Midwife-led versus other models of care for childbearing women
Hatem M, Sandall J, Devane D, Soltani H, Gates S
Cochrane.org
Midwife-led care confers benefits for pregnant women and their babies and is recommended.
In many parts of the world, midwives are the primary providers of care for childbearing women. Elsewhere it may be medical doctors or family physicians who have the main responsibility for care, or the responsibility may be shared. The underpinning philosophy of midwife-led care is normality, continuity of care and being cared for by a known and trusted midwife during labour. There is an emphasis on the natural ability of women to experience birth with minimum intervention. Some models of midwife-led care provide a service through a team of midwives sharing a caseload, often called 'team' midwifery. Another model is 'caseload midwifery', where the aim is to offer greater continuity of caregiver throughout the episode of care. Caseload midwifery aims to ensure that the woman receives all her care from one midwife or her/his practice partner. All models of midwife-led care are provided in a multi-disciplinary network of consultation and referral with other care providers. By contrast, medical-led models of care are where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.
The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects.
The main benefits were a reduction in the use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman's chance of being cared for in labour by a midwife she had got to know, and the chance of feeling in control during labour, having a spontaneous vaginal birth and initiating breastfeeding. However, there was no difference in caesarean birth rates.
Women who were randomised to receive midwife-led care were less likely to lose their baby before 24 weeks' gestation, although there were no differences in the risk of losing the baby after 24 weeks, or overall. In addition, babies of women who were randomised to receive midwife-led care were more likely to have a shorter length of hospital stay.
The review concluded that most women should be offered midwife-led models of care, although caution should be exercised in applying this advice to women with substantial medical or obstetric complications.
Monday, November 23, 2009
Thursday, November 19, 2009
CDC Commentary: H1N1 Vaccination
This two minute clip discusses the H1N1 Vaccination.
We currently have a supply of the individual pre-filled syringes, which are preservative free (meaning no mercury). We do recommend this vaccination for all pregnant and postpartum women. If you are interested in receiving the vaccine and are currently a patient, please feel free to stop by or ask for it at your next visit.
If you are feeling sick or are exposed to someone with a known case of the flu, please call our office for further instructions and advice.
We currently have a supply of the individual pre-filled syringes, which are preservative free (meaning no mercury). We do recommend this vaccination for all pregnant and postpartum women. If you are interested in receiving the vaccine and are currently a patient, please feel free to stop by or ask for it at your next visit.
If you are feeling sick or are exposed to someone with a known case of the flu, please call our office for further instructions and advice.
Monday, November 9, 2009
Share With Women - Epidurals
SHARE WITH WOMEN - American College of Nurse-Midwives
EPIDURAL ANALGESIA
There are many options for managing pain during labor. You might decide before you begin labor that you want pain medication, or you may not want any medications. This handout discusses epidural analgesia.
What is Epidural Analgesia?
Epidural analgesia is a local anesthetic placed in a part of your back where it numbs the nerves that go from your pelvis and legs to your brain. The anesthetic is like the kind you get when you go to the dentist. With an epidural, you get an injection into the space around the nerves in your spine that makes your body numb below the site of the injection.
How Does an Epidural Work?
All of the nerves of the body send their messages to the brain through the spine. Anesthetics are
medicines that block the messages from traveling up nerves to the brain. When the pain messages are blocked before getting to your brain, you do not “feel” the pain.
How is an Epidural Done?
There is a very small space around the nerves in your spine. This is called the epidural space. A specially trained doctor or nurse places a thin tube, called a catheter, into this space. You will have to sit on the side of the bed or curl up on your side on the bed. The nurse or doctor will give you a shot of Novocain in your back. Then the nurse or doctor will put a long needle through the area that is numbed into the epidural space. When he or she has found the space, the thin tube will be threaded through the needle, and the needle is removed. A pump is then set up to deliver the anesthesia through the tube into the epidural space during your labor. After birth, the tube will be taken out. The numbness will begin to go away. You will be able to move your legs and walk in a few hours.
How Well Does an Epidural Work?
For some women, an epidural works very well. Within 15 to 20 minutes of starting the anesthesia, they lose feeling below the waist. Many women are so comfortable they can talk, watch television, or even sleep. Occasionally, the epidural does not work as well, and you may continue to feel pain or pressure even though your legs are numb. There is no way to guess who will get a “pain free” epidural and who will have an epidural that does not work completely.
Are There Risks Associated With Having an Epidural During Labor?
Your labor progress depends on lots of things: the size of your pelvis, the size of your baby, the
position of your baby, and the strength of your contractions. Most of this is out of your control.
Sometimes an epidural can help and sometimes it makes labor longer and more complicated.
Risks of Insertion and Placement of Anesthesia in the Epidural Space
● The epidural is inserted sterilely, but there is a small chance of infection at the site where the needle is inserted. A serious infection could cause paralysis or, very rarely, death.
● The needle could hit a nerve and cause nerve damage or paralysis. In most people, the spinal cord is above the area where the needle is placed, which is why this problem is rare.
● If the epidural is incorrectly placed too high in your back or into spinal fluid, you may lose the
sensation of your breathing and need help to breathe regularly.
Risks During Labor
● If your bladder is full, you will not be able to feel it, so you will need a catheter to drain the urine.
● Women who have an epidural have a higher chance of getting a fever during labor, and then the baby may need additional blood work and observation to rule out infection.
● Women who have an epidural are more likely to need medication to make contractions stronger.
● Your legs will be numb. If your baby gets stuck in a “crooked” position, you will not be able to move around to “jiggle” the baby into a good position. This may increase your chance of needing a cesarean section.
● It may be hard to feel your contractions when you need to push. Pushing takes longer.
● Women who have an epidural have a higher chance of needing a vacuum or forceps to help give birth.
Risks Afterward
● The most common risk of an epidural after the baby is born is a “spinal headache.” This only happens one or two times for every 100 epidurals that are used. This is a terrible headache that comes 1 to 2 days after the epidural is removed. If you get a spinal headache, you will need to return to the hospital to have a special procedure called a “blood patch.” The patch usually helps right away.
● Your baby may have a harder time getting started breastfeeding.
● Many women report ongoing back pain after an epidural, but we do not know if this is because of the epidural or because of other things that may have happened during their labor.
● There is a very, very small risk of permanent paralysis—loss of the ability to move your legs.
What Are the Benefits of an Epidural?
● If the epidural works well, you will not feel the intense pain.
● Sometimes—especially with a first baby—early labor may be long. An epidural can give you a
chance to rest so that you can gather your strength for active labor and birth.
● If you are very anxious, an epidural may help you relax. In some women it appears that the epidural may actually make your labor go more quickly.
● If you need a cesarean section, your epidural can be used to make you numb for the surgery.
● Women with twins or babies in a breech position who plan a vaginal birth may use an epidural so they are prepared for a cesarean section if their baby (or babies) have problems during labor or birth.
FOR MORE INFORMATION
Childbirth Connection:
Options: Labor Pain (Epidural and Spinal)
EPIDURAL ANALGESIA
There are many options for managing pain during labor. You might decide before you begin labor that you want pain medication, or you may not want any medications. This handout discusses epidural analgesia.
What is Epidural Analgesia?
Epidural analgesia is a local anesthetic placed in a part of your back where it numbs the nerves that go from your pelvis and legs to your brain. The anesthetic is like the kind you get when you go to the dentist. With an epidural, you get an injection into the space around the nerves in your spine that makes your body numb below the site of the injection.
How Does an Epidural Work?
All of the nerves of the body send their messages to the brain through the spine. Anesthetics are
medicines that block the messages from traveling up nerves to the brain. When the pain messages are blocked before getting to your brain, you do not “feel” the pain.
How is an Epidural Done?
There is a very small space around the nerves in your spine. This is called the epidural space. A specially trained doctor or nurse places a thin tube, called a catheter, into this space. You will have to sit on the side of the bed or curl up on your side on the bed. The nurse or doctor will give you a shot of Novocain in your back. Then the nurse or doctor will put a long needle through the area that is numbed into the epidural space. When he or she has found the space, the thin tube will be threaded through the needle, and the needle is removed. A pump is then set up to deliver the anesthesia through the tube into the epidural space during your labor. After birth, the tube will be taken out. The numbness will begin to go away. You will be able to move your legs and walk in a few hours.
How Well Does an Epidural Work?
For some women, an epidural works very well. Within 15 to 20 minutes of starting the anesthesia, they lose feeling below the waist. Many women are so comfortable they can talk, watch television, or even sleep. Occasionally, the epidural does not work as well, and you may continue to feel pain or pressure even though your legs are numb. There is no way to guess who will get a “pain free” epidural and who will have an epidural that does not work completely.
Are There Risks Associated With Having an Epidural During Labor?
Your labor progress depends on lots of things: the size of your pelvis, the size of your baby, the
position of your baby, and the strength of your contractions. Most of this is out of your control.
Sometimes an epidural can help and sometimes it makes labor longer and more complicated.
Risks of Insertion and Placement of Anesthesia in the Epidural Space
● The epidural is inserted sterilely, but there is a small chance of infection at the site where the needle is inserted. A serious infection could cause paralysis or, very rarely, death.
● The needle could hit a nerve and cause nerve damage or paralysis. In most people, the spinal cord is above the area where the needle is placed, which is why this problem is rare.
● If the epidural is incorrectly placed too high in your back or into spinal fluid, you may lose the
sensation of your breathing and need help to breathe regularly.
Risks During Labor
● If your bladder is full, you will not be able to feel it, so you will need a catheter to drain the urine.
● Women who have an epidural have a higher chance of getting a fever during labor, and then the baby may need additional blood work and observation to rule out infection.
● Women who have an epidural are more likely to need medication to make contractions stronger.
● Your legs will be numb. If your baby gets stuck in a “crooked” position, you will not be able to move around to “jiggle” the baby into a good position. This may increase your chance of needing a cesarean section.
● It may be hard to feel your contractions when you need to push. Pushing takes longer.
● Women who have an epidural have a higher chance of needing a vacuum or forceps to help give birth.
Risks Afterward
● The most common risk of an epidural after the baby is born is a “spinal headache.” This only happens one or two times for every 100 epidurals that are used. This is a terrible headache that comes 1 to 2 days after the epidural is removed. If you get a spinal headache, you will need to return to the hospital to have a special procedure called a “blood patch.” The patch usually helps right away.
● Your baby may have a harder time getting started breastfeeding.
● Many women report ongoing back pain after an epidural, but we do not know if this is because of the epidural or because of other things that may have happened during their labor.
● There is a very, very small risk of permanent paralysis—loss of the ability to move your legs.
What Are the Benefits of an Epidural?
● If the epidural works well, you will not feel the intense pain.
● Sometimes—especially with a first baby—early labor may be long. An epidural can give you a
chance to rest so that you can gather your strength for active labor and birth.
● If you are very anxious, an epidural may help you relax. In some women it appears that the epidural may actually make your labor go more quickly.
● If you need a cesarean section, your epidural can be used to make you numb for the surgery.
● Women with twins or babies in a breech position who plan a vaginal birth may use an epidural so they are prepared for a cesarean section if their baby (or babies) have problems during labor or birth.
FOR MORE INFORMATION
Childbirth Connection:
Options: Labor Pain (Epidural and Spinal)
Friday, October 30, 2009
Birth Symposium Pictures
The Birth Symposium was a fabulous success attended by many smart and hip women! I was able to attend the first couple hours before having to see patients in the office. I hear that the remainder of the time was no less than stellar though! I took a few pics while I was hanging out...
This is Fatima Muhammad - a doula and driving force behind the symposium...
One of the birth center rooms set up with multiple displays...
Some attendants :)
A patient of ours experiences some of the doula techniques used in coping with labor...
Sharon Olsen IBCLC was available for those with breastfeeding questions or issues...
Lisa Sherwood CNM provided a lecture on the Midwifery Model of Care...
Vendors that attended...
Pam Degraff is a licensed massage therapist as well as a doula. She was on hand to demonstrate the benefits of prenatal massage!
Lynnette Casey CNM and Lisa Sherwood mugging for the camera!
Lynnette Casey CNM, speaking with an attendant. She also provided a lecture on VBACs as well...
This is Fatima Muhammad - a doula and driving force behind the symposium...
One of the birth center rooms set up with multiple displays...
Some attendants :)
A patient of ours experiences some of the doula techniques used in coping with labor...
Sharon Olsen IBCLC was available for those with breastfeeding questions or issues...
Lisa Sherwood CNM provided a lecture on the Midwifery Model of Care...
Vendors that attended...
Pam Degraff is a licensed massage therapist as well as a doula. She was on hand to demonstrate the benefits of prenatal massage!
Lynnette Casey CNM and Lisa Sherwood mugging for the camera!
Lynnette Casey CNM, speaking with an attendant. She also provided a lecture on VBACs as well...
Monday, October 26, 2009
Cord Blood in Regenerative Medicine
More and more families are questioning the possibility of banking umbilical cord blood for assisting with potential medical treatments later in the life of their baby. How could it REALLY be used? The most recent edition of "The OB/GYN and Infertility Nurse" has an article describing the growing use of newborn cord blood in regenerative medicine. The future of utilizing cord blood is exciting. Here's a story about one little girl and how she has benefitted from her parents saving the cord blood at her birth.
"The Case of Chloe Levine...
Jenny Levine of Denver, Colorado, first learned about cord blood's potential medical uses at her OB/GYN visit. She and her husband Ryan, decided to privately bank their second daughter, Chloe's cord blood before her birth. Gradually, her parents realized she was not developing properly. 'At 9 months, Chloes was still unable to hold a bottle and was unable to crawl properly. She had limited use of the right side of her body', said her mother. Chloe was diagnosed with right-sided hemiplegic cerebral palsy, most likely due to an in-utero stroke. 'My husband and I were completely devastated,' said Jenny. The Levines were told that Chloe faced 17 to 18 years of therapy, with no guarantees of success. But the family soon discovered a Duke University study where children with cerebral palsy were being reinfused with their own cord blood stem cells, with encouraging results. Chloe was accepted at Duke and intravenously reinfused with her cells on May 27, 2008. Shortly after, Chloe began to show changes. 'Enough of the stiffness in her right foot had disappeared, and for the first time she could push the peddle down on her battery-powered tractor,' said Jenny. 'She began to expand her vocabulary, saying things like her nickname, Coco. Therapists had worked for weeks before to get her to produce words like these without success.' Today, a year and a half after infusion, Chloe no longer receives physical or speech therapy, and her occupational therapy has been cut in half. She began preschool this fall; she no longer qualifies for special needs services at school."
Yeah, Chloe!!
"The Case of Chloe Levine...
Jenny Levine of Denver, Colorado, first learned about cord blood's potential medical uses at her OB/GYN visit. She and her husband Ryan, decided to privately bank their second daughter, Chloe's cord blood before her birth. Gradually, her parents realized she was not developing properly. 'At 9 months, Chloes was still unable to hold a bottle and was unable to crawl properly. She had limited use of the right side of her body', said her mother. Chloe was diagnosed with right-sided hemiplegic cerebral palsy, most likely due to an in-utero stroke. 'My husband and I were completely devastated,' said Jenny. The Levines were told that Chloe faced 17 to 18 years of therapy, with no guarantees of success. But the family soon discovered a Duke University study where children with cerebral palsy were being reinfused with their own cord blood stem cells, with encouraging results. Chloe was accepted at Duke and intravenously reinfused with her cells on May 27, 2008. Shortly after, Chloe began to show changes. 'Enough of the stiffness in her right foot had disappeared, and for the first time she could push the peddle down on her battery-powered tractor,' said Jenny. 'She began to expand her vocabulary, saying things like her nickname, Coco. Therapists had worked for weeks before to get her to produce words like these without success.' Today, a year and a half after infusion, Chloe no longer receives physical or speech therapy, and her occupational therapy has been cut in half. She began preschool this fall; she no longer qualifies for special needs services at school."
Yeah, Chloe!!
Friday, October 23, 2009
Midwifery Model in New Zealand
Beautiful country...beautiful babies!
Baby Ewan
In 2007-2008 I had the gift of being able to practice midwifery on the South Island of New Zealand in a rural town on the edge of Fiordland National Park, Tuatapere. The town has a "medical centre" which houses "Tuatapere Maternity", a small rural "birthing unit" (similar to our freestanding birth centers in the US). I just returned from 3 weeks "holiday" there and caught up with many of the families I was privileged to serve during my time there. Great fun to see how these sweet babies have grown.
Baby Ewan
In 2007-2008 I had the gift of being able to practice midwifery on the South Island of New Zealand in a rural town on the edge of Fiordland National Park, Tuatapere. The town has a "medical centre" which houses "Tuatapere Maternity", a small rural "birthing unit" (similar to our freestanding birth centers in the US). I just returned from 3 weeks "holiday" there and caught up with many of the families I was privileged to serve during my time there. Great fun to see how these sweet babies have grown.
Midwifery is alive and well in this island nation! It is a country and culture where midwives are the primary obstetric care providers. (If you want to see a physician, you must get a "referral" from your midwife!!) They practice in various settings and promote the "naturalness" of pregnancy and birth. All facilities where birth takes place have been mandated by the government to be certified as "Baby Friendly". Quite a statement about breastfeeding!! Women in New Zealand can have their babies in whatever setting they choose: home, birthing unit or hospital and it is totally supported (and paid for) by the government. Midwives are also responsible for care of the newborn for the first 6 weeks. The government mandates weekly postpartum HOME visits by the midwife. There is only one category of "midwife", unlike the US where we have multiple initials that connote a variety of paths to midwifery (see our BWHC website for a description of major categories). They are governed by a Midwifery Council that describes the practice of midwifery:
"The midwife works in partnership with women, on her own professional responsibility, to give women the necessary support, care and advice during pregnancy, labour and the postpartum period up to six weeks, to facilitate births and to provide care for the newborn.
The midwife understands, promotes and facilitates the physiological processes of pregnancy and childbirth, identifies complications that may arise in mother and baby, accesses appropriate medical assistance, and implements emergency measures as necessary. When women require referral midwives provide midwifery care in collaboration with other health professionals.
Midwives have an important role in health and wellness promotion and education for the woman, her family and the community. Midwifery practice involves informing and preparing the woman and her family for pregnancy, birth, breastfeeding and parenthood and includes certain aspects of women’s health, family planning and infant well-being.
The midwife may practise in any setting, including the home, the community, hospitals, or in any other maternity service. In all settings, the midwife remains responsible and accountable for the care she provides."
If only our government would see the value of midwifery care and breastfeeding...we could be a critical piece in health care reform. (Midwives have been "reforming" healthcare for a very long time!) We could benefit so much from implementing strategies countries the world over have embraced to decrease the maternal -infant morbidity/mortality rates, improve breastfeeding success rates and increase women's satisfaction with their pregnancy and birth experiences.
Monday, October 19, 2009
Seasonal flu and H1N1
We have a lot of questions from patients in our practice about the flu and H1N1. Should they get the vaccines, are they safe. Here is some information to help you decide.
Pregnancy and the Flu
Complications of both the seasonal flu and H1N1, like bacterial pneumonia and dehydration, can be serious and even fatal. Pregnancy can increase the risk of these complications. Pregnant women are more likely to be hospitalized from complications of the flu than non-pregnant women who are the same age. Some of the physiological changes in pregnancy, like those to the immune system, heart and lungs, can increase the risk for complications from the flu.
The American College of Nurse-Midwives, the Centers for Disease Control, the American College of Obstetricians and Gynecologists and the March of Dimes have come together to develop a clear statement about the seriousness of H1N1 flu and the importance of receiving the vaccination.
Can the 2009 H1N1 flu vaccine be given at any time during pregnancy?
Seasonal flu vaccine is recommended for all pregnant women at any time during pregnancy, and has not been shown to cause harm to a pregnant woman or her baby. The Advisory Committee on Immunization Practices also recommends that 2009 H1N1 flu vaccine be given to all pregnant women at any time during pregnancy.
If I deliver my baby before I receive my seasonal flu shot or 2009 H1N1 flu shot, should I still receive them?
Yes. In addition to protecting you from infection, the vaccine may also help protect your young infant. Flu vaccines are recommended only for infants 6 months or older. It is recommended that everyone who lives with or provides care for an infant less than 6 months old receive both the seasonal flu vaccine and the 2009 H1N1 flu vaccine.
I am breastfeeding, can I receive the vaccine?
Yes. Both seasonal flu and 2009 H1N1 influenza vaccines should be given to breastfeeding mothers. Breastfeeding is fully compatible with flu vaccination, and preventing maternal infection provides secondary protection to the infant. Maternal vaccination is especially important for infants less than 6 months old, who are ineligible for vaccination. In addition, transfer of vaccination-related antibodies by breastfeeding further reduces the infant’s chances of getting sick with the flu.
Is the 2009 H1N1 flu vaccine safe for pregnant women?
Flu vaccines have not been shown to cause harm to a pregnant woman or her baby. The seasonal flu shot has been recommended for pregnant women for many years. The 2009 H1N1 flu vaccine will be made using the same processes as the seasonal flu vaccine. Studies that test the 2009 H1N1 flu vaccine in pregnant women began in September. More information is available at http://www3.niaid.nih.gov/news/QA/vteuH1N1qa.htm.
Does the 2009 H1N1 flu vaccine have preservative in it?
Multi-dose vials of flu vaccine contain the preservative thimerosal to prevent bacterial growth. There is no evidence that thimerosal is harmful to a pregnant woman or a fetus. However, because some women are concerned about exposure to preservatives during pregnancy, manufacturers are producing preservative-free seasonal flu vaccine and 2009 H1N1 flu vaccine in single dose syringes. CDC recommends that pregnant women receive flu vaccine with or without thimerosal.
Can I get the seasonal flu vaccine and the 2009 H1N1 flu vaccine at the same time?
Seasonal flu and 2009 H1N1 vaccines may be administered on the same day but given at different sites (e.g. one shot in the left arm and the other shot in the right arm). However, the seasonal vaccine is available now in numerous areas and the 2009 H1N1 influenza vaccine won’t be available until mid-October. So, pregnant women are encouraged to get their seasonal flu vaccine as soon as it is available in their community. The usual seasonal influenza viruses are still expected to cause illness this fall and winter.
Can pregnant women receive the nasal spray vaccine?
The nasal spray vaccine is not licensed for use in pregnant women. Pregnant women should not receive nasal spray vaccine for either seasonal flu or 2009 H1N1 flu. After delivery, women can receive the nasal spray vaccine, even if they are breastfeeding.
What are the possible side effects of the 2009 H1N1 flu vaccine?
Pregnant women are not known to have an increased risk of side effects from the flu vaccine. The side effects from 2009 H1N1 flu vaccine are expected to be similar to those from seasonal flu vaccines. The most common side effects following vaccination are expected to be mild, such as soreness, redness, tenderness or swelling where the shot was given. Some people might experience headache, muscle aches, fever, fatigue, and nausea. If these problems occur, they usually begin soon after the shot is given and may last as long as 1-2 days. Fainting may occur shortly after receiving any injection and has uncommonly been reported after the flu shot. Like any medicines, vaccines can cause serious problems like severe allergic reactions. However life-threatening allergic reactions to vaccines are very rare.
Anyone who has a severe (life-threatening) allergy to eggs or to any other substance in the vaccine should not get the vaccine, regardless of whether they are pregnant.
Pregnancy and the Flu
Complications of both the seasonal flu and H1N1, like bacterial pneumonia and dehydration, can be serious and even fatal. Pregnancy can increase the risk of these complications. Pregnant women are more likely to be hospitalized from complications of the flu than non-pregnant women who are the same age. Some of the physiological changes in pregnancy, like those to the immune system, heart and lungs, can increase the risk for complications from the flu.
The American College of Nurse-Midwives, the Centers for Disease Control, the American College of Obstetricians and Gynecologists and the March of Dimes have come together to develop a clear statement about the seriousness of H1N1 flu and the importance of receiving the vaccination.
Can the 2009 H1N1 flu vaccine be given at any time during pregnancy?
Seasonal flu vaccine is recommended for all pregnant women at any time during pregnancy, and has not been shown to cause harm to a pregnant woman or her baby. The Advisory Committee on Immunization Practices also recommends that 2009 H1N1 flu vaccine be given to all pregnant women at any time during pregnancy.
If I deliver my baby before I receive my seasonal flu shot or 2009 H1N1 flu shot, should I still receive them?
Yes. In addition to protecting you from infection, the vaccine may also help protect your young infant. Flu vaccines are recommended only for infants 6 months or older. It is recommended that everyone who lives with or provides care for an infant less than 6 months old receive both the seasonal flu vaccine and the 2009 H1N1 flu vaccine.
I am breastfeeding, can I receive the vaccine?
Yes. Both seasonal flu and 2009 H1N1 influenza vaccines should be given to breastfeeding mothers. Breastfeeding is fully compatible with flu vaccination, and preventing maternal infection provides secondary protection to the infant. Maternal vaccination is especially important for infants less than 6 months old, who are ineligible for vaccination. In addition, transfer of vaccination-related antibodies by breastfeeding further reduces the infant’s chances of getting sick with the flu.
Is the 2009 H1N1 flu vaccine safe for pregnant women?
Flu vaccines have not been shown to cause harm to a pregnant woman or her baby. The seasonal flu shot has been recommended for pregnant women for many years. The 2009 H1N1 flu vaccine will be made using the same processes as the seasonal flu vaccine. Studies that test the 2009 H1N1 flu vaccine in pregnant women began in September. More information is available at http://www3.niaid.nih.gov/news/QA/vteuH1N1qa.htm.
Does the 2009 H1N1 flu vaccine have preservative in it?
Multi-dose vials of flu vaccine contain the preservative thimerosal to prevent bacterial growth. There is no evidence that thimerosal is harmful to a pregnant woman or a fetus. However, because some women are concerned about exposure to preservatives during pregnancy, manufacturers are producing preservative-free seasonal flu vaccine and 2009 H1N1 flu vaccine in single dose syringes. CDC recommends that pregnant women receive flu vaccine with or without thimerosal.
Can I get the seasonal flu vaccine and the 2009 H1N1 flu vaccine at the same time?
Seasonal flu and 2009 H1N1 vaccines may be administered on the same day but given at different sites (e.g. one shot in the left arm and the other shot in the right arm). However, the seasonal vaccine is available now in numerous areas and the 2009 H1N1 influenza vaccine won’t be available until mid-October. So, pregnant women are encouraged to get their seasonal flu vaccine as soon as it is available in their community. The usual seasonal influenza viruses are still expected to cause illness this fall and winter.
Can pregnant women receive the nasal spray vaccine?
The nasal spray vaccine is not licensed for use in pregnant women. Pregnant women should not receive nasal spray vaccine for either seasonal flu or 2009 H1N1 flu. After delivery, women can receive the nasal spray vaccine, even if they are breastfeeding.
What are the possible side effects of the 2009 H1N1 flu vaccine?
Pregnant women are not known to have an increased risk of side effects from the flu vaccine. The side effects from 2009 H1N1 flu vaccine are expected to be similar to those from seasonal flu vaccines. The most common side effects following vaccination are expected to be mild, such as soreness, redness, tenderness or swelling where the shot was given. Some people might experience headache, muscle aches, fever, fatigue, and nausea. If these problems occur, they usually begin soon after the shot is given and may last as long as 1-2 days. Fainting may occur shortly after receiving any injection and has uncommonly been reported after the flu shot. Like any medicines, vaccines can cause serious problems like severe allergic reactions. However life-threatening allergic reactions to vaccines are very rare.
Anyone who has a severe (life-threatening) allergy to eggs or to any other substance in the vaccine should not get the vaccine, regardless of whether they are pregnant.
What can I do to prevent getting the swine flu?
There are things you can do to prevent getting the the flu. Little things can make a big difference:
* Wash your hands well and often.
* If water or soap are not available, use hand sanitizer.
* When you cough or sneeze, cover your nose and mouth by coughing into your arm. This should be done so that the spray from your cough does not get into the air.
* Properly dispose of your tissue after you use it.
* Wash your hands after coughing or sneezing.
And remember the ‘‘Don’ts’’:
* Don’t touch your nose, mouth, or eyes if you are sick, because that’s where germs like to live.
* Don’t spend time around people who are sick or crowds.
* Don’t go to work or school if you are sick.
Most importantly, call your midwife or doctor if you think you are sick. Medicines are available to help you.
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