GBS testing in pregnancy - WWYD? - Page 2

[Alison]

When I had my first child, the hospital here treated based on risk factors--all the ones mentioned earlier, premature rupture of membranes, fever during labour, premature baby, etc. When the doctor mentioned testing at my 36.5 week appointment, I had no idea what she was talking about. Something like 30% of women will test positive, and the way things have fallen out at the hospital here, if they test positive they will be treated. However, according to the midwife I have, if they test negative, the hospital won't treat with antibiotics, even if they are showing risk factors like fever during labour. I haven't decided yet what to do this time around, the doctor gave me the swab to take home and do myself when/if I decide.

So if they don't know my status, they will treat based on risk factors. If they know my status, they will treat regardless if I'm positive, and basically not treat, regardless of risk factors, if I'm negative. I'm rather hoping I just go into labour tomorrow or something (I'll be 37 weeks then and considered full term) and don't have to make a decision. The midwife thinks I should test. She says a strong case can be made to not treat if I'm positive if there are no other risk factors. I'm not so sure the doctor agrees with her, and it's the doc who's most familiar with the hospital and how it works.

Not sure what to do here.

[vancouverlori]

Wow, this all sounds really complicated. I just refused it the second time (it wasn't an option back with the first) because I felt the risk factors were unlikely. And it was all hunkey-dorey.

So I'd say keep in mind how your first birth went. While my second was longer, it sort of followed a similar normal course. (Though, ironically, I had a fever with the first, but I now blame that on the 2 hours I spent in a scalding hot shower while in active labour. It was gone within 24 hours.)

I don't think anyone was thinking to take garlic or probiotics to "fake a result" on the test, though the focus was on avoiding treatment, especially if it may not be necessary. I think everyone's aware that the point is to improve the flora in the region in question.

For the OP, given the first child's very severe reaction to other antibiotics, I'd say it would be prudent to follow the course least likely to result in exposure of the infant to antibiotics. And it's important to point that out to healthcare providers. Then they'll know that while the benefits outweigh the risks for most mother-baby pairs, in this case, the risk is greater than usual for this particular pair. Statistics are great unless you're an outlier. And although individual reactions like that are not inherited (if your grandma was allergic to penicillin, it doesn't mean you are), the tendency to have those sorts of reactions *is* inherited.

And if they do insist on giving IV Abx to you, then you should be able to ask for a butterfly needle - they're less painful. It's probably not going to be a quick jab like an immunization - it'll be an infusion over at least a couple of minutes usually. (Though this is coming from my general knowledge of IV antibiotics from my new job as a hospital pharmacist at BC Women's and Children's - our midwife friend here may know otherwise.)

And for my information, what kind of health risks are we talking about in the baby if exposed to GBS? Are we talking permanent damage, like heart problems or brain stuff?

[saharasky]

I declined it both times ... though knowing what I know now I might have done the swab just to get the status and then declined the Abx if positive and treat for risk factors.

My son was born at 38 weeks at home but required a hospital transfer due to his lungs not functioning properly (underdeveloped AND not wrung out properly during his VERY quick exit). When we got to the hospital our midwife told the doctors that I had tested negative for GBS to avoid my newborn son having to get a lumbar puncture to determine his GBS status. In retrospect I wonder if we had told them my status was unknown if they wouldn't have just started the Abx as he did meet the criteria of risk factors having underdeveloped lungs. We were sent home when he was ten days old but wound up back in the pediatric ICU when he was 20 days old (he stopped breathing in my arms) while there he tested positive for GBS (it could have been late onset but as they never tested him for it in the first stay I'll never know). He was immediately put on Abx and never did get sick from it. In effect he was 'colonized' but never infected.

In the years since his birth I have done a fair amount of research into GBS exposure and the risks. Of every 100 babies exposed to GBS during birth 1 will catch it (and the Abx during labor DO NOT provide 100% protection). 5% of the babies that catch it will die. 30% will suffer permanent neurological damage and 65% will recover with no lasting effects OR won't be sick at all. So you see the chances of a baby getting sick even without Abx is very slim ...but knowing your status can help you to protect your baby IF an unpredictable situation should arise. You do not want your baby to be one of the 35% to suffer permanently.

No matter who your care provider is you have the right to decline treatment ... it can/may/will create a huge fuss but it is your choice.

If I were to have another I would test, decline Abx, and treat the babe and myself for risk factors. However now that I have had a GBS + babe I am in the permanent + category ..so I would probaly have a different mountain to climb than the average.