Yes or No to test for Strep B?

[miggymama]

I am almost 37 weeks pregnant with my 3rd. I have had home births with my first 2 and plan the same for this baby. I have a new midwife because mine retired last year. My old midwife didn't test for Strep B so it was never an issue. My new midwife likes to test for it...so I am left wondering what to do. She is not requiring me to test but likes to do it. Even if I test positive I wouldn't have antibiotics but I am wondering if knowing(if I test positive) will make me worry. Anyone have any advice? Thanks!!

[kltroy]

Well if you're not going to take the abx anyway, I wouldn't bother with the test. Ultimately, this is about playing the odds. According to the CDC about 25% of all women are GBS positive. If you do not have abx, there is a 1/200 chance that baby will have problems related to GBS. If you DO have abx there is a 1/4000 chance.

Doing the math, if you do not test, there is a 0.25*(0.005) = 0.00125 = 0.125% chance that your baby will have a "surprise" GBS-related problem. Or you can test and, assuming you're negative, have peace of mind.

For me, personally, I always ask myself "what would I do differently if I knew the results of this test? If the answer is nothing, I don't bother.

[miggymama]

Thanks for the reply...

I would love to read the stats that you posted about. I have researched and didn't see anything related to the with antibiotics vs. without if I was a carrier. Do you have an article you could direct me to? Thanks!

[MsBlack]

Have you tried looking at The Centers for Disease Control website (CDC)?

The way that I understand those stats, for mamas who test positive for GBS and DO NOT have antibiotics, about 1 in 200 babies will get infected, and far fewer will get infected if mom does get antibiotics. However, with or without antibiotics during labor for GBS positive moms, as I understand it the death rate for babies is still the same (very low, can't recall now and my computer crash last year means I don't have the link anymore). Which means that if a baby gets infected, the great majority can be helped by antibiotics given when infection is noted. It also means that antibiotics do not help all infected babies--whether antibiotics are given during labor, or only later when infection is noted.

However, the CDC stats are based on hospital births since the homebirth rate nationally is only btwn 1-2%. There are no studies of homebirth and GBS that I am aware of. But because of my own experience and that of many midwives I know, I believe that babies are far less likely to get a GBS infection at home (with planned, attended homebirth anyway) for a variety of reasons and whether or not mom is GBS positive.

To me there is only one reason to have the GBS test, IF you and baby are otherwise healthy, and IF you don't have troubles with vag infections or UTIs: in case of transfer to hospital care during labor or soon after birth, you and baby will be treated with less alarm if you can show that you are GBS negative. When moms are 'unknown GBS status', they and babies are most often treated as if GBS positive--which means that more tests and meds will be pushed! I have seen it both ways, moms with a negative GBS result to show on arrival at hospital have received a far more relaxed approach from med staff than those with no GBS test result to show.

So I see GBS testing as a sort of 'insurance policy in case of transport'--your chance of transfer of care may be low, but having this one thing taken care of can be very helpful if you do transfer. You can pretty much insure a negative test if you do a high rinse/low douche with a .2% solution of hibiclens prior to testing. (most hibiclens is sold at a 4% solution--so you would dilute a 4% solution by 20 times w/water to get the desired solution--1part hibiclens, 20 parts water).

The US is among the very few developed nations that bothers with GBS testing for all moms. In the UK, the hibiclens wash is used in labor on moms with particular risk factors such as lengthy rupture of membranes--and their stats are very close to ours. In other words, routine GBS testing and routine use of antibiotics for those who test positive is not really evidence based care....but that hardly matters if you get to be among the small group who needs med care during or after your birth! You/baby will be subjected to US standards/protocols regarding GBS--so having the negative test on file could do you both a lot of good.

[MegBoz]

Originally Posted by MsBlack

However, with or without antibiotics during labor for GBS positive moms, as I understand it the death rate for babies is still the same

Well, not only that, but the antibiotics increase the rate of antibiotic-resistant infections such as eColi!
http://www.ncbi.nlm.nih.gov/pubmed/19588432

Originally Posted by MsBlack

In the UK, the hibiclens wash is used in labor on moms with particular risk factors such as lengthy rupture of membranes--and their stats are very close to ours.

I tested GBS+ and was FREAKING OUT because I was planning a hospital birth & wanted to spend the vast majority of labor at home. (The CDC protocol wants you having the first dose of IV antiboitics 4-5 hours in advance of birth.) We started researching it & DH had the brilliant idea to see how they handle it in other countries! Sure enough, babycentre.co.uk lists totally different protocols than babycenter.com!

As Ms Black said, they don't routinely test for it. They also don't do the antibiotics unless you have 2 or more risk factors - and the positive swab is only one risk factor.

Personally, I might consider getting the swab done not only in case of transfer, but if I had prolonged ROM, (a second risk factor) I would want to do the hibicleans wash while in labor. Other risk factors that would lead to antibiotics would probably prohibit HB anyway - prematurity, fever in labor, and UTI with GBS.
But I'd also want a colony count because there are degrees of "colonization" (it's not like you are merely positive or negative, you can be positive & mildly colonized, vs. highly colonized.) I would want that info to weigh in my decision since there is also research showing higher degrees of colonization increase the risks (which, I think, is only logical.)

[MegBoz]

FYI, I googled "effect of intrapartum antibiotics gbs" to find articles - there are lots! I'd also go on that "Pub med" site (link I already posted) & search more there.

[kltroy]

Originally Posted by miggymama

I would love to read the stats that you posted about. I have researched and didn't see anything related to the with antibiotics vs. without if I was a carrier. Do you have an article you could direct me to? Thanks!

Here is some helpful information:
http://www.cdc.gov/GroupBstrep/gener...public_faq.htm (especially see the section heading "What are the risks of taking antibiotics to prevent group B strep disease in my newborn?")

There is a good Cocharane Review article on this topic here This pools together all of the randomized controlled trials and tries to draw a conclusion about the overall effect of a treatment. In this case "The incidence of early GBS infection was reduced with antibiotics compared to no treatment... number needed to treat to benefit: 25" In other words, you have to give 25 women with *KNOWN* GBS+ status antibiotics to prevent one case of infant disease. The authors conclude, interestingly, that "There is lack of evidence from well designed and conducted trials to recommend IAP (antibiotics) to reduce neonatal EOGBSD (early onset GBS disease)"

[Materfamilias]

This is a tough call but if you wouldn't do the abx if you were positive, why get the test?

[Comtessa]

Originally Posted by MsBlack

I see GBS testing as a sort of 'insurance policy in case of transport'--your chance of transfer of care may be low, but having this one thing taken care of can be very helpful if you do transfer. You can pretty much insure a negative test if you do a high rinse/low douche with a .2% solution of hibiclens prior to testing.

I want to STRONGLY second everything that MsBlack said in her post. I ended up transferring for exhaustion after 3 days at home, and I was SO grateful when I got there that I had a negative GBS test already on file so they couldn't fight with me about abx. I had enough fighting I needed to do when I got there in order to ensure that I could get the birth I wanted. (I did, by the way. It was a picture-perfect HB transfer.) I'm super-allergic to many abx, which was another strong motivating factor for me to find an alternative. I didn't want to be in labor, in the hospital, arguing with somebody standing over me with a needleful of something my body was going to treat as poison.

I came up GBS+ with my first test, and I bullied my OB into taking a second test after I'd done a week of Hibiclens treatment, so that I could be sure of having the negative test result on file. It was a bit of a pain, but totally worth it. I just kept using the Hibiclens every other day until I went into labor, then every few hours after labor started. MUCH easier than antibiotics - and it eased my mind to know that I was taking precautions against this rare, but very dangerous infection for my baby's sake.

[miggymama]

How do I do a Hib cleanse?

Can you share what you did for the week that followed your positive test. Is this an external cleanse or internal. I asked my midwife about using it during labor and she doesn't like to do this because of the risk that baby might ingest some during labor. Thank you again for your reply. I am carefully considering all sides!

[onyxravnos]

i like knowing.
i wouldn't preemptively treat for it but it lets me know to watch for symptoms in baby that i might otherwise discount.

on testing neg... about 3-4 weeks prior to testing take some probiotics and garlic pills also should you test + keep taking the pills and retest in a week or two. just because you are positive at week 36 doesn't mean you'll be positive at week 40.

[MegBoz]

Originally Posted by Comtessa

I came up GBS+ with my first test, and I bullied my OB into taking a second test

I asked my hospital-based MWs to re-test me too. The OB nurse from their office said, "Well, they will still treat you as if you are + even if you re-test -, so there's no point."


Of course, i didn't say this to her, but I thought, "I don't give a hoot what your protocols are! If I retest -, I'm not taking the dang ABTs, so just test me!"

They did test me, but I had to pay out-of-pocket.

[Comtessa]

Originally Posted by MegBoz

I asked my hospital-based MWs to re-test me too. The OB nurse from their office said, "Well, they will still treat you as if you are + even if you re-test -, so there's no point."

The nurse at my OB's office said the same thing, but I ignored her. Turns out she was wrong - the negative test "cancelled out" the positive test as far as the hospital was concerned. They never gave me any trouble about it at all. (FWIW, I also put a line in my transfer birth plan just in case that said, "I am GBS negative. I do not consent to any antibiotics without evidence of infection.")

The Hibiclens protocol from my MW was as follows: in a clean peri bottle (you could also use a clean squeeze bottle from dish detergent or something similar) mix 1 part Hibiclens to 20 parts water. Mix well. Once a day (I think I did more like every other day), splash a bunch of this solution over the vulva to kill any GBS bacteria. Also squirt a little just inside the vaginal opening - no need to overdo this, as most GBS bacteria lives at the outer edges (i.e., the first inch or two) of the vaginal canal. Cleaning the anal opening is probably a good idea, too, especially right before taking the test, because most docs will swab the whole vaginal/rectal area.

I did this for a week after my positive GBS test, then took my peri bottle with me to my OB appt. and did a quick splash/douche right before taking the second test. My MW also had me do this every 6 hours once labor had started (this is standard procedure in the UK for GBS+ moms, I think).

You can buy Hibiclens in most any drugstore/pharmacy. Or see if your MW has any she can give you - you'll probably only use an ounce of the bottle at most, which means you're buying an awful lot more than you'll need if you buy a whole bottle.

[mouey77]

So I see GBS testing as a sort of 'insurance policy in case of transport'--your chance of transfer of care may be low, but having this one thing taken care of can be very helpful if you do transfer. You can pretty much insure a negative test if you do a high rinse/low douche with a .2% solution of hibiclens prior to testing. (most hibiclens is sold at a 4% solution--so you would dilute a 4% solution by 20 times w/water to get the desired solution--1part hibiclens, 20 parts water).

I did this for several days prior to the testing and on the day of the testing and still had a positive result, so it doesn't insure a negative test. I wish!