Crisis of conscience

[chicoandthemama]

I am almost 34 weeks pregnant. As the due date approaches I am doubting my decision to decline the gbs test. I was positive with my first delivery 2.5 years ago, and received 1 round of IV abx before DS was born. I was very concerned about how that exposure affected him (and me), and began all kinds of inquiry (mostly here, thank you mamas) to learn how to get us both healthy guts. DS ended up sleeping terribly for his first 16 months, has shown shown signs of mild food intolerances, and mild sensory issues.
So this time around, I have been adamant that there'd be no abx, no hibiclens for this delivery. Therefore, no need for a test. But my conscience has not been totally clear with this decision. Yesterday, searching this forum for gbs topics, I realized that it is very likely that I have been experiencing undiagnosed symptomatic gbs for decades. I have been itchy since adolescence, and no gyn/doctor/hcp has been able to identify the cause or help relieve it. As an adult I guessed it was a result of a destroyed gut following the year I spent on abx for recurrent bladder infections at age 9-10. I had not been tested for gbs before my first pregnancy.
So until this discovery, I had been justifying my birthing choices on the idea that passing gbs to the baby in delivery is very rare. But what would the statistics be for people with a well established gbs colonization?
I am now thinking I should go through a regimen to reduce the gbs, take the test to see if it worked, then keep the regimen going until birth. If the test is negative, no worries. If positive, then what? I'll be delivering at a birthing center that will not compel me to do anything, I'll just have to sign a release of liability. I am certain no abx. What I am wondering is, can the test tell me what the levels are? How would hibiclens impact the seeding of the baby's gut?
To address the gbs, I have gone off all sugar except fresh fruit, and white flours. I read a post from JaneS recommending 2 probiotic blends with strains that specifically address the vaginal area and have ordered them. Would those be used both internally and vaginally? I have homemade sauerkraut and kefir regularly. There are several different regimens for controlling gbs that include garlic, vitamin C, echinacea, etc. Anyone have success to report?
I am hoping to keep this post in Health and Healing because this forum is so deep in wisdom. I want to do what's best for the baby, both in short and long term, and I really want to go into the birth feeling good about the choices I've made...

[mommathea]

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Edited by mommathea - 5/11/11 at 1:07pm

[chicoandthemama]

Good question, I am wondering about this, too. It is my understanding that the baby's colon is sterile until seeded by the mother through vaginal birth. Left unseeded, say by use of abx or cesarean birth, the baby's colon will be colonized by whateer is in the air at the time, plus what it will get from breast milk. Hibiclens also wipes out all organisms in the vaginal canal, good and bad. So it is less of a hit to the system than abx, but still not ideal for the baby's gut health.
This may actually be the gist of my question: are the issues that may arise from a sterile vagina worth allaying my fears of the very terrible but rare outcome of gbs infection in the baby? Does that make sense?
I should add that my concerns about gut health are fueled by many things: DS's sleep & sensory issues, DH's excema & skin trouble, my own chronic conditions, plus two nieces on the spectrum and a strong bipolar streak in the male side of my family. If there's some influence I can have to spare the little ones from their own lifelong chronic health issues, I want to try, within reason...

[mbravebird]

Another way to look at it is that gbs is an absolutely normal bacteria to have in your "balance" of bacteria. Like many bacteria, it can cause problems if conditions are ripe for it to, but it's not something you necessarily need to annihilate.

I would say that it makes sense to look for baby's risk factors that would make him/her ripe for infection. It's OK if they are exposed to gbs -- moms have always been giving babies gbs as part of the bacteria cocktail they get coming down the vaginal canal. Some moms have it as a predominant part of their bacteria, some don't. But the risk factor for infection lies with the baby and the conditions of the birth, not with the simple existence of the bacteria.

So, some risk factors are...early onset of labor, a fever of 100.3 or higher during labor, or a prolonged time of laboring after the water has broken (greater than 18 hours.) My point is, you can assess how your delivery is going, and then decide during delivery if you want to use the hibiclens or not.

This type of risk-based assessment is part of the original guidelines issued in 1996 (that's right, it's only been 14 years!). The original guidelines suggested two methods of reducing gbs infection in a newborn: Universal screening(automatic abx) and risk-based screening. When they studied the effectiveness of the two methods, they were very similar in outcomes, but the Universal screening approach was slightly better at preventing gbs infection. Both approaches, though, produce very similar results. There is no need to feel ethically wrong for choosing a risk-based screening approach.

I think your ideas of doing vaginal-based probiotics and other pre-birth regimens is wonderful, and probably further reduces the chances of the bacteria becoming problematic. Who knows, perhaps it reduces the chances of gbs infection just as well as the above two approaches. We don't know, because that third approach has not been studied. Logic says, however, that it would be helpful.

Also, keep in mind that the bacteria come and go, and women who test negative once can test positive later on, and vice versa.

Here is a link to my midwives summary of the same info:
http://mountainviewmidwives.com/group_b_strep.html

[chicoandthemama]

Thank you mbravebird, that's just the type of guidance I was hoping for. I will check out the link.