I don't want an IV of antibiotics - Page 3

[lorijds]

I also am interested in the data regarding the antibiotic reaction. Everything I have ever read does not show that; the risk for morbity and mortality from GBS disease is greater than that of antibiotic reaction in all of the research I have seen. Certainly, we should ALL be aware that taking any any any medication, herbal or vitamin carries the potential of reaction. But that they are equal? I'm not sure I am willing to accept that without seeing some hard data.

We always encourage our clients who choose antibiotics to begin a low daily dose of probiotics at 37 weeks, and then up that to a higher daily dose when labor starts, and continue that for 1-2 weeks after birth. Actually, we just encourage this for anyone who is on antibiotic therapy. Just dont take the probiotic and the antibiotic in the same gulp--take them 2 hours or more apart.

[lorijds]

Oh, maxmama--
I did not have the opportunity to ask the pharmacist--but I asked an older nurse who had been at the hospital 30+ years. She said that we do give one antibiotic that contains lidocaine, but that thisisn't routine with any other.

Another things is that, yes, with our Baxter pumps, the mainline is completely shut down and does not drip at all during the piggyback. However, I would like to note that although our pharmacy tells us the rate to run the antibiotics, but that is the maximum rate and it is part of our hospital protocols that if we want to decrease the rate due to patient comfort, we can. I'm assuming this is an option at many facilities.

Lori

[laralee16]

nak
I had the iv full of cr@p, and it did not burn. it made me cold cold cold.

[schatz]

I'll just add my $.02 fwiw.

I had abx with both dc's because they were both preterm (34 and 34.5 wks) which meant they were "more at risk" and I had unknown GBS status. With dd it caused problems afterward because my labor was longer so the abx got into her system which led to thrush by day 4 after birth. With ds we had no thrush problems but the IV was in for only about 2 hrs before he was born cus labor was quick. I also started probiotics right after delivery with ds cus I knew better after my experience with dd. The IV burned both times but it was not a major problem - unpleasant but not a big deal. The bigger problem was the yeast overgrowth with dd (it went on for four months, passing it back and forth between the two of us).

More anectdotal info: a colleague of mine had her baby at term w/o abx as she tested negative for GBS at 35 wks (or whenever that test is). Her ds ended up in the NICU with GBS infection. I don't know the details of her labor but the whole GBS testing/abx if positive/etc is not foolproof.

If I were you, I would be inclined to work naturally to get rid of the colonization in the urinary tract for a healthier you in general. Then, force a retest. If you end up with the same providers for labor that you have now, I would probably be inclined to go with abx on the front end and deal with possible thrush on the back end rather than be labled a trouble-maker and risk having your baby put in the NICU when it's not warranted. You want the docs/midwives working with you not against you.

[lilyka]

for me it depended on the circumstances. it is rare that it is passed on without additional risk factors. So in the absences of those risk factors (prolonged ruptured memberans, pre-term bith, fever, large amount of bacteria present . . etc . . ) I was leaning towards not doing it. it did mean consenting to an extra 24 hours in the hospital (i was planning on a 6 hour departure which makes 24 hours more seem less dramatic) and blood draw on the baby.

in the end my labor went so fast that I missed it entirely. I went into labor, called to get the results of the culture (which unfortunately were positive) and went in early to my prenatal to discuss options. good thing too. I delivered a few minutes after showing up in my midwifes office. problem solved. we had decided to go with antibiotics to appease the pediatrition and get out. a big winter storm was moving in and we just wanted to be home. also during my pregnancy I met somone whos ebaby was born early and got group be strep. 3 weeks in the NICU on antibiotics and she her chances of death were 1 in 6. I just couldn't risk that. regardless of how rare it was.

So Ava was obviously born without getting those antibiotics into me and had the blood work. if you opt to go this route ask for the NICU to come and get the blood (its is a vein draw). and do not allow an arterial draw. in the absence of any signs of sickness it is not that important. Avas first blood draw came back very bad (I couldn't understand it, she had no open wounds and my water broke 3 minutes before she came out.) turns out it was just a weird fluke.) they never got any more blood after that. she just wouldn't bleed from a poke and she got my really deep veins. we ended up staying 2 1/2 days for observation.

sometimes even the best laid plans get disrupted by real labor. I really had every intention of getting them but Ava had diffrent ideas

but in the absense of risk factors and symptoms I think all of this is largely unessecary.

since you had such a high conolization i would consult with someone on what to do about that and then be retested. I would be concerned with a high colonization not just for the baby but for you. you want your flora etc to be in balance just because it ought to be and an imbalance in one place genrally means an imbalance elsewhere. So definitely get checked again so you at least know if you have fought it off some. I htink if it were stil showing up in your urine they would tell you. but definitely get tested again. it might not change the fact that you are group b positive but it could mean teh different between weather or not you are willing to risk going without the antibiotics.

Ih ad antibiotics with my first because I didn't make it to the test. they were trying to keep me in labor for 5 days because then we would have been clear. but my water had already broken so they gave me antibiotics every couple hours to stave off any infection. unfortunately I didn't make it very long (8 hours total and they stopped the antibiotics once they realized that all the fluids in the world weren't going to slow things down. So I was on massive amounts of saline (they were squeezing the bags in for a while). t he piggy backed the antibiotics and i couldn't have told you the difference of when they were there or not. I also missed the pit. they snuck in (my poor midwife was fighting a loosing battle. but I admire her willingness to fight it to the bloody death) So if you do have an IV have someone keep an egal eye on what is going in.

its such a hard choice. thre are pros and cons both ways. some things are worth the battle and some things aren't. for me IV antibiotics were somewhere between throwing the Dr. a bone so i could have all the other stuf I wanted and that little voice in my head that said "rare but deadly. can you live with that over a comfort issue?" Everyone has thier issues that they need to sort out. if you do take them or don't being confident in your descision that you are doing the best you can for you and your baby will make it all a lot easier to move forward in peace.

[oregongirlie]

All healthcare providers need to be as thorough and articulate in their explanations. It would save a lot of hassle and is a lot more respectful than, "You have to do it." Great post Dr.

[khaoskat]

Originally Posted by illinoismommy

"However, a pregnant woman who is a group B strep carrier (tested positive) at full-term delivery who gets antibiotics can feel confident knowing that she has only a 1 in 4000 chance of delivering a baby with group B strep disease. If a pregnant woman who is a group B strep carrier does not get antibiotics at the time of delivery, her baby has a 1 in 200 chance of developing group B strep disease. "

I guess I'll just get the darn thing..... sigh.... has anyone had the group b strep and can tell me it does *not* burn?

2 pregnancies and no gbs for me so far. Will not be tested for this one for about another 3 weeks....and the results will take several days to get.

I did have IV antibiotics when I had knee surgery several years ago, though, and I don't remember any burning. The IV antibiotics are a precaution in the hospital I used, to ensure that if anything gets into your body during surgery it doesn't cause an infection. In addition, I was on oral antibiotics for about 3 days after surgery (could have been longer that was in 2002).

[indie]

Originally Posted by illinoismommy

I guess I'll just get the darn thing..... sigh.... has anyone had the group b strep and can tell me it does *not* burn?

I got the antibiotics and it did NOT burn. My midwife said that if it burned she could slow it down, but it wasn't a problem.

Read this article before you decide. I'm not going to get the abx next time unless I have risk factors. I feel that pre-treating something that we'll probably not get opens us up to too many potential side effects. There is not as much research out there as I would like, but I feel that the 1 in 200 number reflects women who have unnecessary interventions like vaginal exams. Who knows how many of those cases are iatrogenic?

It is true that having GBS in your urine means that you have a higher colonization, but you should be able to have further tests and in the end the decision should be yours. Its so frustrating to hear about these docs and medwives who think its there business to decide for us.

[indie]

I just read the rest of the responses. I had my abx run much faster than 30 min. It was more like 15 min. It didn't bother me at all.

I'm curious why taking steps to eliminate the GBS or at least get it out of the urinary tract and retesting (perhaps several times to make sure) is not recommended? If its so bad that she has it in her urinary tract then wouldn't it be best for mom and baby to try to get rid of it even if she chooses to use abx during labor? Sooner or later GBS is going to be resistant to all of these abx. Then what are we going to do in cases where there really is a strong risk? Why isn't anyone exploring other ways to deal with this? The risks of abx are not limited to thrush, although thrush can be very, very nasty in some cases.

[indie]

Also, I'd love to see the risks separated out for women who have urinary GBS vs. women who just have vaginal GBS. Is the 1 in 200 a combination of both of these groups?Does any have this information? That would make it much easier for all of us to make informed decisions.

[CEG]

Originally Posted by lorijds

I don't see how if the abx is piggybacked or not makes any difference; the main line stops while the abx solution is running.

I just wanted to second this and add that I had the abx with both of my labors. With my first I tested positive. I loaded up on yogurt and Vit C but opted to get the abx as well. I received five doses (long labor) which was excessive IMO but no one knew my labor would go on that long.

With my second, I declined the test and chose to get the abx. My reasoning is that I know I was colonized so I chose to have the abx regardless of status becuase the colonization is transient.

The risk of GBS infection in the newborn to me is low, with a horrible effect if infection occurs. To me, the abx carry their own risk, but low compared with that of GBS.

GL to you and I hope the midwife on call is great. I have been in a similar situation and got lucky with a wonderful on-call provider. I hope the same happens to you.

ETA: the real point of my post was to say I had a ton of doses and never experienced any burning at all.

[orangebird]

Originally Posted by illinoismommy

I think so too. Does anyone have any information? I don't want to refuse antibiotics and put my baby at risk obviously.... :

Another thing.... you said there is a way for homebirth midwives to test at home? And if you are positive, and you have a homebirth, is there any way to test your baby at home to see if they didn't get it?

Yes, they can test at home as easy as in the office. The swab used is quite portable, the size of a jumbo straw all together, it's basically just a long q-tip that gets put in this little plastic tube to be sent off for the testing. Shje would have to send it from her office, so it doesn't really matter where the actual swabbing is done, home, office, wherever. I have heard of many midwives letting the client swab herself.

Oh wait, you mean test the baby? Just monitor cloely for any "off" symptoms, like fever. I had my last baby at home after no GBS testing. We pretended I was positive just for the sake of how to treat. I had no ABX but she had me check frequent temperatures the first day or two and was to notify her is there were any signs of him getting sick. Of course I am a NICU nurse so I'm used to looking for symptoms of a baby getting sick, but you should be able to monitor the baby fine at home assuming there are no problems that warrant closer observation at a hospital.

No one can make you do anything. Just keep doing what you are doing. Arm yourself with as much factual information as you can. DOn't buy into the hysteria, use facts and common sense as your guide.

[doctorjen]

Okay, I went searching for the rationale behind considering GBS in the urine to be a risk factor for increased perinatal transmission.
The CDC guidelines (which are what hospitals use to determine when to test, when to treat, what meds to use, and what to do with the baby) consider GBS in the urine at any time during pregnancy to be a risk factor requiring treatment in labor. They do not recommend retesting women at 35-37 weeks who have had GBS in the urine.

So then I looked up the references they used for this recommendation. There are 2 studies, one from 1985, one from 1981 about the risk of neonatal transmission in women with GBS bacteruria. One studied also compared the culture rates in the rectum and vagina for women with GBS in the urine. They are relatively small studies - both having around 50 women with GBS in the urine. They found higher rates of illness in infants born to those moms - but the infants were not all tested and proven to have GBS. In fact, I think only 1 infant in either study had GBS sepsis making it pretty small numbers with pretty low statistical value. The one study did find that women with GBS in the urine had higher bacterial loads in the vagina or rectum than women without, though.

Then, I poked around some on medline and found a study from 2003 which looked at women with GBS in the urine during the first trimester. They recultured women at 35-37 weeks, urine, rectal and vaginal cultures and found only a small percentage were still testing positive at 35-37 weeks. This was a small study also, only 53 women.

So it looks like there really isn't great data about why GBS in the urine is considered a risk factor, other than it may be a marker for heavy colonization and some really old studies I found (late 1970s) suggested there were increased rates of illness in infants born to moms with GBS in the urine - but these studies did not culture babies to determine what organism they actually had, and used a urine culture obtained from the mom 3 days AFTER delivery, so I don't know that they have anything to do with what we are talking about.

The 1 in 200 rate of transmission is for all comers, I think. I cannot find real numbers for rates of transmission for different situations (for example, GBS in the urine, in the vagina or rectum, or in folks with risk factors.) The widely used studies that talk about the reduction in risk with antibiotics are projected studies - they estimate what the risk reduction would be, they are not studies that look at what the actual rates were with and without antibiotics. The incidence of GBS sepsis in newborns now is about 0.5 per 1000, but that reflects the current wide spread use of culture and antibiotics in the US. Also, it turns out GBS cases in infants were decreasing before the wide spread use of antibiotics, so it's hard to calculate how much of that is due to current treatment strategies.

I don't know if this data helps or not. I think it's helpful to know the numbers when making your decision, but it's also helpful to know what your providers are going to consider to be their standard and the standard for newborn care to help you decide if you want to swim upstream so to speak.

[~Shanna~]

This thread has been so helpful for me, thank you. I just got a call from my MW yesterday that my urine tested positive at 9 weeks, and they want to put me on amoxicillin.

[kriskriskris]

Hmm, this is an interesting thread. I was tested for both my pregnancies twice, 1when I was about 5-6 weeks and the other at around 37-38. What's interesting is that alot of you are talking about your urine being tested... my OB did a swab test, she swabbed my vaginal/anal area (not sure but it was "down there"). I was GBS positive every time I tested.

Illinoismommy, if it makes you feel any better, (though I was probably lucky) with my second child I was already 7-8 cm. and even though they started the IV they were pretty sure I delivered before the antibiotics had a chance to work, so they tested my daughter for something... I forgot what twice and she was fine.

I am sure everyone has a different opinion but the ped. said that because I delivered shorty after my water broke, the baby had less chance of picking up the GBS... I do agree with others that have said you need to find someone that will be more open to what YOU WANT and give you another test!

GOOD LUCK! I hope everything works out for you!!!

[kylewilliamsmom]

When I had my son in 2003 I was Group B strep positive too. I came it at 4 cm dilated with my water bulging after being 10 days late. I labored for 8 hours and pushed out my son after two rounds of antibiotic. The antibiotic didn't burn, they were more than happy to put a hep-lock on so it was easy for me to go from tub to bed to shower etc. I did have to be hooked up for the 30 minutes it took to administer the two doses. My midwife just informed me this week at my 36.5 week appt for baby no 2 that I am Group b postive again. The antibiotics are administered 2 mg the first dose and every 4 hours after at 1 mg.

I definately agree with those who have encouraged you to look for a healthcare provider that is more compassionate and will listen better to your concerns and opinions, this is YOUR BODY and YOUR BABY!

Good luck.

[CookieMonsterMommy]

Originally Posted by illinoismommy

I guess I'll just get the darn thing..... sigh.... has anyone had the group b strep and can tell me it does *not* burn?

I can tell you as an antepartum nurse that the docs usually prescribe Ampicillin for GBS, and it does *not* burn. Are you allergic to penicillin?

[mamaverdi]

Slightly OT: So why no cephalosporins for pen allergic people?

mv

[CookieMonsterMommy]

MV,

10% chance of a cross allergy. (10% who are allergic to PCN are also allergic to cephalosporins). But then you eliminate a potentially helpful antibiotic, so an allergy testing would be good.

On another OT side note-many PCN allergies are not allergies. They were rash-y reactions that children get and often times out grow. Because of this reaction, people never take them again and no one knows if they were really allergic to it or not. I'm thinking about getting tested to see if mine was a true allergy or not.

[mamaverdi]

What does the testing involve?

My grandmother has an anaphylactic reaction to PCN. Both of my boys have clustering hives with chepalosporins.

Very very very very nervous now about the PCNs....especially with my youngest who is antibiotic resistant with most infections...at the ripe old age of 2.5 yrs.