WWYD if GBS+ & water breaks?

[bayspumpkin]

My 1st & 3rd births, my water didn't break until I was nearing pushing.  My 2nd, my water broke before things got going good & a combination of me thinking "o my goodness I had my last baby an hour after my water broke" & being GBS+, I went in way early to get the antibiotics.  With my 3rd, I was GBS+ again but my water didn't break, so I was able to labor at home for long time.  By the time I got to the hospital, I didn't mind the whole lay down & be hooked up & no food stuff- I was comfortable lying & didn't want to eat.  However, I know every labor is different.  Today when I went to do pre-admission, the nurse told me I needed to come in RIGHT away if my water breaks- this is without even knowing I'm GBS+, this area is just really high intervention.  They even give you a special wash to shower with when you go in labor "just in case you need a c-section".   But, I don't want to be stuck on a timer, I don't want to be stuck laying down- the paper work says bathroom breaks if water isn't broken.  Ice Chips are permitted.  Just stupid.  So, if my water breaks ahead of time, & being GBS+, how long do you think it is safe to stay at home?  & should I lie to them & say it just broke when I go in?  I'm due today!  Which was a whole other source of confusion for the pre-admission department. B/c apparently no one goes overdue around here.

[MegBoz]

I wouldn't start worrying until it was nearing 18 hours of ROM:

from: http://www.babycentre.co.uk/pregnancy/antenatalhealth/physicalhealth/groupbstrep/#8

Is my baby at risk of developing GBS infection?

The Royal College of Obstetricians and Gynaecologists has identified a number of factors that help to predict whether your baby is more likely to develop a GBS infection (RCOG 2003:3-6).
These include, if:
• you go into labour prematurely (before 37 weeks of pregnancy)
• your waters break 18 hours or more before you have your baby

So maybe if it was like 14 hours & I wasn't really in hard labor yet, I'd get worried. Otherwise, much less than 18 hours, I wouldn't worry at all. I personally wouldn't even accept IV ABTs unless I developed 2 or more risk factors (and a + swab is only one risk factor). That's how they manage it in The UK.

I would absolutely, without hesitation LIE about when my water broke. But that is just me. I don't think the risk of water being broken for 12 hours or so is so significant that I need to be pumped with pitocin to rush things alone when ROM happened only 6 hours ago. and if I WAS accepting IV ABTs, I'd be comfortable going beyond 18 hours so long as I didn't have an elevated temperature or other signs of infection.

& based on what you said, it sounds like that would be pushing the pit immediately if you weren't dilating at 1 cm per hour... um, and in order for them to know whether or not you're dilating at 1 cm per hour, they need to do hourly vaginal exams - and VEs increase the risk of GBS infection!!!!!!!!!!!! So stupid. So so stupid. So, yeah, the routine, frequent VEs is yet another reason to stay out of a stupid, high-intervention hospital like that until you are well into hard labor. But, again JMHO.
 

Originally Posted by bayspumpkin 

They even give you a special wash to shower with when you go in labor "just in case you need a c-section". 

That's kinda weird - never heard of that one. I thought they just washed your belly with iodine before making in incision? Why would you need to shower to wash your whole body with the stuff? Besides, even if you DO shower with whatever the wash is when you arrive, if you labor an hour or two post-shower and THEN need a CS, it's not as though your skin can still be considered sterile! Considering in labor you may be hugging your DH, who will be wearing unsterile clothes, walking around your room, which can't be considered 100% sterile everywhere, etc. Weird. Makes me glad, for the millionth time, I'm planning an HB.

[bayspumpkin]

Thank you, that's what I was kind of thinking, just wanted to make sure I wasn't missing something.  I'm wishing I had gone a midwife route myself.  The only homebirth midwife in the area left right at the time I got pregnant & for financial reasons I couldn't justify driving the 2 hours to the nearest birth center, but geeze the closer it gets, the more I regret that.

Just hoping my delivery goes like the last & they won't have time to do any of their craziness.  I don't know what it up with the soap.  Unless it is like Hibiclense or something that is suppose to fight bacteria for hours after washing.  I don't know, your right, unless they want to give me a sterile suit to bring home too, seems silly.  I didn't preregister last time, so I didn't realize the extent of their interventions.  Most are induced around here.  I don't know anyone who hasn't been.  Just met 2 elective primary c-sections, one b/c her doctor convinced her that her pelvis couldn't do it & the other just chose it over the induction at 38 weeks. My cousin had a c-section b/c her doctor didn't expect to have to go over her due date was induced on her due date & of course had a c-section right around "quitting time" for failure to progress.  This will hopefully be my second VBAC & which is also very rare.  When I had my DD the nurse told me it was unusual for the student nurses to witness a birth because most most women are induced in the morning and then have their babies in the evening when the students aren't there.

Yes, be very glad you you are getting a HB.  I'm jealous!

[mckittre]

I had my first in a (much friendlier) hospital, and I was GBS+, and my water broke before labor started.  I called them when my water broke at 3AM, and they told me to come in at 8AM or so unless I felt like I needed to sooner.  So this was a CNM practice delivering in a hospital that does give people the antibiotics.  And they didn't even suggest that I come in for the antibiotics until 5 hours after my water broke, and they didn't seem super worried about it - I could have come in later if I wanted and it wouldn't have freaked them out (I ended up showing up at 8cm, so I was glad I didn't wait too much longer). 

[Zhoujianfu]

So, if my water breaks ahead of time, & being GBS+, how long do you think it is safe to stay at home?  & should I lie to them & say it just broke when I go in?

Hi,

As a parent whose son died of GBS 11 hours after a uncomplicated pregnancy and home birth delivery, I would recommend you follow the CDC's guidelines. Which would be if you're GBS+, to go to the hospital as soon as your water breaks or you go into labor and start to get an antibiotic IV. From experience I can say that nothing, absolutely nothing uncomfortable about the labor/delivery/recovery is worth your baby dying (or becoming permanently disabled). Especially when it's from something so easily preventable these days as GBS.

The CDC has no agenda other than the health of mother and child. They've done the research, they've looked into the possible downsides, alternative medicines, everything. They take forever and they're very conservative... so when they finally do recommend something, you can be pretty sure it's the right thing to do, as far as science best currently understands.

Please, don't spend the rest of your life kicking yourself for being so narrowly focused on a beautiful process that you end up with a horrible result.

josh

[Marcy&Dono]

I think the biggest "problem" here is that many hospitals have a rule that you have to have had 1 dose of antibiotics at least 4 hours before the baby is born, otherwise they'll have to observe the baby for 48hrs to make sure s/he doesn't develop GBS infection (some will even take the baby to NICU pre-emptively, or give antibiotics "just in case.").  So I'd ask about what their procedures are for this.

Otherwise, you should be fine staying at home for a while, and make sure to avoid cervical checks if at all possible.  I'm GBS + and having a homebirth, we'll be doing a Hibiclens wash to prevent GBS transmission to the baby at birth. (http://mountainviewmidwives.com/group_b_strep.html scroll to bottom for info on using Hibiclens vs antibiotics)

[bayspumpkin]

Yes, I think their requirements are 2 doses, 4 hours a part.  I never make that, and we have to stay an extra day.  Very frustrating because they also don't want children under 2 to visit & my dd is 22 months old.  But at least they don't do the NICU or automatic meds for baby.  My OB said that different peds have different policies about having to stay, so maybe I'll try to talk about it with the ped this time & if I show I know about the risks perhaps I won't be required to stay the extra day.  

[carrierwright]

Something to also consider is that strep B is a very normal bacteria to colonize the vaginal tract. When our waters break, nature has created the amniotic fluid to flow outward to clear any pathogens in the vaginal tract. If nothing is inserted into the vagina (ie fingers during an exam) to disrupt this normal pattern then even the positive mother wouldn't have a change of infected the baby. Perhaps having this discussion as early as possible w/your provider and changing providers if he/she isn't very supportive is an option. But of course, hopefully it won't break until pushing again! Best of luck!