is this cheating? (GBS/Hibiclens)

[DeChRi]

I am birthing in the hospital. I have my GBS test next week. I was GBS+ with my last birth, but don't remember if I was the first time or not (this is DD3).

I've been doing a garlic, probiotic, vit c, echanacea, etc etc protocal in hopes of testing negative.

My question is regarding the hibiclens. I know that this is very common for women to do instead of abx, when they have tested + and are in labor. But I also know that many women use it just prior to the GBS test.

I'm wondering if doing a hibiclens just before the test will:
A) reduce the chance of a + test
BUT
B) is that cheating the test? Is there a chance that despite the supplement regimine I am still + but the hibiclens will help facilitate a neg result?

And finally:
C) if 'B' is Yes, and is could result in a neg test even if I am +...is it reasonable to just choose to continue the supps and do a hibiclens on my own in labor just in case?

We are mainly not wanting to spend unwanted time at the hospital as a result of abx dosing and "mandatory" 48 hour stay for GBS babies. Less hastle is neg, but not wanting to cheat the test either.

Thoughts?

[Plummeting]

Since they swab just inside the rectum too, a hibi wash wouldn't get rid of whatever's in there, and I think of you have it in your vagina it will usually be in your rectum too. The hibi wash might help you pass, but I'm not sure. It seems to me that if you're doing it, you're doing it help you pass, right? If you want to skip the abx if you're positive, that seems reasonable to me, provided you don't have a fever during labor, prolonged rupture of membranes, preterm birth, or other factors that would put your baby at high risk of gbs disease. I was positive and declined abx. DD did not develop gbs disease. Different people have different opinions, of course.

[nikirj]

Yes, IMO, hibiclens will create a false negative result (if it even does create a negative result given rectal sampling). Hibiclens is NOT a gentle or natural thing and I don't really understand using it regularly as a prophylactic given how badly it can screw up your flora.

The other things you are doing are very often effective, and if you plan to continue them until birth (the goal being to keep away the GBS, not just to get that negative test result), that would be a true negative result (negative now means likely negative later).

That said, I do understand that some women really feel need to get that negative result because they feel strongly that they would decline antibiotics even if positive, but aren't given the choice.

[nia82]

A little OT, but my swab was not in the rectum. Just a cotton swab gently along the vagina and rectum, like toilet paper, nothing ever was inserted into any opening? Is it common to do it in the rectum? I'd protest.

[lyno]

If you don't want antibiotics in labour just decline them, or decline the screening. If you test positive, just retest at every appointment (while you continue to take garlic, etc) until you test negative.

[CookieMonsterMommy]

Idk how it is everywhere, but in many places if you refuse antibiotics in labor after testing positive, your baby would be subject to blood cultures within a few hours after birth.

Sucks.

IME, yes hibi can def give a false negative. If you do this and test negative I would consider doing it while in labor as well. Weigh the pros and cons and see what's best for you and your baby.

[mwherbs]

if you are going to use it before the test then yes use it in labor- the studies are for treatment in labor and reduce the risk of transfer- the rate of decrease is about the same as treating for treating for risk factors.

[MsBlack]

Yes, my experience is that using hibiclens prior to the GBS test will cause you to have a neg test result.

Yes, strictly speaking this is 'cheating', and you won't really know whether or not you are carrying GBS. HOWEVER! In my opinion, that cheating by informed, thoughtful and responsible parents is pretty much necessitated by the points below:

The US maternity care protocols concerning GBS are in no way evidence based or the least bit logical, first of all. There is a lot I could say to explicate that--but not right now.
2nd, the 'prophylactic' use of abx is potentially harmful to you and your baby.
3rd, the information we now have about both infection risk factors (such as prolonged ROM and other) and signs of possible infection in babies (more clearly understood in their variety/manifestation than ever before), there is only a minute risk that an infection which does arise will go unnoticed/untreated and cause harm or fatality. GBS infection, if it does occur, is most often successfully treated w/abx (NEEDED abx, rather than 'just in case abx')
4th, prophylactic antibiotics do not prevent all infections, and have not reduced the death rate from GBS infection.
5th, prophylactic abx have reduced incidence of GBS infection, but we now have more neonatal e. coli--probably due to abx-resistant strains arising (just one of the risks of US GBS protocols of my point 2).

Because of these things, I encourage all of my clients to use the hibi prior to testing (and we do a slight vag insertion of the swab, dragging it down over the anus but not INTO the rectum). I do urge clients to GBS test (though they may refuse if they choose), because if you should need transfer to the hospital during or after birth, you will be treated as if 'GBS positive' if you are 'unknown GBS status'. If you walk in with a neg test result in hand, it will save you and your baby worlds of hassle and possible harm of various sorts.

Wherever you birth, your care providers are going to be observing all signs in mother and baby, during labor and in the hours/days following birth. The spiking-up of risk factors, and the arising of possible infection symptoms, is extremely unlikely to get missed.

I do not worry about GBS at all. Of course, I do have a dedicated concern for mother/baby health, and do all I can to promote health and prevent risk/harm, including alertness to signs/symptoms of infection. But to me, GBS is not something to worry about in particular--it is just one of various concerns which my clients and are addressing pro-actively toward health during pregnancy and birth/pp through attentive holistic care.

[HappyMommy2]

I believe that anything you can do to avoid unnecessary medical interventions is not "cheating" ... it is protecting you and your family.

[MsBlack]

HappyMommy2--

Now there is putting it into the simplest most astute nutshell! My sentiments exactly....which I never seem to be able express quite so succinctly

thanks for saying it just like that

[DeChRi]

Thank you all for the thoughts and opinions. Lots to think about.

Regarding 'just decline abx'....that is not an option I feel good going with, for a handful of reasons. 1) Baby would be subject to blood cultures, 2) if I am + and get the abx, my ped is comfortable signing us and baby out that next day and bypassing the hospital's "48hr" policy, but not so if we decline. Having a toddler at home, getting home would be great, sooner. 3) yes, I know we can also delcine then sign out AMA, etc...but I am just not ready to go down that road for this. I live in a place that they will flag you for just about anything. I think declining is a very valid option for many, but just not for us this time. Picking our battles. Also, I do not have the option to retest. They do one test and that is what sticks.

MsBlack, really interesting info.

I am honestly still not sure what I will do, but some really good things to consider here. If I do go with the hibiclense prior to the test and get a neg result, I would continue my supp protocal through birth, as well as a hibi buring labor.

I am going to stew on it a bit more. :-)

[Kelly1101]

Originally Posted by MsBlack

4th, prophylactic antibiotics do not prevent all infections, and have not reduced the death rate from GBS infection.
5th, prophylactic abx have reduced incidence of GBS infection,

Is this a mis-type?

[Plummeting]

Originally Posted by Kelly1101

Is this a mis-type?

I took that to mean that while prophylactic abx have reduced the incidence of GBS disease, they have not reduced the mortality rate in infants who develop GBS disease. Meaning there are fewer cases, but if a baby does develop GBS disease in spite of abx (which absolutely does happen), they are just as likely to die as they would be had no prophylactic abx been administered.

[Kelly1101]

Originally Posted by Plummeting

I took that to mean that while prophylactic abx have reduced the incidence of GBS disease, they have not reduced the mortality rate in infants who develop GBS disease. Meaning there are fewer cases, but if a baby does develop GBS disease in spite of abx (which absolutely does happen), they are just as likely to die as they would be had no prophylactic abx been administered.

Aaaah.

I misunderstood it.

So it makes it less likely that the baby will develop a problem, but if a problem does develop it has no real effect.

[mwherbs]

we have had no reduction in infant mortality despite "positive reports" of all types of amazing treatments- you trade off one infection for another or even for a non-infection inflammatory burden
the studies are also showing long term relationship between maternal exposure to antibiotics and eczema/ later asthma

[BirthIsAwesome]

As a doula I have had a few hospital clients who did the exact same regimen as you (except after the neg test she took a 10 day break from Echinacea and then got back on it before the birth---Echinacea has to be taken 10 days on, 10 days off or it stops being effective).

She got a neg test (yay!) and just continued the immune-boosting supplements all the way till the birth to ensure the GBS (if there was any) didn't crop up at all. She did not do hibiclens, but she did refuse superfluous vaginal exams (she only had one when she arrived and one when she wanted to push). IMO, reducing vaginal exams does more for preventing infection than any antibiotics. Just my experience and 2 cents! Good luck!

[Comtessa]

I felt, like you, that using Hibiclens before my GBS test would "cheat" the test, so I just went in and took it. Unfortunately, I got a positive test, and had to bully my OB's office into retaking the test 2 weeks later.

I did a Hibiclens regimen for 2 weeks as directed by my midwife, and got a negative test the second time around. I did maintain a Hibiclens regimen (loosely - i.e., a wash every 3 days or so) until labor (so maybe another 3 weeks or so), then washed about every 6 hours in labor. Not a "natural" way to treat it, of course, but effective and not damaging to do for that amount of time, IMO.

FWIW, both times I took the test, rather than having the OB do the swab, I just had him hand me the swab and I took it into the bathroom and did it myself. Otherwise I would have had to undress, get the gown on, put my feet in stirrups, etc., etc., and that just didn't make any sense to me for such a simple thing. So, if you're worried about them "dipping" into the rectum b/c you don't think that's relevant to the test, then ask to do the swab yourself and just don't swab there. (That's actually what my OB recommended when I took the second test.)

Fortunately, the second test effectively "erased" the first, and so when I ended up as a HB transfer, I had a negative test on file with the hospital already. I also made sure I included on my transfer birth plan that I refused prophylactic abx for any reason, just to be sure.

I told my OB that I would plan on using the Hibiclens protocol in labor rather than abx, if I tested GBS+, and he agreed to support me if I provided clear medical evidence of the effectiveness of the treatment. My MW provided a number of studies, which I gave him to read. Perhaps in the future, he'll be willing to suggest that to other women in my position...