GBS testing in pregnancy - WWYD?

[MOML]

OK, so this is more of a pregnancy related question, but since Canadian health care "rules" seem to be so different than US ones, I was hoping to get a better response here.

I live in Saskatchewan. I'm approaching 29 weeks pregnant with baby #2. I was group B strep negative first time (yay!). I am also deathly afraid of needles and the thought of an IV makes me want to give birth in a ditch by myself. Unfortunately, my HB won't agree to that, plus November in Saskatchewan is mighty cold, and possibly snowy ;)

My GP (who is attending my hospital delivery) says that there are no non-IV options for abx for GBS+ moms.

My GP has agreed to do a GBS swab at 32 weeks, so that if I'm GBS+, I can do a probiotic regimen and try to get a negative result at 36 weeks. However, I'm wondering if that's really the best use of our health care resources? Also, what if I'm GBS- @ 32 weeks, then GBS+ @ 36 weeks? Then I'd be mighty pissed off, for sure. I may not have enough time for a probiotics regimen and re-test. Then, there's that whole best use of health care resources issue, never mind who really wants 3 swabs in one pregnancy!

If I decline the testing and treatment all together, stating that I'd rather opt for treatment of baby post-delivery if GBS really and truly is an issue, what kind of reception am I going to get to that?

Home birth and/or UC is not an option. I tried to convince my HB, but we live an hour from the hospital with the L&D unit, and midwives can only attend in the hospital ... oh, and there are no midwives here because our province has added another level of bureaucratic BS to that process.

[Alison's Mom]

I was GBS+ for my first and just went along with what my dr told me, so had an IV with antibiotics during labour/delivery. Then for my 2nd child, I became more aware of side effects of antibiotics and opted not to get tested for GBS. My dr, who is fairly 'natural labour friendly' was totally OK with that. From my very limited research (ok, next to none :o), I felt that the risk of the infant contracting some bad infection was fairly small.

[lalazap]

If I decline the testing and treatment all together, stating that I'd rather opt for treatment of baby post-delivery if GBS really and truly is an issue, what kind of reception am I going to get to that?


Can't predict your doctor's reaction, but there is a precedent from the UK, endorsed by the Royal College of Obstetricians and Gynecologist, for not testing at all prenatally and just treating in labour based on risk factors - these include maternal fever, rupture of membranes (ROM) >18h, prematurity <37 weeks.

The RCOG guideline can be found here:
http://www.rcog.org.uk/index.asp?PageID=520

You could bring it to your doctor to show that there is an alternative evidence-based approach to GBS, and that you're not just making some crazy decision about it all.

Here in BC, some midwives are comfortable with women testing prenatally to find out their status and, if GBS-positive, deciding to treat on risk factors as described by the RCOG. This combines the two approaches, and though not really accepted as a protocol for a whole population, might be a reasonable decision for you to make. After all, you might still be GBS-negative - and not needing abx even if you had prolonged ROM or other risk factors.

[weliveintheforest]

Your doctor should have no problem with you declining the gbs test, it is your body and your choice after all. If you decide to take the test for whatever reason, I would still do the probiotic / immune booster regimen ahead of time, so that you are more likely to test negative.

if you test negative at 32 weeks do you have to test again, or is that it?

[MOML]

Your doctor should have no problem with you declining the gbs test, it is your body and your choice after all. If you decide to take the test for whatever reason, I would still do the probiotic / immune booster regimen ahead of time, so that you are more likely to test negative.

if you test negative at 32 weeks do you have to test again, or is that it?

If I test negative at 32 weeks, I would still have to retest at 36 weeks, because the results are only valid for 5 weeks. If I go into labour before 36 weeks (gee, I hope not!), then (hopefully) they'd use the 32 week GBS result. If I went into labour at 37 weeks (still not preferable), they may or may not have the results back, and I bet I'd be pressured to get the abx "just in case."

My son has an allergy to erythromycin and zithromax. Projectile grey diarrhea that is NASTY. The zithro wasn't even his Rx ... I was taking that for a lung infection and BFing at the time. So, I'm not exactly keen on abx in general, and especially "just in case."

[MOML]

I have an appointment at 30 weeks, so I will definitely ask her what happens if I refuse to have the GBS swab entirely. I have read the ROCG recommendation as well, so I will come with that. Man, every appointment I'm giving her a reading assignment!!

[dawncayden]

I would just test at 36 weeks (and do probiotics starting right now) and then decide if you want antibiotics or not during and after labour if you are positive. That way you know what to look for if the baby starts wheezing, you'll know its because you tested positive.
If it were me... I'd like to know. :thumb Especially since 1 in 4 women have GBS.

[Cujobunny]

I would decline the test. I did the second time around after my midwife told me about the RCOG guideline.

[janefriar]

Another option is you can also decline the test but agree to be treated with antibiotics based on risk factors (like fever during labour, premature labour, and PROM)

[fridgeart]

Another option is you can also decline the test but agree to be treated with antibiotics based on risk factors (like fever during labour, premature labour, and PROM)

This was the route we took. From 32 weeks I took garlic, probiotics, and vit C rich diet, hoping that it would prevent a + GBS result (and baby!).
Good luck!

[MOML]

I think that is basically the ROCG approach, which I do like. Don't poke me with unnecessary swabs, and don't poke me with unnecessary IVs! I am going to run this approach by my GP next week, and see how many wrinkles her nose makes.

[tooticky]

I'm fuzzy on all of the research that I did at the time (for my second child). I know that I wrestled with the question, and ended up deciding to take the test.

It turned out that I was positive at the time of the test. I told my midwife that I wanted to decline abx, unless I presented most of the risk factors during labour/delivery.

In my case, my labour was too short to worry about it anyways.

[sanguine_speed]

I just want you to be prepared for this possibility:

after I had refused testing, and had to be in hospital due to a hemorrhage, the nurses were going to administer IV abx to my baby because of my refusal to have had them during labour as my status was unknown. There was a brawl and thankfully my midwife was there to fight for me as I was out of it (hemorrhage and all...). Just something to be prepared to fight for if you end up in a transfer.

[MOML]

Well, I'm going to be at a hospital regardless due to my rural location. Luckily (?) I won't need a transfer because the closest hospital with L&D also has a NICU.

However, as I discussed this further with my GP yesterday, she now thinks that maybe oral ABX are an option. Not sure what changed in 2 weeks?!? Last time, she said it was IV only. She's going to ask at L&D and I'll find out at my next appointment.

I think what I'm going to do is go ahead with the swab at my 36 week appointment. If I'm negative, then all this discussion and negotiation was for nothing (for me anyway, but maybe my GP will remember this for her next patient). If I'm positive, we will be sure to watch baby for signs & symptoms of GBS and treat accordingly.

[dot1]

I did a probiotics regimen for a few weeks prior to getting tested at 36 weeks. I figured with a 1 in 4 chance of testing positive, I'd hope for a negative result so no one bothered me about antibiotics. If you don't test you can be guaranteed they will pester you about abx!! I tested negative, fortunately.

To date my dd (18 mo) has never had any exposure to antibiotics, no ear infections (touch wood).

My naturopath said of all the patients she'd followed who's done a probiotics regiment, eating lots of garlic, and inserting probiotic vaginally at night, none of her patients had ever tested positive.

Good luck!

[MOML]

I have decided to take probiotics prophylactically starting yesterday (32w) until my swab (36w). I will also do garlic vaginally for 8 nights before the swab. Hopefully that will be enough to test negative! I was negative during my last pregnancy and did no preparation at all, so hopefully I haven't encountered anything between then & now that would change that. The probiotics & garlic can't hurt.

[Twinklefae]

I find all this funny. My GP (who attended my delivery) said that they only started testing for GBS during pregnancy a few years ago. We decided to go along with the older plan, which is if you spike a fever at all during delivery you get abx. (Which they will do regardless of your GBS test anyway, making the whole thing pointless).

Anyway, good luck!

[kdtmom2be]

I agreed to testing when I was pregnant with DD and saw no problem with it but I had a midwife who I discussed things with first and before I took the test we agreed that IF it was positive we would treat based on risk factors only. I am not a fan of antibiotics when they are unnecessary.

You always have the right to decline medical treatment. Maybe call the hosp yourself and ask if they have a form for declining abx if you are GBS+? Anonymously of course. :) I declined all sort of things with DD and no one batted an eye.

[MOML]

I've decided to go ahead with the GBS swab (in 3 weeks from now). It will give me valuable information - if I'm GBS+, then we know to watch for the signs of GBS in our baby, and/or can choose to have her swabbed and know if she will require treatment/monitoring; if I'm GBS-, then all is well.

If I am GBS+, I will decline the IV abx unless there is a medically indicated reason (as per the RCOG guidelines). My GP has even noted in my chart that I will not be getting IV abx!!!

:thumb

[busybee16]

My GP (who is attending my hospital delivery) says that there are no non-IV options for abx for GBS+ moms.

My GP has agreed to do a GBS swab at 32 weeks, so that if I'm GBS+, I can do a probiotic regimen and try to get a negative result at 36 weeks. However, I'm wondering if that's really the best use of our health care resources? Also, what if I'm GBS- @ 32 weeks, then GBS+ @ 36 weeks? Then I'd be mighty pissed off, for sure. I may not have enough time for a probiotics regimen and re-test. Then, there's that whole best use of health care resources issue, never mind who really wants 3 swabs in one pregnancy!

If I decline the testing and treatment all together, stating that I'd rather opt for treatment of baby post-delivery if GBS really and truly is an issue, what kind of reception am I going to get to that?


i don't want to get all crazy-midwifery-student on you, but i think i may be able to offer something on GBS, as it's a huge topic in obstetrics and also something i discuss with women and their partners all the time here in ON. luckily, the national standards, options, and guidelines for GBS have been drilled into my brain so the stuff i know is also quite current.

first of all, group b strep (GBS) is a totally harmless bacteria that typically lives in our digestive tract. for whatever reason, it periodically takes a holiday to the vagina, where it is absolutely innocuous for women, but can be a potential threat to babies passing through a 'colonized' vagina. even though only 0.5-1% of babies get sick with GBS disease, it is serious enough that the society of obstetricians and gynecologists of canada (SOGC) has strict policies about GBS testing. basically, they want all women to test, and all women who are GBS+ to treat with abx, based on the swab. there is another group in canada (i can't never remember their name) that says to base on risk factors, such as maternal fever, prolonged rupture of membranes, previous baby with GBS disease, preterm labour, and others.

the test itself is no big deal - at least the way we offer it: to get the woman to do it herself, in the privacy of the washroom. you just take a long q-tip, put it inside your vagina, and then just across your anus (NOT inside!!) and back into the tube from whence it came. :) i don't know how OBs do it, but i'd hope they'd trust you to do it yourself! the test is typically good for 5 weeks (meaning that it predicts GBS status from 5 weeks post-test), which is why it's typically administered btwn 35-38 wks. it has fairly low false positive and negative rates too.

lots of people have had success with probiotics and garlic - i myself will use this to prevent GBS from setting up shop in my vagina for sure! however, i also think i will choose to swab, because i personally think it's better to know my options, rather than remaining 'GBS unknown'. i just want to caution us, though, from thinking that the purpose of inserting garlic and taking probiotics is to get a negative test. that is, we want to make sure that we actually DON'T have GBS, we don't want to fool the test into telling us something that is untrue. i don't know if that made any sense...but it sounded as though some folks wanted to try the naturopathic route to simply force a particular test result in order to avoid an IV, the drugs, or whatever. i'm here to say that we WANT the test to tell us accurate information, if we choose to test at all. and many women don't, and are fine.

with GBS, there are two main choices:
1) whether or not to swab (to find out if GBS+)
2) whether or not to treat (if GBS+)
depending on your care provider, you may have little choice in this matter. with midwives, you will have more: in the clinics in which i have worked, for example, we have lengthy discussions with women about their options. some women wish to avoid all tests, or perhaps fear the snowball effect that may occur if they do test. depends on you - will you be more stressed knowing, or not knowing? whenever i counsel women, i ask them what they will do with their information: if they are GBS+, will they want to treat or not? if they definitively do not, under any circumstances, want to take abx, then is it really worth knowing their GBS status? similarly, if women are unsure about whether they will treat, it might be helpful to find out. however, if you have a crazy fast labour, are having an elective C-section, or if your water doesn't break, GBS is somewhat of a moot point! all in all, it's complicated, as i'm sure you all know!!!

for folks wanting to avoid abx and needles, this is a tough call. because yes, the drugs given are antibiotics, and yes, they do need to be administered via IV. the reason is so they get into our system, and therefore the baby's system, as fast as possible. the idea is that we can 'immunize' them against the GBS so that when they pass through the vagina, they are protected. the absorption of oral meds is waaaaay slower, which is why the drugs need to be IV. i wish they'd get cracking on a form that didn't involve needles, as this is a fear for many women.

as for the reception you will get if you refuse abx - well, if you're in the hospital, it won't be pretty. in fact i'm sure some hospitals don't allow it, and may not even have a form to decline it. with a midwife, you're somewhat better off, as you have a champion with you at all times, but even we can be bound by hospital policy. if i think about the hospitals in which i have worked, it is the midwives that have received the flak for the decision, not the client - as in, (disapprovingly) 'why is your client not receiving prophylaxis?' if you are GBS positive especially, i imagine it'd be quite the hullaballoo. :)

anyway, i don't know if that helped. i'm feeling self conscious all of a sudden, so i'm getting out of here!! take care!

[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?