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Anyone switch to a hospital birth just because of being GBS +? - Page 2

post #21 of 26
The info on Detection in urine from the cdc
"GBS identified in clean-catch urine specimens during any trimester is considered a surrogate for heavy maternal colonization and also is associated with a higher risk for early-onset GBS disease" 
     from the Current CDC recommendations also-
"Although some women receive antibiotics to treat GBS bacteriuria during pregnancy, antibiotics do not eliminate GBS from the genitourinary and gastrointestinal tracts, and recolonization after a course of antibiotics is typical (71,131,132). Studies have found that some women with GBS bacteriuria during the first trimester might not have vaginal-rectal colonization detected at 35--37 weeks' gestation (130) or at the time of delivery (133). However, maternal GBS bacteriuria at any point during pregnancy is a recognized risk factor for early-onset GBS disease and therefore has been included as an indication for intrapartum antibiotic prophylaxis since 1996.

Subsequent observational studies have found the effectiveness to be 86%--89% among infants born to women who received intrapartum GBS prophylaxis

In reading over the higher dose 4.8m  IM penicillin the studies were small but promising with no heavily colonized patients ... Highest levels of antibiotics if within 4 weeks of shot, 

i know that the CDC guidelines was recognizing there is something up with other flora but nothing  solidly proven other than greater incidence of resistant ecoli strains...
There are 2 very recently published studies that point to other flora taking the lead in infections.

J Perinatol. 2011 Apr 28. 
Early-onset neonatal sepsis: rate and organism pattern between 2003 and 2008.
Sgro M, Shah PS, Campbell D, Tenuta A, Shivananda S, Lee SK.
Canada"
Skipping intro and basic birth population numbers
"Result:A total of 405 infants had positive blood and/or cerebral spinal fluid cultures over the study period. The EONS rate was 6.8/1000 admissions (n=24969) in the earlier cohort compared with 6.2/1000 admissions (n=37484) in the later cohort (P=0.36). Rate of clinical chorioamnionitis was higher in the later cohort (38 vs 26%; P=0.02). For term infants, coagulase-negative Staphylococcus (CONS) (2.4/1000) followed by group B Streptococcus (GBS) (1.9/1000) were the most common organisms identified. For preterm infants, CONS (2.5/1000) followed by Escherichia coli (2.6/1000) were the most common organisms identified. There was a significant reduction in GBS EONS over time (P<0.01) and a trend toward an increase in other organisms.Conclusion:Although the rate of EONS among neonates admitted to NICUs has not changed, the pattern of infection has changed over the past 6 years. With the increased use of prophylactic antibiotics to mothers, careful surveillance of the changing trend of bacterial organisms among neonates is warranted.
.Journal of Perinatology advance online publication, 28 April 2011; doi:10.1038/jp.2011.40."

Pediatr Neonatol. 2011 Apr;52(2):78-84. Epub 2011 Mar 16.
The Changing Face of Early-onset Neonatal Sepsis After the Implementation of a Maternal Group B Streptococcus Screening and Intrapartum Prophylaxis Policy-A Study in One Medical Center.
Lin CY, Hsu CH, Huang FY, Chang JH, Hung HY, Kao HA, Peng CC, Jim WT, Chi H, Chiu NC, Chang TY, Chen CY, Chen CP.
Division of Neonatology, Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
"The GBS screening rate increased from 10.11% in 2004 to 65% in 2008 and the IAP rate increased from 40% in 2004 to 90% in 2008. The most common EOS pathogen in Period 1 was GBS (45.4%), which decreased to 20% in Period 2 (p=0.081; trend p=0.009). The percentage of EOS because of Escherichia coli in Period 1 was 40.9% but increased to 70% in Period 2 (p=0.059). E coli EOS increased in extremely low birth weight premature babies weighing 500-1000g from Period 1 to Period 2 (p=0.031). The incidence of ampicillin-resistant E coli EOS was relatively high, but no significant change (88.9% vs. 92.9%) after implementation of GBS screening and IAP was noted."
post #22 of 26
Thread Starter 
puddle, thank you. I did pick up a bottle of hibiclens to use at home should the need arise. I don't plan to labor at home very long, but I've already had one episode last week when I went in to the hospital with what was either not real labor, or it was stalled out by the hospital, so I can't go in at the first contraction either. The scenario described above where the mom showed up pushing, her water having broken on the way, was pretty much my previous birth (I was GBS- that time though) so I figure there is a non-insignificant chance I won't make it in time for the antibiotics.
post #23 of 26

If you don't happen to make it to the hospital in time, they can always give antibiotics directly to baby afterwards, which is very effective.

The unit I work on doesn't automatically do this, unless there are some increased risk factors (premature, previous GBS infected baby, GBS in urine). 

Instead, what we do is admit baby as a "Step-Up" in the nursery.  It basically just means that we watch the baby extra close.  Check vitals more often, etc.  Baby is allowed to stay in mother's room, but when mother wants to go to sleep and there isn't going to be an awake adult in the room, the baby comes to the nursery until mom wakes up again.  Also baby is not allowed an early discharge and has a 3-4 day checkup with the Ped. 

There is also a blood test that you can do on baby shortly after the birth to see if an infection is brewing.  (the homebirth midwife that I use has all of her GBS moms take their baby in for this blood test shortly after the birth, since she cannot administer antibiotics in our state)

Another option, some people choose to have their labor induced so that they can be certain to have antibiotics on board.

 

 

Just giving you a bunch of different things to consider and to talk with your provider about.  At the very least, I recommend that you memorize the symptoms of GBS infection in a newborn.

 

Good luck with your birth and congrats on your upcoming bundle of joy!

post #24 of 26

Ryleigh's Mommy, thank you for the great info. I was GBS positive for my first two births and expect I will be for my third, as well. In both my previous labors, I wasn't in labor long enough to receive the full course of abx, so your suggestions are very helpful!

post #25 of 26
Thread Starter 
Just wanted to update this thread with what happened, in case anyone is interested. Like I said, I had a couple of false alarms - irregular but fairly strong contractions so it was a bit of a mind game for me to figure out when to go to the hospital. This happened again starting about 11:45 Sunday night, they didn't seem to be getting stronger or anything so I decided to go to bed, but before bed I did a Hibiclens just in case. Felt a little pop and started leaking water at 1:45, woke up DH, called the hospital, got dressed, called my MIL, started pushing! Very precipitous birth - he was born at 2:20 am. and my DH said the waters broke as his shoulders came out. We had an agreement with our HB midwife that she would come help out if things went fast, even though we'd officially switched care to our family doc. So she came and helped us cut the cord and stitch my tear and everything. No signs of GBS and we are doing great 2.5 days later other than lots of nipple pain while nursing!
post #26 of 26

Yay, congrats mama! Glad to hear everything went so well and that the GBS wasn't an issue. Hope the nipple pain passes soon--lots of lansinoh, air drying, and labor breathing to get you through these rough first days

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