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Group B strep

post #1 of 23
Thread Starter 

In the US the standard protocol is to do a vaginal/rectal swab for GBS around 34-36 weeks. Here in the UK apparently they do a urine test much earlier in pregnancy; no swab later on and no re-testing if the urine sample comes back positive.

 

So now's my chance to test negative and put my fears to rest about how a positive GBS test could play out during labor (IV antibiotics, etc). When I had DS I tested positive. I know that doesn't mean I'm colonized now, but I want to make extra super sure that I've not got it this time around. I found some cleansing protocols archived here on MDC and elsewhere online. Does anyone have any personal experiences or other reccommendations? I'm also curious to hear if anyone has ever been GBS+ and opted out of the IV antibiotics.

 

TIA

post #2 of 23

I tested positive for DS2 and DD.  With DS2, I tested positive on the routine 36 week swab.  I decided not to take the iv abx during labor.  I had no compounding risk factors, and did my research.  Between my pg with DS2 and the one with DD, I had a mild vaginal infection which turned out to be GBS.  Because I wasn't pregnant, I just waited and it went away.  In my pg with DD, however, I developed a UTI at about 20 weeks, and it was from GBS.  We treated with abx at that time.  And because that is one indication of a higher risk of the baby actually becoming infected after birth, I decided I would take the iv abx in labor.  And then I went into labor at 36 weeks, another risk factor.  I definitely intended to get the abx - BUT my labor was 4 hours long and the midwife didn't arrive until 30 minutes before she was born.  So I didn't get them after all.  And DD was perfectly healthy.

 

My urine was clear of GBS at about 12 weeks in this pregnancy, when I thought I was getting a UTI (but turned out to just be exhausted and dehydrated.)  So I think my plan for this pg, unless something changes, is to get the swab at 34 or 35 weeks (because I assume there's a good chance I will have baby on the early side), and decide about the abx depending on whether any other risk factors apply (if my water is broken for a long time, if I am in labor before 38 weeks or so, etc.)

post #3 of 23

Someone gave me the advice to load up on probiotics and drink lots of fresh veggie juice.  I am doing both, in hopes of avoiding another positive GBS.  If I test positive, I am going to opt out of antibiotics this time and I will get a blood test for babe after he/she is born.

post #4 of 23

I tested GBS+ with DD with a swab at 38 weeks. I did not take any protocols for management during labor. I did much research and recognized that the risk for baby was quite low for catastrophic injury or death. Our pedi was aware and just told us it was imperative that we didn't miss any of the wellchecks during the first 2 weeks when GBS infection would be most likely to present and cause issue, other than that she supported the decision to not do routine abx or vaginal cleanses with abx wash {hibicleans}. I did however clean up my diet considerably in the final weeks--anything that feeds an infection should be eliminated {sugar of any kind--even fruits were super limited for me} and anything that fights infection {GREENS!! anything and everything green} was encouraged and welcome. I also inserted garlic clove every night {thread a piece of garlic that you have cut slits in lengthwise to release the good juice with a string and tie so you can retrieve it easier in the morning}, consumed royal jelly and propolis daily in multiple doses {fights infections} and took chinese herbs from my Doctor of Oriental medicine. 

IMO after research on complication for babe, the risks of abx were actually more likely and more relevant. I don't have the numbers in front of me right now, but it was something along the lines of 5% of babies would go on the contract GBS from + mama during birth and of those 5% the incident of serious infection resulting in death or disability was <2% and the risks associated with the abx included death at a higher rate. Like I said, I do not have those numbers in front of me anymore--they aare on a different computer, but if you research this issue make sure you research the side effects of the abx, which I feel like people rarely do--we just assume, its an abx=safe, but that isn't the case.

post #5 of 23

I was GBS+ only for my last pregnancy. My labors are swift, membranes ruptured ten minutes before birth. There was no time for antibiotics. My MW would have given them by injection and it was not a big deal. Neither the MW or pediatrician were overly worried. My babe didn't have a WBV until 2w. That's my only experience. 

post #6 of 23

Wait, you can get that tested for with your URINE sample?  That is so awesome to know.  If I end up at a hospital that is totally how I will maek them do it to me, that swab thing is just painful. 

post #7 of 23

A negative urine test doesn't tell you that you don't have GBS.  You can still have it in your vaginal/rectal area without it being in your urine.  A positive urine test tells you that a) you do have GBS and b) you have lots of it, making your risk of transmitting it to your baby higher.  So I don't think they'd go for only doing a urine screen :-(

post #8 of 23

Also, you can decline the test altogether, which I am doing this time.

post #9 of 23

But if you decline the test and end up in the hospital, you (and your baby) will likely be treated as if you had tested positive.  That's why I tested in my 2nd pg, although I would have done the test anyway in my 3rd pg and this one because I want to know how high my/my baby's risk is likely to be to have as information for decision making.

post #10 of 23
Thread Starter 
Fayebond, yeah apparently GBS can show up in a urine test. As Mamabeakly said, if it pops up in a urine test that's indicative of a more extensive colonization. The reason in doing the urine test and not the swab is that in this country (UK) they don't do the swab they do the urine test. If you're in the US, I'm not sure if a urine test would fly with American providers. It's really funny to feel like such a 1st timer having my 2nd birth; the health systems are so vastly different! Here there's almost no talk about GBS but for example my intake paperwork included a crazy detailed screening questionnaire for thrombosis, something I don't think we ever discussed last time in the US. Also, regarding toxoplasmosis, I got a reminder to wear gloves if I'm lambing (yes, as in helping a ewe to birth).

Anyway, back to GBS...it's been helpful to read everyone replies. Thank you for sharing your perspectives and experiences. My plan from here is to do a 2 week cleanse (super clean eating, probiotics, garlic, etc), pee in the cup, see what the results are, and go from there. I'm still not sure what I'd want to do if it comes back positive...trying to remind myself how that decision is not a concern right now.
post #11 of 23
Quote:
Originally Posted by Mamabeakley View Post

But if you decline the test and end up in the hospital, you (and your baby) will likely be treated as if you had tested positive.  That's why I tested in my 2nd pg, although I would have done the test anyway in my 3rd pg and this one because I want to know how high my/my baby's risk is likely to be to have as information for decision making.

They cannot treat you for something you decline or 'do not consent' to. Even with a positive test, if I showed up in a hospital I would decline ABX IV and treatment. This is one of those things that knowing doesn't change anything, IMO {because I do not use abx}, so since I have tested + I will always have our ped watch our newborns for any signs or GBS infection. Just putting it out there for mamas who aren't keen to treat with ABX--you can decline the test and you can decline the ABX no matter what.

post #12 of 23
Quote:
Originally Posted by cieloazul View Post
Also, regarding toxoplasmosis, I got a reminder to wear gloves if I'm lambing (yes, as in helping a ewe to birth).

funny!

post #13 of 23

mamaharrison, would you mind sharing some of your research.  My hubby and I are currently deciding if I want to be tested and if I do get tested and test positive what treatment if any will we do.  I would love any info you might have!

post #14 of 23
Quote:
Originally Posted by cocobean View Post

mamaharrison, would you mind sharing some of your research.  My hubby and I are currently deciding if I want to be tested and if I do get tested and test positive what treatment if any will we do.  I would love any info you might have!

I have very few resources saved on this computer and as I mentioned this research was done with my DD pregnancy 3 years ago, however, I will say the fundamentally my decisions are based on my understanding and personal beliefs on how harmful abxs are especially for newborns, infants, and children. Bacteria is not all bad, however, abx don't discriminate and wipe out most of everything. If you understand why vaginal birth is important physiologically for innoculation of the newborn's immune functioning and nursing from the mom to pass on her own naturally occurring abx in the development of the immune system then you should be very wary of any treatment of routine abxs for mom or baby since these drugs will completely alter the beginnings of immune functioning, which is HUGE and can have lifelong implications. I have personally had a serious relationship with loss of health due to abx as a child. I can say that there aren't really many, if any circumstances where I would even consider taking western abx drugs, let alone actually taking them. My DD has never had them. Our family is served by a Doctor of Oriental Medicine and we take chines herbs, acupuncture, massage therapy, chiropractic care, and nutrition therapy for health and illness and THIS has kept us healthy for years. So, that being said.....I don't have the need to do tons of research anymore on the topic since I have a protocol that I am comfortable with and that our Health Care providers support and that I have seen work once before ; )

I have limited resources to share, but they are good: 

For garlic protocol to treat GBS: http://www.gentlebirth.org/archives/gbsCohain.html 
I did this protocol for 2 weeks from 37-39 weeks in my DD pregnancy and retested {vaginally not rectally because babies aren't born anally} and was still positive, but kept on going until I birthed at 40 weeks 3days.

This is a GREAT link for multiple resources that will at least give you some real info to think about like, what about ABX resistant GBS?! --http://www.gentlebirth.org/archives/gbs.html

T
his link reminded me that another of my bottom lines was that I am severely allergic to Penicillin and to the abx group 'mycin', which is rare to be allergic to both, but this literally could have killed me, so, of course I was gonna find another way to treat and do a TON of research on the truth behind this routine intervention {it is not a treatment because it is NOT evidence based}.

I don't have the info on stats for how many cases of GBS contracted by birth and how many of those babies go on to have life threatening occurrances, but there are clinical studies {maybe they are linked in Ronnie Falco's info above--it has been a long time since I went through that doc} and you should be able to search and find some good info on hard numbers. 

IMO, this just isn't a BIG deal. It can be IF your baby contracts it, but that is RARE, VERY RARE and much more rare than a host of other serious and life threatening complications that can and do occur at higher frequency with the routine administration of ABX to mama and/or baby. Every one has to do what they are comfortable with and most in the US are {too} comfortable with ABX treatments, however, most haven't done research on the use of these abxs either...so....I don't know where the comfort level has come from...listening to doctors? Cultural normalcy? It isn't evidence based though, at least not for GBS.

post #15 of 23

mamaharrison, thanks for the info!  I could not agree with you more!

post #16 of 23

Definitely if you have abx allergies that's a great reason to avoid doing them if at all possible!  And this is certainly a time that is possible!

 

I don't have abx allergies.  So for me, having done my research, if I have MULTIPLE risk factors, I feel a one-time dose of IV/IM abx during labor is a reasonable protocol in addition to having good infection fighting and preventative practices.  But like I said, I've never been in labor long enough in that situation to actually do it!

 

Also, one thing I thought was interesting with both of my GBS+ pregnancies was that whether I took the abx or not, my midwives protocol was to have me and DH monitoring baby much more aggressively than any hospital would.  We took heartrate, respirations, and temperature every 2 - 4 hours for the first several days - and they would have had us do it longer if we were not already experienced parents who knew what 'normal' looks like in a newborn.  If anything had been wrong, we would have noticed.  Immediately.  In the hospital, with rooming in, newborn care is normally a lot less intensive than that and what our midwives told us was that once they give you the abx they assume they've dealt with the risk so they do no extra monitoring.

post #17 of 23

here is a bunch of works cited info with studies that will have hard numbers--it is going to be an obnoxious list though...sorry...but for those really interested in studies and such there is a lot of great info here. 

Also, I forgot to mention that in the research I did the numbers in Schrag's study said that of the babies who got GBS from mama 75% of those mamas had received IV abx per protocol...so...there is that, too. Following The protocol for abx doesn't=zero chance of infection.

 

Every family determines what is right for them, but no mama should be forced to take abx against her wishes just because care providers are following protocol and can't give specific info on real risks vs. scare tactics.

 

 


J. Stoll, MDa, Nellie I. Hansen, MPHb, Pablo J. Sanchez, MDc, Roger G. Faix, MDd, Brenda B. Poindexter, MD, MSe, Krisa P. Van Meurs, MDf, Matthew J. Bizzarro, MDg, Ronald N. Goldberg, MDh, Ivan D. Frantz III, MDi, Ellen C. Hale, RN, BS, CCRCj, (2011). Early Onset Neonatal Sepsis: The Burden of Group B Streptococcal and E. coli Disease Continues. Pediatrics, 128, 390. (Stoll, et al., 2011)

CDC - 2010 Guidelines for Prevention of Perinatal GBS - Group B Strep. (n.d.). Centers for Disease Control and Prevention. Retrieved February 20, 2012, from http://www.cdc.gov/groupbstrep/guidelines/guidelines.html (CDC, 2012)

R. Phares, PhD; Ruth Lynfield, MD; Monica M. Farley, MD; Janet Mohle-Boetani, MD; Lee H. Harrison, MD; Susan Petit, MPH; Allen S. Craig, MD; William Schaffner, MD; Shelley M. Zansky, PhD; Ken Gershman, MD; Karen R. Stefonek, MPH; Bernadette A. A. (2008). Epidemiology of Invasive Group B Streptococcal Disease in the United States, 1999-2005. JAMA, 299(17), 2056-2065. (Phares, et al., 2008)

W. David MD; Schuchat, Anne MD; Gibbs, Ronald MD; Sweet, Richard MD; Mead, Philip MD; Larsen, John W. MD. (2000). Prevention of Perinatal Group B Streptococcal Infection: Current Controversies. Obstetrics and Gynecology, 96(1), 141-145. (David, et al., 2000)

K. Van Dyke, Ph.D., Christina R. Phares, Ph.D., Ruth Lynfield, M.D., Ann R. Thomas, M.D., Kathryn E. Arnold, M.D., Allen S. Craig, M.D., Janet Mohle-Boetani, M.D., Ken Gershman, M.D., William Schaffner, M.D., Susan Petit, M.P.H., Shelley M. Zansky. (2009). Evaluation of Universal Antenatal Screening for Group B Streptococcus. The New England Journal of Medicine, 360, 2626-2636. (Van Dyke,et al., 2009)

J. Schrag, D.Phil., Sara Zywicki, M.P.H., Monica M. Farley, M.D., Arthur L. Reingold, M.D., Lee H. Harrison, M.D., Lewis B. Lefkowitz, M.D., James L. Hadler, M.D., Richard Danila, M.D., Paul R. Cieslak, M.D., and Anne Schuchat, M.D., .. S. (2000). Group B Streptococcal Disease in the Era of Intrapartum Antibiotic Prophylaxis. The New England Journal of Medicine, 342, 15-20. (Schrag, et al., 2000)

A. Joseph, MD; Suma P. Pyati, MD; N. Jacobs, MD. (1998). Neonatal early-onset Escherichia coli disease the effect of intrapartum Ampicillin. Archives of Pediatrics & Adolescent Medicine, 152, 35-40. (Joseph, et al., 1998)


F. Snail (2003). Intrapartum antibiotics for group B streptococcal colonisation (Cochrane

         review). The Cochrane Library, 4, 1. (Snail, 2003)

Gilbert, GA. (2002). Preventing perinatal group B streptococcal infection: the jury is still out

         (editorial). Medical Journal of Australia, 178, 199-200 (Gilbert, 2002)

post #18 of 23
Quote:
Originally Posted by Mamabeakley View Post

 

 

I don't have abx allergies.  So for me, having done my research, if I have MULTIPLE risk factors, I feel a one-time dose of IV/IM abx during labor is a reasonable protocol in addition to having good infection fighting and preventative practices.  But like I said, I've never been in labor long enough in that situation to actually do it!

 

 

I wasn't always allergic to these drugs. I had a life threatening emergency after taking PCN at the age of 15. ABX carry risks that people don't really think about much. Imagine being in labor fine and then receiving routine ABX and suddenly fighting for your life after a reaction puts you into shock. PCN is a very common drug allergy and it typically is developed after repeated exposure not first time use.

I know this is MY experience, but it is one that docotrs don't even mention when administering this drug and I think that is not informed consent. No one expects bad outcomes, but everyone has the right to know the real risks of treatment vs. non treatment. It sounds like you have done your research and are happy with your decision {i can respect that}, but for those still looking for info this shouldn't be glossed over, IMO.

post #19 of 23

Why is it that you never find out how ordinary it is to have problems from a treatment until AFTER they give it to you?  Ugh.  And the whole swab thing isn't exactly a picnic to go through, either.  

post #20 of 23
Quote:
Originally Posted by fayebond View Post

Why is it that you never find out how ordinary it is to have problems from a treatment until AFTER they give it to you?  Ugh.  And the whole swab thing isn't exactly a picnic to go through, either.  

exactly! It's like if you don't ask the EXACT right questions they just don't tell you--even if you DO ask the right questions they don't tell you the truth half the time. The swabis terrible and they really don't have a need to swab the vagina AND the rectum---If you swab the vagina and it's positive, you can bet its present in the rectum, too {DUH!} and since the babe comes out of the vagina then you would have all the info you need.

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