GBS screening yea/nay?

[PaigeC]

I've been plumbing the archives here at MDC for Group B Strep info. I feel confident that I would not accept antibiotics unless I fell into a risk category (PROM, fever, prematurity).

My question is would it be better for me to refuse the screen altogether? I wonder what the hospital will think about a + screen refusing antibiotics vs. an unscreened woman.

Of course I could get a - and not worry at all. hmm.

What do you think?

[dogmom327]

I refused to be tested. A positive test doesn't mean I'll be positive when I give birth but it does go in my file and potentially cause all sorts of issues if I transfer (I do home births). Like you said, I would consider treatment only if risk factors developed.

[Eman'smom]

I choose to be tested both at our hosptial and hb. At the hospital they treat a non-test as a positive and then I would be faced with waving treatment/getting treatement when I may or may not be positive. I figured get the test if it's neg (it was) I'd be left alone. At our hb I choose to be tested for the unlikely event of transfer.

[jengacnm]

Don't do the test. Getting a known positive when you KNOW you don't want abx except for risk factors puts your care provider in an untenable legal position. Getting antibiotics for prolonged rupture, fever, etc, is standard anyway for GBS unknown.

In other words, it's better to be unknown than to intentionally not treat a positive.

The other scenario-being treated as positive when the status is unknown-is not supported by research OR the CDC.

Jennifer

[MegBoz]

Originally Posted by jengacnm

Getting antibiotics for prolonged rupture, fever, etc, is standard anyway for GBS unknown.

Oh, I was going to say - get the test, then only accept ABTs if you have other risk factors (that's how they manage it in the UK, so it really isn't an unreasonable treatment protocol!) but I didn't know that you'd get the ABTs anyway for those other risk factors. Another GBS risk factor is prematurity - would ABTs be automatic for that & GBS status unknown?

Another issue is that if you are + and get no ABTs, the treatment protocol for the baby is to stay in the hospital 48 hours minimum to monitor. I would expect it to be difficult to find any pedi to agree to deviate from this, as it is the standard. So this is another issue to consider.

I would still get tested, because with PROM, I might otherwise not go to the hospital ASAP (to avoid augmentation to move things along), but if I knew I was GBS+ & had PROM, getting to the hospital sooner would be a higher priority.
You can also do the hibicleans in advance of testing to increase the chance you'll test -.

[beenineucmom]

Originally Posted by MegBoz

Oh, I was going to say - get the test, then only accept ABTs if you have other risk factors (that's how they manage it in the UK, so it really isn't an unreasonable treatment protocol!) but I didn't know that you'd get the ABTs anyway for those other risk factors. Another GBS risk factor is prematurity - would ABTs be automatic for that & GBS status unknown?

Another issue is that if you are + and get no ABTs, the treatment protocol for the baby is to stay in the hospital 48 hours minimum to monitor. I would expect it to be difficult to find any pedi to agree to deviate from this, as it is the standard. So this is another issue to consider.

I would still get tested, because with PROM, I might otherwise not go to the hospital ASAP (to avoid augmentation to move things along), but if I knew I was GBS+ & had PROM, getting to the hospital sooner would be a higher priority.
You can also do the hibicleans in advance of testing to increase the chance you'll test -.

IT is unreasonable if you live in the US. Here we canNOT refuse the abx w/unknown GBS staus. YOU GET 'EM! Or, your doc will dismiss you from his care.

As far as Early L&D... goes you might want to consider that GBS is one of the reasons you are in premature labor in the first place. You would get ABX here in the US. Maybe even want abx. Besides, you don't get tested here in the US until you are 36w along. If you delivered before that time, you would not be tested anyway. SOme OB's do testing early in pregnancy; usually by urine, but not many. Maybe if you have had a premee before or something.

The next part makes perfect sense to me...."I would still get tested b/c with PROM, I might otherwise not go to the hospital ASAP ..." This is a good idea to test for. FInd out if you are positive and if you are and your water is broken for a prolong period of time. At least you are making an informed decision.

So, in light of all this why would you want to make the test neg with the Hibliclens if you really want to know? Why don't you just take what you get? Why would you want to "make the test negative?"
Sandy

[MegBoz]

Originally Posted by beenineucmom

IT is unreasonable if you live in the US. Here we canNOT refuse the abx w/unknown GBS staus. YOU GET 'EM! Or, your doc will dismiss you from his care.

I live in the US too. I mentioned how they do things in the UK because maternity care in the US is currently such an atrocity (that's why I'm involved with CIMS to try to fix it! See siggy). So when I got conflicting advice on how to manage GBS, my DH suggested seeing how they manage it in other countries with far superior maternity care - which I thought was a brilliant idea!

& legally, docs can't "abandon" patients. "Patient Abandonment" is actually an offense, I think a doc can have his license revoked for! In order to dismiss you from his care, he has to give you advanced warning, 30 days comes to mind, help to transfer your care so he ensures you have care, and he can't dismiss you when you're in urgent need (like when you're in labor.)

Of course, if you tell your doc in advance of labor that you will refuse the ABTs, then I suppose it is a risk you'd be dismissed. But you could always show up at the hospital in labor and THEN refuse.

So, in light of all this why would you want to make the test neg with the Hibliclens if you really want to know? Why don't you just take what you get? Why would you want to "make the test negative?"

Good point. And I've thought about that.. If I did hibiclens in advance of the test, and tested negative, I wouldn't know if I was negative anyway.. or if I was negative only BECAUSE I did the hibiclens! Well, if the latter, than it would be important for me to continue to do the hibicleans while in labor to be sure the bacteria are not present for the birth. Of course, I could end up doing the clens for nothing if I would have been negative anyway... but I don't know if that has any risk or negative side effect.

Besides... even if I did NOT do the hibiclens prophalactically in advance of the test, I could still test negative, and then be positive when I finally went into labor - so a negative test STILL doesn't mean you are definitely free of the GBS bacteria at the time of labor! Basically... it's a big "crap-shoot" either way!

[jengacnm]

IT is unreasonable if you live in the US. Here we canNOT refuse the abx w/unknown GBS staus. YOU GET 'EM! Or, your doc will dismiss you from his care.

From the CDC website:

"Women whose culture results are unknown at the time of delivery should be managed according to the risk-based approach; the obstetric risk factors remain unchanged (i.e., delivery at <37 weeks' gestation, duration of membrane rupture >18 hours, or temperature >100.4ºF [>38.0ºC])."

Therefore: if a care provider insists on ABX with unknown gbs status ALONE, NO risk factors, it is his/her "professional discretion" but is not supported by CDC guidelines.

[PTmorgan]

Last pregnancy I decided to get tested, and I indeed turned up positive. Hospital and OB policy is to give antibiotics, of course. I discussed with OB the pros/cons (she didn't have time to actually discuss, but she at least understood that I've been researching). I put in my birth plan that I will use antibiotics ONLY for the risk factors (prolonged ROM, fever, etc). I arrived at the hospital after being in labor for 24 hours - no ROM or fever. The nurse only said to me "I understand you are declining the antibiotics?" "Yes." "You do understand why they are recommended?" "Yes, and I will have them if I get any of the risk factors." "OK" That was it! They never did anything to my baby beyond the daily vital signs.

I was expecting hostility and a hard fight. Surprisingly, they only did light pushing and accepted my wishes.

I plan to do the same thing this time. Since then, I've been doing a lot of research on Hibiclens vaginal washes, and I like the results they are getting. I'd like to do them every 6 hours during labor if I'm positive this time. (I have no idea if they are allowed in the hospital. I'm expecting hostility and a hard fight again! Maybe I'll be pleasantly surprised - this is the same hospital as last time.)