talk to me about homebirth and GBS+

[carriebft]

I have never been positive before but I just got my test back +. I have had 2 babies in the hospital with no issues and one homebirth, again, no issues. All have come on or day before due date and have been healthy weight and all that.

I guess I am looking for experiences on how GBS+ affects/ed homebirth...did you go with abx or no?

Do the abx lower mortality rates? or just infection rates?

any other insights or experiences would be helpful...I am just feeling very lost atm because this has never been an issue for me before.

[XanaduMama]

I was + the first time, hospital birth, and got abx etc. The second time around, homebirth, I knew much more and used hibiclens wash before testing (was negative) and again once labor started. It's as effective as abx at killing off GBS, without any of the nasty systemic effects. Some studies (scroll down) and other articles here:

http://www.gentlebirth.org/archives/gbs.html#Lavage

The protocol for using hibiclens (which you can get in most drugstores--in the first aid section, as I recall, in a blue bottle) here:

www.birthcottage.com/images/GBS%20Protocol.PDF

[MegBoz]

The book "Gentle Birth" By Dr. Sarah Buckley has an EXCELLENT chapter on it. Published in, I think, 2009 so very current too.

Personally if I do test +, I'm going to use the "Risk-based" approach they use in the UK- they recommend ABTs ONLY for 2 or more risk factors. (+ test being only one risk factor). My own personal feelings & choices are as follows:

No other risk factors (beyond + swab) = do nothing.

ROM for 18+ hrs = hibiclens

maternal fever in labor, premature baby, or maternal UTI with GBS = antibiotics.

This is my chosen protocol since premature babies are most at risk for GBS infection, maternal fever means something is wrong (right? Fever is the body fighting something off) & therefore more risk, maternal UTI means high colonization. Whereas ROM just means a higher risk of the infection, but with much MUCH fewer vaginal exams that a HB MW does vs. hospital protocols, I think hibiclens is adequate defense in that case.

Although as I type this... maybe hibiclens is adequate in all cases? Hm - I think the hibiclens studies have had smaller sample sizes, and that's part of why I feel like ABTs are safer in those 3 relatively riskier categories.

In any case, my MW recommends eating fermented foods to reduce the risk in the first place. She estimates only about 10% of her clients test + to begin with, versus 30-40% nationwide. For those who do test +, she has a protocol to eliminate which she says works very well.

[cambridgebaby]

I was GBS+ for my HB and used the hibiclens wash which was fine.  I was GBS+ with my first child (hospital birth) and discovered I was allergic to penicillin, so the hibiclens is a great alternative.  My HB midwives don't administer antibiotics so really the only choice for a HB was hibiclens or nothing.  Luckily my little one was born in her sac, so the risk of GBS for her was even less than usual!

[carriebft]

what do you have to watch the baby for after birth? what are the signs of GBS infection or that there may be a problem? anything that stands out?

[MegBoz]

Originally Posted by carriebft 

what do you have to watch the baby for after birth? what are the signs of GBS infection or that there may be a problem? anything that stands out?

I'd have to check to confirm, but I'm fairly certain low body temp is one sign of infection. This sticks in my mind since it's the opposite of adults (i.e. fever - elevated temperature - is a sign of infection.) I believe also just lethargy/ poor sucking reflex could be symptoms.

It's important to note the difference between early-onset GBS infection (EOGBS) and LATE onset. EOGBS infection shows symptoms within 24 hours like 90-some% of the time (again, the book "Gentle Birth" is a great info source.) Which makes it so idiotic that AAFP & other physician groups have policies that newborns born to GBS+ moms who don't receive ABTs in labor have to stay in hospital 48 hours minimum for observation (that was policy at the hospital where I had my DS. Considering it was a pretty established "standard of care" I figured it wasn't worth fighting, so I had to stick around 48 hours or leave AMA.)

Whereas LOGBS can not show up for 3 weeks or more. LOGBS is also basically unconnected to maternal GBS status anyway. There is a lot of research to back that up, including the fact that LOGBS infection rates haven't changed since the CDC recommended universal GBS screening of all PG women and administration of ABTs to all GBS+ women back in the 1990s.

[carriebft]

I will definitely have the abx on hand and I need to go pick it up this week. I just left my midwife a message but thought I would post here as well....how much does it cost? is it typically covered by insurance?

[CookAMH]

Originally Posted by MegBoz 

The book "Gentle Birth" By Dr. Sarah Buckley has an EXCELLENT chapter on it. Published in, I think, 2009 so very current too.

Personally if I do test +, I'm going to use the "Risk-based" approach they use in the UK- they recommend ABTs ONLY for 2 or more risk factors. (+ test being only one risk factor). My own personal feelings & choices are as follows:

No other risk factors (beyond + swab) = do nothing.

ROM for 18+ hrs = hibiclens

maternal fever in labor, premature baby, or maternal UTI with GBS = antibiotics.

This is my chosen protocol since premature babies are most at risk for GBS infection, maternal fever means something is wrong (right? Fever is the body fighting something off) & therefore more risk, maternal UTI means high colonization. Whereas ROM just means a higher risk of the infection, but with much MUCH fewer vaginal exams that a HB MW does vs. hospital protocols, I think hibiclens is adequate defense in that case.

Although as I type this... maybe hibiclens is adequate in all cases? Hm - I think the hibiclens studies have had smaller sample sizes, and that's part of why I feel like ABTs are safer in those 3 relatively riskier categories.

In any case, my MW recommends eating fermented foods to reduce the risk in the first place. She estimates only about 10% of her clients test + to begin with, versus 30-40% nationwide. For those who do test +, she has a protocol to eliminate which she says works very well.

I agree with everything you said and wanted to add that a homebirth midwife I interviewed said somewhere (maybe not US), they had VERY successful results in using hibiclens in a surgery for prevention of infection. I found that helpful.

And, for the op, from my research, administration of abx for GBS+ women results in 1/200 babies being helped from infection. So, 199 babies get abx unncecessarily, in GBS+ moms. For that reason and by knowing the risk factors, I am not testing.

[carriebft]

After reading though things here and the net, I definitely want them on hand in case of fever or a combining of other factors. From what I have looked at, abx administered in cases of multiple risk factors have shown to be effective, so we will go with it if that happens, kwim?

[lovebeingamomma]

Depends on if your midwife offers IV's and abx, some can do it some can't.  It's not something you can just go pick up at the drugstore.

[MegBoz]

Originally Posted by carriebft 

After reading though things here and the net, I definitely want them on hand in case of fever or a combining of other factors. From what I have looked at, abx administered in cases of multiple risk factors have shown to be effective, so we will go with it if that happens, kwim?

Yes, I KWYM & I'm ITA.

I'm pretty sure my MW said she could get ABTs, although I think she also said she's hesitant to give them at home since there's a small chance the ABTs themselves can cause anaphalytaic shock! (True, or am I thinking of something else?) But I already know I don't have an allergy to the #1 ABT they recommend. (Although I forget which it is.) So that's not a concern for me personally.

& if I have a premature baby, I absolutely would go to the hospital (I think most MWs wouldn't want to attend a premie birth at home anyway) - so maternal fever & UTI with GBS would be only cases in which I'd have ABTs at home. & even then, I think maternal fever might worry me enough to consider transferring to the hospital (not sure though, don't know enough about it - that's a situation I'd look to my MW for her recommendation.)

[carriebft]

My midwife does do IV antibiotics at home. I have to go pick up the script later this week if I want to have them here. I also thought that PROM + fever would be reason enough to transfer for me, but she said she would rather have them on hand because she tells her patients that the abx can be started before/during the transfer process, allowing for more favorable outcomes if there are truly problems of that nature rather than waiting to get all the hospital transfer stuff over with b/c there can be delays even in emergencies.

Preterm is not an issue since I am 37+3 today.

[mamahen2coop]

Im wondering what is the purpose of doing the hibiclens wash to get a neg test.  Wouldn't it just kill the bacteria that are normally there thus just masking the problem?  

[carriebft]

I thought the same thing, which is why I didn't go with washing and retesting.

I did give birth on Feb 5 and chose to do the abx. My sample tested that it was vulnerable to the abx and my midwife told me she felt more comfortable doing it. Also, if we transfered and I did not do the abx, they would want to hold my infant in the hospital longer. She still left it up to me and agreed to do a hibiclens in early labor as well if I wanted. But I really trust my CNM, so I went with the abx. no issues and no yeast after so thats good :)

[XanaduMama]

Originally Posted by mamahen2coop 

Im wondering what is the purpose of doing the hibiclens wash to get a neg test.  Wouldn't it just kill the bacteria that are normally there thus just masking the problem?  

It doesn't just trick the test; it makes you negative, as effectively as abx (though without the systemic side-effects). Of course GBS colonization can come and go, so either way a negative test doesn't guarantee anything in the longer run. Which is why everyone who's really worried about GBS could/should do a wash again when labor begins, whether or not you've previously tested negative. Though for me, the risks of infection are so low that (in the absence of real risk factors) it's not necessary.

OP--congrats on your baby! Glad it all went well.

[Inkedstar]

DD#1 was born in the hosp, ABX given as standard. Still had fevers during delivery (epidural) but baby was not kept longer or ever kept in the nICU.

DD#2 was born at home, tested positive GBS swab test earlier (36 weeks). Hibiclense rinse was our course of action (MW also had IV ABX available) but we did not remember to do it (I was in labor denial until MW arrived, checked me and I was 9cm). No PROM or fevers/low-temps and heart rate was fine for baby.

In short, we forgot to rinse and DD#2 survived my vaginal flora fine.

[ocelotmom]

I was GBS+ with my second (hospital) and third (homebirth) - no problems with either of them. With the homebirth, I did the hibiclens, as in my state, antibiotics aren't an option at a midwife-attended homebirth (this isn't true in all states). My research during pregnancy convinced me that it is quite effective prevention for a problem that is already not a large risk.

In fact, I would have it on hand in future pregnancies and do it if my water broke before labor (as it has with all three of my pregnancies so far), regardless of where I was giving birth. How many people end up delivering before getting the recommended two doses separated by 4 hours of IV antibiotics, especially if they prefer to labor at home as long as possible? It seems good common sense.

[mamahen2coop]

Originally Posted by ocelotmom 

I was GBS+ with my second (hospital) and third (homebirth) - no problems with either of them. With the homebirth, I did the hibiclens, as in my state, antibiotics aren't an option at a midwife-attended homebirth (this isn't true in all states). My research during pregnancy convinced me that it is quite effective prevention for a problem that is already not a large risk.

In fact, I would have it on hand in future pregnancies and do it if my water broke before labor (as it has with all three of my pregnancies so far), regardless of where I was giving birth. How many people end up delivering before getting the recommended two doses separated by 4 hours of IV antibiotics, especially if they prefer to labor at home as long as possible? It seems good common sense.

That was me.  I labored at home until it felt active, got my first dose at the hossy, and he was born 3 hrs later. They did blood cultures on him and we ended up staying an extra day to watch for immediate infection. 
 

[Christine4kiddos]

It is important that you have a GOOD conversation with your midwife. Please do a lot of research.

Facts:

-GBS infection in the NB is rare 1 baby for every 100-200 women who are GBS positive... however when it happens, it is rapid. Death is a definite possible outcome; brain damage is possible...  the "lessor" effects of having a very ill newborn and having that baby in a NICU, unable to nurse, etc... while "better" than death, leave their own mark on the mother and baby.

- Risk of anaphylaxis to ABX is 1 in 5000- 10,0000; 

- Yeast infection is a very real possibility after having such mega doses of antibiotics

- Prophylactic use of abx in labor reduces GBS infection (early onset) by 86%

- Not enough studies have been done, with  a large enough sample of women to prove that vaginal chlorhexidine is just as effective. Please read the Cochrane review... which is the "go to" study review, which picks apart collections of studies specifically to say if the studies themselves were done well/appropriately.

(the cochrane review has also stated that there needs to be more research regarding homebirth safety, but has not declared it unsafe practice)

Do not base your decision on other people's choices: "Oh, I did hibiclens, and we were fine"

I practice both at home and in a birth center. We have women who choose abx, women who decline abx, women who want to use hibiclens, women who chose abx but then have such a fast labor that we can't give them....

We haven't had a case of  GBS infection.  It is a rare thing... .5-1%... however, if it is YOUR baby who is sick, it becomes 100%. Only YOU know your heart, and only you know how you will deal with an outcome if your baby is sick, and you either "fudged" results by sanitizing your vagina before the culture... or by waiting until signs of infection are present. Please research and know all the possible outcomes.

The midwife I practice with used to work in-hospital, and she has seen a few GBS infected NBs. She has stated that it is "awful", very rapid onset, and frightening for the parents (and care-givers!)