Call the Midwife: Katia L'Ecuyer on Group B Strep and Informed Decision-Making

Katia L'Ecuyer, CPM, LDEM serving Salt Lake County and North Utah County

​​This is the fifth post in a series of blog posts based on interviews I’m doing with midwives who serve Utah County and the surrounding areas.

Today, I’m honored to introduce you to Katia L’Ecuyer. Katia owns Innate Midwifery with birth centers in Holladay and West Jordan, UT. She also attends home births in Salt Lake County and north Utah County. She is a Certified Professional Midwife (CPM), a Licensed Direct Entry Midwife (LDEM), and a graduate of Midwives College of Utah. She also holds a bachelor’s degree in biology with a minor in chemistry from Utah Valley University. As a midwife for over 10 years, she has attended over 500 births in both Utah and Costa Rica. Katia is also a midwifery preceptor and enjoys mentoring student midwives.

Innate Midwifery Birth Center in Holladay, UT

During her time at UVU, Katia was the recipient of the Board of Trustees Scholarship in recognition of the research she has conducted on Group B Streptococcus during pregnancy. Even though she has graduated, she continues her research on Group B Strep with the aim of learning more about whether probiotics can be effective in preventing Group B Strep during pregnancy.

Group B Strep (GBS) is a type of bacteria that lives in the intestines and can sometimes travel to the rectum, vagina, and urinary tract. Because this carries a possibility of leading to infection in the newborn baby if a mother has Group B Strep in her vagina at the time of birth, pregnant women are routinely tested near the end of their pregnancy to determine whether they are currently colonized by Group B Strep. Those who are, are termed “GBS positive,” and (in the U.S.), care providers typically recommend that they be given IV antibiotics during labor to kill the bacteria and prevent it from spreading to the baby during birth and possibly causing an infection. To learn more about the evidence on Group B Strep and its significance in pregnancy and birth, check out this article by Evidence Based Birth.

Katia’s research on Group B Strep stems from a 2016 study conducted by Ho et al. In this study, researchers divided 110 GBS positive women in weeks 35-37 of pregnancy into two groups. To one group, they gave two placebo pills to be taken each night at bedtime. To the other group, they gave two probiotic pills (containing the probiotic strains L. rhamnosus GR-1 and L. reuteri RC-14) to swallow every night. They hypothesized that perhaps taking oral probiotics, which colonize the gut with “good” bacteria, would get rid of “bad” bacteria, like GBS.

When these women gave birth about three weeks later, 43% of the women who had taken the probiotics were then GBS negative, whereas only 14% of the women in the placebo group were GBS negative at the time of birth. These results were significant enough for the researchers to conclude that taking L. rhamnosus GR-1 and L. reuteri RC-14 oral probiotics during pregnancy is helpful to reduce GBS colonization in pregnancy.

This study was significant enough to attract the attention of researchers—like Katia—to dig deeper and get a better idea of what was going on with the use of probiotics to prevent or treat GBS, and whether the results could be generalized for all pregnant women. Subsequent researchers found, however, that the results of the 2016 Ho et al. study can’t be generalized to all populations. For instance, when researchers at Stanford University attempted to replicate the study, they did not find the same results.

There are several shortcomings with the study that Katia is digging into and trying to overcome in her research. For instance, we know that it typically takes 30-60 days for oral probiotics to colonize the vaginal and rectal mucosa, but in the Ho et al. study, participants took the probiotics for just three weeks on average. Katia wonders if that oversight may be one reason the results haven’t been replicable.

We also know that our gut microbiome is very influenced by our diet and lifestyle. Since the Ho et al. studied was conducted in Taiwan, it makes sense that its results may not be generalizable to pregnant women in the U.S., who have a very different diet and lifestyle. Katia’s goal is to further investigate these dietary and lifestyle differences and how they play out in the different bacteria that colonize our bodies during pregnancy, and which specific strains of probiotics would then prove most effective in preventing Group B Strep colonization during pregnancy.

Labor and birthing tub at Innate Midwifery Birth Center in Holladay, UT

Research in these fields is time-intensive and not for the impatient. As Katia continues to chip away at cracking the GBS code, she spends daily energy to ensure that her midwifery clients are educated and informed decision-makers. On every topic, with every recommendation she offers, Katia makes sure to give her clients lots of information and point them in the direction of more.

“I have informed consent for everything,” Katia says. “I think it’s a big piece of why people choose midwifery care, is to not be dictated what to do, but to feel like they have a say in their care.”

When emergencies come up and long conversation about the pros and cons of a choice aren’t possible, Katia relies on the relationship of trust she has built up with her clients throughout pregnancy. She’ll have as thorough a conversation with her clients as the situation allows. If a client’s birth isn’t going exactly as they’d hoped and they’re needing to make decisions they didn’t want to make to ensure the safety and health of themselves or their baby, giving them a chance to talk about it as much as possible makes a big difference. “The outcome, we can’t change. But how we feel about the outcome…” Katia believes that these conversations can make a big difference in those feelings. “Those conversations are really meaningful, because it does make the women feel like they were part of the decision-making process.”
​
From my conversation with Katia, I could easily sense her expertise as a midwife and her trust in her clients to be the decision-makers in their pregnancy and birth journey. Whether she’s guiding her clients through the process of making a decision or continuing to research Group B Strep, Katia is thorough, professional, and compassionate in her work.