Group B Strep and UC

[ElizabethE]

Since you ladies have been talking about Group B Strep, can you tell me a little more about it? Specifically, if you know details on how perhaps it’s blown out of proportion or not as much of an emergency as we are typically led to believe? Since beginning on this path of educating myself outside of the system and what we act like is “normal”, I’ve discovered SO many scenarios typically treated as emergencies which actually aren’t. So alarming, really. I’m glad I’ve learned and am continuing to learn more.

Any thoughts or experiences?

[lizzie]

Well ElizabethE, I don't have any statistical facts to back up what I've heard and experienced. But while I've known a friend of a friend whose baby contracted (is that even the right word?) GBS from her mama and ended up hospitalized for a *long* and scary (and necessary) time, my understanding is that that sort of thing is incredibly rare? And basically that any of us could test negative or positive with it on any given day. So, testing negative (or positive) around your 36th week is essentially an arbitrary thing to make people feel "safe" about what they may or may not have, and a neg or pos test a month before delivery has pretty much nothing to do with whether or not you're actually neg or pos when you deliver.

I was neg with my daughter, pos with my son, and they made a huge deal about my needing to come in just *as soon as I could* so I'd have plenty of time to get in all the abx they wanted me to have before delivering. Not being who I am now then, I did just that, but my labors are relatively short and easy, and (oh horror) they only got one dose into me before my son was born. They wanted to give him abx, but I didn't allow it, and everything was fine. My two children so far certainly didn't spend any quality time in the birth canal during the birth, so that too would've cut down significantly on any exposure he may have had.

I am interested in whatever different ways there are to come up with a neg test, but I'm still undecided about actually doing it... that still depends on what sort of prenatal care I do or don't continue with at this point, and my mood on any given day, for that matter! :)

[lizzie]

And oh yeah...  it's also my understanding that there can be two different incubation periods, with newborns exhibiting symptoms (fever, struggling to breathe) fairly soon after birth.. during their first day, anyway, and then some babies not developing symptoms for 2-4 days? I'm sure a mama with more info than I have can clarify and/or correct me on any of these points! :)

[HariB]

 Here is a link I found to an essay on GBS...I think it gives a pretty good explanation, and also has links to other info.

http://womynwisespeaks.wordpress.com/informed-choice/group-b-strep/

I've also seen some explanations by different mws about using hibiclense to get a negative test: use 1 part hibiclense to 20 parts water (assuming you buy what is commonly sold at pharmacies, a 4% hibiclense solution--the idea is to make the solution into a .2% strength--2/10s of 1%-- so it will be strong enough to kill gbs, but not so strong as to burn your mucus membranes.)  You use it to do a low douche/high rinse (and wash off the perineum and anus too) just before doing the gbs swab.

As for the difference between baby being born with the infection, and not getting sick for a few days: it seems that it depends on when baby was exposed.  So maybe water was broken for more than a day or so, gbs could have gotten into the amniotic fluid and started growing enough to make baby sick by the time of birth.  Or, baby wasn't exposed until actually being born, and it takes a few days for gbs to incubate and cause infection.  One also has to consider that gbs lives in our environment--so a baby with a later-starting infection could have been exposed AFTER birth, from something/someone in the environment.  Anyway, the above essay might be helpful, along with some of the links to info.

GBS isn't something I worry about, per se.  I do have a concern for having a negative test, just in case of transfer!  I know a couple families who had endless hassles over 'unknown gbs status' on transfer (treated as if positive).  And others who tested (making sure to get a negative) and when they could show the 'negative status' to the hospital staff, a lot of testing/treatment was avoided.  Not to mention (shall I harp on this one more time???) that it made them look better to staff that they tested at all.

[Tumble Bumbles]

It's extremely rare to pass on to babies and even so, it's extremely rare that they experience serious illness because of it. I realize if your child is the child it happens to, it doesn't seem rare, but in actuality, it is very rare. The chances of being killed driving to the hospital to receive ABX in labor is higher than a newborn contracting it. I don't even get tested for it (I didn't last time either). If I had the risk factors during labor I would likely transfer anyway (fever, ROM longer than 18 hours, etc). Cervical checks can actually introduce it, so I avoid any and all  -- last pregnancy I did have a couple, but this I've had and will have none.

Here are a couple of resources:

http://www.gentlebirth.org/archives/gbsAdamson.html

http://gentlebirth.org/archives/gbs.html

Antibiotics in labor have not been proven to reduce instances of GBS in babies who contract it or improve infant mortality rates.

It's near the bottom of my concerns, to be honest. I do see HariB's point of having unknown GBS status in case of a transfer, but I feel like if I did transfer it would likely be an emergency situation anyway and I probably wouldn't care so much about having to stay 48 hours for observation, or being treated as positive, know what I mean?

[lizzie]

Thank you both for sharing your resources!

It's not high on my list of concerns at all... if I get tested it will be after doing some cleansing to assure a neg test, and a JIC of transfer scenario.

[Mamatoabunch]

In my first pregnancy 17 years ago mothers were not tested. Next pregnancy I had a UTI w/ GBS present, so high colonization. I took antibiotics then. I had a HB and at that time oral antibiotics or herbs were suggested in labor. I went the oral antibiotics route. Labor 24 hours waters broke an hour before she was born. I have since assumed I could be positive. I took herbs my last couple of weeks w/ my fourth. W/ my 5th, 6th, 7th, 8th, and 9th I took vit C and echinacea 34-37 weeks and vit C and grape seed extract 37 to birth. I also took vit C in labor if my water broke before labor. W/ my 10th I did the same regime prenatally and hibiclens in labor.

[ZinniaGarden]

I just want to throw out there that while it is rare, it does happen.  I have a very dear friend that was neg in one pregnancy so they did not test her in her next pregnancy, coincieved right away.  Her second child, a baby girl, was in trouble immediately.  She died 16 hrs after she was born.  If you do the wash to show a neg test or if you do not test at all, if your UC baby is born not breathing well, not eating well or not keeping her temperature up, get her checked out.  It is a rare but potentially deadly infection. 

[Tumble Bumbles]

Yes, I would definitely take the baby in for any respiratory issues or a temp, regardless.

[HariB]

Yeah, TumbleB---

This is how I look at it: know what is normal and not-normal for neonates, and take any/all 'not-normal signs' very seriously, get help.  A baby should be pink down to the toes, breathing easy, nursing well, sleeping but not for too-long of periods and waking on her own to nurse.  Temp should be normal, baby should pee and poop at least once in the first 24hrs and at least twice in the 2nd 24hrs, have alert/awake periods, have good muscle tone...etc.  Any poor signs for me, would be reason for a med exam for baby.  An attentive parent who knows what to look for is not going to  miss anything.  Prophylactic antibiotics do not save every baby anyway--and I have to wonder if they'd have saved the baby in the story above--sounds like that baby was very sick already, in utero.  And most often, antibiotics do save babies who get GBS infection during/after birth, when administered after infection has started.  From what I've seen of the CDC stats, prophylactice antiobiotics do reduce the number of infections...but not the number of deaths from infection.  Which means that it's safe enough to wait and see if your baby gets sick.

Anyway, know what to look for in a newborn, get more trained eyes on baby ASAP, if you're in doubt.

[Tumble Bumbles]

Great post HariB, ITA. Most attentive parents (especially multiparas) know what to look for, even instinctually. We take babe to a 48 hour check-up anyway, for piece of mind but also a "hey we're good parents, see?" check-up to have a paper trail of our worthiness to be parents  jk

But even before then, if I had any reason to believe babe was in any distress given the signs and symptoms -- in addition to intuition -- I wouldn't hesitate to bring them in.

[LadyJennifer]

Thanks for sharing guys, a lot of good info.

I do want to mention that it is normal for newborns to have "dusky" fingers and toes due to immature circulatory systems; so pink to the toes is good, but also normal for toes and fingers to be a little less than pink:)0

[riomidwife]

GBS screening became a standard part of maternity care in recent decades because of a consumer movement to have it available to all women. It was something initially forced on women by the medical industry, but it has morphed into that -- more or less. We used to have "risk-based" treatment where only babies with risk factors were treated with antibiotics in labor via an IV to the mom (<37 weeks, small baby, water broken for >24 hours, etc.). But some babies still got sick and so now the "Standard of care" is to treat all GBS + moms. This has reduced the number of babies contracting GBS disease but has not reduced the number of babies who die from it. Giving such a large percentage of birthing women and babies antibiotics is a mass experiment, in my opinion. That being said, babies who get sick from GBS can get sick very fast. Babies can seem OK, then go south in a heartbeat. It is so important to watch for any signs of infection. In my practice I rarely see GBS in moms that have excellent diets, good digestion, and presumably good intestinal flora balance.

[mamahen2coop]

I haven't read all the replies and dont know a ton, but there was just an obituary in our paper about a 7 day old who died of GBS sepsis. 

I know that she was treated with 2 doses of Clindamycin since she was penicillin allergic.  The pediatricians consider adequate treatment 2 doses with delivery at least 30-60 mins after the second dose.  Its super sad and although I'm researching UC, this case alone made me more nervous to do it.  Although, it does go to show that even "treatment" isnt everything- which is scary!

[mamahen2coop]

riomidwife-  are there any ways to help prevent it?  I have a fairly good diet and lead a healthy lifestyle and was GBS pos with DS and would love to be neg with this one! (sorry if it's OT)

[ElizabethE]

I think the apparent unreliability of GBS testing as well as the potential for such testing to actually introduce foreign bacteria and whatnot to the vagina is reason enough to not find it so important. After listening to the women here and reading up a lot more on the facts, this is the conclusion I am drawing.

Add to that the fact that supposedly many women-- healthy women, even-- supposedly test positive for it, and that babies rarely contract it, and that among those even fewer have any serious complications resulting... seems like just more stuff we are told to fear that are realistically not worth fearing. "Rare" is the key word here, and the fact that you could even test negative and still potentially have and pass it shows the unpredictable nature of this whole thing, anyway.

[LadyJennifer]

I tend to think that giving antibiotics before infection is even present ups the chance of contracting infection because there's less good bacteria to fight infection.
I take a good bit of probiotics leading up to the birth (whole pregnancy really). If there's a healthy balance of flora, bad bacteria won't be able to overgrow.

[mamahen2coop]

What kind of probiotics?

[LadyJennifer]

Right now I'm using the PB8 brand, but before I was using the NSI brand. I just try to get the most cfu for not exorbitant prices.

[riomidwife]

Originally Posted by mamahen2coop 

riomidwife-  are there any ways to help prevent it?  I have a fairly good diet and lead a healthy lifestyle and was GBS pos with DS and would love to be neg with this one! (sorry if it's OT)

a well balanced diet without sugar! or very little! we eat insane amounts of sugar that our our bodies cannot cope with and it throws our systems into imbalance.....try limiting sugars to under 20 grams per day..........fermented foods..........whole foods........reduce packaged foods......staying on top of any food sensitivities/gluten issues........probiotics -- which when taken in pregnancy are associated with a decrease in food allergies in babies........in general doing things that help the gut be healthy and increase the friendly flora. there's a ton about this in the allergy and nutrition forums.

ps: some probiotcs are grown from dairy so if you are sensitive to dairy be on the lookout.