GBS - What would you do?

[boysmom2]

I am planning a hospital birth in a few weeks.  I LOVE my mws and they are cool with whatever I want to do.  This is my 4th birth, and my 2nd with these mws.  But, here's my dilemma: with my other pregnancies I have always tested positive for GBS.   With my last birth, my labor was too quick, so even though I had the IV, it was less than 4 hours before birth, so my poor baby had to have the blood work up done.   

 

Even though I have tested GBS+, I have never had any other risk factors that would cause concern for the baby.  My water has never broken until I'm pushing, my labors just keep getting shorter, baby and I have never had fevers, my mws don't do cervical checks in labor unless I want them to, etc.

 

I would really like to avoid all the GBS nonsense all together this time.  But here are my options.

I can do the testing and hope for a negative result.  Then they'd leave me and baby alone.  

Or, get a positive result and have to likely do both the IV AND blood cultures on the baby, since I don't expect to be at the hospital for very long. 

Or, I can decline the test, thus avoiding the IV, but then still subjecting my newborn to blood cultures.

 

I just can't decide which is my best option.  I'd love to just test negative, but I'm worried that's not going to happen.  I'd be willing to try garlic and hibiclens before the test (which I haven't done previously), but if it doesn't work then I'm stuck.  I'd love to have a way to find out my test results and then decide if I should share it with the hospital.  But that's not an option.  :)  

 

So, thoughts? 

[Mama2ChicknLil]

I would refuse the test altogether and try to refuse the workup, or at least express your desire for it to be postponed and just keep refusing to hand over baby. I tested GBS positive and then had simply refused IV abx and refused to hand over my baby until/unless I was able to be with him (3 hours), and then nursed him nonstop afterwards.

Next time? Assuming I ever do forget the joy of birth and agree to do it again...

I will refuse the test and hire a hb mw. Good luck mama. FWIW I couldn't get the Hibiclense before the test, adn didn't realize at the time that they sell the stuff at Target

Happy New Year!

[Just1More]

Well, with one of mine, I was able to do the test myself in the bathroom.  I rustled my skirt, and then put the swab from the package to the test tube and gave it back.  Obviously, I tested negative...

I don't hold very much with this sort of testing.  I would far rather watch my baby, than poke and prod and assume I can predict the future from a test I took 4 weeks prior (or more!) to birth. Especially of something that can change on a daily basis.

And, in the absence of risk factors, I would refuse all blood testing, etc. 

[boysmom2]

That's what I'd like to do too, but unfortunately that part falls more under hospital policy, so it's not something my mw could help me out with. After the birth, on the way to the pp room, we stop at the nursery.  What they usually do, is send mom to her room while they bathe the baby and then leave him/her under a warmer for a couple of hours.  Once the baby is warmed up, they return him/her to mom's room.  Rooming in is an option, but you can leave your baby in the nursery too.  I'm refusing the nursery bath (i'll do it myself in my room - or not) and refusing to leave the baby in the nursery at all.  But, we'll all have to stop there on our way to the pp room and that's when they do the blood draw.   Also, I'm birthing at a hospital an hour away, so the baby will be seen by a ped there, and not our usual one.  So, it's not like I'l have a ped in my corner either.  And, our home ped is pretty mainstream, though she tolerates my delayed/selective vax schedule, so I don't think she'd agree to write me a note or anything even if she could.  

And, my mw does the test.  I would so love the option of "testing" myself!  :)

[WaitingForKiddos]

I don't know why you can't just refuse the culturing on baby. If you want to know about your own status you can always ask your midwives for a swab for a vaginal culture, do it yourself, and then get the results. A vaginal culture here in So. Cal is about $20. 

...I read that it's hospital policy. Why not just refuse?

[Mama2ChicknLil]

Ugh, my hospital was Baby Friendly...I forget sometimes that not all hospitals are, or are ven trying to be. Sorry. Hard decisions. You absolutly can refuse IV abx though, that is well within your rights. Hospital policy is just about liability, an if you staunchly refuse certain things and agree to sign waivers you can absolutly get away with anything. I allowed the blood cultures only because my DH was worried, but refused EVERYTHUNG else, an like I said,I made them wait until I would be with baby.

Good luck, I might do the test (make sure do follow hibiclense procedure before the test, I think it's a full cleanse within 6 hours of the test?

Good luck mama

FWIW, I had a Designated Bitch for the labor, as I knew I wouldn't be able to be quite as pushy as needed during labor. My sister fended off administrators, obnoxious nurses, and made sure nothing happened that I didn't want...she was amazing. Do you have anyone like that who could be with you?

[hildare]

from what i remember the test for gbs isn't a heel stick, it's a spinal tap? 

if that's the case, i would do the test and the iv if that's the hospital policy.

fortunately it wasn't for me with dd and with this one, i refused the gbs test with dd, but ended up having the abx anyway due to waters rupturing.

but no matter what, i would take abx (no matter how unnecessary) over a spinal test for the bebe.  if it's a heel stick, then i would have a different opinion.

[boysmom2]

With my last baby, he got a blood draw to test for GBS.  It wasn't a heel stick - they took a lot of blood, but no spinal tap.  If I knew for sure I could avoid any testing of him, I'd do the IV, but last time, I got the IV, and they still did the blood draw because he was born less than 4 hours after the IV was started.  Then he ended up with a dairy sensitivity for the first 8-9 months of his life.  I wonder if that could have been partly due to the unnecessary antibiotics exposure.

And, waitingforkiddos, I can do the vaginal culture if I want.  I'm just not sure I want to risk it.  If I test negative, we're both in the clear.  But if I test positive, then I definitely get the IV, plus the baby will probably still need the blood draw since my labors just keep getting shorter.  There's a good chance that the IV won't been in for 4+ hours, and so won't "count."  Then the baby gets a blood draw AND unnecessary antibiotics exposure.  If I don't do the test, only the blood draw happens.  

I have another mw appt on Monday, so I'll probably ask some more about all of this, but so far it doesn't sound like I really have a too many options.  :(

[mum2sarah]

Wish I could have refused the test but it was required to birth at the birth center.  MWs told me that in the past, counts below 10,000 didn't even qualify as GBS positive, but CDC changed the rules and any amount is now considered positive.  I had counts around 1,000 which wouldn't have been anywhere near enough to count as positive in the past but now they are... I got the IV antibiotics, and despite taking acidophilus as a preventative measure we came down with thrush and, nearly 4 months later after numerous treatments, we still haven't kicked it entirely...Lesson learned: do everything you can to avoid those IV antibiotics

[cristeen]

Will the hospital settle for Hibiclens while in labor?  I believe that's been shown to be more effective than IV antibiotics anyway.  You might have to fight for it, but if you can get that, I'd go ahead and consent to the test with the understanding that if it's positive you're still not going to be doing the antibiotics, but the Hibiclens instead. 

[WaitingForKiddos]

Now, I'm coming from a place of having declined everything at the hospital and also forcing them to be baby friendly through my cesarean ...but I still don't get why if you don't want to do one of those things you can't just say 'no thanks' and sign the release waver. 

The GBS swab...no one but you will have the results. Labs accept personal drop offs, you just need the swab. They'll call/fax you, and only you, about the results. 

Originally Posted by boysmom2 

With my last baby, he got a blood draw to test for GBS.  It wasn't a heel stick - they took a lot of blood, but no spinal tap.  If I knew for sure I could avoid any testing of him, I'd do the IV, but last time, I got the IV, and they still did the blood draw because he was born less than 4 hours after the IV was started.  Then he ended up with a dairy sensitivity for the first 8-9 months of his life.  I wonder if that could have been partly due to the unnecessary antibiotics exposure.

And, waitingforkiddos, I can do the vaginal culture if I want.  I'm just not sure I want to risk it.  If I test negative, we're both in the clear.  But if I test positive, then I definitely get the IV, plus the baby will probably still need the blood draw since my labors just keep getting shorter.  There's a good chance that the IV won't been in for 4+ hours, and so won't "count."  Then the baby gets a blood draw AND unnecessary antibiotics exposure.  If I don't do the test, only the blood draw happens.  

I have another mw appt on Monday, so I'll probably ask some more about all of this, but so far it doesn't sound like I really have a too many options.  :(

[boysmom2]

Originally Posted by mum2sarah 

Wish I could have refused the test but it was required to birth at the birth center.  MWs told me that in the past, counts below 10,000 didn't even qualify as GBS positive, but CDC changed the rules and any amount is now considered positive.  I had counts around 1,000 which wouldn't have been anywhere near enough to count as positive in the past but now they are... I got the IV antibiotics, and despite taking acidophilus as a preventative measure we came down with thrush and, nearly 4 months later after numerous treatments, we still haven't kicked it entirely...Lesson learned: do everything you can to avoid those IV antibiotics

This is what frustrates me so much.  IV antibiotics are not without risk, but so many mothers and babies are exposed for no reason. Makes me so angry.

Originally Posted by cristeen 

Will the hospital settle for Hibiclens while in labor?  I believe that's been shown to be more effective than IV antibiotics anyway.  You might have to fight for it, but if you can get that, I'd go ahead and consent to the test with the understanding that if it's positive you're still not going to be doing the antibiotics, but the Hibiclens instead. 

I don't know if they will, but I doubt it (though I will ask).  It's so stupid, since, from what I've read, it's more effective anyway.  Also, I'm not sure what I'm up against as far as being able to deny things since the hospital is in IL, which is a pretty bad birthing climate.  

Originally Posted by WaitingForKiddos 

Now, I'm coming from a place of having declined everything at the hospital and also forcing them to be baby friendly through my cesarean ...but I still don't get why if you don't want to do one of those things you can't just say 'no thanks' and sign the release waver. 

The GBS swab...no one but you will have the results. Labs accept personal drop offs, you just need the swab. They'll call/fax you, and only you, about the results. 

I guess I hadn't thought about having the GBS testing done somewhere else.  If I do it through my mw, then they automatically get the results.  If I test positive with them, then I'm officially positive.  I'll have to look into other testing options.
 

[liberal_chick]

Is there just some reason you can't give a blanket NO to everything?  No, I will not be getting the GBS test.  No, you do not have my consent to blood test my baby.

[boysmom2]

Originally Posted by liberal_chick 

Is there just some reason you can't give a blanket NO to everything?  No, I will not be getting the GBS test.  No, you do not have my consent to blood test my baby.

That's what I'll be asking at my appt on Monday.  I'm worried since I will not have a ped in my corner on this.  I'm already declining everything else they want to do (hep vax, eye goop, bath, etc.), so I'm already the crazy lady.  I'm ok with standing up for myself, I just don't want big trouble, yk?

[olive&pimiento]

I know this will seem extremely managed to some, but just wanted to put out another option.  When I was a student, this is a protocol my preceptors offered to women in your position: Take the test and if it comes back positive, induce with rupture of membranes after two doses of antibiotics.  They would do this at home, so that a woman still had the option of home birth and baby was surely covered by the 2 doses of antibiotics. 

[Katie8681]

What do you think about offering to stay longer after the birth, as in, the full 2-ish days insurance covers, so they can take the baby's vitals and watch closely for signs of sepsis? 

[boysmom2]

Originally Posted by Katie8681 

What do you think about offering to stay longer after the birth, as in, the full 2-ish days insurance covers, so they can take the baby's vitals and watch closely for signs of sepsis? 

I would be fine with that. I'll have to ask about that too.  Plus, my home ped wants to see us as soon as were home, so I can offer that too, I guess.  Just so annoyed to have to be thinking about any of this, yk?

[Katie8681]

Untreated neonatal infection can kill or end in days in the NICU. I know you've seen your 3 babies be healthy with no infection after you had incomplete courses of the antibiotic, but peds and nurses may have seen hundreds, if not thousands, of babies, and some of them have died that way. I know you're annoyed but that's where they're coming from.

[boysmom2]

Originally Posted by Katie8681 

Untreated neonatal infection can kill or end in days in the NICU. I know you've seen your 3 babies be healthy with no infection after you had incomplete courses of the antibiotic, but peds and nurses may have seen hundreds, if not thousands, of babies, and some of them have died that way. I know you're annoyed but that's where they're coming from.

I understand that GBS CAN be a problem, and I'm not against treating an actual infection when it's called for.  But, I really feel it's not in anyone's best interest to be prophylactically treating so many women with IV antibiotics when antibiotics are not without risk themselves and we have such an issue with antibiotic resistance.  I think it would be much more reasonable to test for the presence of GBS, but then wait for the appearance of additional risk factors/symptoms before deciding on a course of treatment.  If mom is positive, but labor is short, the membranes remain intact until close to birth, there is no fever, baby is full-term, and the birth attendants can manage to avoid cervical checks, and then baby is observed for a period of time for symptoms, I see no reason to treat as though there is an infection.  Of course if those things change, then I'd be all for treating.  The problem is that if I test positive, baby and I will be subjected to all of this no matter what else happens.  Plus, the US treatment protocol has not improved overall outcomes anyway.  

Also, GBS can come and go, so a test at 36wks doesn't guarantee anything about the mom's status at the time of birth.  Another reason that treating based solely on the result of a swab seems like a bad idea.

Edited by boysmom2 - 1/6/12 at 6:05pm

[puddle]

I tested positive for GBS, despite doing a hibiclens protocol and taking probiotics before the test.  My doctor basically said refusing the antibiotics was not an option.  I looked into trying to fight the protocols as well as trying to bring home the baby AMA.  While you are within your legal right to do these things, hospitals can and sometimes do involve CPS.  I decided that I wasn't going to fight any of it because I didn't want my birth environment to be any more hostile than it had to be.  It ended up that I had a super fast labor, and even though the hospital was 5 minutes away and we left as soon as my water broke (which is when I hit active labor), I was pushing by the time they tried to get the IV placed.  So, while things overall didn't go great, at least I didn't have antibiotics.  Due to the Vitamin K shot we had to get because of some (unnecessary) birth trauma, the blood draw was a little traumatic because my son's blood was clotting so fast it was difficult to get the amount of blood they needed.  I think though, that it worked out for the best in that respect.  I would prefer the blood draw to the possible effects of antibiotics.  So I guess my only advice, which may not be possible with how far your hospital is, would be to get there too late for the antibiotics if you can't refuse them.  Also, as far as having a "designated bitch," if a doctor thinks someone is impeding medical care, they can have them removed from the room.