Are you getting tested for GBS?

[ks3885]

Hi all. I am an L&D nurse so I never even considered NOT getting tested for GBS since I have seen babies infected, and have heard of at least one death from late-onset GBS infection at my job. However, I have also recently been doing a lot of reading of research articles from different countries, and in the UK they don't even screen for GBS unless there are risk factors such as PTL, etc. To me that just seems strange since if you come in in PTL, they'll probably not have time to wait 48 hours for the culture to come back, so a lot of women probably get treated who don't need it. And reading Dr. Buckley's book on childbirth and parenting really makes it feel hard to justify getting tested...I honestly keep forgetting ot ask my midwife about her own policies about this.

HOWEVER. I also think a lot of chorio's and GBS infections in hospitals are from numerous vaginal exams in labor from lots of different providers, residents, nurses, etc, extended ROM d/t early AROM, etc. And just not being in your own place with your own germs.

Not to mention--the late onset GBS baby I know who died was a PLANNED ELECTIVE C-SECTION for twins. SO go figure. PLUS I saw babies whose moms got "adequate treatment" still get the infection occasionally.

If I'm planning a homebirth anyway, I'm not sure how comfortable I feel sticking Hibiclens into my vagina every couple hours in labor if I found I were GBS positive, I think (and just..feel somehow) that's almost a set-up for weirdness in itself. It's been shown in a couple small studies I think to be effective but then has not been shown to work well in other larger studies, so I sort of feel it's a toss-up and if you're not going to be receiving IV antibiotics ANYWAYS...

HOWEVER. what are you all doing, and what has your experience been with this aspect of "routine American prenatal/labor care"?

[mpvelaz]

I am a labor and delivery nurse also and had a homebirth in August. I did not get tested nor did I do any of the precaustions. It was just not a concern to me, follow your intuition. Also like you said, research says that it is not necessary unless you have the risk factors (Prolong rupture, preterm, etc.), remember that they tend to not practice towards the evidence in the hospital, but instead for convinence and to cover their asses.

[gillibean]

I've never even had a GBS test offered. My first two were with midwives and with my third I was seen at the family medicine clinic at the local hospital (the only option where we now live).

[emnic77]

No. I tested positive with my last pregnancy, I refused antibiotics and did a Hibiclens rinse (not inside, just out!) before I went to the hospital. I was overdue, no other risk factors, my ds was born with the membranes still intact, so I was unconcerned about it. I will maybe do another hibiclens rinse this time but I'm not sure yet.

[SublimeBirthGirl]

With my homebirth I didn't get tested and I didn't do anything special to prevent it.

[MsBlack]

A couple things--

first, a 'late onset' gbs infection is way more likely to have had an environmental origin, not from mom being a carrier. Home or hospital environment, that is, or perhaps from either taking the baby out in public too soon, or having too many visitors at home after the birth.

I only recommend gbs testing for one reason: in case of hospital transfer from homebirth, because the local hospitals are positively rabid about treatment of moms and babies in the case of 'unknown gbs status'--and it really doesn't matter if there are any risk factors present. Moms get IV abx pushed hard, Peds and NICU are adamant about getting a blood culture on baby after the birth, extended NICU stay for babies, all that. Will go so far as to threaten-or actually call--CPS for any parents who object, who want mom's and baby's actual health and birth circumstances to be given due weight. The hospital protocols are quite rigid in most cases. But if you walk into the hospital with a negative gbs test result, there is much less of this hassle to deal with.

THis means that I ask women to do a hibiclens rinse once, just prior to doing the gbs swab--which pretty much guarantees a negative test result. I do not pretend, nor do I want my clients to believe, that there is never any danger due to gbs. I do however, want us all to be working within their present realities and with logical, evidence based care. So I do teach about the risk factors for infection, and I do teach parents what to watch for in any neonate by way of 'troubling signs'--and also visit or call every day for the first week, so that I am helping families to watch over their new one. (after all, all neonates are as vulnerable as they can be resilient--gbs or 'other' possible factors posing the need for careful observation of all of baby's signs during that transition from life on the inside to outside.)

But as far as I can see, there is nothing the least bit logical or evidence based about the way the US thinks about, and deals with the possibility of neonatal gbs infection. So I feel perfectly ok to do what is needed to produce a negative test result by hibiclens rinse prior to the swab being done. Some of my clients still refuse testing (it is their choice) but a couple of them DID get transferred during labor, and did have to deal with the medical hoohaa and threats. Some want to do a 'perfectly honest' swab first (no hibiclens first), so that they know their true gbs status and can work with natural remedies or hibiclens during late pregnancy so as to reduce or eliminate colonization by the time of labor.

So, in short, gbs testing for me is way more about how to cope with irrational but powerful hospital policies, 'just in case' of transfer of care, than about 'fear of infection'. To me it seems like a fairly cheap form of 'insurance' that most families won't need anyway because they'll stay home for birthing....but that some families will be very happy they purchased that insurance, when it turns out that transfer of care is called for.

[Belle]

What Ms.Black said.

We did a lot of soul searching on this. The only reason we considered it was that in case of transfer. In the end we decided that a test that was so easily "beaten" was a useless test anyway. We opted not to do it.

[zookeeper]

We did it this time because we were one of those fortunate people that had CPS called on them the last time. I usually decline the test, but in the event of a transfer, we chose to do it this time. I was neg, and ended up birthing in a hospital. The peace of mind was worth it.

[Belle]

Originally Posted by zookeeper

We did it this time because we were one of those fortunate people that had CPS called on them the last time. I usually decline the test, but in the event of a transfer, we chose to do it this time. I was neg, and ended up birthing in a hospital. The peace of mind was worth it.

[angelachristin]

I would definitely recommend getting it in case of transfer.

My mw doesn't do them. I agree with her reasoning. BUT, guess what? I transferred. And so I had to stay 48 hours for blood cultures on baby, etc. Luckily, I arrived pushing and almost had her in the ER, so there was no time to push antibiotics on me and they didn't do any to the baby after birth, but they were adamant about keeping us to watch her for 48 hours. Which sucked, and sucked even more for my 3-year-old who is still talking about me being in the "hospitalololo" for so long, and how he was "crying, screaming!" when he had to go home and leave us in the hospital the 2nd night. And the hospital was actually pretty accommodating, I arrived and delivered at almost 11 pm on a Monday, and they released us after lunch on Wednesday. The jerky ped was threatening to keep us until the next day, but her cultures were fine. He kept telling me how "negligent" my mw was to not test for GBS.

[DCMama01]

I'm also getting it done for peace of mind (in case of transfer). I tested negative earlier in my pregnancy, and was negative. I have other things to battle on if I were to transfer.

[beebalmmama]

[QUOTE=MsBlack;14608375]A couple things--

I only recommend gbs testing for one reason: in case of hospital transfer from homebirth, because the local hospitals are positively rabid about treatment of moms and babies in the case of 'unknown gbs status'--and it really doesn't matter if there are any risk factors present. Moms get IV abx pushed hard, Peds and NICU are adamant about getting a blood culture on baby after the birth, extended NICU stay for babies, all that. Will go so far as to threaten-or actually call--CPS for any parents who object, who want mom's and baby's actual health and birth circumstances to be given due weight. The hospital protocols are quite rigid in most cases. But if you walk into the hospital with a negative gbs test result, there is much less of this hassle to deal with.

QUOTE]

This is why I decided to get the test. My midwife won't be changing her care in anyway if I am positive. But he hospital here would require much of what MsBlack mentioned above if I don't have a test to prove otherwise. I was negative when I took it with my first (hospital birth) and hoping the same for this one.

[Nicole730]

I am getting tested, but if it's positive I won't be doing anything unless the labor is long, water breaks long before delivery, or baby is in distress. My midwife said she will have medicine (I don't even know what I'd get...) on hand if I am positive and if it is needed.

[ACsMom]

Originally Posted by Nicole730

I am getting tested, but if it's positive I won't be doing anything unless the labor is long, water breaks long before delivery, or baby is in distress. My midwife said she will have medicine (I don't even know what I'd get...) on hand if I am positive and if it is needed.

Pretty much the same here. My midwife offers the test, doesn't require it, and doesn't do anything different if you're positive. I'm like others - I'll be getting tested just in case of transfer.

[Youngfrankenstein]

I am getting the test because I'm doing parallel care with a CNM group and it will then be in the "sacred medical chart"!

My mw said to ask them for 2 swabs: the tradition labial, vaginal, rectal (which is what they will require) and then a vaginal only.

My mw also said that I could do a hibiclens vaginal rinse every six hours in labor if the vaginal is positive.

After reading all of this, I guess I will wait and see the result and then decide if I'm going to do anything about it.

[momma_unlimited]

No. If I had a hospitable transfer, I would just say I was negative. They won't have a chart and I don't mind stretching the truth (I tested negative in my first pregnancy) to keep my babe out of the NICU (went through that with numero uno due to chorio from a 44 hr labor with ruptured membranes & numerous vaginal checks) as long as things go smoothly (my second labor was 2.5 hours so I'm not too worried about chorio anymore).

Personally, after my first birth what stands out most in my mind is not letting anything enter my vagina *at all*, including GBS tester. My current midwife told me of an Amish woman who went 18 days with a leak in her bag of waters who quarantined her house (no visitors) and used her own separate chamber pot- delivered safely with no infection!

I'm also doubling up on high end probiotics (Primal Defense) to give good flora the upper hand.

Ultimately I think you need to "go with your gut". =)