Planning home birth, GBS positive and NEED assistance

[fellow_cyster]

I'm GBS positive, 37 weeks pregnant, planning a home birth (possibly a water birth) and have been researching this for weeks now and I am frustrated at the lack of information out there...hoping you guys can help.

Everything I read either says you have to take antibiotics or your baby will die, OR that antibiotics are worthless and the worst decision. That they don't really show to be a huge help, can create AB resistance, etc.

I have been trying for weeks to rid my body of the GBS (garlic, vitamin C, cranberry, etc) but nothing works, the swabs are still positive and its been found in my urine a few times.

I do not want antibiotics, especially since my midwife only gives Amoxicillin which has been deemed useless against GBS. But everything I read says I may have a higher colonization since its in my urine.

I've read many midwife sites recommending tea tree oil tampons or suppositories, inserting cloves of garlic (which I'm starting tonight) and hibiclens (chlorihexidine) flushes or washes during labor to prevent the GBS.....

My midwife is alright. She wasn't my first choice but all I have due to insurance. She's been great but doesn't provide much relief and mostly blows off the concern, saying there's a 1% chance of the baby getting GBS infection.....however I'm concerned she never treated the GBS in my urine - no sign of infection but I'd have thought she would've or should have treated it?

I know i sound neurotic, I probably have lost my mind by now trying to make a decision on this. Any thoughts or advise would be GREATLY appreciated.

I'd love to hear from some midwives if possible, I was not sure which board to post on to get responses from professionals.... I am just exhausted over trying to make this decision.

Thank you in advance,
Pamela

[kgrace]

I'm a registered nurse and review maternity charts for a hospital.
So I can tell you what I've seen for data, and what the CDC says.
They blanket say antibiotics prophylaxis for all women who swab or urine test postive ever. But, next, if the test results are unknown- they say antibiotics should be given if the baby is less than 37 weeks at delivery, rupture of membranes for greater than 18 hours, or maternal fever.

I personally tested postive for GBS two years ago with my first baby.I had a homebirth with a midwife,and used hibiclense during labor.Baby was fine. However it was an agonizing decision that I wish hadn't been so stressfull. My back up MD made harsh statements about never wanting to see a baby with meningitis again, etc to try to force me to get penicillin. Meanwhile my midwife expressed no concerns, but still made me sign a waiver excepting responsibility for not getting antibiotics in labor, which she couldn't provide anyway. Which esentially doesn't inspire confidence in a first time mom?!

All I can tell you is that I have never reviewed a chart of a GBS septic baby. But plenty of c-sections and inductions gone bad, like everyday. I do wish that there were some more options besides, trying to trick the GBS test, shoving garlic up the vagina (I tried that, I still tested positive), inducing women and giving 6 rounds of penicillin before birth b/c they tested postive!, and I don't understand why the rectum needs to be swabbed, babys don't come out rectums, I know they figure the proximity, but still...
I hope your care providers treat you as a person capable of making the wisest decision on the GBS topic and are supportive in every way!

[emnic77]

I was GBS+ with DS, and I had a UTI early on to go along with it.
I did not want antibiotics, and arrived to the hospital too late for them to work anyway (on purpose, to avoid being hassled about it...I got to the hospital at 8 cm, with a second baby, no way was there going to be enough time for the two doses).

I read everything I could, agonized about it, and went with garlic, grapefruit seed extract, eating 2 grapefruits a day for about 6 weeks (seriously) and taking probiotics religiously. My ds was 8 days over dates, was born with the amniotic sac intact, and I had no fever leading up to or during labor, so I was not concerned with an infection. I also did the hibiclens rinse before I left for the hospital.

This time, for my homebirth, I decided to not test but do the same protocol. My midwife gave me lots of information about hibiclens and it's effectiveness - four studies that show that hibiclens is JUST as effective in preventing GBS infection in the newborn, but also MUCH more effective at preventing an e. Coli infection (which is one of the big risks of a high dose of antibiotics - susceptibility to another infection).
She printed those out for me but if you are interested I can paraphrase them or try to find them later on today/tonight after work.
Bottom line - hibiclens is the standard protocol for GBS in many other countries, and study supports it as an effective prevention. If I had other risk factors (preterm labor, premature and long term rupture of membranes) I *might* consider antibiotics, but definitely not without a very compelling reason.

[sanguine_speed]

I've had the same sort of debate with myself, which is still up in the air because I'm planning a home birth and the protocols are as follows:

If you test + for GBS:
-recommended IV and antibiotics, transfer to hospital at 18 hours of membrane rupture or any sign of infection.

If your status is UNKNOWN (you refused the test):
-recommended IV and antibiotics but you can refuse, status assumed negative unless your membranes have been ruptured for 24 hours or you show signs of infection, and then transfer.

So status unknown gives me 6 hours more of membrane rupture at home than status known positive.

Status known negative would be even better, but I'm not sure I'm willing to chance finding out and putting my midwives in a bad spot by having to force a transfer.

I also had an experience with my 2nd where I had a hospital birth, was GBS+ and refused abx. My membranes ruptured only a couple of hours before birth and no one had any signs of infection, but they pushed really hard to treat my baby with antibiotics immediately after birth (well, once the midwives left the hospital and transfered care). I fought them off, but barely. I think they would have pressured me even if I was status unknown, but I think the BIG pressure was because I was known positive...

So ya I am leaning toward not having the swab at this point.

[MegBoz]

I sooo know how you feel! My doula said, and I quote, "Oh, GBS doesn't bother me." Uh, what?
Whereas the CDC & other sources repeat, "YOUR BABY COULD DIE!" Uh, so where's the truth?!?

My DH has the exceptionally brilliant idea to see what they do in other countries (since maternity care in the US is among the worst in the developed world.) Brilliant!!

Originally Posted by kgrace

what the CDC says.
They blanket say antibiotics prophylaxis for all women who swab or urine test postive ever. But, next, if the test results are unknown- they say antibiotics should be given if the baby is less than 37 weeks at delivery, rupture of membranes for greater than 18 hours, or maternal fever.

Yup! I found on babycentre.co.uk (& maybe other sources too) that in the UK they don't even do GBS swab on all mamas! And if they DO, they only recommend ABTs if you have TWO OR MORE risk factors - the + swab being only one.

Unfortunately, GBS in the urine was one of the other risk factors (along with extended ROM, maternal fever, prematurity (<37W). If you previously had a baby who got infected with GBS, I think most recommend going with the ABTs & not even bothering to swab.

The combo of GBS in urine along with + swab, I may reconsider the ABTs.

They do not "do nothing," they reduce the risk of GBS infection from like 1 or 2 per 100 down to like 1 in 1,000 (or 500, I forget, it's been a couple years for me). That's a substantial decline. HOWEVER - they have all those other risks such as AB resistant infections like e.Coli, INCLUDING 10% side effect risk such as Thrush (which could KILL a BFing relationship - a significant risk, IMO.)

As I put it, taking ABs for GBS is NOT like wearing a helmet while riding a motorcycle - it is not a safety precaution that can save a life & you'd be stupid to NOT do.

It sucks, There's risk on either side. I'd feel horrible if I declined ABTs & baby got infected with GBS, just like I'd feel horrible if I accepted ABTs & baby got AB resistant eColi or we ended up with thrush.

But, again, I'd at least do hibiclens wash having it in your urine, if not try to get ABs - ESPECIALLY if water was broken for more than 12 or so hours before birth. & I'd decline ALL vaginal exams to be extra certain (ask your MW if she knows about a technique to gauge dilation by feeling, I think, top of fundus during a ctrx while you lay on your back.)

[sanguine_speed]

Originally Posted by MegBoz

INCLUDING 10% side effect risk such as Thrush (which could KILL a BFing relationship - a significant risk, IMO.)

I forgot to mention this point but it's also important to me. I had to take antibiotics before and up to labour (pPROM) and then had to breastfeed a preemie while battling thrush. Awful. And yah, I did also take probiotics.

[AlexisT]

I gave birth in the UK. They do not do routine swabs (cost benefit analysis, by the way--take that how you will), but they DO give abx for women who test positive in urine.

[Calleiah]

Theres a really great article here about GBS

http://www.mothering.com/treating-gr...tics-necessary

I've always tested positive. For over 10 years. For what ever reason, I just grow GBS and it causes me no issues. With my girls, I did the abx, however, after doing a ton of reading and research, pros and cons and considering the risk and boarderline/questionable advantage to the abx, we've decided not to with this last kiddo. It feels terrifying to be faced with the numbers that doctors and nurses give you, but after doing my research, I now know they arent giving us ALL the information.

Good luck!

[Kelly1101]

GBS bothers me enough that I did the abx, and will do them again if I am positive again.

However, you are right in that there is no sense getting an antiobiotic that will not work against gbs, so it seems that your route is just to keep a very close eye out for any signs of infection.

[ncolvin]

I read somewhere, not sure where... that if you dont wash the baby its protected from the vernix. Has anyone read or heard this?

[Climbergirl]

Another question.... What would you do if you were allergic to everything in the Penicillin family? Would they give you another antibiotic instead?

Yeah, thrush and starting breastfeeding is NO FUN.

[Wittyone]

I've not seen anything on vernix being protective against GBS.

I heard a thought provoking line of reasoning the other day about why we DO worry about GBS - it is a normal flora in the adult intestinal tract, can be harmless in the vaginal and urinary tract to some degree, but it is NOT normal flora for the newborn respiratory tract and that is why it can cause such devastating illness in the newborn. Now, it's been pointed out already that there are categories of babies at higher risk (pre-37 weeks, ruptured membranes more than 18 hours, maternal fever in labor). The transmission rate for GBS+ mom w/o abx is 1 in 200 (0.5%), transmission rate with antibiotics in 1 in 4000, so it seems that antibiotics are protective to a degree. Unfortunately they are not without side effects, and even the CDC protocol notes they are not a good long term solution. The studies on the effectiveness of hibiclens are very promising with far fewer side effects.

For the poster wondering about alternative to penicillin, generally the next antibiotic in line in clindamycin which is given every 8 hours and often the second dose is never given as the baby comes sooner than that.