Mommypotamus Fri, 19 Sep 2014 01:36:50 +0000 en-US hourly 1 How To Make Chocolate Extract Thu, 18 Sep 2014 16:08:50 +0000 How To Make Chocolate Extract

I hope you’re sitting down . . . Because whoa, this is huge. You know the way it feels when you bite into a warm fudgy brownie, or sip from a mug filled with marshmallows and hot cocoa? Well, it can be better. Yes, BETTER. Awhile ago I read on David Lebovitz’s blog that cacao beans [&hellip

The post How To Make Chocolate Extract appeared first on Mommypotamus.

How To Make Chocolate Extract

I hope you’re sitting down . . .

Because whoa, this is huge. You know the way it feels when you bite into a warm fudgy brownie, or sip from a mug filled with marshmallows and hot cocoa? Well, it can be better. Yes, BETTER.

Awhile ago I read on David Lebovitz’s blog that cacao beans lose the “top notes” of their flavor when they are processed into chocolate. To get those precious top notes back, explains Lebovits, you just add pure chocolate extract made from raw cacao nibs into your sweet treats.

I don’t make desserts all that often, but obviously I had to give this a try. I searched around and found that I can buy it, but because I am a total DIYer I had to find out how to make chocolate extract myself. Folks, this stuff is so easy to make and so delicious it almost feels wrong. Almost. We’re talking the very essence of chocolate – its soul even – all bottled up like a genie ready to grant wishes for chocolate coated bliss. So, you’re probably thinking . . .

Sounds good, but what can I actually do with chocolate extract?

Great question. You can use it to replace vanilla in baked goods – or better yet use them both! I love adding it to flourless brownies, silky chocolate creme pie, homemade “magic shell,” pudding, mousse, cookies, and homemade hot chocolate.

Have I mentioned pancakes, banana bread, and homemade “Nutella”? There are so many possibilities, and we haven’t even talked about blending it with coffee or mint extract yet. Have fun and experiment – it’s pretty hard to go wrong with chocolate anything.

A Note On Ingredients

The main spirits used to make homemade extract – vodka and bourbon – are now often made from GMO-plants and/or enzymes derived from genetically modified organisms. (source) In my post on how to make vanilla extract I discuss how to find options that are likely to be GMO-free. You can find the post here.

How To Make Chocolate Extract


  • 1/2 cup crushed raw cacao nibs (you can buy cacao beans and shell them yourself like I did, or save yourself a whole lot of effort and buy organic pre-shelled cacao nibs here )
  • 8 oz vodka, bourbon or rum


  1. Gently crush cacao nibs to help them release their flavor. This step is optional, but I find it speeds up the ripening process of the extract. I just press mine a smidge with a mallet.
  2. Pour vodka/bourbon/rum over the nibs. Seal jar tightly and give the jar a good shake.
  3. Store in a dark cabinet for at least three months, shaking occasionally.
  4. When the extract has reached the depth of flavor you prefer – a process that can take up to six months depending on your preference – strain out the cacao beans.
  5. In a freezer-safe container, place extract in the freezer overnight. Remove extract the next morning and scrape off any fat that has risen to the top.
  6. Store in either a dark container/dark cabinet.

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Do You Have Adrenal Fatigue? Find Out With This Simple Test Tue, 16 Sep 2014 17:03:24 +0000 Do You Have Adrenal Fatigue? Find Out With This Simple Test

Years ago, when I recovered from . . . A debilitating illness, I resolved never to be a spectator in my own life again. I will ride the bull, say yes to the CNN interview even though I’m running on a few hours of sleep, and draw silly faces on all the eggs in my fridge. And [&hellip

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Do You Have Adrenal Fatigue? Find Out With This Simple Test

Years ago, when I recovered from . . .

A debilitating illness, I resolved never to be a spectator in my own life again. I will ride the bull, say yes to the CNN interview even though I’m running on a few hours of sleep, and draw silly faces on all the eggs in my fridge.

And I still feel that way, except maybe I will do it tomorrow . . . after a long siesta. . . or later, like when the cows come home. Because frankly, my “Need To Do” list (aka go to the grocery store) and my “Want To Do” list (aka take a NAP) have not been getting along lately. Yes, I love life and want to do ALL THE THINGS, but maybe I shouldn’t try to do them all at once, you know?

Lately I’ve noticed that I’m waking up tired and have less patience with the potami. Though in the past I would have beat myself up for my “bad attitude” or tried to give myself a pep talk to snap out of it, this time I’m taking a different approach. I’m acknowledging that my adrenals are tired, and I’m taking steps to give them the rest they need.

What Is Adrenal Fatigue?

The adrenal glands, which sit on top of the kidneys, support us through stressful events. They secrete hormones that make us resilient in times of difficulty, like a sleepless night, illness, surgery, stress at work, stress at home, loss of a loved one, meltdowns at the store with toddlers, financial pressure, etc. The challenges – whether they’re short-term, long-term, severe or relatively mild – can have a cumulative negative affect on adrenal function.

Some types of stress are hard to spot, but that makes them no less problematic. In his book, Adrenal Fatigue: The 21st Century Stress Syndrome, Dr. James Wilson mentions a study which measured the stress hormones of a group of nurses. They weren’t aware of any particular stress in their lives, but their lab tests told a different story.

When our adrenals help us through stressful times, they need a recovery phase afterwards. Just like weight lifters need to take a break between workouts so their muscles can rebuild, the adrenals need rest to stay strong.

And now we all see the problem, right? Modern life is incredibly stressful, and most of us don’t get a lot of downtime. Over a course of years, this can weaken our adrenals, making us less able to adapt to stressful events, less productive and more easily irritated.

Are you nodding your head because this sounds familiar?

Then read on – I have good news! Daddypotamus and I recently took the kids on a much needed trip to the shore, and in between snapping photos like this one of sweet baby Levi . . .

This one of Micah . . .

this one of my boys . . . .

and even jumping in a few myself . . .

. . . I managed to read up on adrenal fatigue and create a plan for my recovery. I was expecting to feel overwhelmed, but just the opposite happened. I discovered several simple things I can do to care for tired adrenals, which I’ll be sharing with you soon. But first, I’ll bet you’re wondering if your low energy levels could really be related to adrenal fatigue.

Though there are lab tests that can confirm adrenal fatigue in a roundabout way, there is no test for it like there is for Strep B.  Adrenal fatigue is a syndrome, meaning that it is a collection of symptoms and physiological signs that form a diagnosis.

What Are The Symptoms Of Adrenal Fatigue?

Though they can vary from person-to-person, you might have adrenal fatigue if you can say “yes” to some of these statements listed in Adrenal Fatigue: The 21st Century Stress Syndrome:

  • My ability to handle stress or pressure has decreased.
  • I seem to have decreased in cognitive ability. I don’t think as clearly as I used to.
  • I tend to avoid emotional situations.
  • I am chronically fatigued; a tiredness that is not usually relieved by sleep.
  • I have decreased tolerance. People irritate me more.
  • My thinking is confused when hurried or under pressure.
  • I am frequently cold.

You can take Dr. Wilson’s full adrenal fatigue quiz here.

Do You Have Adrenal Fatigue? Take The Test!

If any of the statements from the adrenal fatigue checklist sound familiar, you’ll want to take the iris contraction test. Basically, it measures your body’s stamina in response to light stimulation. If your stamina is decreased, this test plus your overall symptoms may indicate that your adrenals are tired and are having difficulty supporting you through stressful events.

Feeling stressed about the possibility of a positive result? According to Dr. Wilson, in most cases you are your own best caretaker when it comes to healing. I’ll be sharing more insights from his book (and others) as I go, but if you’d like to you can pick it up here.

Please keep in mind that – as I wrote in my post on the Vitamin K shot – “Best Boo-Boo Kisser South Of Puckett’s Gas Station” is about as official as things get for me professionally.  I am not a doctor and this is not medical advice. I’m just passing along some information from someone who is a medical professional that I found helpful.

Now, here’s what you’ll need to take the test, which according to Dr. Wilson will detect moderate and severe adrenal fatigue, but not necessarily mild cases.

  • Weak (not too bright) flashlight or pen light
  • Chair
  • Stopwatch or watch with a second hand (I use a stopwatch app on my phone)
  • Mirror
  • Dark room


In a dark room, sit or stand in front of a mirror for about a minute to allow your eyes to adjust to the light. “Then shine a flashlight across one eye (not directly into it) from the side of your head. [Mommypotamus note: Some practitioners say to keep the light about six inches away] Keep the light shining steadily across one eye and watch in the mirror with the other. You should see your pupil (the dark circle in the center of the eye) contract immediately as the light hits your eye. This occurs because the iris, a tiny circular muscle composed of small muscle fibers, contracts and dilates the pupil in response to light. Just like any muscle, after it has been exercised beyond normal capacity, it likes to have a rest.

The pupil normally remains contracted in the increased light. But if you have some form of hypoadrenia [Mommypotamus note: This is the clinical term for adrenal fatigue], the pupil will not be able to hold its contraction and will dilate [open back up] despite the light shining on it. This dilation will take place within 2 minutes and will last for about 30-45 seconds before it recovers and contracts again. Time how long the dilation lasts with the second hand on the watch and record it along with the date. After you do this once, let the eye rest. If you have any difficulty doing this on yourself, do it with a friend. Have a friend shine the light across your eye while both of you watch the pupil size.

Retest monthly. If your eye indicates you are suffering from adrenal fatigue, this also serves as an indicator of recovery. As you recover from adrenal fatigue, the iris will hold its contraction and the pupil will remain small for longer.” (Source: Adrenal Fatigue: The 21st Century Stress Syndrome)

A quick note

I thought this info shared by Susie, a Nutritional Therapy Practitioner, in the comments below was helpful so I’ve updated the post to include it:

“Couple of things to keep in mind for people taking this test:

To address some above comments, in having tested quite a few people this year in NTP school, I find most people’s pupils pulse (release, contract, release, contract, rather quickly), rather than completely releasing for a prolonged period of time. What you’re looking for is a sustained, non-pulsing contraction for 30 seconds. The longer the sustained contraction, the better. Pulsing is better than fully releasing, and some people don’t contract at all, which would be a big indicator.

Secondly, this is an EARLY indicator of adrenal fatigue. Pupillary contraction is not nearly as high on the priority list for your adrenals as, say, blood sugar control or blood pressure maintenance. So not doing well on his test doesn’t mean you’re in dire straights and need major intervention. Having reactive hypoglycemia or scoring poorly on a postural hypotension test (blood pressure dropping when you stand up, getting dizzy/tunnel vision when you stand) are better indicators of real hypoadrenia.”

Okay, I May Have Adrenal Fatigue. What Now?

As Dr. Wilson mentions in his book, adrenal fatigue is diagnosed by assessing symptoms and physiological signs such as iris contraction, blood pressure, and cortisol levels. If the questionnaire I linked to and this test both suggest the possibility of adrenal fatigue, it might be wise to check out the information in his book regarding lab tests that can be performed by a healthcare provider. He covers why, just like with thyroid tests, many tests that come back “normal” really aren’t, and how to make sure you’re getting accurate information.

In the coming weeks and months, I’ll be sharing tips for helping the adrenals function optimally. Stay tuned!

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How to Make Lacto-Fermented Raspberry Soda Fri, 12 Sep 2014 16:13:25 +0000 How to Make Lacto-Fermented Raspberry Soda

Note From Mommypotamus: Today the Potami clan is celebrating Micah’s birthday at the BEACH. While we’re building sandcastles and chasing seagulls, Craig from Fearless Eating is sharing a recipe that is a favorite with kids of all ages – homemade raspberry soda. Thank you for stopping by today, Craig!  I’ve Been On A Soda-Making Roll Lately Considering I’m a Nutritional [&hellip

The post How to Make Lacto-Fermented Raspberry Soda appeared first on Mommypotamus.

How to Make Lacto-Fermented Raspberry Soda

Note From Mommypotamus: Today the Potami clan is celebrating Micah’s birthday at the BEACH. While we’re building sandcastles and chasing seagulls, Craig from Fearless Eating is sharing a recipe that is a favorite with kids of all ages – homemade raspberry soda. Thank you for stopping by today, Craig! 

I’ve Been On A Soda-Making Roll Lately

Considering I’m a Nutritional Therapist who is very anti-sugar, this may sound somewhat surprising. After all, everybody knows soda is bad for them, full of high fructose corn syrup, artificial colorings and preservatives, right?

Well, not this raspberry soda recipe.

And that’s because I’m using real raspberries and the art of lacto-fermentation. Traditionally, lacto-fermented sodas were made from the roots and leaves plants. For example, root beer was made from the roots of the sassafras plant and ginger ale was made from ginger (a root), of course.   

But you could also use fruit as well. In fact, it’s quite a bit easier. And yes, you can substitute almost any fruit in place of the raspberries. This summer I’ve made lacto-fermented blueberry soda, watermelon soda, blackberry soda and now this raspberry soda, all from local, organic fruit. Next week I’ll be trying my hand at grape soda and I’ll be using the concord grapes that grow wild here in New England.

The Health Benefits of Fermented Raspberry Soda

Now as far as lacto-fermentation goes, unlike commercial sodas, lacto-fermented sodas contain enzymes, probiotics and get this… actual nutrients. Furthermore, lacto-fermented sodas contain considerably less sugar as the bacteria feed on and convert them during fermentation. So the longer you let them ferment, the less sugar they’ll contain. You’ll also notice this if you let them sit in your fridge for a while. But real lacto-fermented sodas are so delicious and refreshing that I’d bet they won’t last very long at all, especially if you have kids.

Kids will also love making them. In fact, I think this is a great way to get kids interested in fermentation.  Look at it as a little science experiment in your kitchen. Even if it’s your first time doing it, convey a sense of enthusiasm and mystery to the process. Their natural sense of wonder and curiosity will be fun to observe as the soda starts to bubble and fizz.

And that’s another cool thing about making soda at home. Because unlike commercial sodas that have carbonation added to them, the carbonation in lacto-fermented sodas is simply a natural byproduct of the fermentation process.

Enjoy, But Open Carefully

Finally, one last note. Once you transfer the soda to the soda bottles, both the carbonation and pressure inside the bottles will rapidly increase, so much so that you have to be careful when you open them for the first time!

I learned the hard way and ruined a good shirt as the soda shot up and fizzed all over the place. So please be sure to open the bottles every day to let out the gasses that build up. Once you’ve opened them a few times the pressure will decrease as will the rate of fermentation when you transfer them to the fridge.

Lacto-fermented Raspberry Soda

Makes about 2 quarts


  • 4 cups organic raspberries
  • 1 cup organic cane sugar, dehydrated cane juice or sucanat
  • ½ cup whey (there are other options – see note below)
  • 2 quarts filtered water


1. Simmer raspberries and sugar in water for about 20 -30 minutes

2. Cool to room temperature and strain out raspberries

3. Transfer what’s now essentially sugary raspberry juice to a 2 quart glass ball jar or demijohn.

4. Add whey and let it ferment for at least 3 days. Look for visible signs of fermentation via a slight fizziness. You can let it go longer for a less sweet soda as the bacteria will continue to feed on the sugars and convert them. Taste the soda as you go to get the sweetness you desire.

Note: You don’t have to use whey. Other options for starter cultures include a ginger bug, champagne yeast or water kefir.

5. Transfer soda to soda bottles via a funnel or glass measuring cup.

6. Keep the soda bottles at room temperature and check every day. The carbonation will dramatically increase. Make sure to open the soda bottles every day to let the gasses escape. After a few days you can transfer the bottles to the fridge where the fermentation will slow down.

7. Enjoy!

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Pork Tenderloin Recipe With Apple, Thyme and Mustard Wed, 10 Sep 2014 15:34:26 +0000 Pork Tenderloin Recipe With Apple, Thyme and Mustard

Note From Mommypotamus: Today the Potami clan is on the road – we’re headed to the BEACH! Camp fire cookouts on the sand here we come. (You can follow our adventures here.) While we’re away, Kelli from Happy Healthnut is sharing her recipe for “fancy fake out” pork tenderloin – it’s the perfect way to kick off the fall season. [&hellip

The post Pork Tenderloin Recipe With Apple, Thyme and Mustard appeared first on Mommypotamus.

Pork Tenderloin Recipe With Apple, Thyme and Mustard

Note From Mommypotamus: Today the Potami clan is on the road – we’re headed to the BEACH! Camp fire cookouts on the sand here we come. (You can follow our adventures here.) While we’re away, Kelli from Happy Healthnut is sharing her recipe for “fancy fake out” pork tenderloin – it’s the perfect way to kick off the fall season. Also, I recommend that you check out her note on new USDA recommendations for cooking pork in the instructions . . . very good info.  Thank you for stopping by today, Kelli! 

Every year around this time . . .

The leaves begin to change, the air gets crisp in the morning, and I start to feel the urge to break out the cable-knit sweaters, brew up a chai tea latte, and hit up the apple orchard down the street. Ahhhh fall in Michigan! There is no better time of year! I know that autumn brings beauty to many parts of the country, but as a mid-western girl, I have to say, I’m partial to my Michigan falls.

When autumn rolls around, along with turnover of the leaves comes the turnover of a new batch of seasonal produce. Say goodbye to the tomatoes and zucchini, and hello to the apples and pumpkins. Don’t get me wrong, I love the crisp, fresh flavors of summer, but I welcome the warmth and heartiness that fall produce offers.

As a child, one of my favorite fall meals was a good ole’ porkchopsh and appleshaushe (insert obligatory Humphrey Bogart impression). It’s a classic fall dish, and it was my grandmother’s specialty. But one of my great pleasures in life is taking old, tired classics (delicious, but tired) and putting my own spin on them to make them modern and fresh. Enter mustard and thyme rubbed pork tenderloin with apple and fennel saute! That’s right, folks. It’s not your mama’s (or grand-mama’s) pork chops and applesauce.

This recipe is what I lovingly refer to as a “fancy fake-out”

It sounds all kinds of fancy-schmancy and complicated to make, but it’s actually really simple to prepare. In fact, it is delicious and elegant enough to serve for company, yet it’s quick and easy enough to prepare for any weeknight meal. With a little bit of preparation, you can have this scrumptious meal on the table in under thirty minutes.

Before I get to the recipe, let’s have a little chat about brining pork, shall we? Brining is essentially just soaking or marinating your meat in a salty solution, that has some sort of acidic medium added to it. I’m telling you, people, if you’re not brining your pork products, you are doing yourself a major disservice! First of all, a simple brine imparts amazing flavor on whatever protein (in this case pork) you’re cooking up. Second, brining your pork slowly and gently begins to break down the proteins in the meat just enough to perfectly tenderize it. It also keeps the meat incredibly moist! Then, as if the aforementioned reasons weren’t convincing enough, brining your meat in an acidic medium may also help reduce the inflammatory effect that consuming pork may have on the body. To read more about that, check out this post from Food Renegade.

Enough chit chat….on with it.

The Players

For the Brine:

  • 6 cups of hot water
  • ¼ cup fine sea salt
  • 1 tbsp peppercorns
  • 1 bay leaf
  • ¼ cup raw apple cider vinegar

For the Pork:

  • 2-3 lbs pork tenderloin (they usually come in packs of 2, about 1 to 1 ½ lbs each).
  • ¼ cup stone ground mustard
  • 2 tbsp fresh thyme, chopped
  • 1 tbsp sea salt
  • 2 tsp black pepper
  • 2 tbsp ghee (or other stable cooking fat of choice)

For the Sauté:

  • 1 medium onion, sliced ( I used yellow, but white or red would be fine)
  • 2 heads of fennel, cored and sliced
  • 2 granny smith apples, cored and sliced (I leave the skin on because I enjoy the texture, but feel free to peel them if you like)
  • 1 head of radicchio, cored and shredded
  • 3 cloves of garlic, minced
  • 2 inch knob of fresh ginger, minced
  • 1 tbsp fresh thyme
  • 3 tbsp raw apple cider vinegar
  • 3 tbsp raw honey
  • sea salt and pepper to taste
  • 1 tbsp ghee (or stable cooking fat of choice)

The Process:

* Get the pork brining! To do this, dissolve the sea salt by stirring it around in the hot water in a large bowl.. Once the salt is dissolved, add the peppercorns, bay leaf and vinegar to the mix. At this point, you can either wait until the brine cools, or if you’re impatient like myself, you can add in enough ice cubes to cool it down. You just don’t want the brine to begin to cook the pork. Add the pork tenderloins to the brine, cover it and pop it in the fridge. Twenty-four hours is optimal, but twelve will do. So if you think about it, do this step the night before. If not, just be sure to do it before you leave for work in the morning!

* When you’re ready to cook the pork, remove it from the brine and pat it dry. Often times, pork tenderloin will come with a silver skin on it. The silver skin is tough, so remove it byt slicing it off gently with a sharp knife. You’ll notice that one end of the pork is tapered, so you’ll want to tie the skinny end underneath itself with some kitchen twine so that the pork cooks evenly.

* Preheat your oven to 400 degrees F.

* Get your mise en place together. Mise en place is just a fancy French term for putting in place. Translated it means do your prep work! So in a small bowl, combine the stone ground mustard and 2 tbsp of fresh thyme and set it aside. Chop your onions, apple, fennel, radicchio, garlic and ginger and set them aside.

* Heat two large skillets on the stove top. I like to use cast iron for the pork because it’s oven safe, and you’ll be transferring the pork to the oven to finish cooking. Heat the pan you’ll be cooking the pork in over medium high heat. Heat the pan you’ll be cooking your saute in over medium heat. Add your ghee to their respective skillets to heat.

* Season each pork tenderloin generously with sea salt and pepper on all sides, and rub the mustard and thyme mixture into the meat….really massage it. Get personal with it.

* Add the pork to the hot skillet and sear it on all sides until it’s nicely browned.

* At the same time, add the reserved, chopped veggies to the other skillet. Season generously with sea salt and pepper and add the rest of the fresh thyme. Toss to combine.

* When the pork has seared on all sides, transfer the pan to the oven and cook uncovered for 12-15 minutes, or until it reaches an internal temperature of 145 degrees F. The USDA used to recommend cooking to an internal temp of 160 degrees, but they have since amended that recommendation to 145 degrees. 160 was overkill and made for dry pork!

* While the pork is in the oven, finish up the saute. When the onions and fennel are translucent and the apples have softened slightly, add in the vinegar and honey. Stir, and cook until the vinegar has reduced, about another 2-3 minutes. Taste and season with sea salt and pepper. Remove from the heat and set aside.

* Remove the pork from the oven. Take it out of the pan and set it on a cutting board to rest for five minutes! This is important! Don’t skip this step. The meat will continue to carry-over cook during this time, and the juices will redistribute. If you cut into it right now, the juices will all come running out.

* When the pork has rested, slice it and serve it on top of the saute. Enjoy!


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I’m Group B Strep Positive – Now What? Mon, 08 Sep 2014 16:21:24 +0000 I’m Group B Strep Positive – Now What?

So, You’re Positive And in this case, we’re not just talking about your overall outlook on life. Like so many mamas, you took the Group B Strep test in pregnancy and your results were positive for the presence of the bacteria. Maybe you immediately wondered what you “did wrong,” or if there was anything you could [&hellip

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I’m Group B Strep Positive – Now What?

So, You’re Positive

And in this case, we’re not just talking about your overall outlook on life. Like so many mamas, you took the Group B Strep test in pregnancy and your results were positive for the presence of the bacteria. Maybe you immediately wondered what you “did wrong,” or if there was anything you could do to prevent it.

I know I did. 

I’ve had three births – one where I tested GBS+ and received an intervention, one where I tested GBS+ and did not, and one where I did something differently and did not test GBS+. I learned a lot along the way.

Today I’m going to share my personal process in deciding whether to receive IV antibiotics, a chlorahexadine wash, or no intervention at each birth. Please keep in mind that – as I wrote in my post on the Vitamin K shot – “Best Boo-Boo Kisser South Of Puckett’s Gas Station” is about as official as things get for me professionally.  I am not a doctor, this is not medical advice, and your decision is completely up to you. If you need some convincing on this, read my full disclaimer where I say it over and over again. Okay, let’s jump in!

What is Group B Strep?

Sometimes called GBS, Group B streptococcus is a common bacteria that is often found in the digestive tract and lower genital tract. It is considered a normal part of our microbiome and most people have no symptoms related to its presence. (sourceHowever, newborns affected by it are at risk for developing Group B strep disease, a potentially serious illness.

There are two forms of Group B strep disease in babies: early-onset and late-onset. About 80% of cases are early-onset, which means the illness occurs within seven days of birth, usually within the first 24 hours of life. (source)

The remaining 20% happen between seven days and three months of age – this is referred to as late-onset. “Late-onset GBS infection is more complex and has not been convincingly tied to the GBS status of the mother.” (source) In other words, babies who develop late GBS may have acquired it from their environment.

What are the risks of GBS infection in newborns?

Most newborns who become infected with GBS will make a full recovery, but it can cause “life-threatening complications, such as:

  • blood poisoning (septicaemia)
  • infection of the lung (pneumonia)
  • infection of the lining of the brain (meningitis)” (source)

In addition, some babies who are infected will experience problems such as “cerebral palsy, deafness, blindness and serious learning difficulties.” (source)

How likely is it that I will be GBS+?

GBS is present in the vagina and/or rectum of 10-30% of all pregnant women. (source)

Does every baby born to a GBS+ mother develop an infection?

NO. Even without intervention many GBS+ women will give birth to babies that do not experience any complications. (source) In one Canadian study, 19.5% of women tested at 36 weeks were positive for GBS. Left untreated, about 50% of those women passed GBS on to their babies, but 48-49% percent of the children who were colonized with GBS had no symptoms and 1-2% developed early-onset Group B strep disease. (source)

What factors increase the chances of actual infection?

The three most significant factors for early-onset GBS are:

  • fever during labor
  • the woman’s water breaks 18 hours or more before delivery (this is also known as prolonged rupture of membranes, or PROM)
  • preterm birth (before 37 weeks) or broken water before 37 weeks gestation (source 1source 2)

Other factors include low birth weight, the presence of GBS in your urine at any time during your pregnancy (this means that you may be heavily colonized), a history of giving birth to a child who experienced GBS infection,  chorioamnionitis, allowing membranes to be stripped, and frequent vaginal exams during labor. (source) The last two factors are listed because membrane stripping and frequent vaginal exams may introduce GBS infection or encourage upward movement of vaginal fluid already containing GBS bacteria. (source)

Steps that may reduce the risk of early-onset GBS infection:

  • “Refuse vaginal exams
  • Avoid internal fetal monitoring
  • Refuse membrane stripping or sweeping
  • Avoid induction of labor or application of cervical ripeners
  • Do not permit artificial rupture of membranes” (source)
  • Birthing in water (more on this later)

What are the symptoms of GBS infection?

Symptoms may include any of the following:

  • fever or abnormally low body temperature
  • jaundice (yellowing of the skin and whites of the eyes)
  • poor feeding
  • vomiting, seizures
  • difficulty breathing
  • swelling of the abdomen
  • bloody stools  (source)

Of course, any of the above symptoms can also be a sign of a sick newborn who does not have a bacterial infection. Newborns with any of these symptoms should be immediately evaluated by a medical professional.” (source)

Can a mother develop GBS antibodies that protect her baby?

YES. In this landmark study that the CDC draws many of its GBS recommendations from, researchers concluded that “Sufficient amounts of GBS capsular polysaccharide type-specific serum IgG in mothers have been shown to protect against invasive disease in their infants.”  In plain English, this means that women who have developed an immunity to GBS bacteria pass immunity on to their children.

On the other hand, low antibody levels in the mother put baby at an increased risk for early-onset GBS. Why is that? Some people believe that the women who were found to have low antibody levels either had compromised immune function, a genetic inability to make GBS antibodies, or a recent exposure to GBS that they had not yet built an immunity to, and therefore could not pass on. (source)

Are GBS tests accurate?

Results can vary slightly depending on specimen collection and culturing techniques. In addition, most GBS tests are performed between 36-37 weeks gestation so that the results are known before labor begins. Unfortunately, a woman who tests positive at 36 weeks may be negative during labor, and vice versa.

In this study, women were screened for GBS using a culture test once at 35/36 weeks gestation and once during labor. “Of the women who screened negative for GBS at 35-36 weeks, 91% were still GBS-negative when the gold standard test was done during labor. The other 9% became GBS positive. These 9% were ‘missed’ GBS cases, meaning that these women had GBS, but most (41 out of 42) did not receive antibiotics.

Of the women who screened positive for GBS at 35-36 weeks, 84% were still GBS positive when the gold standard test was done during labor. However, 16% of the GBS-positive women became GBS-negative by the time they went into labor. These 16% received unnecessary antibiotics.” (Source: Evidence-Based Birth)

Another study found that 61% of early-onset GBS cases occurred in babies whose mom’s tested negative for GBS. (source 1source 2) It’s not clear why this is, but it may be because, as mentioned above:

  • the mom’s infection was recent (after the test done at 35-36 weeks) and mom hadn’t fully developed immunity
  • the mom was immune-compromised
  • the mom had a genetic inability to make GBS antibodies

Another possibility is that the baby acquired GBS from a non-maternal source. Hospital-acquired GBS cases are documented. (source)

What are the recommended treatment options?

Chlorahexadine Wash

Because some moms want to avoid IV antibiotics, rinsing the birth canal with a chlorahexadine/Hibiclens antiseptic to kill bacteria  is sometimes recommended as an alternative.

We used to think that babies are 100% bacteria free in the womb, and that their first encounter with GBS would be in the birth canal. Given that scenario, the antiseptic wash makes sense.

HOWEVER, three things ought to be considered when weighing the risks/benefits of this method:

1. New research indicates that babies are not sterile. Dr. Madan, who serves as assistant professor of pediatrics at the Geisel School of Medicine at Dartmouth, has examined the stool of newborn babies whom had not yet eaten their first meal. He found a variety of bacteria in the stool collected from both full-term and premature babies. (source1, source2) Based on his research, some experts now believe that a baby could already be colonized (which is the term used if they remain healthy) or infected with GBS before they descend into the birth canal.

2. It may not work well (if at all). “Even though women who used vaginal chlorhexadine reduced their infants’ risk of being colonized with GBS by 28%, there was no difference in rates of early GBS infection between women who used the chlorhexadine and those who did not.” (source) In other words, there were fewer “colonizations” – introduction of GBS in which the baby remained healthy – and the same amount of illnesses that resulted. We’ll discuss why this might be in the next section on antibiotics.

3. The microbiome needs to be considered. Passing through the birth canal is a once-in-a-lifetime opportunity for a child to inherit our microbiome. It’s difficult to overstate how important this may prove to be for lifelong health.

“Scientists are only just beginning to understand the microbiome – the unique colony of microbial organisms that populates every human – and they’re looking into the role it plays, not just in birth, but in every aspect of our mental and physical health. So cutting edge is this field that some refer to the microbiome as a ‘newly discovered organ’, and believe that further understanding of it may throw light on some major areas of humanity: disease, personality, life expectancy, and more.

As a baby is born vaginally, the colonisation of the microbiome begins. In fact, studies of the birth canal have shown that in the time before labour starts, the make up of vaginal bacteria changes, for example to include extra Lactobacillus, a bacteria that aids in the digestion of milk. Studies comparing the microbiomes of vaginally born babies with those born via caesarean have shown differences in their gut bacteria as much as seven years after delivery.

There is much we don’t yet understand about why or how much these differences may matter. But scientists are beginning to explore connections between the microbiome of caesarean born babies, and the rising cases of health problems such as obesity, asthma, eczema, and type 1 diabetes.” (source)

You can find a more technical discussion on microbiomes and birth here, or you can watch the fun video below.

Is an antiseptic rinse better than nothing if antibiotics are not an option/not wanted? Perhaps the best way to answer that question is to discuss the risk and benefits of antibiotics.

IV Antibiotics for GBS+ Mothers

The Centers for Disease Control (CDC) and American Congress of Obstetricians and Gynecologists (ACOG) both recommend that all women who test positive for Group B Strep receive IV antibiotics during labor. However, critics say that in at least some cases, there is no clear benefit to that approach. Here’s why:

A Cochrane analysis found that antibiotics do not affect GBS death rates

According to a Cochrane Review, the death rate from GBS remains the same whether or not antibiotics are administered. There was a reduction of babies who became ill, but mortality rates were not affected when IV antibiotics were administered.

Furthermore, the Cochrane Review concluded that very few women who are GBS+ give birth to babies who become infected with Group B strep disease, and “antibiotics can have harmful effects such as severe maternal allergic reactions, increase in drug‐resistant organisms and exposure of newborn infants to resistant bacteria, and postnatal maternal and neonatal yeast infections. This review finds that giving antibiotics is not supported by conclusive evidence.”

Antibiotics may make babies more vulnerable to superbugs

Why is it that both the chlorahexadine wash and IV antibiotics seem to reduce the rate of GBS colonization (and in some studies illness) but not deaths? One theory is that while these methods do kill most GBS bacteria, a certain number may have mutated in a way that makes them resistant to antibiotics. When these strains are left behind, they band together to form a superbug – an infection that is resistant to one or more antibiotics. Essentially, the idea is that you take a relatively harmless colony – something like a small town with cooks, bakers, schoolteachers, etc. – and through antibiotic administration eliminate everyone but the soldiers. Obviously, a band of soldiers is more likely to win a battle than a band of bakers. (As a note: Most antibiotic resistant bacteria are not necessarily soldiers – aka more dangerous than other types when they start out. However, they can become dangerous simply because they are difficult to stop.)

What evidence is there to support the theory that babies who succumb to GBS infections may be encountering antibiotic resistant GBS bacteria?

In a study of 43 newborns diagnosed with blood infections from GBS or other bacteria, 88-91% of those whose mothers were given antibiotics during labor were suffering from an infection that was resistant to antibiotics. Specifically, the bacteria was resistant to the same antibiotic that was administered during labor. (source 1, source 2) In the same study, only 18-20% of infants whose mothers had not received antibiotics during labor had infections that were resistant to antibiotics.

Is routine administration of antibiotics during labor creating a GBS superbug? 

Possibly.  In the past, GBS was easily treated with common antibiotics such as penicillin, but now strains are showing up that can resist “last resort” options such as vancomycin. (source1, source 2) It is unclear why this is, but some believe that the widespread use of antibiotics among laboring women could be part of the reason.

Can antibiotics the increase risk of other blood infections?

“While many studies have found that giving antibiotics during labor to women who test positive for GBS decreases the rate of GBS infection among newborns, research is beginning to show that this benefit is being outweighed by increases in other forms of infection. One study, which looked at the rates of blood infection among newborns over a period of six years, found that the use of antibiotics during labor reduced the instance of GBS infection in newborns but increased the incidence of other forms of blood infection.23 The overall effect was that the incidence of newborn blood infection remained unchanged.” (source)

A study published in 2002 found that when GBS cases decreased by 3/4 due to the use of antibiotics, cases of e. coli doubled. “The shift is worrisome,” wrote The New York Times, “because E. coli bacteria can be more deadly than streptococcus germs.” It is thought that when certain antibiotics wipe out good and bad bacteria in the gut, pathogens like e. coli may use the opportunity to take over before the good bacteria can re-establish itself.

This is not a universal perspective, though. The CDC does not think there is a link between antibiotic use and e. coli. You can read their report here.

Do antibiotics raise the risk of yeast infections/thrush?

Very possibly. Antibiotics during labor or anytime thereafter kill good and bad bacteria but leave candida albicans intact. (source) With its competition eliminated, candida may thrive and cause yeast infections/thrush. According to this study, women and babies who received antibiotics during labor were more likely to suffer from candida related infections.

Do IV antibiotics increase a child’s risk of asthma and allergies?

Several studies do suggest that early exposure to antibiotics may be a risk factor for allergies and asthma. This study found that one-year-olds were more likely to suffer from wheezing and allergies, while this review of several studies also found a possible link to eczema.

What other side effects might there be?

“Although rare, severe allergic reactions in mothers have been reported. The risk is estimated to be 1 in 10,000 for a severe reaction, and 1 in 100,000 for a fatal reaction. (Weiss and Adkinson 1988).” (source)

Are any new approaches for antibiotic use being explored?

According to Gentle Birth, “some OBs and pediatricians have a new approach; for cases of prolonged rupture of membranes, they’re only giving antibiotics if the mom runs a fever. Otherwise, they just do a simple blood test on the baby (can be done from cord blood or a heelstick if they miss the cord blood opportunity) to check for C-reactive protein. This is an indicator of an acute infection. If it’s negative, everyone can be reassured that baby’s fine, even though mom didn’t get antibiotics; if it’s positive (for whatever reason!), then baby will be appropriately treated for an acute infection. This has great potential for focusing the treatment where it is most needed and not exposing all the others to unnecessary side effects and increased risks from resistant bacteria.”

Another option may be to test women for antibodies to GBS (GBS capsular polysaccharide type-specific serum IgG) when testing them for the presence of GBS. Since we know that they pass on those antibodies, it might be worthwhile to have that info when making a decision on whether to administer antibiotics.

How does water birth affect Group B Strep?

In 4,432 waterbirths studied, only one resulted in a case of early onset newborn GBS, “suggesting that low-risk women who give birth in water may have a far lower rate of newborn GBS than women who have a dry birth. The last reported rate of newborn GBS for dry births was 1 in 1450. Several theories for this phenomenon are suggested in this article:

(1) inoculating the baby with mother’s intestinal flora at birth protects against GBS infection;

(2) water washes off the GBS bacteria acquired during the descent through the vagina;

(3) the water dilutes the GBS bacteria and mixes it with a multitude of other intestinal bacteria that compete with GBS;

(4) early onset GBS is elicited by complications and interventions at birth, which occur less often at water-births;

(5) kangaroo care at birth promotes healthy newborns;

(6) GBS and antibiotic-resistant GBS are more prevalent in hospital environments, where waterbirths are not an option;

(7) a higher rate of underreporting of adverse events at waterbirths compared to dry births; and/or

(8) a massively successful international campaign has covered up the reporting of all deaths and disease from GBS after waterbirths.” (source)

What about late onset GBS?

Currently “No strategies exist to prevent late-onset disease, although more than half of reported cases of neonatal GBS disease now occur during the late-onset period. In addition, concern continues among health officials that widespread intrapartum antimicrobial use might delay, rather than prevent, GBS disease onset, resulting in increased rates of late-onset disease. No evidence exists to suggest an increase; however, careful monitoring of disease trends remains a priority.” (source)

 Are there any natural treatments for Group B Strep?

Though they have not been studied formally, many midwives have found at-home remedies helpful in avoiding Group B Strep, eliminating it after a positive result, or both. Here are some of their suggestions. Please note that when taking this approach it is usually recommended that moms be tested between 32-36 weeks so they have time to be re-tested. When you are retested, you can evaluate how these approaches are working for you and modify things if needed.

Strategies for avoiding or eliminating Group B Strep

  • Fermented Foods – Consume foods rich in beneficial bacteria such as yogurt, kefir, and sauerkraut throughout pregnancy.
  • Raw Garlic Daily – I’d take about 2-4 cloves per day in addition to whatever is cooked with. Simply mince and allow to sit for 10 minutes to activate the anti-microbial compound allicin, then add to a salad, salsa, etc, or swallow it in one go with a glass of water. Personally, I wouldn’t use the capsule form because highly-concentrated doses may have a blood thinning effect. (source) I don’t say this to scare anyone. Even water can be toxic in high enough doses, so this isn’t an indictment of garlic. Just a reminder that whole food forms are often very gentle while still being incredibly beneficial.
  • Echinacea and Astragalus Tincture – “Take 1/3 teaspoon of echinacea and astragalus tinctures twice daily. You can get dried astragalus in the herb department of health food stores. Cook two strips into a pot of rice or soup 2-3 times per week. Remove the strips when done cooking and eat the rice or soup. Astragalus is an immune system tonic used in Chinese medicine.” (source)
  • Burdock Root and Echinacea Infusion – Emily of Holistic Squid shares how to prepare it here.
  • Apple Cider Vinegar Bath  – “This method is quite possibly the most effective. Three times a week, take a bath with 1/4 cup of apple cider vinegar added to the bath. The smell might be less than desirable, but it works. The theory is that the bacteria cannot live in the acidic environment of the vinegar and therefore dies.” (source)
  • Apple Cider Vinegar Tonic - Other midwives recommend 2 teaspoons of raw apple cider vinegar in water daily during the last trimester to prevent colonization. Raw apple cider vinegar is great for overall digestion and can often help with heartburn as well.
  • Daily Vitamin C – I prefer whole f00d-based versions that contain co-factors for optimal absorption. Unfortunately, about 99% of all vitamin C products on the market today are synthetically made ascorbic acid or something similar, and some studies show that these synthetic versions can actually weaken the mitochondria and possibly cause kidney stones. (source) Unfortunately, it’s not so easy to tell what’s what just by reading labels:

“Almost all of the vitamin C in supplements is made in a laboratory, despite labeling that implies otherwise. For example, the label might say, “ascorbic acid from sago palm.” Dextrose, a form of sugar that contains no vitamin C at all, is extracted from sago palm and used as the base molecular material for a complex laboratory process that synthesizes vitamin C. Or the label might say “vitamin C derived from the finest natural sources.” True, but the vitamin C was synthesized. It might also say “with rose hips and acerola,” which are then used as the base material for the tablet or capsule. But a tablet of rose hips or acerola can contain only about forty milligrams of truly natural vitamin C; the rest is synthesized.” Ron Schmid, ND ~ Dietary Supplements: What The Industry Does Not Want You To Know

When looking for a quality Vitamin C supplement I suggest looking for something in which the Vitamin C is derived from 100% whole food sources, like rose hip tea or elderberry syrupAcerola powder is also generally a very good option, but there is not much research on its use with pregnant/nursing women so talk to your trusted healthcare provider before using it. (I did find a website that said they didn’t see any reason to think their acerola supplement would cause a problem for pregnant women, but their particular product is a blend of acerola powder plus synthetic ascorbic acid so I personally wouldn’t use it)

  • Garlic Suppository – You can find “how to” instructions from Emily of Holistic Squid here. However, something to keep in mind is that the effect of garlic suppositories is relatively temporary, so if you use this method before taking a GBS test and then do not continue using it, there is a possibility that if GBS was present (but suppressed) that it will grow back.

What should I do?

As you can see, there is no “one-size-fits-all” method that is right for everyone. I suggest that you discuss your personal circumstances, along with the risks and benefits of each approach, with your healthcare provider. And of course, make sure to ask lots of questions.

What I did with my three children

As I mentioned at the beginning of this post, I’ve had three births – one where I tested GBS+ and did the wash, one where I tested GBS+ and did not, and one where I did something differently and did not test GBS+.

With my firstborn, Katie, my GBS results were delayed due to a mixup with my midwife. I was positive, but did not know it until very late in my pregnancy. I wanted to avoid IV antibiotics if possible but didn’t have very much time to research. In the end, I opted for my midwife’s recommendation, which was to rinse my birth canal with chlorahexadine. I did not know anything about how this might affect my daughter’s microbiome at the time.

When I became pregnant with baby #2, Micah, I tested positive for GBS again. However, after reading more on the microbiome and talking things over with my midwife, I decided to decline IV antibiotics and the chlorahexadine wash. For me, it was a research-based decision in which I weighed my personal risks and benefits. For example, I considered the fact that one of the most vulnerable populations are pre-term babies. My son was born at 41+ weeks gestation. I ate a 100% traditional diet with lots of fermented foods, got plenty of Vitamin D from the sun, and worked to boost immune function through some of the natural supplements listed above. I also educated myself on the symptoms of early-onset GBS.

I started using this probiotic before I became pregnant with Levi (baby #3), and was surprised to learn when we finally tested that I was negative for GBS. Per the guidelines set by the CDC, ACOG and healthcare providers, no antibiotics or antiseptic washes were considered.

None of my children developed GBS disease. All were born in water, which as I mentioned earlier reduces the likelihood of developing GBS disease. Of course, this is just what I chose to do. You may choose something entirely different, and that’s ok.

Looking For More Info On Birth Choices?

Happy Healthy Child: A Holistic Approach is a DVD childbirth education course that shares insights from over 30 world-renowned OB/GYNs, midwives, pediatricians, scientists, psychologists, childbirth educators, sleep experts and lactation specialists that can help improve the birth experience and overall outcome mama’s and their babies.

If you read through this site much you’l find many of the same names mentioned – these are the people I turned to when I was researching things like routine ultrasounds, co-sleeping, natural birth and more. People like:

  • Dr. Bob Sears, who received his pediatric training at Harvard Medical School’s Children’s Hospital in Boston and The Hospital for Sick Children in Toronto — the largest children’s hospital in the world. Dr. Sears is the author of over 30 books on childcare and a fellow of the American Academy of Pediatrics (AAP) and the Royal College of Pediatricians.
  • Ina May Gaskin, who has been called “the mother of authentic midwifery
  • Dr. James McKenna, head of the University of Notre Dame’s Mother-Baby Behavioral Sleep LaboratoryThis post and this post are based on his work.
  • and Dr. Sarah Buckley, who was the first to make me dig deeper into routine ultrasounds

Topics covered include:

  • Optimal nutrition for you and your developing fetus (I did not agree with all the recommendations in this section. Beautiful Babies is a better resource for dietary recommendations in my opinion.)
  • The best ways to prepare for your labor and birth
  •  Building your birth team
  •  Overcoming the intensity of labor
  •  Common interventions and how to avoid the unnecessary ones
  •  Taking care of your new baby (bonding, breastfeeding, infant sleep, etc.)

(Read my full review here)

Have you ever been GBS+? What was your approach?

The post I’m Group B Strep Positive – Now What? appeared first on Mommypotamus.

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