Declining GBS test?

[bluedaisy]

I had an appointment at 35 weeks yesterday and my midwife brought up the issue of the group B strep test which I'm supposed to get at my next appointment.

My midwife knows that I want a low intervention natural birth and she recommended that I decline even getting tested for Group B strep. She said it's so common and so many women test positive, and that will open the door for interventions that I don't want (i'll be delivering in a hospital). She said the hospital will treat me like I'm negative if I've declined the test. She said there are certain risk factors that make the baby more susceptible to getting an infection, but without those risk factor the chance of the baby getting anything is so small.

Did anyone else decline even being tested? Is there anyone who tested positive who was able to avoid extra interventions?

[Mama_Leah]

I was GBS + with #3, still had a homebirth and the only "intervention" was antibiotics when labor started and it didn't cause any problems at all.

[dolcedaze]

I was told by my midwives last time that if I did a hospital transfer without a negative test on record, I'd be treated as positive. I went ahead and did the test for that reason, because testing seemed to take risks of antibiotics away without adding any risks at all. I'll probably do the same this time, although it depends if I go to any more hospital appointments at all

[MyBoysBlue]

If you haven't already read it I would suggest you read the Mothering article on GBS:

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

You may also want to look into this especially if you decline:

http://www.joyousbirth.info/articles...lapproach.html

I was tested and was + for DS 2 and I had a UC. DS was just fine. But I followed the holistic approach for almost 2 weeks before he was born. I feel that I was most likely - by the birth but I didn't get retested so I can't prove it.

[MegBoz]

I tested positive & was downright devastated. I had my heart set on laboring at home as long as possible (I really didn't want to be in the hospital AT ALL, but I did like my MWs.)
Well, it turns out 1st stage FLEW for me! Carried till 41W 4D, had my membranes stripped, 2 hours later cntrx started, and less than 5 hours after that, I felt the urge to push before I'd even left the house! When I arrived, the MW checked me & confirmed that I was 10cm & she felt the forewaters. I heard a nurse say something to her about ABT, but she said, "There's no time." She was right, BTW - baby was out about 40 min later.

I really stressed over GBS. My doula, on the one hand, said, "Don't worry about it. Don't get ABTs." Whereas the CDC and ONE of my MWs (the "med-wife") says it's important to get the ABTs. Huh? Why the discrepancy?!

Well, my DH had the brilliant idea to see how they manage it in other countries. In the UK, it seems most common to give IV ABTs ONLY if you have more than one risk factor. Testing positive is ONLY ONE risk factor. The others are:

• prematurity
• water broken 18 or 24 hours in advance of labor
• urinary tract infection with GBS
• maternal fever in labor
• previous child with GBS

Since my DS was fine, I've decided to do the UK thing with my #2. And that is - get tested, but ONLY accept ABTs IF I develop another risk factor.

I'd rather KNOW if I'm positive so I can make the right decision. Yes, I know the hospital policy is to give me ABTs based on only that one risk factor and if I do test positive, I'll have a battle on my hands. However, I already know one MW is on my side in this matter (She flat out told me she thinks the policy in the US will change to the UK policy in the future!) And I have "Informed consent." I can rattle off all the stats & risks of both accepting & declining the ABTs - I'm perfectly well informed & have no problem standing up for myself. Oh, and I have a DH and a doula who are also quite good at speaking up!

[boscopup]

Around here, they usually treat you as positive if you don't get tested, BUT... I was planning to decline the test. Thankfully, I delivered before I was even offered the test. One benefit to cooking my kids quick, I guess.

For me, my main concerns about testing and abx are 1) I have fast labors and would not be able to do 4 hours of abx, and 2) unnecessary abx use in labor is causing a rise in abx-resistant e-coli, which is a major killer of preemies. Having had a preemie (who thankfully did NOT get sick) and talking to moms of preemies who did get e-coli and some who even lost their babies because of it, I just can't do the abx without having risk factors for GBS infection besides just being GBS+ on a test (which something like 25% of all women will test +... that's a LOT of unnecessary abx!!!).

I prefer to decline cervical exams, not allow my water to be artificially broken, not allow cervical exams after my water has broken especially (had to fight with the hospital on this one when I had PPROM at 29 weeks.. my DH was a wonderful advocate for me!), if I had ROM for a long time, I would temp every 4 hours, etc.

[nashvillemidwife]

You've got a very laid-back hospital if they're treating an unknown status as a negative result. In fact, that's a little negligent - they need to acknowledge the unknown and be on the lookout for risk factors, which is much different than assuming you are negative. A negative result means that antibiotics aren't called for even if you develop risk factors.

[bluedaisy]

Thanks for all the responses.

I was also surprised that the hospital would treat me as negative if I don't get tested. My midwife said that she herself declined the test and that the hospital is used to midwife patients declining (it's a pretty large midwife group). She said if I test positive, they wouldn't want me to labor at home, I'd have antibiotics, and they would keep the baby in the hospital for 48 hours. WIthout taking the test, they wouldn't have a problem with me laboring at home, they wouldn't administer antibiotics, and the baby could get an earlier discharge from the hospital. She mentioned as long as I don't have any risk factors (mentioned by pp above), the chances for passing GBS to my baby are so low.

Part of me wants to take the test so that if I'm negative I don't have to worry and if I'm positive I can try natural means to clear the infection. But I also am concerned about "fighting" with the hospital against interventions if I am positive.

Also, my midwife brought this up and recommended I decline the test after looking at my birth preferences and seeing that i wanted a low intervention birth. she mentioned that it seems like i want a birth that is similar to what she wanted, and that i should decline the GBS test. The fact that she would offer this information without me even asking about it makes it seem like she doesn't think GBS is a very big deal, and that there are others in the practice who have declined the test. After having such a hard fight with these midwives over declining prenatal rhogam, I was VERY surprised at her attitude towards GBS. It also makes me think that she may have had some experience with women who had unnecessary and unwanted interventions after testing positive.

[nashvillemidwife]

Here if you don't have the test they will automatically keep the baby 48 hours, and may even start them on prophylactic antibiotics while they await cultures to see if the baby has GBS. They're going to get all kinds of pokes and prods and observation in the nursery. If you're positive and get the antibiotics they assume the baby is good to go.

[HotJabanero]

I just wanted to say that the antibiotics can most certainly cause problems. I have a friend due and day now that tested pos with her first and so is treated pos with all the rest. She is now due with #5. Anyway she develops such a severe case of yeast/thrush the she has NEVER successfully breastfed any of her infants and doesn't even plan to try as her nipples are so scarred from the horrible bleeding infections she develops from thrush. Not to mention the horrible yeast infections she deals with down under.

Just wanted to throw it out there that some women do have pretty severe complications because of the antibiotics.

I never allow the test and I home birth so not prob there however I had a transfer with my third and they had no problem with me signing out AMA, less than 12 hrs later, with her after they explained thoroughly what to watch for.

[septbabymama]

I tested + for GBS, too, and worried about the antibiotics, but I ended up having too fast of a labor so there was no time for the antibiotics. We ended up staying 2 days at the hospital to get a culture done on the baby to make sure she didn't test positive. My water didn't break so the chance of the baby testing positive was low, but I'm glad to have gotten the GBS test. I think it's too risky for the baby not to test for it.

As for getting thrush, there are many ways it can be treated such as using Grapefruit Seed Extract among other things. It can be very difficult to get rid of, but it can be treated and you can have a successful nursing relationship.

Originally Posted by HotJabanero

I just wanted to say that the antibiotics can most certainly cause problems. I have a friend due and day now that tested pos with her first and so is treated pos with all the rest. She is now due with #5. Anyway she develops such a severe case of yeast/thrush the she has NEVER successfully breastfed any of her infants and doesn't even plan to try as her nipples are so scarred from the horrible bleeding infections she develops from thrush. Not to mention the horrible yeast infections she deals with down under.

Just wanted to throw it out there that some women do have pretty severe complications because of the antibiotics.

I never allow the test and I home birth so not prob there however I had a transfer with my third and they had no problem with me signing out AMA, less than 12 hrs later, with her after they explained thoroughly what to watch for.

[alegna]

I decline the test, but birth at home and would not have the antibiotics if +

-Angela

[momm-i-o]

It was a big deal for me to decline the test- the NP almost rolled her eyes at me in frustration (I'd also declined the glucose test and tetanus booster shot at 6 wks pp all in the same day). I took a probiotic daily and had been treated for candida at the acupuncturist so I felt that even if I were + I wouldn't get the antibiotic anyway. The NP tried to threaten me with an antibiotic at the hospital but I countered with telling her I wouldn't consent. She badgered me for a few more minutes and then had to move on. The whole protocol of testing and treatment seems rather sketchy to me- almost like the dawning of a new intervention or reason for c/s.

[channelofpeace]

I declined it with my last baby and was treated as negative.

[phatchristy]

GBS is one of the tests I don't decline because around here they're pretty vocal that in case of transfer if you decline you will be treated automatically as positive. What bothered me most was their babies were given antibiotics, given extra tests and separated from mom.

I have been negative with each pregnancy. I also have pretty short labors and my bow has either remained intact the whole time or poped during crowning.

[HotJabanero]

Originally Posted by septbabymama

As for getting thrush, there are many ways it can be treated such as using Grapefruit Seed Extract among other things. It can be very difficult to get rid of, but it can be treated and you can have a successful nursing relationship.

There are many ways to treat it I myself beat it naturally with my first and had a very bad infection. I have the scar to prove it.

However my friend is probably one of the few that doesn't respond to natural treatments and even took some very high powered medication to kill it and it was still a several month battle, with each of her four, that made her very very sick. She doesn't have it in her to try again. I wish she would consider not taking the abx but she is more scared of a pontential infected babe thanks to her fear mongering doc.

So I disagree it is not *always* curable for a happy nursing relationship.

[HotJabanero]

I hope I didn't give the impression that my friend only tries for a few days. With all four she has battled the yeast for 4-6 months with bleeding cracking thrush nipples the entire time. Nursing is very important to her and her heart is broken that is has never been anything but hell for her.

I know this complication is rare but it is directly rooted in her abx at the birth. As a side note she doesn't do abx for any other reason because of this because even not nursing she develops horrible systemic yeast. So she is sensitive to it always. This may be rare but it does happen and shouldn't be brushed off when making decisions about abx in labor.

[the_lissa]

There is also the concern of prophylactic abx causing gbs to become abx resistant.

[MegBoz]

If I had gotten the sufficient amount of ABX (2 bags total, starting 5 hours before delivery), they would have discharged babe after 24 hours.
With no ABX, my hospital protocol was to keep babe 48 hours & observe. This is standard protocol (I saw it on an American Perinatology website.) They do NOT give prophalactic ABX or a do a septic workup on babe if he shows no symptoms. They do, however, draw blood. I think he had blood drawn 3X in his first 48 hours of life. Yes, I'm bummed about this, but, IMO it's not as bad as the prophalactyic ABX given to me in labor.

Obviously, I'd recommend checking out protocol at your hospital if you are + and don't get enough ABX.

I believe ABX for Mom in labor causes problems about 10% of the time! In addition to thrush, I think rashes have been caused as well. (My doula had this with her first & said it took MONTHS to go away!) ABX resistant bacteria like eColi have also been proven as a risk.

[chandasz]

Interesting to see the different protocols.

My MW calls this Evil vagina syndrome.... She told me she has never had a bad outcome from GBS infection although we know that there is a small percentage of babies that DO get sick from GBS and a small percentage of these DO die.

I don't think this is completely black and white.

I tested negatively for my first and chose not to test for my second. I did do a regimen of natural ways to ward it off.

Where I am- if you choose not to test- you are only treated prophylactically if there are other risk factors (like the UK model). If you test postively and decline ABX-- your baby will be observed for 48 and in some cases treated prophylactically.

So- my thoughts are if you are planning to decline ABX- don't test.

The problem that surrounds GBS is the nature of the "infection". Just because you test negative at 36 weeks- does not guarantee you will be negative at 40 weeks when you show up in labor.

I think if you show other risk factors or are "heavily colonized"-- then perhaps ABX is not a bad choice....

All about risks v benefits and that's going to be different from mom to mom!