GBS - What would you do? - Page 2

[boysmom2]

Originally Posted by 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. 

It's odd, but it seems if I refuse the GBS test I can refuse the antibiotics, but if I test positive I can't.  That's why I'm leaning towards just not testing, since at least that would help us avoid the antibiotics.  But I just feel awful about subjecting my tiny newborn to a huge blood draw if it's not truly needed.  Like I've said, if there were actual reasons to suspect the baby was in danger I'd be all for testing/treating.  But it just doesn't seem justified to do all this automatically.  

[MamatobabyA]

Are you getting the PKU test at 24 hours?  I have many mom's who refuse the CBC at 4 hours of age will are ok with them sending one when they prick the heel for PKU (since they are pricking anyway).  Our peds group doesn't love this option, but at least you will get some numbers for them and a little peace of mind for yourself.

Breast feed your little one while the prick.  Sucking is a natural pain reliever and I have stuck many baby heels on the breast who barely flinched.

[lovebeingamomma]

I did garlic (whole clove, pointy ends cut off) vaginally overnight for 6 nights before the test (should have done it for 8 just didn't start early enough), and it worked, I got a negative after testing positive my last two pregnancies.  I proceeded to do garlic vaginally as much as I could up until birth to be on the safe side.  Just my story- what a relief it was to a get a negative! 

and to add- I couldn't sleep the first night I did the garlic, you will instantly taste garlic in your mouth and it's gross.  But you get used to it!  And it's worth it.  My midwife noted I did NOT smell like garlic at my apt's, which was a relief lol!

[boysmom2]

Originally Posted by MamatobabyA 

Are you getting the PKU test at 24 hours?  I have many mom's who refuse the CBC at 4 hours of age will are ok with them sending one when they prick the heel for PKU (since they are pricking anyway).  Our peds group doesn't love this option, but at least you will get some numbers for them and a little peace of mind for yourself.

Breast feed your little one while the prick.  Sucking is a natural pain reliever and I have stuck many baby heels on the breast who barely flinched.

I'll have to ask about that too.  I just remember with my last baby that it was a BIG blood draw (not a heal stick) and it took a long time to do it.  And they wouldn't let me hold him while they did it.  :(

[boysmom2]

Originally Posted by lovebeingamomma 

I did garlic (whole clove, pointy ends cut off) vaginally overnight for 6 nights before the test (should have done it for 8 just didn't start early enough), and it worked, I got a negative after testing positive my last two pregnancies.  I proceeded to do garlic vaginally as much as I could up until birth to be on the safe side.  Just my story- what a relief it was to a get a negative! 

and to add- I couldn't sleep the first night I did the garlic, you will instantly taste garlic in your mouth and it's gross.  But you get used to it!  And it's worth it.  My midwife noted I did NOT smell like garlic at my apt's, which was a relief lol!

I've used garlic for yeast before, so I'd totally be willing to do it.  I'm glad to hear that it work for you. I just wish I could know for sure that it would do it - I'm worried that it wouldn't work and then I would be stuck with a positive result on file.  
 

[mamagrove]

Jumping in late here, but the title caught my eye...

I tested positive for GBS with DD, had the antibiotics, & fully believe it contributed (or maybe completely caused) her many GI issues after birth that persisted until she was almost 3. The first year was extremely difficult, but we continued to have some issues even until she was around 3. She had severe reflux, ended up on an antacid medication (which I now know also probably made things worse, but I was a newbie then...), multiple food intolerances, & had to use a very expensive hydrolyzed formula until she was over a year old (I was unable to breastfeed after 10.5 weeks, which devastated me).

With DS I was really hoping to avoid all that, so I did the garlic for a couple of nights in a row, I think about a week before the test, & that time I tested negative - YAY! So I did not have antibiotics, & DS did not have the GI issues DD have (although at 10mos he was diagnosed with peanut/tree nut/coconut allergies...). Coincidence? I think not.  Let me also mention that with DD I did take prenatal vitamins & DHA, but I had no knowledge of Vitamin D deficiency at that time. I was probably severely deficient, & I'm sure that didn't help me avoid being colonized with GBS. I don't know if that's related or not, but by the time DS was conceived, I had read about Vit D & been supplementing for several months. My levels were finally up to where they should be, so perhaps that also helped my general immunity.

Anyway, also about the hospital --- I'm a hospital L&D nurse myself, & you absolutely can refuse antibiotics. That is regardless of which state or which hospital you deliver in. You always have the right to refuse any medical intervention, no matter what they try to say to convince you. Sign whatever refusal you need to, but you do NOT have to have antibiotics against your wishes.
 

If you test positive & refuse antibiotics, of course they will want to do the blood tests on baby. You absolutely can also refuse those, although personally I would rather consent to that plus observation for any signs of infection (fever, or inability to maintain temperature, etc) than have all that comes with the antibiotics, like you said. The blood test is not just for blood cultures, but also a blood count, looking for an elevated white blood cell count specifically, which would indicate infection, regardless if that came from GBS or some other source. The blood culture would say if it was GBS or not, but those take a day or three to come back.

Anyway, that's just my two cents, sorry for jumping in halfway through. Good luck with everything! =)

[MamatobabyA]

I'll have to ask about that too.  I just remember with my last baby that it was a BIG blood draw (not a heal stick) and it took a long time to do it.  And they wouldn't let me hold him while they did it.  :(

Uncool.  No wonder you are having so much trouble with this :(  There is no reason for them to collect a CBC any other way than heel stick.  Perhaps they were drawing blood cultures?  I think I would start there.  Would they settle for "just" a CBC?  If so, would they be willing to collect from a heel stick using neonate collection tubes?  Then, if there is reason to suspect GBS, they can proceed with blood cultures?

I'm a postpartum nurse at the largest local hospital.  For babies with a GBS positive or unknown mom our protocol is a temp every 8 hours and a CBC (via heel stick) at 4 and 24 hours of age.  A babe without any symptoms and a normal white count has no other testing done unless there are breathing difficulties.  If the white count is elevated then we may draw some cultures or check a chest x-ray in extreme cases. 

[cat13]

I think that because you've tested positive in the past, I would test again if it were me. That way, you have the information available to you to make the best decision at the time. If you decide not to use abx, then decline. It is your right to do so.

In my situation, I tested positive and then began a protocol by my MW to reduce/get rid of the GBS. Unfortunately I went into labor before I could complete it, but I had originally decided to decline abx anyway. But I ended up having a pretty long labor after my water broke, so I changed my mind and decided to go for abx.  But I am grateful that I had care providers who supported all this, and I understand that if you don't, then you'll need to make other decisions.

If you do decide to get abx, please be sure to have some probiotics ready ASAP. In the craziness of the birth, I totally forgot about the abx and ended up with thrush a couple days later... not a great way to begin a breastfeeding relationship.

[calapitters]

OP, I think we must be twins of some sort; this is exactly my story and my big dilemma with this pregnancy.  My mw's and birthing center (hospital based) aren't quite as rigid as your hospital seems to be, so I feel that I can refuse without and harassment, but I'm very worried about a possible infection in my tiny baby.  This worry has always persuaded me to choose IV antibiotics, but getting to the birthing center last time in time for them caused everyone so much stress and needless transitions and I wound up there twice before I was really in labor just because I was so paranoid that I wouldn't get the whole 4 hour dose, never mind that they recommend 2 doses. Sure enough, I didn't, so I'm very curious about other options this time, though still terrified of infection.  

[KTinSeattle]

Maybe I can help -- I'm a hospital pediatrician, and although I don't agree with your plan to avoid prophylactic antibiotics, I can assure you that the hospital providers have no reason to do lab tests on the baby for "inadequate prophylaxis" (that's what we call it when you are GBS unknown, or you get antibiotics less than 4 hrs before delivery) as long as there are no signs of active infection, the baby is term, and your membranes were ruptured (water broken) for less than 18 hours.  Unfortunately some providers still follow outdated guidelines that required CBC (complete blood count) and blood culture for inadequate prophylaxis, but the 2010 CDC guidelines (http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf, see page 22 for specifics to your situation) do not recommend blood tests.  HOWEVER, if your baby is showing any signs of sepsis (infection) such as high or low temps, breathing fast or hard, low blood sugar, etc, OR you have signs of chorioamnionitis (infection of your uterus/amniotic fluid) then they will absolutely do blood tests and likely start IV antibiotics on the baby.  And no, you can't "decline" those -- you have rights as a parent, but if you refuse medically necessary treatment, the care providers have a responsibility for the baby's health.  

[Katie8681]

KT, that link didn't work for me. http://www.cdc.gov/groupbstrep/guidelines/guidelines.html  should take you there.

[boysmom2]

Originally Posted by KTinSeattle 

Maybe I can help -- I'm a hospital pediatrician, and although I don't agree with your plan to avoid prophylactic antibiotics, I can assure you that the hospital providers have no reason to do lab tests on the baby for "inadequate prophylaxis" (that's what we call it when you are GBS unknown, or you get antibiotics less than 4 hrs before delivery) as long as there are no signs of active infection, the baby is term, and your membranes were ruptured (water broken) for less than 18 hours.  Unfortunately some providers still follow outdated guidelines that required CBC (complete blood count) and blood culture for inadequate prophylaxis, but the 2010 CDC guidelines (http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf, see page 22 for specifics to your situation) do not recommend blood tests.  HOWEVER, if your baby is showing any signs of sepsis (infection) such as high or low temps, breathing fast or hard, low blood sugar, etc, OR you have signs of chorioamnionitis (infection of your uterus/amniotic fluid) then they will absolutely do blood tests and likely start IV antibiotics on the baby.  And no, you can't "decline" those -- you have rights as a parent, but if you refuse medically necessary treatment, the care providers have a responsibility for the baby's health.  

Thank you SO much!  I really appreciate you providing this, despite disagreeing with me.  THAT's what more doctors should be like.  Give me your opinion, present current medical recommendations, but respect my ability to use my brain to make my own decisions.  Thank you.

And, if there was ANY reason to expect that there was an actual infection, I would not hesitate at all to have the baby or myself treated.  I just really feel like there's a good chance that the baby and I would be exposed unnecessarily if we do the prophylaxis.  I'd rather save the antibiotics for when there is an actual problem, not just the small possibility of one.  
 

Originally Posted by Katie8681 

KT, that link didn't work for me. http://www.cdc.gov/groupbstrep/guidelines/guidelines.html  should take you there.

Thanks!  I'll be printing this out to bring with me.
 

[KTinSeattle]

No problem.  I am totally on board with avoiding unnecessary intervention.  Where we might quibble is on the definition of "necessary."  (I mean no disrespect; that comment just comes from painful conversations with parents who refuse various tests and treatments believing that they know better -- they may know their child better than I, but I know neonatal sepsis and meningitis better.  If you had ever seen GBS sepsis or known an infant who was affected, you might weigh differently the risks and benefits of a dose or two of antibiotics.)

My link included my sentence punctuation, a comma, which is why it didn't work.  Delete that and it should be ok: http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf

[boysmom2]

Originally Posted by KTinSeattle 

No problem.  I am totally on board with avoiding unnecessary intervention.  Where we might quibble is on the definition of "necessary."  (I mean no disrespect; that comment just comes from painful conversations with parents who refuse various tests and treatments believing that they know better -- they may know their child better than I, but I know neonatal sepsis and meningitis better.  If you had ever seen GBS sepsis or known an infant who was affected, you might weigh differently the risks and benefits of a dose or two of antibiotics.)

My link included my sentence punctuation, a comma, which is why it didn't work.  Delete that and it should be ok: http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf

I understand that GBS can be very serious, and I appreciate your concern.  Where I really feel like this is unnecessary, or pointless, is that I don't expect it's very likely that we'd get the abx 4+hrs before birth anyway.  So then we've been exposed, but it won't "count" anyway.  In that case, and especially in the absence of other risk factors (I have short labors, ROM within minutes of birth, no vag exams ever, etc.), I would rather just have the baby and I observed and treat accordingly.  Again, I really appreciate the link.  I've printed several copies and plan to discuss it with my mw, ped, etc.  Thanks!!

[xnwife]

I will share my story:

To be perfectly honest I am pretty cautious regarding this issue and have no problems with the IV and antibiotics. In fact, I quite love the IV and the boost of energy that the extra fluids gave me. However, I have a history of precipitous labors and I have never had a full dose of antibiotics for either one of my labors. Because of this, after I had DS2 the hospital did in fact test him for sepsis even though my labor was very quick and the membranes did not rupture until 5 min before I pushed him out.

They took blood from his foot and because of the coagulation issues mentioned by others they had to do it a few times. The results showed + that a cluster was growing. A cluster is more typical of a contaminate. Baby looked good, was nursing great, perfectly healthy. However because of the lab results they admitted him to the NICU and pumped him full of antibiotics. In the end, the test had been contaminated. He did not have sepsis. He was treated unneccesarily and we were sent a big fat bill. He also had thrush as a result and they overlooked a severe tongue tie during his stay which we had to return to the hospital for surgery and by then our nursing relationship suffered. It was awful. I understand that the hospital was following protocol and being very conservative but it was not a good experience I feel that they did not take everything into consideration when making their verdict to admit him.

 We have decided to have a homebirth this time, so I won't even be tested but I will assume that I will be GBS+.  I also plan to begin treatment for GBS now, regardless of our birth plans because even if I wanted to pursue a hospital birth, the likelihood of getting even a full round of antibiotics is pretty slim so it is a moot point for someone with precipitous labor to rely on antibiotics.

I have also been reading that if a baby truly has sepsis that the antibiotics given during birth may interfere with treatment as the baby may have built up an immunity making their systems resistant to the antibiotics--and that really scares me.

[Katie8681]

Originally Posted by xnwife 

I have also been reading that if a baby truly has sepsis that the antibiotics given during birth may interfere with treatment as the baby may have built up an immunity making their systems resistant to the antibiotics--and that really scares me.

This is a misunderstanding of "resistance". When people talk about antibiotics and resistance, it means, briefly, this: When bacteria are exposed to an antibiotic, particularly for a short period of time, the bacteria that are very vulnerable to that antibiotic are killed, but some, due to their genetics, are not as vulnerable. Those bacteria stay alive and become dominant because they no longer have competition from those vulnerable bacteria. They are "resistant" to the antibiotic and now they can cause an infection that can't be treated with that drug. They can also go on and share the part of their genetics that make them resistant to the antibiotic with other bacteria. But the person himself isn't resistant. Just a little FYI. 

[mesa]

Originally Posted by KTinSeattle 

Maybe I can help -- I'm a hospital pediatrician, and although I don't agree with your plan to avoid prophylactic antibiotics, I can assure you that the hospital providers have no reason to do lab tests on the baby for "inadequate prophylaxis" (that's what we call it when you are GBS unknown, or you get antibiotics less than 4 hrs before delivery) as long as there are no signs of active infection, the baby is term, and your membranes were ruptured (water broken) for less than 18 hours.  Unfortunately some providers still follow outdated guidelines that required CBC (complete blood count) and blood culture for inadequate prophylaxis, but the 2010 CDC guidelines (http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf, see page 22 for specifics to your situation) do not recommend blood tests.  HOWEVER, if your baby is showing any signs of sepsis (infection) such as high or low temps, breathing fast or hard, low blood sugar, etc, OR you have signs of chorioamnionitis (infection of your uterus/amniotic fluid) then they will absolutely do blood tests and likely start IV antibiotics on the baby.  And no, you can't "decline" those -- you have rights as a parent, but if you refuse medically necessary treatment, the care providers have a responsibility for the baby's health.  

see, reading this makes me MAD. Not at you, KT, but at the hospital peds who basically scared my husband to death and forced him to consent to the culture when my son Aiden was born Oct 2010. I was 42+4, he was healthy, and my water was broken for less than two hours. My entire LABOR was less than two hours. I had planned a home birth but when I went so postdates I had to transfer to the Army hospital in Seoul Korea for AROM. They told me that because my GBS status was unknown (and I obviously had not labored close to long enough for abx) they needed to do a culture. I refused, so the Captain pediatrician pulled my husband into the hallway and scared him with dead babies and issues at work (my husband is a soldier), and also told him he had NO choice in the matter. Non negotiable, is the language I believe he used. They put a tourniquet on Aiden's arm, and drew an amazing amount of blood...then forced us to stay in the hospital for THREE DAYS until the results came back. We could not check out AMA due to issues with my husband's chain of command, I wasn't about to do anything that could possibly get him in trouble, so there I sat, with my 9 pound, 5 ounce baby, perfectly healthy after a 2 hour unmedicated labor and birth, for three miserable days. Even the attending OB was baffled by their treatment of us...but the peds wouldn't budge. One told me we could go after 48 hours, then the other came in and retracted that, saying we had to wait the full 3 days for culture results. Not a very good ending to what had been a perfect birth.

[Just1More]

Other than the prophylactic antibiotics, I agree and believe this advice to be evidence based.

The part that makes me angry, as well (again, not at you, KT), is that women just don't have the choice about it.  It's like vaxing.  I'd be okay giving my kids a few here and there...but if I do that, then I loose my right to a religious exemption.  So, really, instead of free (as in polictically) healthcare, I have to weasel my way through to follow my conscience.  THAT is infuriating.   If the OP tests, she looses the right to make her own decisions.  If she doesn't test, she may far a bit better.  The problem, as I see it, is not the tests or the vaxes, but the lack of freedom.
 

Originally Posted by KTinSeattle 

Maybe I can help -- I'm a hospital pediatrician, and although I don't agree with your plan to avoid prophylactic antibiotics, I can assure you that the hospital providers have no reason to do lab tests on the baby for "inadequate prophylaxis" (that's what we call it when you are GBS unknown, or you get antibiotics less than 4 hrs before delivery) as long as there are no signs of active infection, the baby is term, and your membranes were ruptured (water broken) for less than 18 hours.  Unfortunately some providers still follow outdated guidelines that required CBC (complete blood count) and blood culture for inadequate prophylaxis, but the 2010 CDC guidelines (http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf, see page 22 for specifics to your situation) do not recommend blood tests.  HOWEVER, if your baby is showing any signs of sepsis (infection) such as high or low temps, breathing fast or hard, low blood sugar, etc, OR you have signs of chorioamnionitis (infection of your uterus/amniotic fluid) then they will absolutely do blood tests and likely start IV antibiotics on the baby.  And no, you can't "decline" those -- you have rights as a parent, but if you refuse medically necessary treatment, the care providers have a responsibility for the baby's health.  

[KTinSeattle]

Mesa, that sounds like a really frustrating experience.  For what it's worth, the peds were following the correct guidelines at the time.  The ones I wrote about were written in late 2010, probably not publicized well until mid-2011, and as the thread-starter has indicated, are still not followed by everyone.  Standard of care is a moving target, as you know.  But that's a whole 'nother topic.  We do the best we can with the info that we have in the healthcare system that exists.  Alternately, as some of you choose, you avoid the system altogether, and accept the repercussions.  I work in the system with the firm belief that the system, as frustrating and constraining as it can be, is in place to provide the best and safest care that we know how.  

[LionessMom]

Originally Posted by KTinSeattle 

Mesa, that sounds like a really frustrating experience.  For what it's worth, the peds were following the correct guidelines at the time.  The ones I wrote about were written in late 2010, probably not publicized well until mid-2011, and as the thread-starter has indicated, are still not followed by everyone.  Standard of care is a moving target, as you know.  But that's a whole 'nother topic.  We do the best we can with the info that we have in the healthcare system that exists.  Alternately, as some of you choose, you avoid the system altogether, and accept the repercussions.  I work in the system with the firm belief that the system, as frustrating and constraining as it can be, is in place to provide the best and safest care that we know how.  

this is what bothers me. the system thinks it knows everything but yet they dont have all the most recent guidelines. so they force parents to submit to their care. either by coercion or by flat out not telling them all the repercussions of the treatment. they are being told its ok, we know what we are doing, there are no bad side effects, this is best etc. most parents havent done their own research to make their own decisions and just go along with what the hosp or doc wants. then if something goes wrong, it is just something that happens. when it was actually one of the bad things that could happen from the treatment. then you get parents who have done their research and know what they are talking about and refuse treatment, knowing what the side effects are and what could go wrong. those parents have to worry that their baby or child will be taken by child services for refusing treatment. even thought their research has shown that the treatment is ineffective or has more neg side effects than they would be ok with. the system is a bully. i am not convinced the system is the best and safest care. even my own kids pediatrician will agree with me. she is the one who suggested a homebirth, not circing, bfing, and doesnt think all vaxes are neccessary. she did her own research instead of just believing what she was taught in doctor school. when i go to the hosp i feel like i have to be constantly on guard against them violating my child. they are not in charge. i am the one paying them. they need to do what i ask them to do and respect my rights to make my own decisions for me and my child. we are intelligent people here. we take the time to ask questions and research our options to figure out what is needed and what is not. and my research has shown the system to be the last place i want to take my children's health.