Anyone had a homebirth after URINE being GBS positive

[tanyab]

I am currently looking into midwives and obviously they are unable to give me antibiotics for GBS. With my first I had a GBS infection in my urine, which apparently makes it more serious than just being detected in the vagina. I was given antibiotics at the time and then again through labor. I was never re-tested - they just assumed it would still be there - which makes me ponder why they bothered to give me the oral antibiotics at all!

I am nervous that because this was detected in my urine, and is apparently difficult to eradicate if it is there, rather than just vagina. I am nervous that if I go ahead with a homebirth I will be risking my babies health (albeit only a little) and the stress of that might make my homebirth too stressful for me.

Anyone here had a homebirth or know of anyone who has had a homebirth after testing +ve on a urine culture? How did it go? Any thoughts on how I might be able to eradicate GBS from my bladder?

Thanks

[Bmorefarmgirl]

are your midwives unable to give you abx because they are cpm's or something? my midwife gives iv antibiotics for gbs positive home births. they put in a heplock and give it every 4 hours just like in the hospital.

[homewithtwinsmama]

Originally Posted by tanyab

I am currently looking into midwives and obviously they are unable to give me antibiotics for GBS. With my first I had a GBS infection in my urine, which apparently makes it more serious than just being detected in the vagina. I was given antibiotics at the time and then again through labor. I was never re-tested - they just assumed it would still be there - which makes me ponder why they bothered to give me the oral antibiotics at all!

I am nervous that because this was detected in my urine, and is apparently difficult to eradicate if it is there, rather than just vagina. I am nervous that if I go ahead with a homebirth I will be risking my babies health (albeit only a little) and the stress of that might make my homebirth too stressful for me.

Anyone here had a homebirth or know of anyone who has had a homebirth after testing +ve on a urine culture? How did it go? Any thoughts on how I might be able to eradicate GBS from my bladder?

Thanks

If you have a CNM at your homebirth you can have antibiotics at home. If not you could do the hibiclens wash protocol with your direct entry midwife. If your water does not break early in labor and baby comes soon after the risk is even lower.

[tanyab]

They are all CPMs that I am interviewing - I could be wrong but it seems that the CNMs all work in hospitals.

[Jane]

It's thought (with some good evidence) that GBS bacteria that is able to get into the bladder and colonize it is particularly devious bacteria that could also get into the baby's lungs, too. So, while the antibiotics eliminate it from the bladder, it retreats to its normal home in the rectum and intestines.
If GBS is detected in the urine at any time in pregnancy, it's recommended to do antibiotics in labor, the same as if the mother tested positive in the vagina at 36 weeks or if she had a previous baby with GBS pneumonia.
However, you don't have to go with the recommendations. You could retest at 36 weeks for more information. You could find a midwife that will do antibiotics at home. You could plan a homebirth as long as you don't have more than X hours between ruptured membranes and birth. You could *try* going to the hospital for antibiotics and then leaving AMA. You could try to convince another provider to give Clindamycin for 8 hour coverage instead of your homebirth midwife. You could travel to Washington where CPM's can give antibiotics. *wink* OK, that's not fair. One of my besties lives in Colorado and she's an awesome midwife.

[tanyab]

Originally Posted by Apricot

It's thought (with some good evidence) that GBS bacteria that is able to get into the bladder and colonize it is particularly devious bacteria that could also get into the baby's lungs, too. So, while the antibiotics eliminate it from the bladder, it retreats to its normal home in the rectum and intestines.
If GBS is detected in the urine at any time in pregnancy, it's recommended to do antibiotics in labor, the same as if the mother tested positive in the vagina at 36 weeks or if she had a previous baby with GBS pneumonia.
However, you don't have to go with the recommendations. You could retest at 36 weeks for more information. You could find a midwife that will do antibiotics at home. You could plan a homebirth as long as you don't have more than X hours between ruptured membranes and birth. You could *try* going to the hospital for antibiotics and then leaving AMA. You could try to convince another provider to give Clindamycin for 8 hour coverage instead of your homebirth midwife. You could travel to Washington where CPM's can give antibiotics. *wink* OK, that's not fair. One of my besties lives in Colorado and she's an awesome midwife.

Do you know if I have an increased risk of positive GBS in my urine this pregnancy since I did in the last one? I know it can come and go vaginally, but was curious about the whole bladder / urine thing.

[Jane]

The CDC recommendation is only for the same pregnancy. I don't know what data they are basing that recommendation on, just that it only holds for the same pregnancy. That's not the same as saying it isn't higher, just that it seems to lead me that way.

[nurturedbirth]

Couple ideas:

If you test positive this pregnancy, try contacting Kristi Zittle at His Grace Herbals. She has had success eliminating GBS, even urinary infection, with one of her proprietary herbal blends.

There are a few CNMs attending out-of-hospital births in Colorado. One option is the Mountain Midwifery Birth Center in Englewood (http://www.mountainmidwifery.com). The other is Janet Schwab (homebirths) who you can find here: http://www.2eachherown.com/.

[freistms]

I have had a recurrent bladder infection this pregnancy that was NOT cultured, so I have no idea what actually caused it. I've been trying to figure out what the risks are with a GBS bladder infection just because I want to be making informed decisions.

From everything that I've read, GBS in the bladder is not any different than GBS in the gut or the vagina. The reason it puts you in a higher risk category under CDC standards is that GBS in the bladder is considered to be a proxy for *heavy* colonization. I can't find any research to support this assumption. There isn't anything that indicates that just because you had it in your bladder once, you will be heavily colonized forever, especially if you no longer have it in your bladder NOW, several years later. I don't understand why it is commonly understood that GBS status can change, and rather quickly, but it is assumed that GBS status won't change if you have a UTI. It's bizarre.

It is frustrating that there isn't clearer information out there about what the recommendations related to GBS UTI are based on. I feel like it is really difficult to make informed decisions with respect to this issue because there isn't enough information available.

I feel for you. I'm confused and concerned, too, and I don't even know for sure whether I need to be. Blah.

[nikirj]

GBS in the urine in first trimester is no longer considered an automatic indication for antibiotics in labor, because risk is only slightly elevated (40% vs 25%). New (2007) recommendations were to go by the 35-37 week screening whether there was GBS in first trimester or not (if the GBS was in third trimester, it remains an assumed positive). The CDC is expected to release another set of guidelines in the first half of 2010, so we'll see what they say.

Being GBS positive in a prior pregnancy doesn't increase your risk all that much for being positive in your current pregnancy, even with a prior positive urine. I wouldn't assume that you are positive at all. Some midwives have GBS prevention protocols that include natural approaches, so even if you are in a state where CPMs can't administer antibiotics at birth, your MW might have a different approach. None of them are "proven" "scientifically," but some MWs have very strong evidence of them working within their own practices.

[LisaSedai]

I've also had a GBS UTI in this pregnancy and have been planning an HBAC with a CPM who can't give IV abx during labor According to this site http://groupbstrep-ivil.tripod.com/id14.html if you are GBS+ with a risk factor (like GBS UTI) and you *don't* get IV abx your baby's risk goes up to 1:25 (CDC stats I think) if you do get abx the risk is 1:4000. I'm going to ask my MW if she will let me hire a home health IV therapy agency nurse to come in and dose me during delivery. (this is at MW's house next state over b/c I live in a illegal state) I don't know if this is even possible- I'll have to find some MD who will prescribe it for me. If MW says no, I guess it will be the hospital for me

[mommamisty]

I have been GBS+ all 4 pregnancies, I had a homebirth w #3 with a CPM, I opted to have abx that my midwife carried from Mexico during labor.
I am early in this pregnancy but assume I will be + this time as well so spoke w my MW at interview about how she deals w/ GBS+, she said that it is so erratic and can be + one day and - next.. she said that she treats everyone w chlorhexidine wash I believe it is.
In any case I don't think you will have a hard time finding a midwife to do your HB if you decide this id what you want, is it something you are discussing at your interviews?

[mommamisty]

I found this and thought might be helpful.
http://www.gentlebirth.org/archives/gbs.html#Lavage