advice on Group B Strep...

[JenniferLS]

Without trying to read through every single thread to find my answers, can anyone direct me to a discussion, or have some answers on hand?

I would like to have a homebirth for my next child (no. 3) but I'm wondering...I was positive for Group B Strep for my first two children...so each one got antibiotics just before birth...to top it off, my OB said that even if I had tested negative, they would have likely done antibiotics anyway...since I tested positive before.

I have since come to the conclusion that even if I DID test positive again, I would not want the antibiotics. Has anyone done a homebirth and been positive for Group B Strep? If so, what is the standard procedure for homebirths...do most midwives just think it's not that important...or what? This is all new to me. Any thoughts would be helpful.

Also...another homebirth question...what's the business about all this Vit K shot stuff? Is that something that's not typically done for homebirths?
Just wondering what the ACTUAL necessity is for it.

Thanks!
Jennifer

[jennyfah]

GBS was the only test I did for my last pregnancy. I swabbed myself in the bathroom while my midwife waiting in my living room. Had I tested positive for GBS I probably would have followed the Hibiclens wash protocol.

Here's an old thread about that if you're interested:
http://www.mothering.com/discussions...d.php?t=326493

Some midwives like to have the test in your file in case of a hospital transfer; it would be one less battle to fight, I suppose.

Both GBS and Vitamin K are very complex issues, and everyone has their own opinions/experience around them. We did not do Vitamin K with our homebirth, but had DS experienced trauma (bruising or something) we probably would have been OK with it.

Best wishes for a lovely birth!
jen

[hikingmommy]

He he, another Jennifer posting here.

I didn't do the test for GBS this time. I was positive last time, and have chosen to treat myself as if I'm positive again. I'm taking a lot of supplements - garlic, cranberry, echinacea, astragalus, bee propolis, vit. C w/ flavinoids to try to decrease it in my body. I'm also using a garlic clove vaginally at night. In labor I plan on rinsing w/ Hibiclens and water every few hours. I am confident that I'm doing all I can to prevent transmitting the infection, if present, to the baby, and I'd probably do the same thing if I were birthing in a hospital.

Vitamin K is necessary to prevent bleeding in the brain for a baby if there's a difficult birth. It helps with clotting. Babies can't make their own for I think about a month. (I'm not sure on the exact timing, though.) I chose to buy the oral vitamin K to give to the baby at birth, 1 week, and 4 weeks. I liked this source for info. about it: http://www.womens-health.co.uk/vitk.asp. It's quite rare that babies have bleeding in their brain after birth, but it is very serious if it happens.

[MamaGlow]

I tested pos for my 2nd and 3rd babies (1st and 2nd hb)... with the first I did a supplement protocol, similar to hikingmommy's list... I believe it strengthened the amniotic sac, and it stayed intact through crowning. With that pg I also re-tested a few days before he was born and was neg at that time...

with the second, my water broke early (had not been following the same protocol, not sure why?) but had hibiclens on hand and did that once my water broke...

I was personally not symptomatic, and neither of those children had any difficulties after...

[JenniferLS]

thanks and a few more questions...

OK...so am i understanding correctly that once you have GBS, you always have it? Or is it just something that shows up when pregnant? My sister is
real big into colloidal silver--she makes her own all the time and uses it for absolutely EVERYTHING...and a couple years ago when I told her that
I had to have the antibiotics...she said I should just take the colloidal silver and get rid of the infection once and for all...and then next time I wouldn't need it.

So that's one question...the other question...the things like cranberry juice, garlic, probiotics, whatever...those are things I already do all the time...yet...I was still positive last pregnancy. So what does that mean exactly...just beef it up when pregnant to make sure I get rid of infection?

Thanks again for all your answers!

Jennifer

[hikingmommy]

GBS lives on the skin and in the bodies of many women. It can come and go. There's no guarantee that your status when tested will still be accurate at the time of your baby's birth. The standard among doctors seems to be to assume once positive, always positive. I don't know what the stats are, if there even are any, but I know it can be "here today, gone tomorrow." That's why they don't just prescribe oral abx, b/c once you finish the course, the bacteria can come back.

For some women, taking supplements can get rid of the bacteria. I'm hoping for that, but not counting on it, which is why I'm doing the garlic vaginally and rinsing w/ Hibiclens during labor.

It's worth looking into the risk factors for infection, too (like maternal fever, waters breaking more than 24 hours before birth, premature birth, etc.). They may help you decide how to treat yourself during labor. If you don't have any of the risk factors, the chances of your baby contracting the infection are quite low, even if you carry the bacteria.

[JenniferLS]

hiking mommy

Thanks for your information...VERY HELPFUL...it's all becoming a little more clear now. So, with my first two, my water never broke early...had to be broken by OB...and I CERTAINLY did not have early labor (not early enough, by my standards! :-)
So does that check in my favor for risk factors? Am I understanding this incorrectly, or is it the actual water breaking that can transfer the infection? That's just sort of how it sounded from the other thread I read.

Thanks again!
Jennifer

[saharasky]

I refused testing with both of my children as I was planning a homebirth and did not want to deal with antibiotics. Everything I had read at that point (7 and 4 years ago) supported the fact that I could test positive one day and give birth 3 weeks later and be negative or vice versa.

The following link is one of my favorite articles: http://www.aims.org.uk/Journal/Vol15...roupBStrep.htm
it is from the UK where they have a different philosophy/mode of treatment for GBS than here in Canada or the US.

AS for both of my homebirths ...both times membranes ruptured within an hour of birth. None of the risk factors were present except for my son who though born at 38 weeks had underdeveloped lungs. He was transferred to the hospital for help breathing and my midwife told the doctors that I HAD done the GBS test and it was negative ...she did this in order to avoid having him subjected to a lumbar puncture. We came home when he was ten days old ... he caught a horrible cold and ten days later stopped breathing in my arms ...we returned to the hospital where he tested positive for GBS colonization ...meaning he had GBS in his body (and was treated for it with antibiotics as a precautionary measure) but was never 'infected' ... because he tested positive later than 7 days old it was acalled late onset ...but I will never know if he got it from birth or somewhere else.

The stats around exposure to GBS say that about 1% of babies exposed to GBS at birth can become infected. Of those 30% will suffer permanent neurological damage and 5% die ... 65% will suffer no long term effects.

If I were to do it again I would test but still refuse the antibiotics (overuse of antibiotics is causing a whole other set of problems with antibiotic resistant bacteria especially since antibiotics became routine for treating GBS + women prior to child birth) ... I would test so that IF I were transferred I would KNOW that my child was at risk and be able to treat him with appropriate antibiotics 'just in case'. However my status is pretty much carved in stone as far as HCP's are concerned ... they don't know what my actual GBS status was ...but they DO know that I had a GBS + baby and therefore I would have to argue pretty strongly for no antibiotics regardless of testing + or negative.

HTH

[StephM76]

I was GBS positive for my first 3 births. My last one, I was negative.

If I had tested positive, I wouldn't have taken the antibiotics unless the risk factors were present. (Water breaking early, temperature, etc.)

[XanaduMama]

I tested positive with #1, so with #2 (HB), I made sure to test negative. Took loads of vitamin C and probiotics throughout pregnancy, then did the Hibiclens wash the night before testing. Got a negative test back

Got NO internal exams that whole pregnancy, until MW said I was ready to push (and I didn't believe her, lol).

http://www.gentlebirth.org/archives/gbs.html

and especially

http://www.gentlebirth.org/archives/gbs.html#Lavage

[hikingmommy]

Originally Posted by JenniferLS

Thanks for your information...VERY HELPFUL...it's all becoming a little more clear now. So, with my first two, my water never broke early...had to be broken by OB...and I CERTAINLY did not have early labor (not early enough, by my standards! :-)
So does that check in my favor for risk factors? Am I understanding this incorrectly, or is it the actual water breaking that can transfer the infection? That's just sort of how it sounded from the other thread I read.

Thanks again!
Jennifer

Yeah, the problem w/ the water breaking is that it opens the uterus up to the bacteria getting in b/c that barrier is no longer there. Cervical checks after the water breaks can increase the likelihood of infection b/c it can push the bacteria up higher/introduce new bacteria. The longer the waters are broken before birth, the more likely the bacteria can make their way into the uterus.

[Love_My_Babies]

I had a hb and was gbs+. I did the hibiclense treatments starting when my contractions became stronger. My labor and delivery was fast, and he was born in his amniotic sac. So, he never came into contact with the birth canal anyway.

My MW did not do cervical checks because she didn't want to push any bacteria toward the cervix/uterus. She also suggests that if your water breaks and you don't deliver within 12 hours to go to the hospital for a round of IV antibiotics and then go back home to deliver. She does that often.

Just be aware of the symptoms of infection. If you or the baby have a fever at all, don't delay in getting medical care.

[octanebeetle27]

Not trying to hijack this thread but while we are on the subject of GBS...

I tested GBS+ with my first pregnancy and then assumed I was + with the next two pregnancies (had U.T.Is where my urine culture showed GBS). This pregnancy I ended up with a very nasty kidney infection that landed me in the hospital on I.V. antibiotics (once again, GBS in the culture). My mw doesn't seem to be too concerned--she rec the hibiclense treatment during labor and a few other things (Vit c, getting lots of rest to keep immune system strong, limited or no internals during labor, etc).

Guess I'm just looking for reassurance that I'm not crazy to labor w/out antibiotics despite the fact that I am probably/possibly heavily colonized with GBS!!

Again--sorry to hijack the thread!!!

[UhOhWhatNow]

I declined the test... baby and I are fine. I would never have gotten IV anyway, I am too phobic and it would have ruined my birth. I had a birth center birth, but MW let me call all the shots. They did suggest a rinse for me to do every day but I admit I never bothered...

We did vit K but she asked if we wanted it. I had forgotten they do it... so I asked her to explain the reasons to do it or not do it and she did, she was completely neutral... so we decided to do it just in case. I appreciated it was in NO way pushed onto us!

[JenniferLS]

WOW! I LOVE this website!

I don't know how I ever got along without this site! Every time I post a question I get SO MANY helpful responses! WOW! Thank you everyone for your input! I definitely want to find a way to avoid antibiotics. My firstborn who is almost 4 now was diagnosed with autism a year ago...he's barely on the spectrum now...but I believe that a lot of things we did starting with birth could have helped contribute to his regression...IV antibiotics for GBS, Hep B in hospital---it should be a law that you cannot get Hep B vax in hospital if child had antibiotics! DUH! Why would anyone do that?!?!? I sure wish I had known that four years ago! I know that antibiotics can lower the immune system, right? So all those factors probably did not help my son. I did the same with my daughter who just turned 2...and she's perfectly fine...no problems at all, and has had every vax except MMR (waiting AWHILE for that one)...but now I know better and want to
be proactive right from the beginning. So I will definitely want to avoid antibiotics and vaxes too early, etc.

HIKING MOMMY...QUICK QUESTION...
You were explaining to me about the waters breaking, etc...I guess my understanding was that the baby could be infected "on the way out" so to speak, at birth. Is that unlikely if the other risk factors (water breaking early, internal exams etc.) aren't there? Sorry for so many questions...I just want to be absolutely clear on all this.

THANKS AGAIN, EVERYONE!!!!

Jennifer

[acp]

I would definitely talk to your midwife to see what her protocols and suggestions are. She might have a lot of good info.

I think it's very unlikely that the baby will be infected, even if you're GBS +, if you don't have the risk factors you mentioned (water breaking early, lots of internal exams, etc), but I know my MW had told me that there were lots of things I could do short of ABX to minimize those risks even farther.
I did do the test (mostly so in case of a hospital transfer, since most hospitals will assume positive and automatically put you on ABX if you haven't done the test), and was negative, but if I had been positive, my mw told me there was a whole spectrum of things we could do including ABX, though she preferred not to go that route.

But the short answer to your question is that it's very easy to have a home birth even if you're GBS +.

On the Vitamin K, I've gone back and forth on it (we're currently expecting baby #2 in a home birth any day). We got both that and the eye goop for my daughter (hospital birth), and this time I know we want to avoid the eye goop since there's no need for it. On Vit K, I think I've decided to skip it too, unless there's a reason - if there's any bruising or if it's a long or traumatic birth, then I think we'd probably do it. I don't feel as strongly about it as I do some of the other "standard" birth procedures, but I don't want to do it if there's no reason to. Also, if you have a boy and are planning to circ, I think a lot of people recommend it. (as others mentioned, it's to help with blood clotting). My midwife did suggest that I take alfalfa and liquid chlorophyll and other things to help my own Vitamin K levels - I think there's some debate over how much, if at all, that gets passed on to the baby, but it can't hurt, and it's also good to help YOUR blood clotting at birth.

Good luck!

[amymaew]

I was GBS+ with both of my homebirths. With Henry I didn't get abx b/c it was a quick labor and the mw was only there for about 30 minutes before he was born. With Caroline I got abx when we thought I was in labor, but I wasn't actually in labor lol. We ended up inducing her with AROM around 1pm, and I said to the mw "if I'm still pregnant at midnight I'll get the abx." An hour and a half later I was holding her, so no abx. I did do the garlic and the acidophilis and the hibiclens and all that with both of them.

Vitamin K - Henry didn't get it, Caroline did. I make that decision at birth - if it was a traumatic or long 2nd stage or if there's bruising I get it. I'd definitely get it if I was going to circ before 8 days!

[Lynn08]

When I tested positive, my CNM (who is VERY cruchy ) and I decided on a supplement regimen (including garlic and colloidal silver). When I went into labor, I used a vaginal wash (I don't remember what it was, but the MW provided it) every 6 hours until transition. I didn't have any of the other risk factors (I think I had 3 internal exams the whole pg, with 2 of them being during labor, and my water didn't break until lovey was almost out) but everything was fine.

As for Vit K, we discussed the pros and cons with the MW and decided that we would do an oral application (is that the right word?) at birth, but no more unless necessary.

IMO, if you have a MW who does homebirths, you have a MW who is willing to work with you (esp regarding alternative treatments).

[aggie03]

Im getting abx IM shots at home in labor. Not too happy about it (4ml each...OUCH!) Im allergic to Pen and always get a rash with any abx, and deal with major yeast infections after....BUT DH likes the security and extra precaution and I am happy to please all for my HB.

[Comtessa]

This just occurred to me at my OB appt. this morning, to worry about GBS, since he said he'd do the test at our next visit. His automatic protocol is IV abx in labor (though he agreed to consider chlorhexadine if I brought in the study that demonstrated it was just as effective). Even so, though, you can't get IV abx at home! I don't think my midwife would bring along that sort of thing... she's a CPM (unlicensed in my state) and I'm fairly sure that would be considered "practicing medicine without a license"

I promised my DH when we planned our HB that "if I develop any risk factors in pregnancy, I promise we'll go to the hospital to have the baby." However, I don't think GBS+ is a risk factor that precludes HB... is it?? But, DH is already so anxious and upset about the HB (with us having zero risk factors - healthy normal baby, healthy mama) that if we add any variables or risk factors I feel like I will have to agree to a hospital birth in order to keep our marriage from falling apart.

So how on earth do I ensure that the GBS test comes back negative? Should I start on chlorhexadine now and keep it up 'til my next appt.? I did promise DH, but I'll be devastated if I have to give up my HB for something like this. I can also do the garlic thing, etc., but that gets pretty overwhelming (I use it for yeast infections sometimes, and the smell is overpowering to me who likes the smell of garlic) and not so sexy, KWIM? Any suggestions?

Isn't it just possible to test the baby after it's born, and if it's positive then use antibiotics?