GBS: IV vs. IM in labor?

[Ixcuina]

I tested pos. at 35 weeks. Have been on the naturopathic regime for almost 2 weeks and am re-testing soon. BUT....if I remain positive, my midwife has offered me the option of having an intramuscular injection of antibiotics during labor (vs. an IV). Supposedly I only need to have the injection 1hour before birth and it is 'good' for 24 hours (this is a 2nd birth so I am 'hoping' to not go past 24 hours!) I believe it would be Ampicillin.

Has anyone else been offered this option or have more info about it? I could not find anything online (except for references to IM shot during last month of pregnancy, not during labor). I have also heard that it hurts like heck and that is why they often add lidocaine to the mix. Not sure how I feel about the lidocaine.

Hope to have time to re-test, and hope to come back negative so it is a non-issue. I was GBS neg. with first child. I am also considering not having any antibiotics if I don't develop any of the 'risk factors' (PROM for more than 18 hours, etc).

Thanks in advance! This is so confusing a subject :

[Greaseball]

Well, once I went to the hospital for a kidney infection and they offered me either an IV or an IM. They said the IV would take about 20 minutes and not hurt, while the IM would be extremely painful and hurt for days afterward.

I asked for the IV and it hurt so much! They couldn't even get it in because I kept screaming. Finally they brought in the IM and I barely felt it when they gave it to me, and there was no pain at all afterwards.

I had IV abx in the hospital for dd and it was the worst part of labor. They told me it had to be IV; they wouldn't consider IM. I interviewed a midwife who said she will do either IM or oral if I am + this time; she doesn't do IVs. I'm glad! There is no way I would have one again.

The IV I had in the hospital burned my arm so they had to slow the drip way down. They said I would only have to be on it for 20 minutes every 4 hours but it was more like an hour because of how slow it was going.

So, in my experience, IMs are not bad at all.

[Ixcuina]

Thanks for the info! The thing about the IM shot hurting...well, I figure if I am in labor anyhow....though I am sure I could imagine it hurting worse, especially if it did hurt for days after.

I wonder which antibiotic your midwife would use if you had an IM injection in labor? Do you know? My midwife does not do IVs either, but we could have arranged for another midwife to come and do one if I wanted.

Hoping the re-test at 37 weeks comes out negative! I have been using every naturopathic regimen in the books!

[jgale]

A lot of practitioners will only offer IV antibiotics because, as far as I know, the research that was done on treating GBS prophylactically in labor was done with IV. So while the IM might work just as well, there is not any research to show that that is the case.
As for which hurts more: the IV penicillin (which is what the CDC recommends) hurts more than IV ampicillin (which is what a lot of homebirth midwives and birth centers use because it is easier to get than penicillin). Usually starting an IV is less painful than getting an IM shot (it depends on how good your veins are and how much medicine they are injecting IM of course) but the IV penicillin can really burn as it infuses.
Well enough rambling for now. Good luck with your decision. J

[Ixcuina]

Thanks for you info J!

I finally found out the drug used in the intramuscular injection is a ceftriaxone called Rocephine. It reaches peak levels in the blood in around 2 hours and only one injection is needed for 24 hours. So, it seems best suited in situations were there may not be enough time for IV antibiotics and w/penicillin and ampicil. you are supposed to have 4 hours of drug before birth. But, like you said, we don't have the official research to back it up because it isn't something that would be used on a regular basis. Also, it costs a lot more than penicillin making it less attractive to be used often. One thing about the Rocephin is that it is supposedly a painful injection so it is mixed with lidocaine which is *another* drug. Drugs are what I hoped to avoid during this birth :-(

We are doing one more re-test next week and will get a colony count with it (low, med or high) if it is still positive for GBS...and I guess I will take it from there as to how I feel about the whole thing. :

[Spark]

Just wanted to say I'm sending negative vibes to you!

(This doesn't sound like positive thinking, but actually it is!)

Negative, negative, negative!

[Ixcuina]

Thank you, thank you, thank you

From me and

[Plaid Leopard]

Hi-

I did the IM antibiotics with my DDs birth. I believe we used ampicillin. I don't remember it being especially painful. A shot in the butt in the middle of labor is certainly not fun - and it may have been sore for a couple of days but honestly, I don't remember. I had other things on my mind

I can't remember exactly how we did it. My water broke early in the am without contractions, and I think we did the first shot of antibitiocs once I was in active labor - which wasn't until late that night. We did a second shot 4 hours labor. Not sure if we did a third..

I am looking at having to take antibiotics this time around too. I'm not happy about it. My midwife tested me really early (i'm only 30 weeks now) and wanted me to take oral abx right away. I told here it was way too early to take them because that left a lot of time for the GBS to come back. Plus, I have read that oral abx are not effective anyway. Can anyone back that up for me?

My midwife cannot prescribe abx. I would have to go see a doctor to get the prescrip. Ugh. Hoping the next test is negative...

Ixcuina - hope you test negative too.

[TrishWSU]

I hope I'm not too late with this post. I was(am?) GBS positive. My MW expalined it to me that you're only at a real risk of infecting the baby if your membranes have been ruptured for more than 18 hours, the risk further increases with the more vaginal exams your given after membranes rupture. It was my decision to have the IV antibotics on hand and only get them if I neared this point. As it turned out, my water didn't break until I was pushing so it wasn't even an issue. But we did opt to get the eye ointment because of the GBS, but we waited for like 2 hours before administering it. Best of luck for your birth.

[Plaid Leopard]

I just read on Midwifery.com that inserting a clove of garlic in the vagina at night can significantly reduce GBS count, and is good for treating yeast and other bacterial infections. Think I will try it.

I talked to my midwife about abx not being necessary unless certain risk factors are present but with a homebirth I can't just get an IV if any of these risks come up.

[TrishWSU]

I had to go to the doc to get the abx, too. What a waste of time! I think the paper work took longer than my time with the doc. She said she just had to physically see me before she could prescribe the abx. Kind of makes you understand why there are so many problems with insurance plans and medical coverage in this country when we have to do things like that.

I guess the IV thing is something that differs from state to state. I'm in Washington State, and my MW couldn't prescribe the abx but she could administer an IV at home.

Anyway, I'm hoping that both of you have negative test so it won't be an issue.

Happy birthing!!

[bullfrog]

There is a new article in the Nov/Dec issue of Mothering about GBS and the effectiveness of antibiotics in labor. It's a really great article and gives me hope. Antibiotics may even decrease your baby's chances of fighting off GBS if he/she contracts it.

I had IV antibiotics for my first birth - and then my baby had some water in her lungs a few hours after her birth - I got the whole speech about how tragic this was and that she probably wouldn't make it - how dangerous GBS is for newborns ect...by the way - she wasn't sick at all - no fever just low o2 saturation.
She was in ICU for 4 days on IV antibiotics. I was so angry because there was no mention that even with IV antibiotics she was still at risk. I was foolish then and listened to everything my MD told me - researched very little on my own. Now I know thank goodness - that I have a chance to eliminate the bacteria before I give birth.
Good luck to all - it's not an easy decision. But for me having a homebirth and knowing what I know about diet and alternatives to antibiotics - I feel secure I'll make the right decision when the time comes.
Embalene

[Greaseball]

I just had my first mw appt. She says she doesn't routinely test for GBS, only if the mother asks. I told her I wanted the test, and she said if it's positive I can take oral abx for a week and then have 1 or 2 IMs in labor. She says that if a baby is going to get sick from GBS, IVs in labor are given way too late.

Everyone seems to say something different about it, so I'm going with what my mw says. She is also very confident that this time I will test negative, since last time I was in poor health and am much better this time. She says it's not once positive, always positive the way OBs say it is.