Positive for Group B Strep « Back to Group Discussions

[kaliki_kila]

My heart fell this morning when I logged on to Kaiser to see that my test results are in for Group B Strep and I am positive.

I did everything that I was told to do by the doula who taught our Bradley class - I took probiotics, used a garlic insert, ate a lot of yogurt, everything that I could do to try and sway the results.  This is also my first baby so I had no indication that I would test positive for this.  

Now please help me to deal with this and tell me everything you can about this so I can make an informed choice.

My deepest hope was to labor at home for as long as possible and now that is out the window.  I will have to go in early enough to get antibiotics.

The Bradley teacher talked a lot about the antibiotics and told us as in class that we shouldn't get the antibiotics at all because the chances of the baby contracting Group B are very slim.  I need to go back over all the documents she gave us that essentially said the antibiotics might not be good for the baby while in labor.  But then the baby would have to be held for monitoring and we would probably be sent home while the baby stays in the nursery for a few days.

Help!    I know I can deal with this but just need all the information you can throw at me.

[Mamabeakley]

I found Mothering's articles about this issue very helpful.  I don't have links handy but I bet they're pretty easy to find on this website.  

It sounds to me like you probably need to have a talk with your provider/doula/CBE about what exactly happens if you decline antibiotics or simply don't get to the hospital in time to administer them according to protocol (it does happen by accident all the time - what do they do with a GBS+ mama and an obviously healthy baby - do they REALLY keep them all in the NICU or Nursery for days?)  If that's REALLY  what happens, then you need to know that and account for it.  If that's what they say happens but actually if baby is healthy they let you go home, that's a different story.

My personal analysis of the risks/benefits has been that if I were GBS+ AND had another risk factor (pre-term, prolonged rupture of membranes, or signs of infection) I would take the antibiotics during labor (except my labors have been short enough that I couldn't have.)    Otherwise (if I were GBS+ but did not have any other risk factors) I wouldn't take the antibiotics and would prefer to treat a sick baby than an apparently well mama.

You CAN figure this out, you're right.  ((((Hugs))))

[sweetmilk]

Well it may depend on the hospital policy . but I know a few people that got to the hospital and it was time to push and   the baby was out in no time. They did test positive to the test but the time spent at the hospital was so short ,the antibiotic wouldve not had time to work so they didnt get it. And all babies were find and when home with mummy. Dont panic over this. Where there is a will there is a way. What can they really do if you refuse to take it?.....probably nothing. I am still waiting for my result. I should get them Monday.We will see maybe I will be the one in panic then!!!! For my part I am not to trill about feeding antibiotic to my baby(because it would leak in breastmilk) first thing into this world. but that is just me.

[tropicana74]

Originally Posted by kaliki_kila 

My deepest hope was to labor at home for as long as possible and now that is out the window.  I will have to go in early enough to get antibiotics.

Nope, it's not out the window. If it were me I would still stay home and labor as long as possible (unless of course you were dealing with other issues that Mamabeakley pointed out ~ pre-term, prolonged rupture of membranes, or signs of infection).  If you aren't there in time, then you aren't there in time....nothing anyone can do about it. The chance of baby getting this are SUPER slim if you have no other factors.

And, they can't MAKE your baby stay either. It is your baby and you can check them out (they will make you sign something saying you are doing it against medical advice). Each pediatrician is going to have their own take on that one. The ped is going to be the one to fuss over it more than your OB or MW would.

[rnra]

I too think it would be a good idea to have a candid discussion with your care provider about the positive GBS results.  You can read the CDC guidelines for antibiotic use here:  http://www.cdc.gov/groupbstrep/about/prevention.html

[lovingsong]

Kaliki_kila, mama, I know the feeling. It's a really hard decision to make. GBS is one of those situations where there is no clear answer, and a lot of people feel strongly towards one side of the argument or the other, with good scientific backing on both sides. It's a transient bacteria, the testing is not foolproof, and there are a lot of potential alternative remedies which sometimes work and sometimes don't. I agonized over whether to test, and then when I did finally test and got a positive result, I agonized over what to do. Garlic suppository or chlorhexidine and retest? Antibiotics? - and if so, when and which kind and how often? The risks of GBS are very slight, but they do exist, and everyone has to make a decision that feels right for them.

I would think good and hard about whether you want the antibiotics. It's a hard decision to make because we do not always know the effects of abx on ourselves, let alone on our unborn children, but it has been proven to reduce instances of natal infection. Think about how the idea of abx in labor makes you feel, and decide whether you want to take the chance of GBS or  the chance of abx complications - both slight but both possible. If you decide you do want to do the abx, you can still get to the hospital as late as possible to avoid having more than one dose and also to avoid any potential interventions that might make it more risky, like stripping or vaginal exams. As long as you receive one round of abx 4-6 hours from the birth, that should be enough for the hospital (though they do recommend two doses they are usually ok only giving one). Also, my midwife explained that so long as your water doesn't break, the baby is not making contact with your birth canal and thus is at very low risk of infection. Along  these lines, if you haven't already, it might be good to start taking 2 capsules of omega 3 daily to ensure that you can get to the hospital as late as possible. I can't say for sure whether the omega 3 actually works this way, but it is supposed to strengthen your membranes and ensure that your water doesn't break before contractions start. This way the water will hopefully break as your baby is being born, and not before.

Good luck mama!

[kaliki_kila]

Thanks everyone for your input.  I had a good cry with my dh reassuring me this morning that everything will be fine in the end.  

I have been taking fish oil/omega 3 all through my pregnancy.  I found some other things mentioned online that I can take and I'll pick them up today - garlic, vitamin c, more probiotics, echinacea.

I have a very supportive midwife at Kaiser who took me into her office my last appointment and gave me the longest and most motivating speech on natural childbirth completely out of the blue.  I'm going to talk at length with her about all the implications of this and what my options are and what Kaiser's policies are depending on what happens.

I still want to labor at home as long as I can.  I want to know if I will still be able to labor in the tub at Kaiser and if one round of antibiotics would be enough without further monitoring of the baby if I did go that route.  The nice thing is that this Kaiser I will be delivering at is baby friendly certified, has almost a 100% breastfeeding rate (thrush is another thing I'm worried about as well), so I know that they will be easier to work with to get the birth I'm hoping for.

I'm also dealing with some emotional feelings about this - I told my dh that I feel kind of unclean because there is something in me that can harm my baby.  I know it's a very common thing that up to 30% of women test positive for, but I just hate that feeling.

[tropicana74]

Originally Posted by kaliki_kila 

I'm also dealing with some emotional feelings about this - I told my dh that I feel kind of unclean because there is something in me that can harm my baby.  I know it's a very common thing that up to 30% of women test positive for, but I just hate that feeling.

That sounds normal. I would probably feel the same way too. Sorry you are having to deal with this. 

Originally Posted by kaliki_kila 

  The nice thing is that this Kaiser I will be delivering at is baby friendly certified, has almost a 100% breastfeeding rate (thrush is another thing I'm worried about as well),

That is always my concern too when I hear about abx treatment prior to or during labor. I have seen too many mamas end up with thrush right off the bat because of the abx. 
I am glad Kaiser has become more baby-friendly. I was actually born in Kaiser in Walnut Creek (that was the only one around back in 1974)! I think my mom had 5 out of 6 of her kids there. She had natural labors/births but she had to fight for them. When she had my sister the doctor gave her a shot of something against her will and she was pi$$ed! The OB felt bad so he actually let her reach down and catch my sister....unheard of back then!!

[Mamabeakley]

I understand that feeling of being 'unclean' - and it's a feeling, not a fact.  That doesn't make it less important . . . BUT it's also important to remember the facts: that GBS is a NORMAL part of the flora in your gut which usually doesn't cause any problems even when it migrates to other parts of your body.  And, that they way they do the test doesn't tell you whether the bacteria is in fact in your vaginal tract or in your anus, since they swab both with one swab.  Your baby gets 'colonized' with thousands of different kinds of bacteria on his/her way through your vaginal tract, the vast majority of which are healthful and a part of the initiation of his/her immune system.  That includes GBS for MOST babies of mothers who are GBS positive.  It only makes a VERY SMALL percentage of babies sick.

[Lilac11]

I feel for you during this dilemma.  But I agree you have a lot of options!

I would definitely agree about meeting with your provider about it and making a list of questions for them, including their professional opinion of risk/benefit of each option you are considering!

[mamaharrison]

I am GBS+ and never take ABX. I have a fatal allergy to ABX used.

Here is a lot of great info. It is NOT proven that ABX given in labor reduce infection rate. In fact, it does contribute to resistant strains of the bacteria and if you have a resistant strain then the ABX you get may be completely ineffective. http://www.gentlebirth.org/archives/gbs.html

Ultimately do what YOU are comfortable with. I birthed DD in a hospital and they released us in less than 24 hours. IMO, this is more of an issue to discuss with your pediatrician than anyone else. We have a pediatrician who was able to explain to us the real risks involved vs. the imagined risks and who also felt very comfortable caring for our baby and monitoring for GBS. 

[JudiAU]

I mostly post in November 2012 but I thought I would review what my homebirth midwife has told me. I am GBS+ for the first time. My water broke in both previous labors about 7 hours before I went into labor. And my second labor was only 2 hours and I gave birth at home, unassisted, and unplanned. So, I have additional risk factors and I also have taken antibiotics exactly one, got hives, and have family allergies to most other antibiotics. 

So, background in Europe they usually don't test at all and with no care, about 2% of babes get infected. If they are infected about 1/3 die and or have some serious birth injury like hearing or vision damage. 

There is solid research that a hibicleanse/probiotics routine can knock out the bacteria equally as well as antibiotics. The new protocol is actually 2 hours before labor but most docs still say 4. You can take antibiotics prior to going into labor, knock out the infection, but you need to keep taking it until you give birth to keep the infection at bay.

So, failed the test and have been doing a thrice daily + any other bowel movements wash. Use peri bottle, cover the bottom with hibicleanse, fill 2/3 way with water and wash very well. You don't need to rinse the whole vagina but do go up a bit. We retested in a week but I haven't heard the results yet. Either way, I'll continue until and during birth. Probiotics too. 

I also had the option of going on antibiotics until labor or starting immediately when labor starts. I filled the perscription but I haven't decided what I will do with it. I am waiting to hear if I knocked it out with the first round of hibiclens. 

Good overview here: http://mountainviewmidwives.com/group_b_strep.html  She also gave me a copy of the Mothering article.

So, for me, I don't have to worry about silly hospital procedures but I do have to be cautious about transfer itself.

[mamaharrison]

Just as an FYI: Hibicleanse is a powerful chemical agent and does have its own side effects. It is not a begnin or natural treatment even though many MWs tout it to be. It can and does wipe out good and bad bacteria and vaginal flora and can contribute to secondary infections as a result. It is essentially douche, which most of us know to be very harmful to the natural environment of the vagina. Babes NEED to pass through the vaginal flora of mama in order to start building a healthy immune system--if we remove ALL bacteria, good and bad, from the environment we are robbing our children of a healthy start in life.
It is a big issue with serious consequences on both sides, but it is rarely presented as such to mamas. Make sure you are making a truly informed decision on it--one that you are comfortable with. 
It helped me to look at the studies of the complications of the treatments being offered--there are fatal outcomes for ABX method, too.

[kaliki_kila]

Originally Posted by tropicana74 

I was actually born in Kaiser in Walnut Creek (that was the only one around back in 1974)! I think my mom had 5 out of 6 of her kids there. She had natural labors/births but she had to fight for them. When she had my sister the doctor gave her a shot of something against her will and she was pi$$ed! The OB felt bad so he actually let her reach down and catch my sister....unheard of back then!!

Now that Kaiser is the best one to deliver at if you want to have a natural birth, with midwives delivering and only doctors if you are high risk.  I've heard if you bring a doula, they will give you a room and then just leave you alone the whole time.  I would go there, but it's a little too far.

Originally Posted by Mamabeakley 

I understand that feeling of being 'unclean' - and it's a feeling, not a fact.  That doesn't make it less important . . . BUT it's also important to remember the facts: that GBS is a NORMAL part of the flora in your gut...

Thanks for that.  :)

Does anyone know anything about giving probiotics to newborns?  That is one option I am looking at if I do decide to get antibiotics.  They do give penicillin, which I am reading is the best antibiotic to get for GBS of all the choices.  I don't know what brand of baby probiotics would be best to get and if I would just give it as a one time thing after the birth to re-colonize his gut or if I would continue to give it as an ongoing thing.

Thank you everyone for all the information.  I've been doing a lot of research and looking into all the options you have given me.

[kaliki_kila]

Originally Posted by mamaharrison 

Babes NEED to pass through the vaginal flora of mama in order to start building a healthy immune system--if we remove ALL bacteria, good and bad, from the environment we are robbing our children of a healthy start in life.
 

Just curious... what about babies who are born in the caul?

Does anyone know if they generally consider you GBS+ for all subsequent babies as well or if they let you retest with each pregnancy?

[Lilac11]

You retest with each pregnancy!

[mamaharrison]

Originally Posted by kaliki_kila 

Just curious... what about babies who are born in the caul?

Does anyone know if they generally consider you GBS+ for all subsequent babies as well or if they let you retest with each pregnancy?

The caul is a semi permeable membrane, meaning that the vaginal flora still enters their system ; ) Babies born with intact membranes can still contract GBS, too. 

You can retest for each pregnancy, but once you are GBS+ you are generally considered to be positive i future pregnancies. You can always deny or request the test be repeated.

[lovingsong]

I think it depends where you live, because where I am they do not consider you positive or offer abx just because you tested positive in a previous pregnancy. They test you at each pregnancy and go by those results. The only time the status "carries" over is if you had a GBS infected baby in a previous pregnancy (not the same as mama being colonized). Of course, this protocol depends on where you live, so what is true around here might not be true for you. However, if you test negative in this pregnancy after testing positive in the same pregnancy, that's a different story.

About being born in the caul: Although it is semi-permeable, so long as the membranes don't rupture it's very unlikely that your baby will come in contact with the GBS bacteria, so babies born in the caul are pretty much protected. I'm actually praying for an "in-caul" birth for that reason, though it's usually 1 in 80,000 so certainly not worth it to hold my breath ;-) Also, in terms of abx, you need them to be in your system for 4 hours for them to work, so it's not helpful to wait for the water to break to take the abx because if that happens within 4 hours of the baby being born, the abx that you took would essentially be useless.

However, I agree with Mama Harrison about hibiclens; a lot of midwives hold by it and even say that it is less evil than abx because it doesn't cross the membranes, but there really isn't enough information about pre-natal use, only intrapartum use - and in terms of intrapartum use, it has been shown to be as effective as abx, but not necessarily safe for you or the baby. It's still chemicals and you are still douching, and to me both of those things sound counter-intuitive in pregnancy.

I just have to say that I could talk for hours about this issue, as could many people who have encountered it personally, and the reason is because it is so full of grey areas, from testing to diagnosis to treatment. Everyone has to choose the regimen they feel best about. For whatever reason, perhaps because I've got close ties to some horror stories about it or perhaps because of my own fears as a first-time mother, especially giving birth at home, GBS scares me and I feel the need to take care of it. Other people, less exposed to those horror stories and perhaps with different fears in pregnancy, might look at those same risk factors and decide that it is not necessary to treat.

I decided to test and came out positive. I did the chlorhexidine treatment, VERY reluctantly, for a week before deciding I just couldn't do it anymore. Since I first tested, I've been taking 5 billion units of acidopholus a day plus 1200 mg of garlic, and 1000 mg of vitamin C, in addition to prental vitamins and omega 3. I retested last night and I'll see what happens in a couple of days; if I come out negative, I will probably only take the abx if I encounter the risk factors (PROM or high fever). If I retest positive, though, I plan on taking abx from active labor and on. I've found a midwife who will do it at home, and decided this is the best of both worlds - yes I'll be taking abx, but at least neither me nor baby will be exposed to hospital germs. This is my decision, however, and I know others would feel differently. And regarding probiotics, you can give it to the baby after it is born; just ask your midwife for exactly how much and how. It's not a perfect fix and obviously a drug free birth would be best, but it really adds up to what makes you feel most comfortable.

[kaliki_kila]

Originally Posted by lovingsong 

I decided to test and came out positive. I did the chlorhexidine treatment, VERY reluctantly, for a week before deciding I just couldn't do it anymore. Since I first tested, I've been taking 5 billion units of acidopholus a day plus 1200 mg of garlic, and 1000 mg of vitamin C, in addition to prental vitamins and omega 3. I retested last night and I'll see what happens in a couple of days; if I come out negative, I will probably only take the abx if I encounter the risk factors (PROM or high fever). If I retest positive, though, I plan on taking abx from active labor and on. I've found a midwife who will do it at home, and decided this is the best of both worlds - yes I'll be taking abx, but at least neither me nor baby will be exposed to hospital germs. This is my decision, however, and I know others would feel differently. And regarding probiotics, you can give it to the baby after it is born; just ask your midwife for exactly how much and how. It's not a perfect fix and obviously a drug free birth would be best, but it really adds up to what makes you feel most comfortable.

I saw your thread from earlier.  Sorry to hear that you tested positive as well :(  I'm taking garlic, vitamin C, fish oil, probiotics and echinacea.  I'm still looking into what probiotics would be best for the baby.  Are you going to give your baby probiotics if you do get the antibiotics?  I'm not sure if the midwife would know what kind is best, but I can ask at my next appointment.

[rnra]

Originally Posted by mamaharrison 

You can retest for each pregnancy, but once you are GBS+ you are generally considered to be positive i future pregnancies. You can always deny or request the test be repeated.

The only time GBS status is carried over from one pregnancy to another is if the baby is infected with GBS after delivery.  If a baby has GBS sepsis, then all future pregnancies are automatically treated as GBS+.

If the mom is GBS+ but the baby has no after effects, then that GBS "episode" is null and void during the next pregnancy and testing is done again.