Thoughts on Group B Strep - especially if you are having an out of hospital birth « Back to Group Discussions

[Vegan Princess]

I have the group B strep issue on my mind this week. I finally read my midwife's long handout on it that she e-mailed to me a while ago. You can opt out of the test or if you test positive you can opt out of anything you want. That said, if you test positive and you want antibiotics, you need to have a hospital birth! I never considered this! I was negative last time, but I do know my last midwife did the antibiotics at the birth center, if need be. And I know that your status can change every couple weeks even!

I have some friends who had a baby and my friend was positive and for some reason she did non get the antibiotics. I don't know details - it wasn't something she declined. I think more like she had no clue and either they doc didn't know her status or messed up by not giving it. Anyway, baby got it and nearly died. Spent 2 weeks in the NICU. I know the odds of transmission are supposedly low even if you are positive, but the odds of your baby dying if they get it are 6% - which is too high for me to feel ok about. 

I think I'm extra concerned bc at my last 3 visits my pee has been cloudy or there have been leukocytes (white blood cells). My midwife hasn't really been concerned bc there is no other indication of infection in my urine. I've been taking measures to treat a UTI, even though I don't feel like I have one (d-mannose, cranactin, probiotics and vitamin C). I'm just concerned that maybe by not treating a UTI or whatever with antibiotics, I could be setting myself up to end up GBS+. I'm really worried about potentially losing my homebirth over this!

I know my midwife offers hibiclens treatment instead of antiobiotics as an option. And she did say she would consider possibly doing an IV for me if need be (so happy to hear that!). She did say you have to have the antibiotics at least 2 hours before you deliver and it's very possible we wouldn't even have time (7.5 hour labor with my first so who knows what it will be this time).

Sorry to ramble. I'm probably worrying myself over nothing. Hopefully I'll just turn out to be negative. But I would love to hear others' thoughts - whether you feel ok declining to go to the hospital for antibiotics and why or if you are even going to do the test, etc. Do most homebirth midwives not do the abx?

Thanks!

Cindy

[onyxravnos]

well with my first I was + but he had other issues so was a hospital birth anyway. My 2cd I was - so it was a non issue, and I haven't tested yet for this one. 

My plan last time (and again this time) is to dose up heavy on garlic pills and probiotics a few weeks before testing and get the test done.  Now should it come back I wont be getting antibiotics as I'm planing another UBAC but I know that I will be aware to be extra prudent in monitoring baby for ANY signs of infection. 

Now of course if I test positive at 36 weeks I could easily test negative at 40, or vice versa. and as you mentioned contracting it is rather low. I like to KNOW so I know what I need to watch for but I wont be getting routine antibiotics.

[springmum]

I think your worries are realistic. I wouldn't have put too much thought into it if I hadn't had a UTI caused by GBS at 11 weeks. In my reading that puts me at a 4x higher risk for passing it on to baby, scary enough for me (I also know someone who almost lost their baby to GBS) My midwives policy b/c of that risk is that I automatically need abx in labour (and I can't have a homebirth b/c of this too)

That and Dandy's experience of preterm labour due to GBS have made me take it a bit more seriously.

After I was diagnosed I needed abx...nothing natural was knocking it out (D Mannose doesn't work on GBS for example, it attaches to e.coli bacteria as I learned, I also learned that cranberry may not be effective for GBS, but the info wasn't clear on that- though it was definitely true for me, I drank gallons of it) After the abx to make sure it didn't come back I did do garlic vag inserts, probiotic vag inserts, have gone completely sugar free except for fruit (GBS love sugar apparently too), keep my immune system up with vitamins and foods.

I am still going to ask to be retested, just to see if I at least have a lower colony count. 

The other thing about abx that gave me a worry was that not all GBS respond to all abx's. They really need to type specific it (as in my case I needed to switch abx b/c the first one worked and then didn't a couple of days later) So if they give you a swab and say you need them, are they just giving the standard abx that they give everyone, or are they making sure it's specific - b/c otherwise that's another set of problems.I"m going to ask when tested again to be sure to see what abx it will respond to.

Do I love the idea of abx for me after all I went through with DS and his food intolerances - not one bit. BUT I have more knowledge now about diet and probiotics to lessen any negative effects from them (upping vitamins, huge doses of probiotics, completely sugar free, low refined carbs - we're gluten free so that means staying away from all the high starch breads etc)

Fingers crossed that your negative and don't even have to worry further about it!

[Vegan Princess]

Springmum: How did you know your UTI was caused by GBS? What did they do in order to tell you that? My midwife keeps telling me I have no other signs of infection other than white blood cells in my pee - which can be totally normal, even with no infection present. I do have my chart from my last preg and I had white blood cells in my pee at a few visits around now then too and it wasn't even mentioned to me. 

I think I might just add in some more of the GBS preventors until I test too. Echinacea (already taking probiotics) and I can't recall the others off hand but they are in the handout she gave me. 

She said she could test me at my 34 week appointment - i asked if we could do it early so I'm not left wondering. Just that results are only valid until 39-40 weeks if we do that so we'd maybe have to test again if I go late (I was 2 weeks early last time though). Though now I'm thinking maybe if I just have extra time to take precautionary measures, it would be better. I have no idea. LOL.

Cindy

[springmum]

Vegan - I was having UTI symptoms (including the beginning stages of kidney infection symptoms) so they did a dip in office and sent a sample to be properly cultured at the lab. Then they specified which abx would be appropriate, and they could do a colony count (high or low etc) I've never had a UTI in my entire life, so this was very new and very upsetting :(

My urine hasn't been dipped or cultured since, and likely won't be unless I ask specifically or have anything strange going on. I have heard the white blood cells in urine can be normal too, but I guess you could always ask them to send in a proper sample for culturing if it's on your mind. 

I don't know how cut and dry this all is abx vs not, white blood cells with no symptoms vs getting treatment. I just keep thinking back to Dandy's situation and also how clear they were with me that an untreated UTI (caused by GBS) COULD lead to an infection of the placenta if it spread. I'm not one to jump on the abx bandwagon to easily for too many things, but unfortunately my situation has made it a little more necessary.

[pregnova]

Maybe you'd like to read this blog post by a midwife about GBS, http://www.glorialemay.com/blog/?p=615

It's pretty informative. 

[Vegan Princess]

Thanks for the link Pregnova. It is very similar to the long handout from my midwife. 

Well I had a quick chat w/my midwife today. I'm going to take echinacea 2x/day (for 10 days then take 10 days off, etc) and garlic 2x/day (orally) as well as the probiotics and vitamin C I'm already taking to tackle to possible UTI. Also continue the d-mannose/cran and drink uva ursi tea until we see what my urine is like at my next appointment. She thought it couldn't hurt to do the prophylactic measures to kill GBS. We agreed to wait until the 36 week visit to test and just let all these measures do their thing. If I don't have GBS anyway, at least maybe this stuff will keep me from getting sick when DD starts preschool in a couple weeks! 

I guess I will revisit my thoughts on antibiotics, etc. when I know my status. But for now I'm just praying it's negative and not an issue!

BTW it's a like a cruel joke trying to make a pregnant woman cut out all sugar! Does that mean no fruit? UGH. I'm failing miserably at that part!

Cindy

[micromama]

Have you heard of Femdophilus? It's supposed to be very effective in preventing GBS and in treating other "women's issues".

[Vegan Princess]

Is it any different than other probiotics? Or is it just being repackaged and marketed to women?

Cindy

[micromama]

It's a probiotic, but different strains than most probiotics-- the strains are supposed to target the urinary tract, etc.

[dannic]

I have actually never tested.  MY sis, who delivers in a hosp. has had it the last two pregnancies.  My complaint is that they test her at 34 ish weeks and then assume that they need a protocal based on something that may not be there at birth.  She has asked, and they won't retest later.  So for one, birth she opted to not get the abx and do the 48 hr stay.  Her last birth she wanted to be home sooner, so had to come in at the on set of labor and get the abx, and her labor stalled (she usually doesn't go in until active labor and then has the baby in a few hours).  They admitted her anyway (instead of sending her home) and she (imo) barely made it through without a section.  She is preg. again and is going to plan on the 48 hr stay in leu of a long labor and all that stress. 

I use the hibiclens and also probiotics for me and for baby once baby is here.  In my state, having a positive opts yuo out of homebirth--or, at least, opts your midwife out of legally caring for you.  None of her many clients test...

[hansigurumi]

Hi Cindy,

I was GBS positive during my first birth, which was at a birth center.  I had oral antibiotics when my water broke, and every 6 hours after until the delivery (3 doses, I think).  At that time, I was actually pretty annoyed about the antibiotics; during that pregnancy, I had at least a dozen yeast infections, and taking the antibiotics seemed to be asking for more yeast problems after the birth.  Amazingly, I had no yeast problems after the birth (yay!).  And I'm thankful that the antibiotics decreased the risk of a GBS infection in my youngster.  The key warning my MWs at the time had was that they knew that if I were GBS+ and had not had the antibiotics, any illness in the baby would be taken as a reason to keep the kiddo in the NICU for a couple of weeks; I wasn't really willing to accept that risk.  Plus, a 1 in 200 chance of illness vs. a 1: 3000 with the antibiotics seemed like odds not to be screwed with.

I'm curious about why your MW doesn't do an antibiotic course.  All the MW practices around here seem to have ways of administering the ABX out-of-hospital (with informed consent, of course; some folks who are GBS+ don't get the ABX).  Hmmmm.  I am curious about why having a home birth and antibiotics for being GBS+ are not mutually compatible.  

~Hansi

[Vegan Princess]

Hanisigurumi: I'm not sure why she doesn't typically do the abx. I haven't actually seen my midwife since I read her handout and started pondering all of this. I've asked her some questions via email and phone but we still haven't had a long talk about it. She is coming tomorrow so I will be interested to get her thoughts and rationale behind what she does and doesn't do. My guess is most of her clients don't worry about the abx as much as me? I'm feeling a bit confused. Like I 100% wanted abx before but now the more I read, I'm not sure I do and maybe would be ok with the hibiclens she offers. I don't know.

I'm getting the swab done a week from Friday by my ob. So I guess I will talk to my midwife more tomorrow and then revisit it all in 2 weeks. And for now I'm still taking garlic, echinacea, probiotic and the stuff to ward off a uti. If my pee has any leukocytes in it tomorrow we are going to send if to a labto be cultured.

Cindy

[hansigurumi]

Best of luck at your appt tomorrow, Cindy!  Hope that you have nothing to worry about.  

Are there any journal articles on the efficacy of the natural remedy you mentioned?  Just curious...  It was not even mentioned as an option for me last time.  

[Vegan Princess]

So I had my visit today. My midwife is newly lisenced. I'm one of her first clients on her own (though a midwife of 20 yrs will be at the birth). She was the student midwife at my birth center birth. She pulled out my first midwife's policy and brought it today. Her policy was to offer 3 kinds of abx in case people were allergic. Either iv or shot in the buttt. The home birth midwife she has been working with until now is very anti abx. Most of that midwifes clients do get tested but many use the herbal remedies before like I am doing so 90% come back neg. she said the few who come back positive use hibiclens andeveryone has been fine. So my midwife decided she's willingto order and do the abx for me if I am positive! Though I am still on the fence about abx versus hibiclens and there maybe wouldn't be enough time for abx anyway if labor is fast. It needs to be at least 2 hours before delivery. Anyway I am glad that having to go to the hospital over this isn't an issue. Hopefully I don't haven't anyway.

Hang: studies on which? Hibiclens or taking garlic, etc to prevent it? I think there might be studies sited in the handout my midwifes gave me.

Cindy

[dannic]

Originally Posted by hansigurumi 

Hi Cindy,

I was GBS positive during my first birth, which was at a birth center.  I had oral antibiotics when my water broke, and every 6 hours after until the delivery (3 doses, I think).  At that time, I was actually pretty annoyed about the antibiotics; during that pregnancy, I had at least a dozen yeast infections, and taking the antibiotics seemed to be asking for more yeast problems after the birth.  Amazingly, I had no yeast problems after the birth (yay!).  And I'm thankful that the antibiotics decreased the risk of a GBS infection in my youngster.  The key warning my MWs at the time had was that they knew that if I were GBS+ and had not had the antibiotics, any illness in the baby would be taken as a reason to keep the kiddo in the NICU for a couple of weeks; I wasn't really willing to accept that risk.  Plus, a 1 in 200 chance of illness vs. a 1: 3000 with the antibiotics seemed like odds not to be screwed with.

I'm curious about why your MW doesn't do an antibiotic course.  All the MW practices around here seem to have ways of administering the ABX out-of-hospital (with informed consent, of course; some folks who are GBS+ don't get the ABX).  Hmmmm.  I am curious about why having a home birth and antibiotics for being GBS+ are not mutually compatible.  

~Hansi

State regulations vary on many aspects of homebirth...for us, abx cannot be administered by a MW...andd the gbs+ will risk you out of HB.  (legally)  a crying shame.  I have kids with allergies and there are correlaries between abx and allergies, so I am more willing to not take them and watch baby than risk higher incidence of food allergies...

[moonInLion]