A UTI is defined objectively as bacteruria on routine urinalysis or subjectively as dysuria, urgency, frequency, dyspareunia, malaise, fever of unknown origin, suprapubic pressure and/or spasmic cramps in midline.

Urinary Tract Infection in Pregnancy

The midwife should obtain clean catch urine specimen for culture and urinalysis.

The midwife should encourage the client to increase her fluids, including unsweetened cranberry juice or cranberry extract (both of which can be obtained from natural or health food stores). She should review the client's diet, eliminating coffee, black tea or sodas, and adding fluids with vitamin C and bioflavinoids. Herbal teas, such as Uva Ursi (the only antiseptic herb which passes through the kidneys) may be used. If using herbs for medicinal purposes, use 1 oz of the leaves and place them in a jar and pour boiling water over them. Let them steep for 4 hours or overnight. Drink 1/4 cup 4 times daily for prevention and 1/2 cup 4 times daily when fighting an active infection. The midwife should provide counseling as needed.

The midwife should check for costalvertral angle (CVA) tenderness found with kidney involvement. This examination is done by making a fist and lightly pound the woman's back from the top -> down, on either side of the spine. If infection is present there will be tenderness just above the crests of the pelvis.

If urine culture continues to be positive after treatment or CVA tenderness is found, the client should consult with her health care provider for further therapy.

The midwife should repeat urinalysis after therapy and periodically thereafter or at any sign of recurrance.