Group B Strep in Homebirth?

[downwardhusky]

Hello,

I'm interested if anyone has any information on how common these infections are in homebirths. DH and I talked to a certified nurse midwife who offers preventative IV antibiotics if I test GBS positive and want them at home. However, she mentioned that one of the reasons the bacteria might infect the babies during childbirth is frequent internal checking during labor (bringing the bacteria up into the birth canal) which is more common in the hospital setting.

We are going to interview other midwives, but nonetheless if there were compelling data that strep B infection to the baby is less common in homebirth I'd be interested to find out.

Thanks!

[alegna]

Lots of things carry an increased risk of GBS in the newborn.

Personally I won't even test for it.

-Angela

[mrspianoman]

Ina May's Guide to Childbirth by Ina May Gaskin had a good pro/con explanation of antibiotic treatment for GBS+. It was in the appendix.

I recently found a good article about it here on Mothering.com.

http://tinyurl.com/9qewb

[MsBlack]

There's a lot I could say...but will limit it to this:

I was researching GBS last year, and came across the CDC statistic of 'infection for 1 in 200 babies of GBS-positive moms who do NOT get antibiotics'. This certainly did not reflect my reality as a hbmw, nor the realities of the other hbmws I know. So I conducted an informal survey of hbmws I know; some do have mandatory GBS testing for clients, others don't.

Result: out of 4000 total births (5mws, some w/more than 1000 births behind them, some w/less than 500), there were exactly 3 cases of neonatal GBS infection of the early onset variety. One neonatal death from infection.

So...I do believe that homebirth is generally safer for babies, perhaps especially when mom is GBS positive. Remember that 'infections' do not occur merely because germs are present (there are germs of all kinds, present everywhere!). Infections--in anyone, any age any time-- occur in the presence of germs, *compounded* by other stressors** that reduce the body's ability to fight off the germs. At home, there are usually far fewer stressors in general--more relaxed surroundings and events, no strangers, no separation of mom and baby, immediate and uninterrupted BFing/bonding, far fewer 'routines' (eye goop, needle sticks, etc).

That is the short version! Hopefully gives you something to think about.

**'stressors': things that cause physical and emotional dys-stress (distress), as opposed to the normal, healthy kinds of stress such as those included in normal labor/birth.

[possum]

There was a great article in Mothering Mag:
http://www.mothering.com/articles/pr...n/group-b.html

"There are three significant factors that place a woman at increased risk of delivering an infant who becomes ill from GBS: fever during labor, her water breaking 18 hours or more before delivery (prolonged rupture of membranes, or PROM), and/or labor or broken water before 37 weeks gestation.
. . .
In the absence of the first three risk factors (fever during labor, PROM, or labor before 37 weeks), the risk of a newborn developing GBS infection is very small."

I declined testing, and my mw's agreed that it was unnecessary. If you have those risk factors, your baby might benefit from anti-biotics - there are obvuisly many things to weigh. Also, since the test is done ahead of time - often more than a month before the baby actually arrives, it tells you nothing about the bacteria in your vagina at the time of birth. You could get a - and actually be colonized at the birth or vice versa.
Melinda

[mwherbs]

so Canadian studies show that internal monitors and frequent checking increased group B strep infection-
there is an increase in Streptococcus agalactiae (GBS) in people with type B blood
big risk factor if mom has GBS colonized urinary tract , silent or obvious UTI is considered to be a high colony count and it is usually the really aggressive strain that is more likely to cause an infection in the newborn-although treating in pregnancy is not done frequently unless symptomatic- a recent article in the green journal says that should be treated because there is a much higher risk of chorioamnionitis in women who have GBS bacteriuria something like 10% of the women in the study --
meconium increases the likelihood of GBS infection being transmitted-

personally I would probably accept the RX get it filled then decide in early labor if I were going to use it-- or if you have GBS bacteriuria -that way you could have your home birth and be protected as well--
I would also recommend using the hibiclens protocols with or without the RX antibiotics because it covers a spectrum of bacteria- while leaving lactobacillus alone--

as far as the bacteriuria -- things that work for other UTIs like blueberry juice and straight cranberry juices help the body by preventing bacterial attachment - which is what GBS does just like ecoli- adheres to the mucous membranes strongly--
---- as for midwife attended births having lower numbers-- maybe but we are also transferring a big at risk population because we don't do preterm births-
and when we look at our numbers so if there are 4000 births total- the presumed colonized group would be 1/4-1/3 of your population 1000-1333 of that 5-6.7 untreated babies would be infected that there were 3 it's about half the expected infection rate but were there any transfers of care for PROM or UTI or PTL ... that may reflect a risk factor avoidance?when looking at the risk factor incidence of GBS .5/1000 .

[NJKim]

My midwife recommends taking probiotics at 28 weeks to avoid testing positive for GSB, preferably in pill form but you could also add Kefir and yogurt with live cultures to your diet.