How to prevent testing positive for GBS- Probiotics?

[Celticqueen]

Tested positive with first, negative with 2nd. The difference between my first and second was that in the second pregnancy, I had midwives at a waterbirth center and they recommended probiotics every day. Is this legit? Is this the reason I probably tested negative that time?

Besides probiotics, is there anything else that I should change about my diet to prevent it?

I am not getting the birthing experience I want this time around because insurance will not cover the waterbirth center again (I am devestated about it), so I am going to a hospital, just like my first pregnancy.

I do NOT want to be hooked up to IV's during labor, absolutely not. So I am desperately trying everything in my power to have a good birth like my last one, despite it being a hospital birth. 

You can't refuse antibiotics if you test positive at a hospital. Can you? It's SO RARE for the baby to get infected by GBS, from my understanding. I do not want them, I do not want IV's. Just a peaceful, independent labor experience. Anything I can do to not test positive again would be so wonderful...

Suggestions welcome, please!

Thanks in advance

[Celticqueen]

Ok, do any of you take probiotics in pregnancy to help prevent testing positive?

[MarineWife]

My MW suggested probiotics. I also take garlic, echnicacea, grapefruit seed extract and vitamin C every day for a week before the test. Insert a garlic clove into the vagina every night for 3 nights before the test. Refuse the anal swab.

As far as whether or not you can refuse antibiotics, I don't really know. Technically, you should be able to refuse anything. You'd have to really press your HCP and/or the hospital admins about that.

I'm having a homebirth and was given the option of testing or not so I chose not to even test. The hospital I would go to in an emergency has the new rapid tests so I can get that done at the time if it comes up.

[dot1]

You have the right to refuse anything you want.  By law, medical professionals are required to have "informed consent" prior to administering any sort of medical treatment.  Consent can take many forms....but at the end of the day, if you say, "I am not consenting to having IV antibiotics and I am fully aware of the risks of not doing so" then it would be unethical on their part to force anything....and even more unethical to deny further treatment as a result of you not consenting to one minor aspect of your "treatment".   If you tested positive and were still certain you would refuse the IV, then it's a good idea to learn about informed consent laws (re medical treatment) governing your state so you can know your legal rights and be prepared with the facts in case they try to bully you into a decision.  All physicians (and nurses and other medical professionals) are required to abide by the code of ethics governing their practice, which includes ensuring informed consent and enabling autonomy (patients making their own decision with their input).  If they don't, then they can risk losing their license to practice.  

When I researched GBS a few years ago, I recall numbers something like a 1 in 200 chance of baby becoming seriously ill or dying from GBS infection (if abx not administered).  Doesn't seem like a super high risk, but it sure would be devastating for someone to be in that half a percent.

My naturopath has said that every one of her patients who took probiotics (she recommends inserting in vagina, but I just took them orally) have tested negative for GBS.  I ate lots of garlic, cut back on sweets and upped the protein to keep my blood sugars stable, and popped lots of probiotics for a few weeks prior to testing.  Worked for me.   Good luck.

[AnnieA]

I asked my OB about refusing the test and/or refusing abx and his response was that I should talk to our pediatrician because that's whose patient would be affected, not his. Our ped was adamant about getting the testing and/or abx because he's had babies die from GBS infections. In the end I decided to do the testing but checked with my OB to make sure that it was a vaginal swab only, not vaginal and anal. I started taking a high dose of probiotics about a week before the test and inserted a garlic clove nightly for about 3-4 nights before the test as well. I tested negative. Of course this is my first pregnancy so I've never tested positive so maybe I didn't have it at all to begin with but I figured I would do as much as I could to prevent testing positive. Good luck!

[MarineWife]

The main problem with the GBS testing is that your status can change quickly. You could be negative at 36w but + at birth or vice versa. It's really a ridiculous test. I talked to my MWs in length about what would or could happen if I don't test. They said they'd treat me the same either way because I could also refuse abx if I tested +. They would watch me closely for any signs of infection or prolonged rupture of membranes and other risk factors and then evaluate baby accordingly. Something to think about. The UK doesn't do routine testing of GBS and they have a lower rate of babies being infected. Interesting, huh? Even if you are GBS+, there's really a low risk of your baby getting it and dying. The problem is that routine labor practices in the US, such as numerous cervical checks and AROM, increase the risks of infection.

My concern with refusing abx in a hospital if you do test + is that someone could report you to CPS for endangering your baby. Even if the allegations are unfounded, you would still have to go through an investigation and would then have a permanent record with CPS. I hate that things are like that and I really am not trying to scare anyone but it's the reality.

[Celticqueen]

"rupture of membranes " increasing risk. I must find out how much exactly that risk goes up. Both my labors started with the water breaking first at home, then contractions starting the next day. I am apparently at high probability of that happening again and again.

So just for that reason alone I am wondering if I should just test for it.

Also, good point about the flora changing after 36 weeks. So true! That can definitely happen. The body varies so much day to day

[meesh933]

Originally Posted by MarineWife 


My concern with refusing abx in a hospital if you do test + is that someone could report you to CPS for endangering your baby. Even if the allegations are unfounded, you would still have to go through an investigation and would then have a permanent record with CPS. I hate that things are like that and I really am not trying to scare anyone but it's the reality.

This is the only reason I consented to GBS testing last time. In the event that I transferred to the hospital without proof of being negative, I would be given abx or they'd likely call CPS. Even my midwife said that she hates practicing this way, but the only reason she'd recommend it is as a CYA measure. To "fix" a negative test, I took probiotics, garlic oil, ate tons of garlic/vitamin C, and did a Hibiclens rinse 2x/day for a few days to a week before the test. This time I won't even get the test, honestly.

[MarineWife]

Originally Posted by Celticqueen 

"rupture of membranes " increasing risk. I must find out how much exactly that risk goes up. Both my labors started with the water breaking first at home, then contractions starting the next day. I am apparently at high probability of that happening again and again.

I was going to say that it's not just the rupture of the membranes. It's the early, prolonged or artificial rupture, most likely along with numerous internal cervical checks, that increases the risk of infection. It might be hard to find "real" statistics on that since you'd most likely be looking at the risk involved in hospital births with lots of interventions. I'm always wary of any statistics or risks I read related to pregnancy, labor and birth because I think we've become so far removed from what's normal and natural that we don't know. The info only pertains to medically treated pgs and hospital labors and births.

Some women can walk around for weeks with ruptured membranes and be fine. Personally, in your case, I'd just more likely want to do what my MWs said and watch very closely for any signs of actual infection and refuse cervical checks. They really aren't necessary in labor and can actually disturb things. I refused all cervical checks except one right before pushing when I had my 2nd child in a hospital. With my last pg with a home birth MW, I never once had my cervix checked the entire pg or even labor. She didn't even check for full dilation before the pushing stage. Doctors in hospitals won't like that but you can refuse them.

This is the only reason I consented to GBS testing last time. In the event that I transferred to the hospital without proof of being negative, I would be given abx or they'd likely call CPS.

That was my main concern with not being tested. My MW said if I did end up in the hospital and was not tested, whether I got abx there or not, they'd want to keep my baby for 48 hours for observation. Luckily, she worked at this hospital until recently so she knows how things work and what they have and don't have. She knows they have the new rapid GBS test but they won't offer it so I would have to demand it. If I get that and I'm negative, I'm good to go. If I were to be + and still refused abx, they would insist on keeping the baby like I said. I don't really know what would happen if I refused that and took my baby home. My MW did say that the hospital I would go to has standing orders to respect her and any of her homebirthers who come there and that they would be less likely to call CPS. It's a military hospital so the rules are a little different than a civilian hospital.

[emmaegbert]

I tested positive with both previous pregnancies. During my second I was eating a no-sugar, low-carb, high-fat/protein diet and testing my blood sugar at least 4x per day due to gestational diabetes, so I know for darn sure that my blood sugar was stable (not sure why that would affect bacteria, but it certainly could help keep candida at bay) and I was taking big doses of probiotics and still tested positive. This time I kind of expect to, but my current MWs have some kind of antibiotic gel they recommend using and then retesting. They say all their patients come negative after that.

Originally Posted by dot1 

My naturopath has said that every one of her patients who took probiotics (she recommends inserting in vagina, but I just took them orally) have tested negative for GBS.  I ate lots of garlic, cut back on sweets and upped the protein to keep my blood sugars stable, and popped lots of probiotics for a few weeks prior to testing.  Worked for me.   Good luck.

IME it might not be worth refusing ABX if your hospital requires them (my first was born a hospital-based birth center, second at home and planning HB with this one. HBMWs have different protocols on this stuff). I didn't refuse the ABX but simply didn't get them in time b/c I had a short labor with my first. They did not administer IV ABX to my son but they kept us for 4 days in hospital to "monitor" him. Personally I would rather have the ABX than have my newborn hospitalized for days on end, or possibly have ABX administered to the baby or risk being accused of child endangerment. (A friend in another hospital had such a bad experience after missing the window of time for IV ABX-- her infant son had FOUR DAYS of IV ABX-- healthy full-term baby kept in NICU and mom sent home-- while they did bacterial cultures on baby who turned out to be... you guessed it... just fine).

This time I plan to do garlic suppositories and both oral and vaginal probiotics (didn't last time, b/c my MWs were fairly anti-ABX so I knew they wouldn't require them for me, they were ready to do hibiclense wash protocol if I had any additional risk factors like PROM, long labor, etc, which I did not... these ones are more mainstream in that regard... new city, new state, etc). I will also do the gel they require. I am allergic to penicillin which gave them some pause b/c it also changes what abx they can use in labor. My previous labors were quite short though, with my second MWs only got there 15 minutes before she was born... I have to also be prepared to not have time for IV...

I think for reasons PP mentioned, its a pretty bad test. But that is not to say that GBS can't be a serious thing for a newborn. But the test is just so unreliable b/c of reasons already mentioned. And any infection for a newborn can be quite serious, so whether you tested neg or positive for GBS you need to watch a newborn very carefully for signs of infection.

[MarineWife]

Originally Posted by emmaegbert 

I tested positive with both previous pregnancies. During my second I was eating a no-sugar, low-carb, high-fat/protein diet and testing my blood sugar at least 4x per day due to gestational diabetes, so I know for darn sure that my blood sugar was stable (not sure why that would affect bacteria, but it certainly could help keep candida at bay) and I was taking big doses of probiotics and still tested positive. This time I kind of expect to, but my current MWs have some kind of antibiotic gel they recommend using and then retesting. They say all their patients come negative after that.

Do you know if you had vaginal and anal swabs taken or just vaginal? I had always tested + in the past until I found out they take an anal swab sample for testing in addition to a vaginal sample. The last time I was tested, with ds3 in 2007, I refused the anal swab and was negative.

[emmaegbert]

interesting. I swabbed myself per the verbal instructions both times before and yeah, they told me to do both. I will talk to MWs about just doing the vaginal this time.
 

Originally Posted by MarineWife 



Do you know if you had vaginal and anal swabs taken or just vaginal? I had always tested + in the past until I found out they take an anal swab sample for testing in addition to a vaginal sample. The last time I was tested, with ds3 in 2007, I refused the anal swab and was negative.

[MarineWife]

I wouldn't even talk to them about it. Depending on the situation, I'd just tell them I'll do the vaginal but not the anal. If they are hospital based MWs who have to follow certain protocol, I probably wouldn't say anything at all. Just do the vaginal and be done with it. My MW told she's had clients who didn't swab anything, just took the swab out of the package (broke the seal, I guess) and put it back. They still got + results. Now how can that be?

[Celticqueen]

Ok, I had a thought today...The appendix. Only in recent years did scientists discover its purpose: to help regulate gut flora. Basically, a filter that holds a lot of the "bad bacteria". Apparently, people (like me) who have had their appendix taken out need to eat twice as many probiotics as other people to help maintain good flora because the filter is gone.

I wonder if people who have it taken out are more at risk for testing positive for GBS in pregnancy? This is something I'll ask my midwife in a couple weeks...

[emmaegbert]

Quote:

Originally Posted by MarineWife 

 watch very closely for any signs of actual infection and refuse cervical checks. They really aren't necessary in labor and can actually disturb things. I refused all cervical checks except one right before pushing when I had my 2nd child in a hospital. With my last pg with a home birth MW, I never once had my cervix checked the entire pg or even labor. She didn't even check for full dilation before the pushing stage. Doctors in hospitals won't like that but you can refuse them.
 

This is what I did with my second (which was a planned HB and my HBMWs never did one internal check) but when I was seeing the hospital CNMs for co-care (one was totally cool about it and the other really would sort of pressure me to let her check my cervix, she also wanted to "sweep my membranes" and I was like, NO WAY, I already tested positive for GBS so I want to avoid anything that might introduce bacteria past the cervix!). With my first, I had only 2 cervical checks- one to be admitted to the hospital birth center, and one after I yelled out that the baby was coming out, and they ran in and wanted to see if I was "ready" (haha. I could not have stopped at that point, second stage labor has been totally involuntary for me both times, all I do is try to relax through it b/c it goes so freaking fast).

Interesting thought about the appendix. Though I have one, and have been GBS+ both times, have also at various times had problems with recurring yeast infections... so I dunno. Maybe it would be worse without it? Anyway like I said, I will be pounding the probiotics and probably doing the garlic suppositories once I get to about 32 weeks (which is when I return home, I am out in the boonies these days, with no probiotics for sale anywhere). For now, I eat very low-sugar low-carb and include cultured foods in my daily diet...