Anyone else GBS+? How real are the worries?

[JFTB1177]

This is the first time I've ever tested GBS+. I am just over 40 weeks and had a cervical check yesterday and now I am really concerned it is putting my baby at risk. I know the more internal exams, the more the risk of *any* infection, but does it put my baby more at risk of getting GBS, or is it only if my water breaks?

I am going to try to keep cervical checks to a minimum, but it is hard as I am going for another VBAC and my doc wants to stay on top of my progress (he is letting me go to 42 weeks). He was going to sweep my membranes next week (that got my labor started with my HBAC 2 years ago) but is on the fence with that now (and honestly so am I) because of my positive GBS status.

I would love to hear from those of you who are also GBS+, or who have test positive in the past, etc. How real are these risks? Btw I will be getting antiobiotics during labor (via heplock), I am allergic to penicillin so they cultured me to find the right antibiotic. I am just so scared of something happening to my baby! I know the actual risks (stats) are low but when it does happen it is bad. :(

[eastmillcreekmama]

I was GBS  + with my first pregnancy. The information I have from my midwives was that the risk is pretty minimal until about 18 hours after your water breaks. After that, the recommended protocol is to receive prophyllactic antibiotics, but until that point, it's not so much, though you aren't without any risk at all. I had a home birth, and delivered at 16.5 hours after my water broke spontaneously, and everything was fine. My midwives didn't do any cervical checks until it looked like I was pushing (they wanted to make sure I was fully dilated). I don't know if they were avoiding it because of GBS or not. Anyway, I would recommend against sweeping membranes, and allow the waters to break spontaneously. Most women's waters break well into labor, and well within 18 hours of birth.

[korintherin]

I was GBS+ with my first pregnancy and the L&D staff wanted to start the ABX before my water broke. I wish I had known about the 18 hours protocol, because the IV was distracting (but not as distracting as repeatedly throwing up, and they administered Zofran via IV, so it wasn't all bad).

My only internal exams were after transition (I was pushing but not dilated enough) and then again a couple of hours later (fully dilated then). I don't think I had one at the last couple of checkups. If your water hasn't broken, your last exam is unlikely to have introduced the bacteria to the baby.

Good luck!

[Tmama]

Originally Posted by JFTB1177 

 I know the more internal exams, the more the risk of *any* infection,

I just have to ask why is this?  Sorry I can't help with your question but I was reading your post and am confused as to why you could get an infection just from getting a cervical check?  Is that just with GBS +?  Sorry for my ignorance...  but I really thought as long as the OB has gloves on, there shouldn't be an issue?  I would think the docs would be as sterile as possible just the same as when I get a pap.

Great, one more thing for me to think about...

[korintherin]

Even if the doc's gloves are sterile (and I hope they would be), your vaginal area might not be. So something living "further down" might get carried up higher by dr's gloves.

[MarineWife]

Another thing to consider when getting a dx of GBS+ is whether or not they took a sample from your anal area as well. I learned with my 3rd child that is part of the testing. You may not feel or be aware that they've done that. You could be GBS+ there but not in or around your vagina. I have always tested GBS+. Once I learned that I insisted on taking my own sample the last time I was tested and told them I wouldn't be swabbing my anal area. Lo and behold, the test came back negative. It's something to ask about because GBS+ on your backside is really not a risk at all. I really don't know why docs think it's relevant.

[thankful85]

That's true.  When I was seeing an OB with my other pregnancies they swabbed the anal area and it came back positive.  This time I'm seeing a midwife and she did a vaginal swab...results should be in today so I'm curious now.

[MarineWife]

Originally Posted by thankful85 

That's true.  When I was seeing an OB with my other pregnancies they swabbed the anal area and it came back positive.  This time I'm seeing a midwife and she did a vaginal swab...results should be in today so I'm curious now.

I haven't asked specifically what the risks are but my home birth MW doesn't seem to think it's all that dangerous. She lets all her clients swab themselves, or not. She gives them a swab and they go in the bathroom and do whatever they want with it. They don't have to actually swab anything, just take it out of the package and put it back in.

If I went to a hospital, I was told I'd be "required" to come in within 4 hours of going into labor no matter what so they would have time to give me at least 2 doses of antibiotics.

[HappyMonkey]

This is a really good article on the subject from Mothering.com

[MegBoz]

Originally Posted by JFTB1177 

I know the actual risks (stats) are low but when it does happen it is bad. :(

Actually the mortality rate for babies who contract GBS infection isn't that bad. From the mothering article, " Of those infants who do develop a severe early-onset GBS infection, approximately 6 percent will die from complications of the infection.^43"

That is 6% of those who DO contract GBS - and a low % of babies - especially full term babies - will contract it in the first place - even with + mothers. The article details how low the # really are.

Personally I think ABTs for all women who test + is ridiculous - and one of my MWs with my DS, a hospital-based CNM, agreed. I think the risk-based protocol they follow in the UK makes a LOT more sense. http://www.babycentre.co.uk/pregnancy/antenatalhealth/physicalhealth/groupbstrep/#8

It's the plan I'll follow this time - although in the case of broken water for 18+ hours, I'll go for hibiclens wash. 

As someone mentioned, even with gloves, VEs increase risk of infection. I believe GBS bacteria tend to live towards the outer portion of the vagina - the bacteria is less likely to be present up in the cervix & uterus - so VEs TAKE the bacteria and PUT it up into the uterus! Whereas it's not there otherwise. Knowing this, and knowing how commonly AROM is done in American hospitals (and like 91% of births in American are in hospitals), I would presume contributes to the (I think) 2% of babies who get GBS in positive mothers with no ABTs.

In other words, I think it's fair to say--- babies born to mothers with no other risk factors but a + swab would have better odds than a 1 in 50 chance of getting an early-onset GBS infection if they weren't born in a typical American, highly-managed hospital birth scenario.

The book "Gentle birth, gentle mothering" by Dr. Sarah Buckley has great info on this.

Originally Posted by JFTB1177 

I am going to try to keep cervical checks to a minimum, but it is hard as I am going for another VBAC and my doc wants to stay on top of my progress (he is letting me go to 42 weeks). He was going to sweep my membranes next week (that got my labor started with my HBAC 2 years ago) but is on the fence with that now (and honestly so am I) because of my positive GBS status.

Huh? Why does he need to "stay on top of your progress" just because you're a VBAC? I mean, cervical status in late pregnancy doesn't tell you anything at all about when you'll go into labor & have the baby & thus is utterly & totally worthless info (unless you want to obtain a Bishop's score to consider possibly inducing.) Is that different somehow for VBACs?

One of the CNMs in the hospital practice where I had my DS was opposed to membrane stripping in GBS+ mamas, but the other 2 weren't. I did have mine stripped at 41W4D & it kicked off labor in 2 hours (although research on stripping is really split - some studies show zero difference. I think it only helps kick-start things if you're about to go into labor on your own anyway.)

I don't know if it's ever been studied, but I imagine a TRUE sweep - like a 2 second-long circle with a finger just inside the cervix - should NOT increase risk of infection any more than  a regular old VE to asses cervical status would. I mean, it's basically the same thing right? The HCP just feels your cervix.

I think the "Stretch" & sweep where an HCP is in there a while fiddling around would be a lot more likely to cause problems. THAT I would personally avoid. When my MW did my sweep, it literally was a 2-second long circle with her finger tip.

All of that aside, if you're only being "allowed" to go to 42W (ick, sorry, I hate using that term. I totally respect & understand that you would agree not to go into post-dates territory, it's true the risk of stillbirth goes up past 42W, so I totally get that! But I HATE the whole "Doc is allowing/letting me." Just nauseates me.) Anyway, if you're facing ERCS vs. membrane stripping at 41W6D, I'd definitely go for the sweep -- especially if you already know you want ABTs.

[JFTB1177]

Originally Posted by MarineWife 

Another thing to consider when getting a dx of GBS+ is whether or not they took a sample from your anal area as well.  

Yes! I know for a fact that my doc swabbed my vagina and then anal area, because he told me what he was doing as he did it.

[JFTB1177]

Originally Posted by MegBoz 

Originally Posted by JFTB1177 

I know the actual risks (stats) are low but when it does happen it is bad. :(

Actually the mortality rate for babies who contract GBS infection isn't that bad. From the mothering article, " Of those infants who do develop a severe early-onset GBS infection, approximately 6 percent will die from complications of the infection.^43"

That is 6% of those who DO contract GBS - and a low % of babies - especially full term babies - will contract it in the first place - even with + mothers. The article details how low the # really are.

Personally I think ABTs for all women who test + is ridiculous - and one of my MWs with my DS, a hospital-based CNM, agreed. I think the risk-based protocol they follow in the UK makes a LOT more sense. http://www.babycentre.co.uk/pregnancy/antenatalhealth/physicalhealth/groupbstrep/#8

It's the plan I'll follow this time - although in the case of broken water for 18+ hours, I'll go for hibiclens wash. 

As someone mentioned, even with gloves, VEs increase risk of infection. I believe GBS bacteria tend to live towards the outer portion of the vagina - the bacteria is less likely to be present up in the cervix & uterus - so VEs TAKE the bacteria and PUT it up into the uterus! Whereas it's not there otherwise. Knowing this, and knowing how commonly AROM is done in American hospitals (and like 91% of births in American are in hospitals), I would presume contributes to the (I think) 2% of babies who get GBS in positive mothers with no ABTs.

In other words, I think it's fair to say--- babies born to mothers with no other risk factors but a + swab would have better odds than a 1 in 50 chance of getting an early-onset GBS infection if they weren't born in a typical American, highly-managed hospital birth scenario.

The book "Gentle birth, gentle mothering" by Dr. Sarah Buckley has great info on this.

Originally Posted by JFTB1177 

I am going to try to keep cervical checks to a minimum, but it is hard as I am going for another VBAC and my doc wants to stay on top of my progress (he is letting me go to 42 weeks). He was going to sweep my membranes next week (that got my labor started with my HBAC 2 years ago) but is on the fence with that now (and honestly so am I) because of my positive GBS status.

Huh? Why does he need to "stay on top of your progress" just because you're a VBAC? I mean, cervical status in late pregnancy doesn't tell you anything at all about when you'll go into labor & have the baby & thus is utterly & totally worthless info (unless you want to obtain a Bishop's score to consider possibly inducing.) Is that different somehow for VBACs?

One of the CNMs in the hospital practice where I had my DS was opposed to membrane stripping in GBS+ mamas, but the other 2 weren't. I did have mine stripped at 41W4D & it kicked off labor in 2 hours (although research on stripping is really split - some studies show zero difference. I think it only helps kick-start things if you're about to go into labor on your own anyway.)

I don't know if it's ever been studied, but I imagine a TRUE sweep - like a 2 second-long circle with a finger just inside the cervix - should NOT increase risk of infection any more than  a regular old VE to asses cervical status would. I mean, it's basically the same thing right? The HCP just feels your cervix.

I think the "Stretch" & sweep where an HCP is in there a while fiddling around would be a lot more likely to cause problems. THAT I would personally avoid. When my MW did my sweep, it literally was a 2-second long circle with her finger tip.

All of that aside, if you're only being "allowed" to go to 42W (ick, sorry, I hate using that term. I totally respect & understand that you would agree not to go into post-dates territory, it's true the risk of stillbirth goes up past 42W, so I totally get that! But I HATE the whole "Doc is allowing/letting me." Just nauseates me.) Anyway, if you're facing ERCS vs. membrane stripping at 41W6D, I'd definitely go for the sweep -- especially if you already know you want ABTs.

Hey thanks for all the info!! :) I know, I hate the "allowing me to go to x weeks" thing too. What is the difference between "stretch and sweep" and a true sweep? My MW  did a sweep with my last PG and my labor started the next day. Do you think it was a "true sweep"? I feel so clueless about this! I want to do anything to avoid another c/s. Luckily baby is at least anterior this time (both of my last 2 were posterior, my HBAC baby turned at the last minute after pushing for 6 hours).
 

[JFTB1177]

Originally Posted by HappyMonkey 

This is a really good article on the subject from Mothering.com

Thanks!!!! :)

 

[MegBoz]

Quote:

Originally Posted by JFTB1177 

What is the difference between "stretch and sweep" and a true sweep?

I actually didn't realize there was any sort of difference either until I read another thread about it on the birth & beyond forum about a month ago. Membrane 'sweeping' or 'stripping' involves lifting the amniotic sac off the cervix. I would think it SHOULD be a quick procedure. As I said, my 'sweep' was literally a 2-second circle with my MW's finger & she was back out of my vagina again. I assume that is a "normal" sweep, although I'm not certain.

Someone said her HCP (can't remember if it was OB or MW) was up in the cervix for like a couple minutes trying to manually stretch her cervix!! Yikes! 

So knowing that, if I were to consent to a sweep again, I'd make sure before my MW got her hand inside me to discuss the difference between a simple sweep and 'stretching.'

Also, a co-worker told me her OB did a sweep at 38 or 39W and it was painful. Mine was uncomfortable, but not the least bit painful, so I wonder if my co-worker had something different done. & the only reason mine was even uncomfortable is because that MW has really tiny hands & she was pushing kinda hard to even reach her finger into my cervix, Ha! She apologized for it too (LOVE her, great MW.)

[JFTB1177]

Originally Posted by MegBoz 

Quote:

Originally Posted by JFTB1177 

What is the difference between "stretch and sweep" and a true sweep?

I actually didn't realize there was any sort of difference either until I read another thread about it on the birth & beyond forum about a month ago. Membrane 'sweeping' or 'stripping' involves lifting the amniotic sac off the cervix. I would think it SHOULD be a quick procedure. As I said, my 'sweep' was literally a 2-second circle with my MW's finger & she was back out of my vagina again. I assume that is a "normal" sweep, although I'm not certain.

Someone said her HCP (can't remember if it was OB or MW) was up in the cervix for like a couple minutes trying to manually stretch her cervix!! Yikes! 

So knowing that, if I were to consent to a sweep again, I'd make sure before my MW got her hand inside me to discuss the difference between a simple sweep and 'stretching.'

Also, a co-worker told me her OB did a sweep at 38 or 39W and it was painful. Mine was uncomfortable, but not the least bit painful, so I wonder if my co-worker had something different done. & the only reason mine was even uncomfortable is because that MW has really tiny hands & she was pushing kinda hard to even reach her finger into my cervix, Ha! She apologized for it too (LOVE her, great MW.)

When my MW did my membrane sweep 2 years ago, it HURT!!!!!! Not "uncomfortable", but very painful, I think I went white when she did it! It was also longer than 2 seconds. It did work though, and like I said, my labor started the next day.