antibiotics/hibiclens for GBS+

[Ssmmbb78]

hello,

i am interested in hearing the experiences of moms who were/are GBS+ with deciding whether to use antibiotics and/or hibiclens wash for a home birth. i was GBS+ my last pregnancy and had antibiotics during my daughter's hospital birth. i subsequently developed thrush which i think was due to the antibiotics. thrush was so awful for me that i really want to avoid it happening again. i am GBS+ this time too and am trying to decide whether to take the antibiotics again, or do a hibiclens wash protocol instead. some studies seem to suggest that hibiclens is as effective as antibiotics while others are inconclusive.

i tried lots of nutritional stuff to avoid a positive culture this time, but got one anyway. my midwife has said i could do the hibiclens and retest, but that most likely this would just give me a negative result temporarily and "trick" the test (however if i saw my results change from positive or negative as a result of the hibiclens, i'd probably feel more confident in its effectiveness). is there any other benefit to retesting?

i've done a lot of research on this topic. i know that the risk of transmission and illness for our baby is small even if i do nothing, and that the risk of getting thrush from the antibiotics is much higher, but i also worry that if by some slim chance the baby did get sick, i would feel awful because GBS illness can be very serious.

from what i understand, the risk of transmission increases with membranes ruptured 18 or more hours, fever in labor, and birth before 37 weeks gestation. assuming i have none of these risk factors (eg my bag stays intact, labor goes relatively fast, no fever, etc.) i think i'd be comfortable just doing the hibiclens. but i'm curious what others have done.

one other question -- i also am not sure how our pediatrician will respond if i take our newborn for a checkup and disclose that i was GBS+ but did not take the antibiotics. has anyone dealt with declining antibiotics at a home birth and then having a pediatrician question it?

if anyone has thoughts, experiences, research, etc. to share on this topic, i would be grateful!

[emnic77]

I declined abx with my last pregnancy, I was GBS+. I did the hibiclens wash. DS was a hospital birth, I had very little trouble declining the ABX. I had no risk factors (was overdue, water didn't break until he crowned, etc). The pediatrician gave us a list of things to watch for when we left the hospital 10 hours after birth, we had to sign a bunch of crap, but no one gave us any problem and his actual pediatrician never mentioned it.

I have no intention of 1) GBS testing again, 2) getting abx (homebirth this time), but I will do the hibiclens wash again to be safe.

[Gray's Mommy]

I've tested positive with both pregnancies & will probably test + again
I chose to use antbx with both (hospital & homebirth) and will be doing everything to NOT be positive this time. I'm going to be doing alot of garlic/other stuff to help the results.
My pedi never even asked about GBS during the checkup.

[XanaduMama]

The hibiclens wash doesn't "trick the test"--it makes you test negative by making you negative. Yes, you may then become positive again by the time you give birth, but that's true of any negative test: GBS colonization comes and goes.

I got the abx with my first; I did the wash, tested negative, and did nothing in labor with my second. If my labor had gone on longer, I'd have done another wash then (but it all went quickly and smoothly, so I wasn't worried).

I tested the second time (home birth), bc I was concerned about having to transfer and being treated as though I was positive in the absence of a negative test. I've heard horror stories of babies kidnapped to the NICU etc in such situations.

The ped won't ask you about your GBS status, so don't worry about that. If baby shows no symptoms, then there's no reason for them to ask.

[threadbey]

I was positive with my first (swab was vagina and rectum) and had iv abx at my homebirth. Second time I was really worried because we're in a different country and mws here can't do the iv. But this time I tested neg (swab was only of the cervix, with a speculum).

I'm not sure what I will do with a possible third - we would prob be back in the states and my mws there are pretty adamant about it all. I would definitely ask for the internal-only swab and might go for just hibicleanse if positive, but I would be much more concerned if the test was positive way up at my cervix, anyway, so might go for the abx.

I didn't get thrush the first time, thank heavens. I might feel more strongly if I had! It was awfully nice not to have the iv, though.

[Ssmmbb78]

thank you everyone for your replies! it is really helpful to read about how you decided to do what you did.

i spoke to my midwife about this and she said that trying the hibiclense retesting might be a good thing in that if i get a negative culture, that can be in my official record, and also because if it changes my test result, it will help ease my mind and be persuaded that the hibiclens will be effective in labor. so i think i'm going to use the hibiclens, retest, and see what happens. if i'm still positive, i'll probably be more likely to do the antibiotics. if i'm negative, i think i'll go with the hibiclens. and she said that if labor goes pretty quickly then hibiclens would make more sense than trying to get antibiotics in quickly since they wouldn't really have much effect anyway if there's not much time left.

thank you again!! i'd still be interested in hearing others' thoughts on how you decided to do what you did.

[MsBlack]

Originally Posted by Ssmmbb78

i spoke to my midwife about this and she said that trying the hibiclense retesting might be a good thing in that if i get a negative culture, that can be in my official record, and also because if it changes my test result, it will help ease my mind and be persuaded that the hibiclens will be effective in labor. so i think i'm going to use the hibiclens, retest, and see what happens. if i'm still positive, i'll probably be more likely to do the antibiotics. if i'm negative, i think i'll go with the hibiclens. and she said that if labor goes pretty quickly then hibiclens would make more sense than trying to get antibiotics in quickly since they wouldn't really have much effect anyway if there's not much time left.

This sounds like good sense to me. In a homebirth situation, IMO your baby is far less likely to actually get sick (from anything, GBS included) if birth is essentially normal and baby is essentially healthy anyway (it is the smaller, earlier, otherwise unhealthy babies or those who have high-intervention, high stress births that get sick most often, anyway). Homebirth, with less invasion of mamas, and little to no disruption of birth and bonding/breastfeeding, is simply less stressful for both moms and babies on all levels, and therefore less likely to bring any negative results for either one (not impossible mind you--just less likely than in a hospital, The homebirth studies do show a far lower instance of injury and all other forms of 'morbidity' including infections, than hospital rates).

I add that I am not aware of any studies of GBS rates at homebirths without antibiotics--all studies on GBS infection are hospital based. My informal surveys of mws and moms show that the rate of GBS infection is lower than hospital rates when mamas have had no antibiotics (the CDC says something like 1 in 200 babies get infected when moms test positive but have no abx--death rate is far lower, just talking about all infections).

While I respect your right to choose, and definitely applaud your careful looking at this issue so as to be as informed and empowered as possible, I do add that
a) antibiotics do NOT prevent all neonatal gbs infections/deaths
b) as you know, thrush is a possibility that I believe is far higher in occurrence than infections themselves--and for some this yeast infection can have longterm negative impact on moms/babies/breastfeeding (this is an observational/anectdotal theory of mine, not research based btw...as far as I know, it's not considered important enough to warrant research)
c) antibiotic overuse is responsible for the mutation of the antibiotic-resistant Superbugs we now have aplenty.
d) even though there are now fewer *GBS* infections and deaths since antibiotics protocols were instituted, we have *more* e coli infections/deaths now. Antibiotic-resistant e coli infections.

Truly, I see no logic in US med theory and protocols concerning GBS--and the US is the only developed country utilizing these protocols. You have to remember that it is not ONLY antibiotic use that has reduced neonatal infections, but other things as well--such as improved awareness of neonate signs of infection/impending infection and earlier treatment, tighter protocols in hospitals concerning handwashing by staff, tighter restrictions on visitors to the newborn nursery and various other things.

These things make a difference because of this: if a baby gets infected in the first week or so, it is assumed that the infection originated with birth--with mom being a GBS carrier. However, even moms who test negative, or who take plenty of antibiotics, end up with sick babies sometimes. This is because many a GBS/other infection is acquired in the hospital itself--whether via staff members, visitors, other patients, etc. It is not usually possible to say with certainty where an infection originates--unless baby is born sick, or mom is actively infected during labor (both are fairly rare occurrences)--then one can be certain that the infection originated with mom. It is only when an infection occurs in the 2nd-3rd week or beyond that med ppl will call it 'community acquired' or 'environmentally acquired' (from surfaces/air in the home) --but it is difficult to pinpoint where ANY infection originated, even in those first days. Just to remind you that the stats do not mention such points as I have; the 'results and conclusions' are in some ways based on assumptions which are very difficult to prove--such as the assumption that early neonate infections (in first week) are always acquired from mom.

good luck with all of this--I can see you are navigating with care and consideration, always a good thing in my book!

[wiggles06]

I did the garlic theraphy that my midwife recommended and it worked. I tested positive at 37 weeks and did the garlic for 8 consecutive days. I had my retest at 39 weeks and I was negative. I highly recommend it!!!

Here is how it works:

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

http://www.midwiferytoday.com/articles/garlic.asp

Hope this helps. Good luck.

Mommy to my little pumpkin 4/2/09 and loving wifey to my college sweetheart 9/16/08

[ShwarmaQueen]

This is a totally dumb question, but do you just wash the outside or do an internal douche type wash with the hibiclens solution? Also, what is the solution ratio (hibiclens to water)?

[XanaduMama]

Here's the hibiclens protocol: www.birthcottage.com/images/GBS%20Protocol.PDF

Many people say washing the exterior is fine, since that's usually where the bacteria are concentrated, but I used a syringe and *gently* irrigated inside my vagina as well, for good measure, as high as I could reach.

[ShwarmaQueen]

Originally Posted by XanaduMama

Here's the hibiclens protocol: www.birthcottage.com/images/GBS%20Protocol.PDF

Awesome, thanks!

[mwherbs]

here is what I am wondering- what are your vitamin D levels? the recent information explosion on vitamin d has me thinking that there may be a connection between GBS status and vitamin D- there was a recent study on BV and vitamin D levels in pregnancy-
we often have had moms do the alternative protocols including the 1 clove of garlic/ week and it helps but maybe we have been missing this important piece on immunity all along.

[marrymeflyfree]

Originally Posted by Ssmmbb78

i am interested in hearing the experiences of moms who were/are GBS+ with deciding whether to use antibiotics and/or hibiclens wash for a home birth.

I just birthed 5 days ago...IV abx were not an option at homebirth for me, so it was either hibiclens or nothing. Given that, I elected to just forgo GBS testing altogether and decided to do the vaginal rinse during labor no matter what. I felt comfortable with that since this protocol is commonly used outside the US, and since some of the research showed it to be as effective as abx. I did the rinse either every 4 or 6 hours - just 5 days ago, but I've already forgotten!

one other question -- i also am not sure how our pediatrician will respond if i take our newborn for a checkup and disclose that i was GBS+ but did not take the antibiotics.

We ended transferring, sadly...argh. My water had been broken for nearly 24 hours when we showed up. The hospital staff were generally supportive, but they (namely, their pediatrician) were not keen on the fact that my GBS status was unknown. They swabbed me almost as soon as I was in the bed. The hospital ped did very strongly push me to give the baby abx after the birth because of the unknown status. I declined, and said if the baby showed any signs of infection or if her white count came back as elevated in the post-birth bloodwork, that I would reconsider. Her white count was normal, she was perfectly healthy, and that GBS swab came back with a negative result. Perhaps I'd been negative all along, or maybe I wasn't but the hibiclens went to work. I'll never know! But I would choose the same course again in the future. (Our daughter's actual pediatrician did stop by to see her in the hospital...she was not familiar with the hibiclens protocol, but supported our decisions on it once I explained it.)

[Comtessa]

I tested GBS+ the first time, used the Hibiclens, and tested negative the second time. I just continued using the Hibiclens once every day or so for the remainder of my pregnancy, and once every couple of hours during labor, to ensure that I stayed negative. This isn't "tricking the test," it's ensuring that you are GBS negative when you give birth!

My OB didn't want me to do a re-test (his position was "once positive, always positive"), but I pushed for it until he agreed. I was glad to get the negative re-test, because when my HB ended in transfer, they were able to look at my file and see a GBS- test result. I didn't have to fight at all on the abx issue - and it would definitely have been a fight at that point.

My next pregnancy, I'll avoid the hassle of the first GBS+ result and use the Hibiclens before the first test.