re just going to be reviewing an app that is actually pretty pertinent to conceiving or just tracking your menstrual cycle. So, it’s called menstruation and ovulation calendar. And I have the version three. It is free but there’s also like a full paid version. So just have the free app but everyone loves free.
So, basically this app kind of gives you a calendar format and you can just click on the day and within that it gives you options so it, you can hit yes or no if it’s a menstruation day. Yes or no if you took a pill, if you’ve had intercourse, you can enter notes just to kind of have to refer back on. If you’re doing like the basal body temperature you can input your temperature and then there are other categories such as making notes or kind of grading on a scale for abdominal pain, vaginal discharge, headache and bleeding.
And I actually use this app after I gave birth to my first child just to track my postpartum periods because they were just a little, you know, wonky at first and you didn’t really have like a regular cycle or was like the same number of days every cycle. So, I tracked it for several months then we were ready to try to conceive. I went back, well we tried for a couple of months and nothing was happening and then I realized this app doesn’t calculate your cycle length for you so you actually have to input that manually. And the, I just had to kind of average it. I was just a couple of days off, I didn’t do my math correctly. So once I did my math, then I inputted my cycle length and it’ll show you what days you’re likely ovulating and really likely ovulating you know and so just kind of shows you like one O, two O’s or three O’s to just kind of help you if you’re trying to conceive so

SUNNY GAULT: Or if you’re trying to not conceive

STEPHANIE GLOVER: Or if you just need to track like other things you know.

DOCTOR JAN PENVOSE-YI: Natural family planning yeah

STEPHANIE GLOVER: Yeah, I mean, I remember I could even track because when I’m pregnant, I’m a vivid dreamer anyway but I get really crazy. So you know I would use notes and be like had some crazy dreams or I think I had implantation bleeding you know and then I could refer back and do some math and see if that’s actually what it was so

SUNNY GAULT: I like the app, you know I like apps that are very simple. And this seems to be you know, you open it up and there’s a calendar and then you just click on the dates so I like that. And then it kind of gives you you’re options from there. It does look like you can upgrade like it ask me when I first logged in, you know, do you wanted to change the colour of the screen, what’s your secondary colour, I’m like, what do you mean here. So that was, that was kind of a little, a little strange but yeah it seems getting in I was just doing the math, I don’t know if this is TMI but I missed a year out and I still haven’t had my period yet. So this is actually breastfeeding. Thank you breastfeeding! But this is something that you know I’m up keeping, I’m expecting it to come, you know and so maybe I’ll just start using this you know when that flow shows up again and kind of, because you’re right the postpartum period is a really weird.

STEPHANIE GLOVER: Yeah it can just take a while. Yes with breastfeeding. And then it’s nice too because once you, like if you look at this from the calendar view instead of going into the details of the day, it’ll show you if you’ve made certain notes. So at a glance you can see that, like the pink days are the days that I was on my period and you can see that I have maybe notes for those days and I could look in for more so

SUNNY GAULT: Oh nice okay

STEPHANIE GLOVER: Yeah

SUNNY GAULT: So it kind of gives you an overview when you look at the calendar

STEPHANIE GLOVER: Yeah. So I’m sure there are fancier apps out there but, I mean I give this a thumbs up. It’s worked for me so

SUNNY GAULT: And it’s free

STEPHANIE GLOVER: And it’s free

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STEPHANIE GLOVER: Today we are learning all about the most common infections in pregnancy. Joining us here in the studio is Doctor Jan Penvose-Yi. Welcome to Preggie Pals again Jan

DOCTOR JAN PENVOSE-YI: Great to be back

STEPHANIE GLOVER: So let’s start with, we are going to go through some just really common basic infections that women experience. So let’s start with the good ol’ yeast infection

SUNNY GAULT: Good old

STEPHANIE GLOVER: I mean who doesn’t love talking about yeast infections right

DOCTOR JAN PENVOSE-YI: I love to talk about yeast infections

STEPHANIE GLOVER: So can you tell us what a yeast infection is?

DOCTOR JAN PENVOSE-YI: So, basically we are going to use, we are going to use the real terms which I do with all my kids which they hate but your vagina is full of normal healthy bacteria and some yeast. And so an infection is one of those bacteria either doesn’t belong or a yeast that doesn’t belong or it overgrows, one that belongs there but then it overgrows. And so some of us can carry a little bit of an overgrowth, just kind of a carrier but some of us have the overgrowth to the point that it’s an infection. It’s causing problems. So, typically yeast infection is an overgrowth of the candida usually, it’s a type that we talk about and it’s causing you problems. It’s causing itching, it’s causing burning. Not everybody gets discharge, that’s a misconception that a lot of people have “oh I should have this thick white cottage cheese discharge” Well not so true.
Some people just get the inflammation and even swelling of the labia and or they can have like a thin tan white watery discharge. So everybody’s different and that’s typically from the inflammation that’s happening that watery discharge that we get

STEPHANIE GLOVER: Okay and is it, are some people just more prone than others or is there an actual cause for..

DOCTOR JAN PENVOSE-YI: Truly yeah there can be even genetic factors. Some people are just more prone to them. People who are diabetic and aren’t controlling their blood sugars really well they are more prone to it. And truly some physical factors such as, you know, you’re hot and moist down there a lot and you sweat more stockings, certain party-liners or that you wear a lot. Things like that can cause problems for you too. And that you know, and people who are immune supress. People who have HIV, who have immune suppression from drugs or taking for other illnesses they can be more prone to an overgrowth happening and imbalance.

STEPHANIE GLOVER: Okay and even taking antibiotics sometimes too

DOCTOR JAN PENVOSE-YI: That’s a classic, classic reason for it and some people are very prone to it. Some people could take you know three weeks of antibiotics and not have a problem. Again there’s probably that genetic factor. Where some other women, you know take a five day course or something and there it is

STEPHANIE GLOVER: And can pregnancy make you more prone to getting that or

DOCTOR JAN PENVOSE-YI: Absolutely because oestrogen’s another trigger for it. So certain birth control pills especially the higher oestrogen pills can change the floor down there. And pregnancy is a state of high oestrogen and there you go

SUNNY GAULT: So I have a question about oestrogens. So, if you’re pregnant and you know you’re having a baby girl, that’s oestrogen for the baby but can that actually increase I mean there’s technically more oestrogen period, right?

DOCTOR JAN PENVOSE-YI: Correct

SUNNY GAULT: Okay does that

DOCTOR JAN PENVOSE-YI: That’s a good question that we don’t have an answer for. I thought about it. Honestly I’ve thought about that before because you know the whole, this is kind of off track, but birth control pills for example we now know that it’s okay I got pregnant on my birth control and I kept taking it till I didn’t get my period and is that more risky for a male foetus for example because you’re taking oestrogen, there’s I don’t have an answer for that. But it’s really thoughtful and I think of it but I haven’t ever really found an answer for that, probably not. Not enough of a level for the little peanut in there especially early in the pregnancy but

STEPHANIE GLOVER: Well and I mean hormones aside, I remember my cousin, she told me in my first pregnancy she’s like I have one word to describe pregnancy and it’s moist. And I’m like

DOCTOR JAN PENVOSE-YI: Yeah

AMY DUGAN: Yeah. You get to know your body’s in ways you never thought you would.

STEPHANIE GLOVER: Right

KIRSTEN STRATON: Accurate

DOCTOR JAN PENVOSE-YI: It’s a great way to describe it because some people weren’t moist before

SUNNY GAULT: Yeah

DOCTOR JAN PENVOSE-YI: Some people are. So they think something’s seriously wrong with them till they’ve gone through a pregnancy and

STEPHANIE GLOVER: Yeah

SUNNY GAULT: Right

DOCTOR JAN PENVOSE-YI: And then you get the corolle postpartum or you’re dry

SUNNY GAULT: Right

DOCTOR JAN PENVOSE-YI: And you are the breastfeeding, you know. . .

SUNNY GAULT: Right

STEPHANIE GLOVER: Definitely. And so, how, you mentioned there are different types of symptoms so what usually causes a woman to go and you said to scratching or discharge and then how would, how would a provider say you know, yes this is yeast infection or

DOCTOR JAN PENVOSE-YI: Right. So we want to do an exam, first of all, you know. First of all you get the history and the history’s always very important. So you want to find out are there other things going on because there’s other infections we’ll talk about later. You know are there other products as someone’s using, have they change what they’re doing, have they changed their underwear, have they changed their panty-liners, all of that kind of stuff. You want to ask them if something’s changed. So history’s super, super duper important and have they had these before? Are they somebody who’s familiar with it? Do they know their body? You know, its incidental but sometimes they’ll say my mom always had problems, she tells me I’ve got the yeast infection. So we want to, you know first to go get the history and then we are going to take a look and absolutely we’re looking for swelling, redness, sometimes to what we call a fissure or looks like someone scratched on there. And it may be from scratching itself or just the irritation’s really erodes the skin.

Then we look inside the vagina and we take a look at is there the discharge and is there’s the same kind of effects inside. And what we can do if we see the discharge or not even see that classic cottage cheese but just some discharge we’ll swab the walls of the q tip. We put the speculum in, swab the walls with q tip and we can make a little slide with some saline and we can also add some potassium hydroxide that helps us see yeast in a different way. And then we can look under a microscope right then and there and that’s actually usually better than culturing someone out which can, you know. You can just be somebody who has yeast but it’s not an infection and may not be the cause of your problems because we’re supposed to have yeast on there. So, we really want the whole picture. And so, you know, for somebody who’s having recurrent infections that we don’t seem to be getting rid of then we might want to do the culture as well see actually we can type about what kind of yeast they’re having

STEPHANIE GLOVER: And so for yeast infection that’ll go untreated or maybe that’s just a recurrent, are there risks to mom or baby?

DOCTOR JAN PENVOSE-YI: So in pregnancy, there technically there’s not really risks to mom and baby for yeast infection except that we can see that mom’s who’ve had carried a high load of it during the pregnancy. So an asymptomatic yeast overgrowth that maybe baby’s going to be more prone to yeast infections topical like diaper rash postpartum and things like that. So I’ve had one patient who has a history once of the baby having significant problems with yeast postpartum but extremely rare and I’ve never found it in the textbook so and that’s on the history

STEPHANIE GLOVER: Okay and are there treatments that are safe during pregnancy?

DOCTOR JAN PENVOSE-YI: Absolutely! Absolutely! It’s still controversial whether or not we can just say yes that Diflucan that pill that everybody loves that one dose pill that stays in your system for ten days, you know, can we just take that in pregnancy. There are some concerns that can cause defects especially in the first trimester but at high doses. So, you know the mom who said oh my gosh I didn’t know I was pregnant and I took a Diflucan and I’m so stressed and you know there’s no studies that shows that’s a problem and probably we could give one does of Diflucan especially in the first trimester of pregnancy. But typically what they recommend are topical, topical vaginal inserts

STEPHANIE GLOVER: Like the Monostads.

DOCTOR JAN PENVOSE-YI: Yeah, especially the Glutinoso is the real popular one because it shown to be safer. The other one is the Miconazole. Those are the two most favoured vaginal once in pregnancy. If I get a mom who’s close to term and she’s just got a horrible infection and she’s just had it and she’s I’m not putting that up, that up in there. And so I give her a Diflucan because you know she’s close to term and there’s nothing shown that it’s a problem

STEPHANIE GLOVER: Okay. Now, raise your hand or who had the yeast infection in pregnancy. And okay we’ve got, well including myself, three. Yeah and did you have to treat it topically or

KIRSTEN STRATON: I did. Well the reason I got mine was I was hospitalized for pneumonia with my second pregnancy and so I had a bunch of antibiotics. Just tons, IV, oral, everything that works. So, my doctor when she was discharging me whacked him with a box of Monostads and said, I was like what this, what’s this for? And she was like “coz it’s coming”. And sure enough, she was right. So, yes one of the lesser choices in pregnancy

STEPHANIE GLOVER: Yeah. And I think I just, I didn’t really have a history of it but I called you know the nurse line and it was something that they were comfortable with just saying

SUNNY GAULT: That’s what I did

STEPHANIE GLOVER: Yeah. Typical, this kind of meets all the criteria and give this a try and then if you have problems because I think I took like the seven day kind of internal cream

SUNNY GAULT: And that’s a good point to make because they didn’t specify with me. They just kind of said Monostads or whatever. And so, I had never had a yeast infection before. And this is when I was pregnant with my twins. And it was later on in the pregnancy. And I didn’t know what to get. So my husband, you know, I’m at home with my boys plus I’m like hugely pregnant. So my husband goes out to the store to get something and he calls me and he’s like “I don’t know what to get, there’s all these things at the store. What do I do?” And so I’m like coaching him through but they didn’t tell me what dosage to get and oh my goodness if you do the one dosage, watch out it is like fire crush

DOCTOR JAN PENVOSE-YI: I was just going to bring that up, it’s so funny. I don’t let my patients get somewhat, because some people can tolerate it but for most people that is, it’s almost worse than the yeast infection

SUNNY GAULT: It is worse than the yeast infection

STEPHANIE GLOVER: My doctor thankfully said, no one day, no three day, just go seven days so

SUNNY GAULT: Okay

DOCTOR JAN PENVOSE-YI: I usually do five day in pregnancy

STEPHANIE GLOVER: Okay

DOCTOR JAN PENVOSE-YI: You know if there’s a five day alternative. Because seven day? I find compliance to be an issue

SUNNY GAULT: Oh yeah

DOCTOR JAN PENVOSE-YI: But it is nicer for you if you can spread it out overtime

SUNNY GAULT: Oh and I didn’t even realized that it had something to do with dosage. I guess I should have figured that out. But yeah then afterwards I’m calling because I’m “don’t take it off, what do I do” I couldn’t even, I couldn’t even think pass what was happening that time

DOCTOR JAN PENVOSE-YI: Yeah

SUNNY GAULT: You know, between my legs. And so,

STEPHANIE GLOVER: As poor mamas right?

DOCTOR JAN PENVOSE-YI: Yeah

SUNNY GAULT: But at least you know you’ve already done it you know, whatever.

STEPHANIE GLOVER: Right

SUNNY GAULT: It’s kind of a done deal and then I ended up getting another one just a couple of weeks later. And then I said, do not get that one dosage thing, it is like three, four days or after

STEPHANIE GLOVER: Yeah, and then you became a pro

SUNNY GAULT: And now I’m a pro on yeast infection

STEPHANIE GLOVER: Well we can move on to another super glamorous topic of urinary tract infections or UTI’s. So, Doctor Penvose-Yi, what is a UTI?

DOCTOR JAN PENVOSE-YI: So, UTI is a urinary tract infection. It starts at your urethra where you pee from into your bladder and then up to ureters to your kidney. So it’s something all along that system. However, most of us when we say I got a UTI mean my bladders infected. Okay? So, in pregnancy we’re more prone to urinary tract infection. And again the hormonal changes and things can affect that as well. But it can be a serious thing in pregnancy. And basically it’s bacteria in your bladder, or any part of that system that can cause a problem. And in pregnancy it’s riskier to ascend up into your kidneys too. You have a higher risk of in pregnancy and it can be a bad thing

STEPHANIE GLOVER: Yeah I remember I got one really early on with my second pregnancy and I had not, I’ve only had one, I think prior to that and it was an immediate kidney infection when I was seventeen and so I was completely afraid of it getting to that point. And I think I just again called the nurse line and it was at night on a Sunday and so the on-call doctor called and he was like, I just sent a prescription. We’ll see you in a couple of days anyway, but no. like, go take the antibiotics, this is kind of a big deal also. Did anyone else have any UTI’s in pregnancy? Yeah

KIRSTEN STRATON: Yeah, I had them all the time because I was [inaudible 00:18:14] dehydrated so yeah I was always getting. And it’s so hard, sometimes because you always have to pee anyway when you’re pregnant. So, sometimes it’s hard to distinguish this just because I’m pregnant and you know I had an overactive bladder or you know. But then you get some of these less lovely symptoms like the burning in this

SUNNY GAULT: Oh my gosh the burning is horrible

KIRSTEN STRATON: Yeah

STEPHANIE GLOVER: Or I always call that like the pressure. And I’m just, you know, I just felt like a heaviness kind of

KIRSTEN STRATON: The urgency

STEPHANIE GLOVER: Yeah

SUNNY GAULT: You have to pee and you can’t. It’s what it feels like...

STEPHANIE GLOVER: Yeah. If a woman doesn’t notice that she has symptoms like is there any way that an OB or care provider might still detect it.

DOCTOR JAN PENVOSE-YI: Sure. Sure. So, some of the things you’ve been saying are good about symptoms. We have pain with urination, we go quite often, we have urgency where you feel like you have to go and then you get there and nothing comes out. And that one of the other symptoms that people might notice is like you feel really floggy urinating and then the second you stop urinating you feel like you’re going to die again. So, those are all things that can lead to but there are also subtle symptoms right? And so, and the mom, what does the mom say? The pregnant mom, “I don’t know, I go to the bathroom all the time anyhow right? So, sometimes even just incidentally you may have that vague fullness or that vague discomfort and so we’ll, you know, we’ll feel and think, hmm maybe. But, the easiest way to do it, thank goodness is you just do a, is clean a catch of urine as you can in a cup and we can actually dip it in the office and see if it contains certain things like white blood cells, evidence of blood in the urine that’s another thing. Some people can frankly see the blood in the urine, but not everybody does. And so, we can dip it in the office

STEPHANIE GLOVER: And that’s routine anyway. Typically right? You pee in a cup...

DOCTOR JAN PENVOSE-YI: Right. So we want, all you pregnant moms out there, if you think there’s something wrong, whether or not you think it’s a vaginal infection or your bladder or something, always tell your provider before you give them that urine because they want a clean catch sample. They want you to do those little wipes first before you give that sample. A lot of times I’ll get in a room as a doctor and the patient tells me the history and all of a sudden I’ll say, you got to leave me urine sample. Doctor I just emptied my bladder for you. So if there’s something that you think is off, you definitely want to tell whosever put you in the room before you give that urine sample. And that’s the quickest way to tell. But here’s a little piece of information too that I think is important especially if you’re someone who’s prone to recurrent urine infections is that if we can get a culture before you start the antibiotics that’s great, because then we can know what bacteria we’re dealing with. Most of the time it’s that E.coli bacteria. But it helps for people who get recurrence. Now the flipside of that is I finally got my first urinary tract infection not pregnant and it was so awful. I said from that day forward, anybody can call me at any hour of the day if they are suffering as bad as I’m suffering, I will treat them. I will get up, I will find the pharmacy if I need to for them and treat because for some people it can be awful. But if we can get a urine sample before, it’s better for the long term history of things

STEPHANIE GLOVER: And while you’re pregnant, so you know, clearly you can take antibiotics

DOCTOR JAN PENVOSE-YI: Absolutely, absolutely

STEPHANIE GLOVER: And then there’s that other medication, I don’t know the name for that, kind of helps with the pain of it. Is that safe in pregnancy?

DOCTOR JAN PENVOSE-YI: Some of them are safe. There’s a couple of variance of it but it does make your urine orange and it can get to the baby’s. So we usually don’t do that in pregnancy

STEPHANIE GLOVER: Okay. Gotcha

DOCTOR JAN PENVOSE-YI: We don’t want orange babies

STEPHANIE GLOVER: So if a UTI goes untreated and essentially troubles with the kidneys, what does that mean for a pregnant woman?

DOCTOR JAN PENVOSE-YI: Well just to keep it short for you, it’s a very important thing to care of a kidney infection in pregnancy. Can put you at risk for pre-term labour and things like that. It can lead to high fevers which aren’t good for pregnant mom. The good news is, it’s treatable you get an, but it requires hospitalization. You get IV antibiotics until you’re twenty four hours without fever and then you can go home and finish out on oral antibiotics. But the main thing is that it’s just not something that you can treat without antibiotics. You know, maybe an early urinary tract infection you can do some of those homeopathic things affects it. But a kidney infection, you have to take it seriously. It’s always important to let your doctor know, if we give you an antibiotic, if you don’t want to take it just let us know that you’re not going to take it and why so that we can make sure you’re getting the right treatment for you to have

STEPHANIE GLOVER: Great. Thank you. When we come back we’ll discuss a couple of more common infections in pregnancy bacterial vaginosis and group b strep, we’ll be right back

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STEPHANIE GLOVER: Welcome back. Today we’re discussing common infections in pregnancy, Doctor Penvose-Yi is our expert today. So let’s chat about bacterial vaginosis or also known as BV. What is bacterial vaginosis?

DOCTOR JAN PENVOSE-YI: So like we talked about earlier with the yeast infections, it’s an overgrowth of certain bacteria. The most classic one is Gerard Neurala. And it can cause in most cases a thin proliferative watery discharge and everyone classically says it has a fishy odour associated with it. So, most of the time when people have this they complain of it

STEPHANIE GLOVER: Okay. And so, if they suspected that they had it, they would come in for a culture or a swab or

DOCTOR JAN PENVOSE-YI: Absolutely, kind of the same test as the yeast infection. You come in, you get the speculum exam, you get a q tip, we can look under the microscope, there’s you can see the actual epithelial cells that line the vagina covered with these bacteria. And then we can know usually right away that you need to be treated. Again that’s something you can send in for culture if the, sometimes you, it looks, it looks like a duck, walks like a duck you put it under the microscope, it doesn’t look like a duck. So you got to send it off to prove it, you may treat your patient anyhow because you have suspicions for that. And that, I’ll let you go ahead

STEPHANIE GLOVER: Oh, well yeah I mean I was going to ask, so what is the, is the treatment safe for pregnancy and what is that treatment

DOCTOR JAN PENVOSE-YI: Yeah. Absolutely, there are antibiotics

STEPHANIE GLOVER: Okay

DOCTOR JAN PENVOSE-YI: And it’s absolutely safe in pregnancy. You know, we don’t like to give you anything that you can’t have in pregnancy

STEPHANIE GLOVER: If, you know if you do have a presence of this bacteria is there a risk to mom or baby?

DOCTOR JAN PENVOSE-YI: Actually there are some studies and good studies that show that it, you know, it can be associated with miscarriage if untreated and pre-term labour if untreated. And you know, and that’s one of the things of pre-term labour we don’t always know what causes it. A lot of times our suspicion for infections, this is one that we know put’s us at risk for it. So, again one of those times if your doctor wants you to take that antibiotic. Either you got to be taking it or try other ways and get re-cultured to make sure that

STEPHANIE GLOVER: Keep that baby in as long as

DOCTOR JAN PENVOSE-YI: Yeah we like to keep those babies in. Plus most of the time women want that infection gone. There’s some people that don’t have the symptoms but it’s usually one that they are very uncomfortable like again like you said

STEPHANIE GLOVER: And are there ways to prevent it?

DOCTOR JAN PENVOSE-YI: So yes, there’s little pamphlets we can give people certain hygiene products can cause it. They, again get that ph balance off and that is what happens and it can overgrow. Because our you know our whole body has this nice ph or good for acidic or basic and if it’s at the right level, hopefully things grow in harmony. If it’s at the wrong level like too basic you can get an overgrowth for these bacteria. So, things that can do the scented soaps, that you know, that everybody likes to use and as your scented tampons, scented pads, some people can use them, some people can’t. And pregnancy again are whole systems off so yeah

STEPHANIE GLOVER: Okay, now I know we didn’t give that bacteria tons of time just because I wanted to head over to group b strep. Also referred to as GBS because I know this is a very common one and there’s a lot of information out there on it. So, I think it deserves a little bit of extra time. If you could explain to us what group b strep is.

DOCTOR JAN PENVOSE-YI: So, I’ll give you my normal spiel on this because I like all my pregnant moms to know this but group b strep or GBS is a normal bacteria again just like what we talked about. Everybody has it, sometimes in pregnancy it overgrows. So, as long, as long as it’s not bothering us and say we cultured you, sometimes doctors will, your providers will culture you early in pregnancy, sometime they don’t. Sometimes it’s routine, sometimes it’s not. But say we culture you you’ve got absolutely no symptoms, I’m not going to freak out about group b strep on your vaginal culture early in pregnancy. If we see it in your urine because it can colonize the vagina, the urethra, the bla, if we see it in your urine anytime in pregnancy it means you’re colonized of that bacteria it means you have higher levels of that bacteria. Okay so those are, those are like the asymptomatic carriers. Typically I always tell people when you’re not pregnant, if you’ve got group b strep and I find it and you come in complaining and the whole exams negative and I find a little group b strep on your culture, I’m not usually going to treat you unless you’re saying doc the symptoms just aren’t going away

STEPHANIE GLOVER: What would the symptoms be? I actually don’t think I realize that there weren’t many for it

DOCTOR JAN PENVOSE-YI: There aren’t

STEPHANIE GLOVER: Okay

DOCTOR JAN PENVOSE-YI: There aren’t. And that’s the thing, but say the patient comes in with a typical infections, so like they think it’s yeast infection or they think it’s a bacterial vaginosis

STEPHANIE GLOVER: Okay

DOCTOR JAN PENVOSE-YI: When you do the exam and you don’t see what they’re saying or you just don’t see it. So, and then it comes back in and truly we’re not supposed to treat it because

STEPHANIE GLOVER: Because it’s normal

DOCTOR JAN PENVOSE-YI: It’s normal. Absolutely but sometimes incidentally it’s one of those things that practice it goes over what you read and what you’re taught. You treat and the patient feels better but we know we try to educate them first so that you know we get that all together. But in pregnancy the biggest concern is for the baby after delivery or the mom after delivery. If we carry high levels of it, mom can get an infection of the uterus after delivery and baby can have infection of the lungs

STEPHANIE GLOVER: Okay

DOCTOR JAN PENVOSE-YI: They can have like a [inaudible] or where the blood gets infected. And then they can have meningitis. So, that’s all scary. I know we’re going to have a personal story on this. So what I tell my mom’s is we’re going to culture you for this, we’re going to do a little swab of the vagina and around the rectum. And if this comes back positive, it does not mean that your baby’s automatically going to get one of these infections okay? But what it means is, ideally we treat you in labour, so to get that number of that bacteria nice and low so when the baby comes through the birth canal that it’s not exposed to a lot of these bacteria. And then I tell them, so say you come in you’re one of those lucky moms, you come in and you’re reap born labour and you shoot your baby out. You’re like “oh doctor, I didn’t get antibiotics. I was supposed two doses of that antibiotic. What am I going to do?” and I say look, this doesn’t mean your baby’s going to be infected first of all that you didn’t spend much time in the birth canal and you know not to worry. But the paediatricians will keep an eye out for up to three months after the delivery. So they’re going to, you know, they know this baby came through a group b strep positive canal, they’re going to know to pay attention any signs of infection they’re going to take, you know, seriously

STEPHANIE GLOVER: Okay. And so, raise up hands here now, who had GBS or who was GBS positive in pregnancy?

AMY DUGAN: Only for one of my babies

STEPHANIE GLOVER: Me too

AMY DUGAN: And my, yeah. It’s the first one you know I feel like I was like, I don’t know I won the lottery or something, you know looking back because you go in and it’s like so weird anyway because they’re like “oh we’re just going to swab around all your [inaudible 00:28:33] and I’m like, right. Because this isn’t weird enough, you know. And so yeah, that one went great and the second one I’m like “alright, feeling good.

Already had one kid, you know, what’s the worst that could happen?” and then yeah I come back and they’re like oh you have group b strep. You know it’s kind of like they sit you down like they’re going to tell you something really terrible, like I have to tell you something, you have group b strep. And I’m like, I don’t know what that means. And you know, and then they’re like oh well you know, and then they try to pull back like “oh no, you know it’s like all the cool kids have group b strep” you know and it’s just so weird and so you’re like okay what do I do?

So I go in and my baby was ready to come out and eventually it took her a while but you know when she wanted to, she did. And so, you know, we drove to the hospital, I did most of my labour at home, because that’s what I wanted to do and so you know we come in and you know when you first go in to the hospital they’re always like “well we’ll see if you can stay” you know and you’re like, okay.

So they examine me and they’re like oh you are at a seven, you really mean business. And so, they took me in another room and I’m like “but wait, I’m group be strep positive. So I know like alert the process you know. And so, they’re like “okay” so they hook up, I mean, I have like four nurses working on me because we’re like you’re going to have this baby and now you tell us you have the group b and so I’m like okay, so they gave me the antibiotic and so I’m like, doing my best, you know I’m like, I want to have this baby, but like I need two bags of antibiotic.

You know and you know suddenly it becomes like this speed type situation like don’t slow the bus down or everything’s going to explode. And so, yeah, so they got one and a half bags of fluid and then I was like I can’t. Like, I need to have this baby, like it’s going to explode out. And so, yeah, so they, I had her and then, but then there’s all that stress after like, why I only got one and a half bags going on. What’s going to happen? You know, I mean right when I found out I had and we went home and Googled it which is like the worst day ever because there’s no doctor

STEPHANIE GLOVER: Doctor Google.

AMY DUGAN: There’s no doctor

DOCTOR JAN PENVOSE-YI: Absolutely

AMY DUGAN: There’s no doctor to be like, but it’s going to be okay, you know what I mean? And you’re just like, read them out all these meningitis and you’re like oh my gosh like people die from that. And I’m like, my baby, and so, you know, the nurses were like, why are you worried? And I’m like, well because they’re like, that means she gets like one extra blood test. So, yes, so for all of you pregnant people out there listening, I have a baby who’s perfectly fine. And like alive and just completely nuts and I had group b. So, don’t worry

KIRSTEN STRATON: I have the GBS

STEPHANIE GLOVER: And Kristen you had that too?

KIRSTEN STRATON: I did not have it. I’ve had several of my doula clients have it and I mean it’s certainly not, you don’t want to underscore or downplay the risk of it but it’s not, it doesn’t mean you can’t have the birth you want. Doesn’t mean that you’re baby’s you know, not going to be okay

STEPHANIE GLOVER: Right

KIRSTEN STRATON: But it’s definitely something to discuss with your care provider. Absolutely

STEPHANIE GLOVER: So my provider’s different than Amy’s though because I actually got to swab myself with my second pregnancy

AMY DUGAN: Oh yeah they offered me and I said no

STEPHANIE GLOVER: Okay

AMY DUGAN: I will respectfully decline, you can do that for me.

STEPHANIE GLOVER: Well and my toddler was in the room so that was a special sharing moment for us. But I swab myself and then, and then I just went about my week or whatever and I was being seen weekly at the time. And I came back and like “oh yes you have it and you’re positive” so, it was not, the you know they didn’t sit me down, they didn’t call me, they were like it’s not a big deal with anything to call you.

I did have a very precipitous labour so I showed up pushing to the hospital. And it was a little bit longer and I could ask Doctor Panvose-Yi this question but I was about eighteen hours post rupture, I had a slow amniotic leak. And but no labour signs, and I was going for a VBAC and I was a little, a little bit of a rubble and so when I showed up eighteen hours post rupture I did kind of get a finger wagging.

But they got in about half of the antibiotics and then I think we just stayed like an extra night in the hospital under observation. And it was okay and I wouldn’t, I will go on the record to say I don’t recommend that for people that was just my situation. But there was a lot of support and I felt on very good hands you know because she was monitored so, but it’s funny all the, the different, different stories around it. And so, I do want to ask, what is the usual recommendation if you do test positive, and your water breaks? Are there considerations within labour that you would typically advice?

DOCTOR JAN PENVOSE-YI: Yeah, so absolutely. So, you, especially to say you’re first time mom, your water breaks, you may not be going to labour for hours, maybe overnight. So, we don’t necessarily, we’re going to assess you, are you early labour? Are you even early labour? Do we have to induce labour? How long are we going to watch you? So, basically you start the antibiotic with labour, or if you think the patients, I usually say around four centimetres and actively contracting

STEPHANIE GLOVER: Okay

DOCTOR JAN PENVOSE-YI: Or if you’ve gone eighteen hours without it and there’s signs of infection, usually for me eighteen hours I really would prefer my patient on it just because I like to prevent things I can prevent

STEPHANIE GLOVER: Definitely

DOCTOR JAN PENVOSE-YI: And those are pretty much the recommendations to follow

STEPHANIE GLOVER: Okay

DOCTOR JAN PENVOSE-YI: And again when you take the group strep swab, that’s the time to educate your patient, not when you come back because people, once you tell them there’s something positive and they don’t know anything about it, they pretty much shut you off and the worst case scenario just hits their heads

STEPHANIE GLOVER: And they’re Googling.

DOCTOR JAN PENVOSE-YI: Yeah they’re Googling.

AMY DUGAN: Yeah I know. I know it’s me

STEPHANIE GLOVER: And so, can GBS be prevented or are there ways to not have the bacteria colonized?

DOCTOR JAN PENVOSE-YI: That’s one not really

STEPHANIE GLOVER: Okay

DOCTOR JAN PENVOSE-YI: It’s kind of one of those things. If you, and the one thing we didn’t bring about is, if you’ve actually had a baby infected with group b strep and the other pregnancy we’re going to treat you in labour and delivery for that

STEPHANIE GLOVER: Just automatically

DOCTOR JAN PENVOSE-YI: Just automatically

STEPHANIE GLOVER: Interesting

DOCTOR JAN PENVOSE-YI: Not necessarily because you had it last pregnancy but if your baby had an actual infection from that so but yeah no this is not a one that we’re going to prevent

STEPHANIE GLOVER: Okay

DOCTOR JAN PENVOSE-YI: Yeah

STEPHANIE GLOVER: So with probiotics or not really

DOCTOR JAN PENVOSE-YI: No

STEPHANIE GLOVER: Okay! Interesting! Amy and I both had experiences with one being positive, one pregnancy having GBS positive results and the other negative, is that pretty common or

DOCTOR JAN PENVOSE-YI: Yeah, actually

STEPHANIE GLOVER: Okay

DOCTOR JAN PENVOSE-YI: Yeah it happens all the time

STEPHANIE GLOVER: You don’t typically have like all of necessarily all pregnancies have the same outcome

DOCTOR JAN PENVOSE-YI: Somebody who’s a big colonized is the ones who find it in urine. You know it might not may actually be an infection but it’s in your urine. And we’ll treat that if it shows up in your urine; we treat it and make sure it goes away

STEPHANIE GLOVER: Okay

DOCTOR JAN PENVOSE-YI: Yeah, so because we don’t want those levels to keep growing. But that’s somebody who are going to have a higher suspicion the next pregnancy it’s going to show up again

STEPHANIE GLOVER: Okay. Well great. Well thank you so much Doctor Penvose-Yi for joining us today

DOCTOR JAN PENVOSE-YI: Absolutely

STEPHANIE GLOVER: For more information about Doctor Penvose-Yi as well as information about any of our panellist, visit the episode page on our website. This conversation continues for members of the Preggie Pals club. After the show, Doctor Penvose-Yi is going to be discussing sexually transmitted infections. To join our club, visit our website www.newmommymedia.com

[Theme Music]

ANNIE LAIRD: Here’s a question for one of our experts. Angie from San Antonio, Texas writes: I just had my twenty week ultrasound and found out that my baby has a cleft lip. I’m scared for what this means for my baby. What kind of surgery is done to fix it when my baby is born?

DOCTOR FREDERICK JOHNSON: Hi this is Doctor Frederick Johnson, the paediatrician from San Diego. The good news is it’s not that uncommon and can be repaired usually within the first two to three months of life, sometimes a bit earlier. The only issue like the extend of the cleft slit and whether there’s a cleft palette also. So, by itself a cleft lip is not a big problem, there might be a tiny scar there after they repair it. But it shouldn’t go much further than that and hopefully there’s no other issues. So I hope that answer your questions and I hope you have a happy pregnancy. Take care

[Theme Music]

STEPHANIE GLOVER: That wraps up our show for today. We appreciate you listening to Preggie Pals.
Don’t forget to check out our sister shows
• Parent Savers for parents with new born, infants and toddlers
• Twin Talks for parents of multiples
• Our show The Boob Group for moms who breastfeed their babies

This Preggie Pals; “Your Pregnancy Your Way”

[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

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