advice on Group B Strep... - Page 2

[hikingmommy]

Originally Posted by JenniferLS

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

I'm no expert, but my understanding is that while the baby can get infected on the way out, if the waters have broken long before the birth, the bacteria can get into the uterus and infect the baby before he/she comes out. I believe that the longer the baby is exposed to the bacteria, the greater the chance of infection. I think if the waters haven't been broken for long and there haven't been a lot of internal exams, no sign of fever, etc., then the chance of baby getting infected during the birth itself are very slim.

[acp]

Originally Posted by 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?

Comtessa, I'm sorry you're dealing with this - I don't think being GBS positive should be a reason at all to not have a home birth, but I understand that it gets tricky with a nervous DH.
My midwife actually had a lot of suggestions for helping to ensure you get a negative test - which she swears have had really good results for her. Mostly eating lots of things with active cultures - yogurts and fermented foods, etc, and taking probiotics, and inserting probiotics (needs to be a kind that can easily dissolve) vaginally at night, for a couple weeks before the test.
I followed her advice to an extent, and did get a negative test - who knows if that helps, but I figured it couldn't hurt. 2/3 of women test negative without doing anything, so your chances are reasonably good you'll be negative and won't need to worry about this.

But - maybe arm yourself with some research to try to convince DH in case you do get a positive? You could talk to your midwife to see how she handles GBS + in her clients, and see if she can help him understand that it IS treatable through other means than IV ABX, and that it's not something that should be a "risk factor" ruling out home birth...
Good luck!

[bubbamummy]

In the UK you are not tested for GBS unless you have had numerous infections during pregnancy.

Therefore I am sure thousands and thousands of UK women give birth who are unknowingly GBS+ (home births and hospital) I was never tested and so have absolutely no idea if I was + or not!

[jengacnm]

I'm a home birth CNM and here is my "schpiel":

If a group of 200 women who are GBS positive DO NOT get treated with abx, 1 baby will get sick with invasive GBS disease.

If a group of 4000 women who are GBS positive DO get treated with abx, 1 baby will get sick with invasive GBS disease.

If a woman chooses to test and is positive, for me/us to deliberately not treat a positive is legally indefensible.

If a woman doesn't want to test, we will only treat for risk factors: broken water >18 hours, maternal fever, preterm birth.

So I discuss this thoroughly the visit before and make clear to the woman that it's OK if she doesn't test, but please don't do the test and expect to argue her way out of treatment if she's positive.

IV abx is my treatment of choice because it is what has been shown to work. I don't support hibiclens washes as equally effective because the one case of invasive GBS disease I've seen was to a baby who was born in the caul.

If a woman is GBS negative, we don't have to treat even if her water is broken more than 18 hours, etc. So having a GBS negative result is a good thing.

If a woman does probiotics, etc, for a negative GBS, she needs to continue doing it until the birth. We don't want to TEST negative, we want to BE negative.

Other notes:

The midwife who told the NICU staff that a woman was GBS negative when she hadn't tested may have thought she was doing her client a favor by avoiding a lumbar puncture. The reality is that GBS meningitis is incredibly serious and requires 2 weeks of IV antibiotics. If the baby had had GBS meningitis, that the midwife said the client had been negative may have delayed treatment.

The doctor who treats "once GBS positive, always GBS positive" is not working by CDC standards. Women need to be treated as always GBS positive if they had a previous baby with INVASIVE GBS DISEASE, not just have been positive before.

My $0.02...

Jennifer (yep, another one...)

[bubbamummy]

My midwife said one day you can test positive and the next day negative which makes it a waste of time as you may test negative on the day youre tested but be positive on the day you deliver...is this true??


sorry to hijack the thread

[AngelBee]

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[Comtessa]

Originally Posted by jengacnm

I'm a home birth CNM and here is my "schpiel":

Jennifer, thanks for your excellent response, you've helped me get this in much better perspective. I'm willing to do whatever I have to do to have a home birth - but the safety of the little one is always the most important thing for everyone, of course. It sounds like the best bet to ensure both things is to start in on a probiotic regimen now and keep it up 'til the baby's born. It can only help and can't hurt, right?