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GBS - to test or not to test?

post #1 of 23
Thread Starter 

Hi ladies,

 

Any thoughts on testing for GBS?

 

It's not required where I live because the percentage of babies infected, even if the mother is colonized, is really low (like .02% or something).

 

That being said, I'm planning a home birth and don't want to take any chances on my baby's health. I've heard some horror stories about infected GBS babies from home births and am trying to ensure that I am as low-risk as possible!

 

What your thoughts on this matter? If I do test positive, I actually can't do a home birth, but I don't think that should be a reason NOT to test.... On the other hand, I understand that even if I am colonized the chances of it passing to my baby are very low. What do y'all think?

 

Thanks :-)

post #2 of 23

I will not be testing. If taking the test could risk you out of a home birth is that a chance you are willing to take? Have you seen the preventative measures you can take (garlic, probiotics etc to clear up GBS prior to delivery)?

Did you see this article?
http://mothering.com/pregnancy-birth/treating-group-b-strep

A lot of good statistics and thoughts in there (it is long).

post #3 of 23
Thread Starter 

Risking out of home birth if GBS really can be fatal is a chance I'm willing to take... I read about a home birth mama whose baby died of GBS-related respiratory problems just a few hours after being born (and yes, the mama put garlic up her vagina every day for two weeks prior to giving birth) and having a home birth is not worth _that_ to me....However, this is the paragraph of the report that makes me wonder:

 

"Some studies have shown a decrease in GBS infection in newborns whose mothers accepted IV antibiotics during labor, but no decrease in the incidence of death. Still other research has found that preventive use of antibiotics is not always effective. In fact, one study found no decrease in GBS infection or deaths among newborns whose mothers were given IV antibiotics during labor."

 

I have seen the article and other like it, which is why I'm confused about whether or not to test....I don't want to take any chance, but if testing won't make a difference, then I don't want to do the unnecessary....

post #4 of 23

Well, I guess that was what I was meaning. While there is always a small (very small risk in my opinion) of infection, it doesn't really seem like the hospital or antibiotics can always prevent it anyway so I would hate to see you risk out of HB (if that is really where your heart is) for a hospital birth that potentially wouldn't be any safer, YKWM?

post #5 of 23
I'm doing it cause the more info the better IMHO. If I'm positive I will cross that road when we come to it. Maybe they won't let me in the tub if I have IV abx? Was neg last time.

Thanks for the article!
post #6 of 23

I am testing because IF I ended up in the hospital, I would rather have a defined 'status' on my record than not.  And, IF I am positive, I will treat with IM or IV abx IF I end up having more than one risk factor (pre-term, prolonged rupture of membranes, elevated temp, etc PLUS a positive test).

 

I have a history of GBS infection, so I've looked at the studies etc and made the choice that make sense to me.  I was negative with DS1's pregnancy, but positive with DS2s.  I had no other risk factors with him and would have declined the abx had I had time to get them (labor was 6 hours total and MW didn't offer them.)  Then I had a vaginal infection (which I didn't treat with abx - it wasn't a huge deal, just annoying) which was caused by GBS between pregnancies, and a urinary tract infection during my pregnancy with DD that was caused by GBS.  At that point, we assumed my level of risk was elevated 1x for her birth and did not test - also we ran out of time.  I went into labor with her at 36+ weeks, and because that is pre-term (technically) I would have taken IV abx if I had had time.  As it was, labor was 4 hours start to finish and the MW didn't arrive until 1 hour before she was born, so no time.  She was 100% fine. 

 

My MWs have pointed out to me that what they do when a mama declines abx is to ask parents to keep rigorous notes on baby's heart rate, respiration, and temperature (looking for signs of infection, every 4 hours) for 3 - 4 days - which is actually much more proactive than what would happen in a hospital setting once abx have been given during labor where I live.  We did that with DS2 and DD and I found it reassuring (although I also think I would notice if something were wrong with my baby - I'm pretty tuned in, am an experienced mom, and also have had relatively easy recoveries.)

post #7 of 23

Hope you don't mind a long-ish reply :-)

 

Personally, if not testing wouldn't jeopardize my HB plans, I would not test. Meaning, if my MW was required to treat me as GBS positive unless I tested otherwise, that might be a reason I would test but otherwise I'd decline it. Either that, or I'd ask for a urine test instead of a swab; more on that below.

 

First off, this page has a ton of great info and resources -- http://www.gentlebirth.org/archives/gbs.html -- I suggest you check it out if you haven't already.

 

I was GBS positive when I had my son. That was with care from CNMs in an American hospital setting. DS being my first, I didn't know the first thing about GBS or what having it even meant. So with no thoughts on the matter whatsoever, I did the vaginal/rectal swab thing they do around 32-34 weeks. It was positive. My MW explained how the protocol was that GBS positive moms are supposed to go right to the hospital if their water breaks, and that they get IV antibiotics during labor. Never having labored before, it sounded like NBD to me. Only after that positive test result did I read up on GBS. As fate would have it, a couple days before my EDD my water did begin to leak (not a full on gush). At least by then I knew enough about alternative approaches that I felt comfortable buying myself a little bit of time at home to see if labor would start in earnest before clocking-in at the hospital where they'd want to deliver DS within 24 hours. So I started myself on a super vaginal-cleanliness aware protocol and dosed up orally on echinacea, garlic, and vitamins C & E. A day or two later I was still leaking and not contracting in any significant way. At that point, I called my MW and went to L&D where I got IV antibiotics and some prostoglandins to jump-start labor (thankfully I avoided pit and all other drugs from there on out). The IV was a huge PITA. It really affected the way I could labor. It's like if I could change just one thing about DS' birth it would be to get that thing off my arm. In the end, my MWs were cool about the timeline, they were fine with my decision to decline the pit and labor at my own pace. DS was born more than 24 hours after I got to L&D and a day or two after I started to leak. He was totally fine, no GBS complications or anything like that. Was that the antibiotics or was it that he wouldn't have gotten it anyway? Who knows.

 

So with that experience behind me, GBS was on my radar with this pregnancy. But this time I'm having my baby in the UK where clinical practices differ from those in the States. Still, the setting is kind of similar to my last birth. I'm with what's basically a CNM and plan to deliver at a birthing center co-located with a hospital. One thing I found interesting is that here they don't do the 3rd trimester swab test, they do a urine test in the 1st trimester. As I understand it, many more women will pop positive on a swab than on a urine test. But if you're positive on the urine test that probably means you're extensively colonized and therefore at a higher risk of passing GBS on to baby. So there's two different "positive" thresholds for these two different tests. A few months ago I did consent to the urine test, figuring if I'm that extensively colonized I want to know it. In the two weeks leading up to the test I followed some of the recommendations I found through the website above. Basically I was on cleanse-type diet (modified to meet my nutritional needs during pregnancy, as in I might need more protein but I certainly didn't need cookies), did all sorts of vaginal remedies like TTO, garlic, hydrogen peroxide, and ACV; and took probiotics, ACV, echinacea, and garlic orally. The day before the test and the day of the test I did a diluted chlorhexidine wash (the best part was buying it at the feed store...um, I need this special soap...yeah, sure, for my dog). Who knows how all that affected my flora but I did test negative. Because GBS can come and go, I plan to repeat that protocol (probably in a slightly more relaxed fashion) starting a week before my EDD.

 

There's some interesting research out there about chlorhexidine as a vaginal wash during labor when GBS is present, in lieu of IV antibiotics. It's a hardcore chemical but with a pretty low level of invasivness and totally do-able at a HB. There's also some research on giving antibiotics orally or by injection instead of as an IV. I can't remember the particulars, but as I recall that approach didn't sound super promising.

 

IMO this is one of those hard "N of 1" choices. It goes without saying that I would be devastated if my baby is the one in ___ who dies from GBS complications. But does that justify a policy of interventions, interventions that carry their own risks, for the other ___% who will be fine? I don't know. I think we each have to decide for ourselves. And it's a really hard choice when what we think/feel/know/believe will keep ourselves and our children safe doesn't always align with laws and institutional policies.

 

Good luck. Let us know what you decide and how it all turns out. I'd be curious to hear your MW's take on the situation too.

post #8 of 23

Thank you mamabeakly and cieloazul for sharing your experiences with GBS.

post #9 of 23

I was going to share the same resource as Cieo--http://www.gentlebirth.org/archives/gbs.html and then this one, too http://www.glorialemay.com/blog/?p=615

T
here is a difference between being colonized with GBS, which is what the swab determines, and having an active GBS infection. It is absolutely normal for a woman to test positive for GBS--as up to 30% of us have been colonized at some point in our lives and this is not a pathogenic infection, but rather one that can and does live within some healthy women. Also, the swab done both vaginally and anally is really ridiculous, IMO. For women who are colonized with GBS--it lives in their intestinal tract, which means that a positive in the rectal swab would be obvious, however, I don't birth babies from my anus and neither do you. Still there is this pervasive thought that if it is colonizing your rectum then it must also be in your vagina since they are SO close {obviously there would be factors where this could certainly be true for one woman and not another--like if you engage in anal play during sex}. IF I were to consent to a swab it would only be of my vagina OR I would allow two separate swabs, one each of vagina and rectum. 

The incidence of life threatening infection for babe is 0.02% of those who have been colonized and infected and that is out of the under 10% of babes who actually become infected from their GBS positive moms during birth {I can't remember the stat, but the link above has a study with it}. SO, we are talking about a VERY VERY small risk factor here. It DOES happen, and you can always find a story about it, but there are risks in EVERYTHING--more children die of circumcision than this WAY MORE and yet the AAP just changed its policy to advocate for this elective surgery on newborns. 

For me, the basics were this--I read about the 'treatment' and found that there were MORE fatalities associated with the ABX treatment {because of unknown allergic reaction for mom and/or baby}. So, imagine fighting for your life WHILE you are in labor for a statistic above because there is more of a probability of that happening than a serious GBS infection occurring. 

I will not test this time. I did test positive during DD pregnancy. I am fatally allergic to BOTH abx that would have been administered to me as a 'precaution'. Thank god I already knew that {because I had near fatal reactions a decade ago}.

I am interested as to why your HB wouldn't be possible with GBS+ though--in Florida that doesn't risk you out of a HB. There are many protocols--the garlic one, the hubicleans one {I would not wash my vagina out with chemicals EVER--that's the whole point of vaginal birth--to innoculate your babe with our flora--we all have a balance of beneficial and pathogenic bacteria within our systems at all times and this is normal!}. Also, the statistics show that being born into water lowers colonization for babes and certainly being born into water is more preferable for mom and baby considering the option of IV abx would limit your movements and require you to be in bed to birth. So, it just angers me--why don't hospitals institute the policy that ALL GBS+ mamas birth in water vs. have IV abx?? One has obvious side effects that are detrimental to mom and baby and the other is generally pleasant. 

Finally, IMHO the best thing you can do for your babe is to partner with a highly skilled pediatrician who is experienced and comfortable with the recognizing the signs and symptoms of GBS infection in your newborn, both acute and let stage, and treating the infection. Go interview peds. Talk to them about this issue. You will obviously find some who will fear monger you the same as an OB would on the topic, but that isn't evidence based, obviously. We have a lovely ped. who is a rare breed--she has a solo practice, which means SHE is the ped and we always see her. When we interviewed her I told her I was GGBS+ and that I would not be doing profilatctic ABX under any circumstances--even if I was ruptured beyond 18 hours, had a fever, etc...--she was quite comfortable with that and sited the low incidence of infection and the even lower incidence of infection with serious complications in newborns. She told us how to monitor babe at home and what would need to happen if babe presented with signs of infection. WE discussed EVERYTHING, right then! She walked us through what decisions we would be looking at making in a critical situation and completely informed us. She also comes to the home within the first 12-25 hours after babe is born and then again at 48 hours and then made it clear how important it was for us to come to the check ups during the initial period so that she had the chance to visually exam babe for this--in other words, not just weight checks ; )--remember that we are actively monitoring for infection and THAT is truly proactive, IMO, and doesn't carry any side effects for me or babe. 

No one wants to loss a baby, a child. EVER. especially if they are told it could have been prevented. I never found that taking IV abx would ensure that in all the research I have done on it despite the fact that MOST OBs will tell you that is the case. It is up to you to do the research on it. I would never trivialize those who have suffered the loss because of infection. It must be horrendous. However, just as horrendous and IMO {because it hits so close to home} unacceptable are those whose mommas died when they didn't have to because the routine intervention caused a fatal allergic reaction for them. GBS infection is treatable if it is caught right away and the evidence just doesn't support the treatment they are handing out.



 

post #10 of 23
I tested GBS positive in the first trimester with a urine test, generally they repeat the test with a swab at 34 weeks, but in my case according to the doc, since I tested positive, it's unlikely to go away at 34 weeks, so there is no need to retest. I will be getting a capped off IV when I start labor, in my view, better safe than sorry. According to my my doctor there are almost zero chances of the baby contracting the infection when antibiotics are administered to mother in labor. I am still worried, can the baby contract it while in uterus? I would take any preventative measure I possibly can to at least mitigate the risk of passing it on to the baby.
post #11 of 23
Quote:
Originally Posted by tetiana View Post

I am still worried, can the baby contract it while in uterus? I would take any preventative measure I possibly can to at least mitigate the risk of passing it on to the baby.

 

Someone can correct me if I'm wrong, but if your vaginal/anal flora is colonized with it it's mainly a risk if your water breaks significantly before birth and then some risk when baby is coming out and encountering the flora.  

 

I've heard of some women doing a hibiclens (spelling) rinse if they were gbs positive once they went into labor to cleanse the area.

 

Generally though most homebirth midwives can give antibiotics during labor, however they do need time to take effect.  At least over here GBS positive women tend to opt for that, it's not something that risks you out of homebirth.

 

Over here all four times I've tested negative.  Hopefully that will continue with this birth.  I tend to birth really fast as well.  Some things as well I have chosen to do because in case of transfer the lack of knowledge can affect how the baby is treated at the hospital, regardless of the reason for the transfer.  That's something that I talk to the midwives about because I don't want the baby to have things like antibiotics (which wacky as it is I have heard happening in transfer cases where gbs status is unknown) or unnecessary needle sticks/pokes prodding to happen.

post #12 of 23
Thread Starter 

Thank you all for your replies. I'm going to read through all these links carefully, because I am really torn on the subject. I want to make the best decision for my baby, and this is just one of those non-black and white issues that we as mamas need to deal with.

 

@mamaharrison, I live in Israel, and CNMs are no longer permitted (as of June) to administer abx on GBS women, which means if I tested positive I'd either have to go to the hospital to do abx or make sure not to tell my midwife if I chose to ignore the results. I therefore only want to test if I'm sure I would take the abx if the results are positive. I will definitely let y'all know what I decide :-) 

post #13 of 23
Quote:
Originally Posted by lovingsong View Post

Thank you all for your replies. I'm going to read through all these links carefully, because I am really torn on the subject. I want to make the best decision for my baby, and this is just one of those non-black and white issues that we as mamas need to deal with.

 

@mamaharrison, I live in Israel, and CNMs are no longer permitted (as of June) to administer abx on GBS women, which means if I tested positive I'd either have to go to the hospital to do abx or make sure not to tell my midwife if I chose to ignore the results. I therefore only want to test if I'm sure I would take the abx if the results are positive. I will definitely let y'all know what I decide :-) 

WOW! So are you saying that in the event of a positive GBS culture you have no choice whether to take ABX? You MUST take a bx? I understand that MWs cannot administer abx at home, but what if you test positive and decide not to treat with abx? can't you just continue with your HB as normal?

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

. According to my my doctor there are almost zero chances of the baby contracting the infection when antibiotics are administered to mother in labor.

There are also almost zero chances that the baby will get a GBS infection and die if not treated with ABX during labor. The stats on that are 0.02% on that, yet they want to treat EVERY woman who is positive--sounds like the same 'chances' almost zero and 0.02% ....doesn't it?

The baby cannot get colonized nor infected while in utero. This bacteria lives within the digestive tract and rectum of about 30% of healthy, normal women without incidence to them. In order to get colonized and/or infected babe would have to come into contact with the bacteria directly and have other indications for infection transmission--kinda like not everyone who is around you will catch your cold.

I forgot to mention that there has been a rise in vanco-mycin resistant GBS strains since the inception of this protocol and so, there is a very liekly chance that the ABX administered will not be effective against GBS colonization/infection in your newborn. Kinda like when you get Penicillan to treat your ear infection and after the full course you still have the ear infection :( You can be treated and find your baby still gets colonized or infected. http://www.gentlebirth.org/archives/nosocoml.html#Likelihood

 


Edited by mamaharrison - 10/15/12 at 11:07am
post #15 of 23
Quote:
Originally Posted by lovingsong View Post

Thank you all for your replies. I'm going to read through all these links carefully, because I am really torn on the subject. I want to make the best decision for my baby, and this is just one of those non-black and white issues that we as mamas need to deal with.

 

@mamaharrison, I live in Israel, and CNMs are no longer permitted (as of June) to administer abx on GBS women, which means if I tested positive I'd either have to go to the hospital to do abx or make sure not to tell my midwife if I chose to ignore the results. I therefore only want to test if I'm sure I would take the abx if the results are positive. I will definitely let y'all know what I decide :-) 

 

How about the hibiclens wash?  Go do some research on it so you can get a feel.  In some countries that is what they do for GBS positive women.  The issue here is that if you transfer and have an unknown status they will give you abx OR give your baby abx when they are out.  For me I'd rather know then make decisions accordingly.  

 

Chlorhexidine (Hibiclens) Protocol for Labor (from drmomma.org)

Chlorhexidine vaginal wash at the onset of labor or at rupture of membranes, whichever comes first, repeated every six hours.

Method:

• 2 Tbsp Hibiclens (4% chlorhexidine solution) mixed with 20 oz sterile water.
• You may be most comfortable in a squatting or sitting position (even on the toilet) or laying down with your hips slightly elevated.
• Put 4oz of the mixture into a periwash bottle. Use the entire amount for each application.
• Slowly instill the solution into the vagina under very gentle pressure using a peribottle.
• Begin at onset of labor or ROM and repeat every six hours.
• A woman can self administer the vaginal flush, and her spouse/partner can assist as well if she wishes.

post #16 of 23

These mws seem like they have a decent page on it.  In their state they must not be able to do IV ABX, in our state we can.  I think that is a factor to heavily consider.  They(click for page) talk about the three 'risk factors'....labor prior to 37 weeks of pregnancyfever of 100.3 or higher, or prolonged rupture of membranes (>18 hours).

post #17 of 23
Quote:
Originally Posted by phatchristy View Post

 

How about the hibiclens wash?  Go do some research on it so you can get a feel.  In some countries that is what they do for GBS positive women.  The issue here is that if you transfer and have an unknown status they will give you abx OR give your baby abx when they are out.  For me I'd rather know then make decisions accordingly.  

 

Chlorhexidine (Hibiclens) Protocol for Labor (from drmomma.org)

Chlorhexidine vaginal wash at the onset of labor or at rupture of membranes, whichever comes first, repeated every six hours.

Method:

• 2 Tbsp Hibiclens (4% chlorhexidine solution) mixed with 20 oz sterile water.
• You may be most comfortable in a squatting or sitting position (even on the toilet) or laying down with your hips slightly elevated.
• Put 4oz of the mixture into a periwash bottle. Use the entire amount for each application.
• Slowly instill the solution into the vagina under very gentle pressure using a peribottle.
• Begin at onset of labor or ROM and repeat every six hours.
• A woman can self administer the vaginal flush, and her spouse/partner can assist as well if she wishes.

They cannot force ABX on you or your baby just because your GBS status is unknown. You can refuse! WE live in the same area Phatchristy and have had the same MW. Ask her, she will let you know they cannot force you or babe to have ABX for an unknown GBS status and even if they did suggest it it is well within your rights for you to refuse for both yourself and babe. 

Also, hibicleans is a very strong chemical and it strips your vagina of all the flora--good and bad. It also comes with its fair share of side effects, too and also doesn't guaarentee babe won't contract GBS. Just to give another perspective.

post #18 of 23

Mamaharrison, I'm pretty sure I have read of cases of in utero infection.  But that would only happen if there were a leak in the bag of waters and bacteria were introduced, a very rare happenstance I am sure.  I don't think it's something to base a decision about testing/abx on because the protocols suggested wouldn't do anything much about that situation.

post #19 of 23
Quote:
Originally Posted by Mamabeakley View Post

Mamaharrison, I'm pretty sure I have read of cases of in utero infection.  But that would only happen if there were a leak in the bag of waters and bacteria were introduced, a very rare happenstance I am sure.  I don't think it's something to base a decision about testing/abx on because the protocols suggested wouldn't do anything much about that situation.

I would be interested to read that if you could find the info. Theoretically, it makes sense if there is a ruputre of membranes in utero without birth being imminent for days or weeks, but it would be even rarer statistically than colonization via birth.

post #20 of 23

Here's a reference - no idea how reliable this is - but it's interesting.  It seems to be saying that many cases of infection actually existed prior to birth (i.e., not due to colonization as baby passed through vagina) http://www.glowm.com/?p=glowm.cml/section_view&articleid=179#1264

 

And this is a case study from the NIH website about twins where the one with ruptured membranes was fine and the one with intact membranes got sick:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2364382/

 

Actually, I think the possbility that most cases of GBS infection come in utero and are only discovered after birth makes the case against testing and treating as per protocol pretty strong.  I'll still test because of my concern about having an early baby and ending up in hospital - hospitals really like their i's dotted and t's crossed.  And I'd still treat given 2x risk factors.  But NOT simply for a positive test.

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