Talk to me about Group B Strep...

[matthia]

I had an entirely-unrelated-to-this-post hospital scare last week (everything is fine with me and baby) but while I was there they tested my urine and it came back positive for GBS protiens. My MW recommends that I treat with antibiotics immediately because GBS protien in my urine is symptomatic of a bladder infection, even if I have no other symptoms. Also she says that bladder infections in pregnancy can lead to pre-term labour and since I am only 24 weeks, I VERY MUCH want to avoid that. I trust my MW a lot. She is very low on interventions of any kind (I have had no prenatal testing done besides a 20week ultrasound) and supportive of my desire to keep things this way.

Anyways, she brought up the fact that I might need GBS treatment again once I hit active labour, but said we can talk about that when I get closer to term.
sooooo, I was wondering what your experiences were with GBS? or what information you might have read that you think I might find useful to make an informed decision...?

From what little I have had the chance to read so far, I think a bit of extra antibiotics sounds much preferable to the possibility a very sick newborn, but I'd still like to hear what you have to say....

* Also, my MW says treatment in no way risks me out of the homebirth I want.

[RedOakMomma]

I had two natural births at a hospital, and I was GBS+.

For me, since I didn't want a long-term IV drip, I asked that they give me a heparin lock in my hand. It's a little U-shaped tube that they tape down to your hand. I got two treatments of IV antibiotics while in active labor, and that was it. No problem. They're on a portable IV pole, too, so if you want to you can move around. I didn't feel like it interfered with my labor at all.

[sanguine_speed]

My perspective right now is based on past experiences and based on the midwifery practice guidelines in my region.

With my 2nd, I did the test and was +. I thought it would not interfere with a normal birth. I decided to refuse abx until I had signs of infection or until my membranes had been ruptured for a long time. Well, my daughter was born after only 2 hours of membrane rupture, and she and I were both asymptomatic. I thought we were fine. BUT, then I ended up having a transfer of care (from midwives in hosp to OB in hosp) for a PPH, and when the midwives left, the nurses started in on trying to treat my baby with antibiotics because I had refused them in labour. This wasn't something I knew they would want to do, and I had a hard time fighting them on this (but I did, successfully). Some say they would have tried to do the same if my GBS status was unknown, but I think their bark was louder for the known positive status than if my status had remained unknown with no other risk factors/symptoms.

Now, I am planning a home birth (if the baby turns head-down--midwives here aren't legally allowed to attend a breech at home). If I do test positive for GBS, I'd have to transfer to the hospital at 18 hours after a membrane rupture, regardless of whether I have symptoms of infection. However, if I do not do the test and my status is unknown, I can avoid a transfer for a good 24 hours as long as I have no symptoms of infection. That is, my status is presumed negative in that case. Since I have had a membrane rupture before labour before, I consider a membrane rupture before labour to be more likely for me again. I don't want to be forced to the hospital at 18 hours just because they know I'm GBS+.

Also, I have a horrible fear of IVs based on several previous negative experiences. For many women, an IV is not a big deal. For me, it doesn't matter if it's an active IV or a heparin lock, it will NOT allow me to labour and birth naturally. It would be like someone asking a non-IV-phobiaed person to labour while someone hit her with a stick at least once a minute...it's that level of fear, discomfort and distraction to me and I could not labour like that without sedation or pain relief. So I don't want to invite unnecessary pressure for something that terrifies me so strongly and would very likely lead to further intervention and risk for myself and the baby.

This all said, I will have an IV if truly necessary. For instance, my membranes ruptured at 33 weeks last time and I had an IV for 48 hours for abx. It was pure hell on earth for me, excrutiatingly painful the entire time, I couldn't sleep or move...but I knew it was necessary.

Oh, I also wanted to add that after the second child, after I had refused abx for GBS+ and had a pph, I ended up developing an intrauterine infecction and required a D&C plus IV antibiotics (go figure). I really struggled with thrush between my baby and I and it was hard to beat it. I do consider the risk of thrush to be a factor in deciding whether to use antibiotics in cases where there is no sign of infection, or risk is low even with GBS+ status.

[Plummeting]

I would definitely treat right now, as it's not a good idea to have a UTI while pregnant, for the reasons your midwife gave. In my state it is legal for midwives to give the same IV abx at home that they would give in the hospital, so it's definitely just as safe to birth at home if you are strep B + and would like the IV abx. I'm assuming based on what your midwife said that the laws are probably the same in your state. Some people do choose not to do the IV abx at all, or to do them only in the case of prolonged rupture of membranes or other risk factors, such as fever during labor/delivery.

I do recall reading that having a UTI caused by strep B during pregnancy increases the risk of your baby developing GBS disease, even if you treat the UTI before labor, so you might want to ask your midwife about that or look for the studies on that. I didn't save anything since it didn't apply to me. (I was GBS+ at my 37 week culture, but I've never had a UTI during pregnancy.) I am choosing not to do the IV abx unless there is some indication such as one of those mentioned above, but if I had a GBS UTI during pregnancy I probably would do them, just because I know that increases the risk of the baby having GBS disease. But again, you'd want to talk to your midwife and see what she says about that. I haven't done a lot of research on that particular scenario since it didn't apply, and perhaps what I think I know isn't accurate.

[Jelinifer]

I tested GBS+ in my urine back at the beginning of my pg. My birth center midwives prescribed me a week's regimine of oral Ampicillin to try and wipe out the UTI infection to start with. They recommended probiotics and Vitamin C supplements after the antibiotics and they'll swab me at 36 weeks.... If I test + aftet that, I have the option of a Hibiclens douche during labor, IV antibiotics, or refusing any interventions if I choose. I have a major psychosomatic issue with IVs like the PP, so I'll be starting with Hibiclens and moving onto IV Ampicillin administered by the midwives only if I'm in labor after 24 hours of broken menbranes.

[Mandynee22]

At my hospital, with my OBs, if you have GBS then they give you a hep lock and you get antibiotics every four hours through that but it doesn't change anything else (like you can still labor in the tub and walk and do everything)
I was positive with DD, not with DS or this new baby though.

[TheGorge]

Originally Posted by Mandynee22

At my hospital, with my OBs, if you have GBS then they give you a hep lock and you get antibiotics every four hours through that but it doesn't change anything else (like you can still labor in the tub and walk and do everything)
I was positive with DD, not with DS or this new baby though.

Same policy at my hospital. My OBGYN just talked to me about doing this test in 2 weeks. She said it will be one of the things that will determine how long I can wait before coming to the hospital.

I read a bunch of stuff on this yesterday, and here's what I saw: there are people who say the test proves nothing one way or another, other people say positive test is 93% predictive of positive status at labor, which says nothing about the chance of being positive at labor after a negative test result, now that I think about it. My husband is concerned that once the IV is in, it'll be that much easier to get other stuff in. I think that would be a mild inconvenience, but then, 0.03% of infants apparently die from this, with more having complications.

[Plummeting]

Originally Posted by TheGorge

I think that would be a mild inconvenience, but then, 0.03% of infants apparently die from this, with more having complications.

At issue is whether or not the IV antibiotics reduce mortality and other complications. Some studies (not all) have shown that routine IV antibiotics for all strep b+ women do NOT reduce all cause mortality. Instead, as mortality from GBS disease declines, mortality from e. coli increases. Additionally, some studies (not all) have shown that babies whose mothers receive IV abx during labor are more likely to develop treatment resistant infections and are also more likely to develop asthma. IMO those are the real issues, and those are the issues on which a woman needs to base these decisions, not whether or not an IV is uncomfortable or hinders one's ability to get in and out of a birth tub. There are plenty of studies available on pubmed that reach all sorts of different conclusions. Additionally, there have been lots and lots of threads here about it, with all kinds of information.

[TheGorge]

Hey, thanks for making me search for more info. I think I found a great CDC discussion of everything related to Group B here - http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5111a1.htm

They specifically discuss all the aspects you mention, as well as the algorithms and specific drugs that may be used by hospitals.

Also, they talk about a vaccine. This was in 2002 - I wonder what's going on with the vaccine trials?

EDIT: Found this about the vaccine (modest efficacy, safe, but no commercial version yet):
http://www.medscape.com/viewarticle/711702

[emnic77]

I was GBS+ for my ds's birth, which was a completely natural (not even a hep-lock) hospital birth. After much research, I declined antibiotics. I upped my intake of vitamin C, garlic, grapefruit seed extract, and did a hibiclens rinse before I went to the hospital, and refused all but ONE internal exam, and that was only before my water was broken. My DS was 41+ weeks, my water didn't break until he was born, and I had no other risk factors to transmit a GBS infection to him.

If I had one of those risk factors I would possibly consider the antibiotics, but the research I did found no correlation between prophylactic antibiotics and lowering the risk of a dangerous GBS transmission, and a mega-dose of antibiotics for a baby was not something I was comfortable with (due to higher instances of OTHER infections, including resistant strains) unless there was a VERY clear risk/benefit reward, and there was not.

[guerrabug45]

With my ds my urine tested positive for the gbs early on. I am VERY phobic of anything injected into my system, much less an iv that just stays there. I was very sick and lightheaded when they put the iv in at the hospital, but then the job of birthing my baby started in earnest. Honestly, I was too distracted with the labor and pushing to even care about the iv. Once my son was born and I had my head about me again that's when I started to feel sick and queasy at the thought of it all. This time around no gbs in urine, crossing fingers it won't be on the swab either.

[guestmama9973]

I refused antibiotics with my last pregnancy, which was at home. my water broke less than 2 minutes before birth, my whole labor was 8 hours. We were both fine. there really is not a lot of research supporting treating all women with abx. And antibiotics wreck havoc on your system, which will already be stressed from giving birth. My first birth(in a hospital) involved an Iv, antibiotics, AROM, and ended up in a c-section. I was not prepared with my first pregnancy. I knew little besides what "what to expect when your expecting" had to say. My obgyn later told me that the antibiotics weren't needed, and the the c-section was for her to get home to her family. after that, I read everything I could about birth,complications, and learned to trust myself and my body. If I had had prolonged rupture of membranes or something, maybe I would've submitted to antibiotics..

[DeChRi]

I had 2 drug free births, both GBS+, both with abx via hep lock, neither of which hindered my labor/delivery at all. That being said, I am blessed that I have a very durable system when it comes to yeast, thrush, etc....abx don't tend to phase me and neither time has bothered or caused issues with babe either. If they did bother me in those manners, I would consider declining if I didn't have membranes reptured, no internals, etc.

[matthia]

Thanks for all the info, guys!

I am treating my asymptomatic UTI with anitbiotics right now, mostly because I am only 24 weeks and definitely want to do what I can to avoid pre-term labour (even if it's pretty rare). I think the heparin lock sounds like what I would most likely have, although when I was at the hospital last week it took 4 (!!!) tries to get my stupid IV in so I'm not looking forward to that at all.
If my water doesn't break until I'm pushing, does anyone know if this decreases the risk of transferring GBS to the baby?
I am hoping I test (-) at the 36 week check but my MW said since I have had it once, I would be automatically assumed GBS+ if I was having a hospital birth and the recommendation would be to treat with abx regardless....I guess I have a while to make any final decisions.

The abx I'm on right now are wrecking havoc on my digestive tract and are making me feel a mildly nauseaus, so I am also a little worried about that kind of extra strain on my system after giving birth....