Question about GBS treatment options

[Nicole B]

I have a friend on another board that found out recently that she is GBS positive and she is wanting a very low intervention (natural as possible) hospital birth.

She really does not wish to be hooked up to an IV receiving antibiotics.
Is there other options for her?
Is it possible to get the same effect through periodic oral doses of antibiotics?
I'm sure if she refused it altogether they'd kidnap her baby to special care nursery for who knows how long:

Anyway any advice is greatly appreciated!
TIA!!!:

[nashvillemidwife]

What would happen if she simply declined to have the IV antibiotics?

She would need to be covered by the oral antibiotics from now until delivery, so the frequency of repeating the rounds will differ according to the antibiotic's half life.

There are the chlorhexidine rises. There's a lot of information out there, so I'll let you google it yourself.

[trimestersdoula]

Actually the chances of anything happening have been found to be the same with OR without antibiotics. I honestly don't think those antibiotics do much except help the mother to believe her and her baby are safer than they were without them.

[Nicole B]

Yeah I know and I personally don't even think the test is worth the vag exam it takes to get the culture
But it seems that in the hospital setting if you don't play by their rules they literally take your baby for ransom:
I was just trying to help her search for a compromise that her and her OB would be happy with

[nashvillemidwife]

trimestersdoula, where did you get that information? The research I have says antibiotics cut the risk of having a sick baby in half. If the baby does get sick, there's been no difference in outcomes as to whether the mother was treated or not, but it's not true that antibiotics don't have an effect on any outcome.

Since we began implementing prevention strategies the rates of GBS disease of the newborn have been reduced dramatically. The number of babies who are at risk without prophylactic intervention is still very low, but the testings/antibiotic recommendations have had a significant impact.

[maxmama]

EVen if her abx are IV, she doesn't need to be hooked up through labor. We saline lock our GBS prophylaxes. If they use an alternate regimen, like clinda, then it's only every eight hours instead of four.

We will on occasion even send home our SROM GBS+ moms and have them come back in eight hours for another dose if they're not in labor.

Just to clarify, you don't need a vag exam for GBS. It's a q-tip and you can do it yourself.

[wendy1221]

Originally Posted by nashvillemidwife

What would happen if she simply declined to have the IV antibiotics?

She would need to be covered by the oral antibiotics from now until delivery, so the frequency of repeating the rounds will differ according to the antibiotic's half life.

There are the chlorhexidine rises. There's a lot of information out there, so I'll let you google it yourself.

My sister did the chlorhexidine rinses and retested negative. That would be my first choice, personally.

[Nicole B]

Both my previous drs just automatically gave me a vag exam and did the swab durring it...
I've never even been given the option of doing it myself
The saline lock does sound like a better compromise that being attached throughout labor to an IV drip

Does anyone know the percentage of pg women who test pos for GBS?
I hear more about it now more than ever before

[maxmama]

Originally Posted by Nicole B

Both my previous drs just automatically gave me a vag exam and did the swab durring it...
I've never even been given the option of doing it myself
The saline lock does sound like a better compromise that being attached throughout labor to an IV drip

Does anyone know the percentage of pg women who test pos for GBS?
I hear more about it now more than ever before

Everyone carries GBS in the gut. About 30% of women become colonized in the rectum or vagina (which is when the risk arises).

[trimestersdoula]

Originally Posted by nashvillemidwife

trimestersdoula, where did you get that information? The research I have says antibiotics cut the risk of having a sick baby in half. If the baby does get sick, there's been no difference in outcomes as to whether the mother was treated or not, but it's not true that antibiotics don't have an effect on any outcome.

Since we began implementing prevention strategies the rates of GBS disease of the newborn have been reduced dramatically. The number of babies who are at risk without prophylactic intervention is still very low, but the testings/antibiotic recommendations have had a significant impact.

I will find where I found that. Be back soon

[trimestersdoula]

Found it!

http://www.mothering.com/articles/pr...n/group-b.html

[wannabe]

Originally Posted by maxmama

EVen if her abx are IV, she doesn't need to be hooked up through labor. We saline lock our GBS prophylaxes. If they use an alternate regimen, like clinda, then it's only every eight hours instead of four.

We will on occasion even send home our SROM GBS+ moms and have them come back in eight hours for another dose if they're not in labor.

Just to clarify, you don't need a vag exam for GBS. It's a q-tip and you can do it yourself.

Yeah, that. And you don't even need a heplock.

My waters broke at 7am, I went in to the hospital at 10:30, had an IV of antibiotics run in (took 20 minutes), took the needle out and went home. My baby was born four hours before I was due for the next round at 8pm.

[nashvillemidwife]

Originally Posted by wendy1221

My sister did the chlorhexidine rinses and retested negative. That would be my first choice, personally.

If you're going to do them prenatally, you should repeat them periodically. Unfortunately we don't know how often, but just like the antibiotics, once it knocks out the bacteria it can re-colonize.

[nashvillemidwife]

maxmana, GBS is not usual intestinal flora, though everyone says that. It's benign, doesn't cause any problems, but still not "normal".

trimestersdoula, that article cites one study of at least dozens that found different conclusions. The study included testing moms for the bacteria at 28 weeks, which in no way indicates the status of those women at the time they were given antibiotics.

I have issues with a couple things in that article. For example, "Approximately 0.5 percent of women found to have GBS bacteria in their genital areas at 35 to 37 weeks into their pregnancies will go on to deliver a baby who becomes ill from GBS. This is 0.5 percent of women who receive no antibiotics during labor and delivery."

Most babies who get sick did have antibiotics, because in this day and age most babies who are at risk were exposed to antibiotics per the CDC recommendations. All due respect to the author, but her statement seems to reflect what she assumed was a logical conclusion, but it's wrong.

I'm not advocating IV antibiotics, but let's keep our facts straight.

[Ironica]

Originally Posted by nashvillemidwife

I have issues with a couple things in that article. For example, "Approximately 0.5 percent of women found to have GBS bacteria in their genital areas at 35 to 37 weeks into their pregnancies will go on to deliver a baby who becomes ill from GBS. This is 0.5 percent of women who receive no antibiotics during labor and delivery."

Most babies who get sick did have antibiotics, because in this day and age most babies who are at risk were exposed to antibiotics per the CDC recommendations. All due respect to the author, but her statement seems to reflect what she assumed was a logical conclusion, but it's wrong.

You can find that statistic on cdc.gov, and they are from the 1993 surveillance project that produced the first antibiotic protocol that went into effect in 1994. That protocol did not include screening, and only gave antibiotics based on risk factors (prolonged rupture of membranes, premature labor/birth, maternal fever, signs of infection in amniotic fluid, etc.). They then compared the results of that protocol with screening at 36 weeks and prophylactic use of antibiotics, and found the second protocol to be more effective at preventing early-onset GBS.

The CDC's surveillance shows that 1 in 200 is the expected GBS transmission rate for GBS-positive mothers without antibiotic treatment; 1 in 4000 is the expected transmission rate for GBS-positive moms WITH prophylactic antibiotic treatment. The protocol does cut the transmission rate by a factor of 20; however, it cuts it from a very low place, and given that around 30% of women will test positive on the screen, and only 6.5% of babies who contract early-onset GBS die from it (again, from cdc.gov), it means giving IV antibiotics to one MILLION women to save the lives of 325 newborns (based on the number of births per year in the US, with some heavy rounding down due to out-of-hospital births, women who decline antibiotics, or births that occur to rapidly for antibiotics to be used).

CDC is also engaging in heavy surveillance to watch for penicillin-resistant strains of GBS, which would be a public health disaster. Of course, if you were *trying* to breed a penicillin-resistant strain of GBS, it'd be hard to find a more effective way than to identify a million people a year that carry the bacteria and infusing them with penicillin.

I'm not a birth or even health professional by any stretch, but my credentials do include a great deal of looking at population statistics and public sector decision-making processes ;-) so when GBS became a personal issue for me, I started poking around.

[nashvillemidwife]

Thank you for that information. I have studied this in depth and written articles about it for my clients and other midwives. The amount of data out there is mind blowing and my 3" binder of research is busting at the seams!

Yes, it does seem ridiculous that we are exposing so many women to antibiotics for whom their baby would never get sick without them. However, when your baby is one of those 325 to die because there was no prevention protocol is can be hard to appreciate that reasoning. I'm eager to see how things turn out with the vaccine they're working on.

[maxmama]

Originally Posted by nashvillemidwife

maxmana, GBS is not usual intestinal flora, though everyone says that. It's benign, doesn't cause any problems, but still not "normal".

trimestersdoula, that article cites one study of at least dozens that found different conclusions. The study included testing moms for the bacteria at 28 weeks, which in no way indicates the status of those women at the time they were given antibiotics.

I have issues with a couple things in that article. For example, "Approximately 0.5 percent of women found to have GBS bacteria in their genital areas at 35 to 37 weeks into their pregnancies will go on to deliver a baby who becomes ill from GBS. This is 0.5 percent of women who receive no antibiotics during labor and delivery."

Most babies who get sick did have antibiotics, because in this day and age most babies who are at risk were exposed to antibiotics per the CDC recommendations. All due respect to the author, but her statement seems to reflect what she assumed was a logical conclusion, but it's wrong.

I'm not advocating IV antibiotics, but let's keep our facts straight.

Benign and widely present does to me equal "usual", as it's not pathologic except in birth. But so be it.

[trimestersdoula]

Originally Posted by nashvillemidwife

I'm eager to see how things turn out with the vaccine they're working on.

For GBS??? Good lord!

[nashvillemidwife]

Sorry to be so short, I didn't mean any offense. But if you look at a list of normal human intestinal flora you won't be beta strep listed. Still not a problem, but it's just not true that everybody has it.

[nashvillemidwife]

I personally would rather see a vaccine for high risk babies than such widespread use of powerful antibiotics.