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Declining GBS Testing

3K views 16 replies 14 participants last post by  emmaegbert 
#1 ·
Inspired by this: http://simpleorganic.net/10-childbirth-norms-parents-can-refuse/

Have any of you declined or plan on declining the GBS test? What did you tell your OB? Can you just say "no thanks" (and maybe sign a waver) and leave it at that?

I really wanted to decline the glucose test too, but lost my nerve. :/ Results ended up negative, as they were with my first pregnancy, so it kind of reaffirms that, for me, putting a massive amount of extra sugar in my system is not really helping anyone.

Any other thoughts on the article I posted? I'm curious to know what you all think about declining the Vit K shot and the eye ointment also.

Thanks!
 
#2 ·
I thought it was a good "opinions" article. Not much research there but at least gave an idea of what someone else has done.

I agree with her for the most part and that is ther route I have taken.

I have never had an ob so I don't know how that works. We use a hb mw and if a dr is necessaryI use my family practice dr. who is also an ob but I chose him because he is natural minded in a lot of ways. Really trusts my opinions, etc. as a mother. That was important to me.

- Glucose test- I have never had one. I have an allergy to corn syrup and become very ill when too much sugar is put in my body, I just don't feel good. My mw told me that there are many signs to look for and we would just keep an eye on those and go further if something came up. All was well so never had to go further with it (Although I feel if there had been a problem my mw would have been able to catch it fairly early as the care was very good and she was very aware of my "normal")

-GBS- I have declined this each time as well. My mw told me that the test isn't extremely accurate and that you might test neg/pos and then be the opposite by the birth. We ended up transfering w/ ds 1 and the hospital staff had a fit. we had to stay a bit longer to monitor ds but as soon as we got a hold of my dr we were released as he knew my mw would be checking on me frequently and monitoring the baby.

vit K- I have declined when not necessary. Ds1 is the only one of my babies that had it and he was stuck in the birth canal for a while. He had bruising, etc. from banging up against my pubic bone as well as from the vacuum suction that had to be used.

My other children did not have any birth trauma so it was not necessary. I will do this on an as needed basis.

eye goop- as i do not have gonnoreah or chlamidia then this is not necessary at all (and if somehow I do at this point I think this might be the least of my worries:)).

she also touched on:

u/s- I do these when necessary (and I consider extreme maternal anxiety a necessity). The most I have ever had is 2 during a pg and the least is 0 (2 of my babies didn't have any).

internal exams- i have had very few of these in my pregnancies. I might ask to be checked in labor (usually moments before baby is born bcs that is usually when I feel done and want to know I have progressed). Rarely get checked during pg though. I don't want to risk infection, don't like how it feels, and am not sure that it tells us much info.

birth/labor interventions-I have had home births and have let the natural process take its course. It works very well for us.

These are just my opinion, what I have done, and what has worked for my family. Each person/situation is different and I feel it is important for each person/family to make decisions that they are comfortable. The main part of this is that they MAKE THE DECISION and don't just do it because that is what they were told to do or the dr just did it with out asking.

Best of luck with all of your choices.
 
#3 ·
I have no risk factors for GD and my body just does not handle the OGTT test well at all. I wasn't able to do it with our son (just couldn't physically get it down and keep it down). I passed with Kadie, had a fasting glucose test instead. This time I refused it but offered to have another fasting glucose test again. One OB, "my" OB was fine with me not having it. Another one in the same office I saw tried to push me into it saying that if he was my doctor and I refused he'd treat me as if we had GD and tell me I needed finger pricks to test blood sugar daily because the risks of GD are just so high for Mom and Baby...good thing he's not my doctor, lol. I went back to "my" OB to discuss what this other OB had said, he reiterated that I was a knowledgeable, informed patient and if I didn't want to do it it was OK with him and told me why he felt it was OK for me to skip it.

As far as GBS goes, I haven't made up my mind about that yet. IMO, GBS infections are baaaad but the number of babies that actually develope them is low. It's really a crap shoot.
 
#4 ·
For those of you declining the GBS, can you tell me why? I really know very little about it. Are you opposed to it because it's a potentially wasteful/uncalled for use of antibiotics? Is the treatment hard on the mother or baby? It seems like though the risk is low of GBS affecting baby, if it did it's awful right? And how unreliable is the test in others' experiences? I know it's possible to test positive for it at week 36 and actually be negative by birth. I guess if it were me and I was positive at 36 weeks, I'd want to treat regardless to rest easy but maybe there's something I don't understand. Thanks for any info or experiences you have.
 
#5 ·
If you're giving birth in hospital, find out your hospital's procedures if you decline GBS testing. Some hospitals have fairly invasive procedures for unknown GBS status--either they assume you're positive anyway, or they put the baby under extra observation. Tbh, I'd rather have the test and maybe get unnecessary antibiotics than subject the baby to more tests/meds/procedures. Although I may not even need the test as I'm probably having an RCS and will get abx anyway. (I was admitted to the hospital this week and the resident wanted to do a GBS test in case I had to deliver--I pointed out that I was a previous-CS patient, so they couldn't induce me [never mind that baby was transverse that day!] and asked if they needed to do it for an RCS. No, they don't, which is what I thought.)

I do the Vitamin K shot. The research I've seen has been positive on outcomes. It's done in other countries (unlike some procedures that seem to be unique to the US), the cancer link got debunked, and oral Vitamin K is apparently less effective at preventing late-onset disease.

I get tons of u/s as I am a high risk pregnancy (I'm also on 2x/weekly NSTs). Eye goop isn't a concern for me, for the same reason as GBS.

As for prenatals: Folic acid is only part of the problem. Many women are also deficient in iron and Vitamin D. I can't tolerate prenatals so I take kids' gummies with extra D and iron (SlowFe) as I have known deficiencies in both.
 
#6 ·
Babydust - I don't think it's that the test is unreliable but because your status can change fairly quickly the results are somewhat irrelevant if you are test 4-6 weeks before you give birth. Most people are concerned about the antibiotics - it's hard on our system & on the baby's. Myself, I know if I take antibiotics I am pretty much guaranteed a yeast infection - combine that with bfing & I fear I would be at risk for developing thrush in myself &/or the baby - not a great way to start things. If they could time the test more appropriately I think I would have less difficulties with taking the antibiotics.

I agree with Alexis that if you don't do the test & are in a hospital you are much more likely to be treated as if you are positive.
 
#7 ·
I declined the test because in Canada there are 2 standards of care. One is to test everyone, and the other is to give antibiotics if there are risk factors such as unexplained maternal fever, preterm labor, or water if your water has been broken for some time. In the hospital where I birthed they keep you 48 hours if you are positive. A nurse was questioning whether or not to let me go because i was status unknown, but the doc signed off on me w/o a word to me so I guess it was all good, idk. My dd got an extra heel prick that I thought was for pku but it wasn't and since the nurse who came later to do the actual pku test didn't speak the same language as me I couldn't ask what the first heel prick was...so maybe it was to check my babe for GBS and that is why the Dr. let me go because they tested and she was fine...no idea really because I left right after the pku test and it slipped my mind to ask someone else. But yeah, check the hospital policy.
 
#8 ·
I plan to do the GBS screen. It isn't perfect, but everyone knows that, so they usually treat the results accordingly. (And it isn't *that* unreliable. My understanding of the available data is that if you screen positive at 36 weeks, there's a very solid chance you'll still be positive at the birth, and vice versa.)

I had suspected chorioamnionitis in labour with DS and we both got broad spectrum abx up the wazoo for days. We did end up with thrush, and honestly, it was a pain, but it wasn't insurmountable. A septic baby, on the other hand, while far less likely, is incredibly bad. That's a situation that can go south very, very quickly. My personal risk-benefit calculation on this one is that the severity is so big that it dominates the low probability. Others may (and clearly do) disagree.

Quote:
Originally Posted by carriede View Post

Any other thoughts on the article I posted? I'm curious to know what you all think about declining the Vit K shot and the eye ointment also.
The article is your standard list of crunchy birth choices. I agree with some, disagree with others. For example, I agree on declining internal exams as much as possible (certainly prior to labour), avoiding stripping membranes, and avoiding induction in many cases (though not all.)

However, I think it's important to have a clear sense of what you are declining, and why. Just because it's on the standard crunchy list of things to decline doesn't necessarily mean it's wrong for me, if you know what I mean.

For example, take eye goop. Although I am very confident that I have neither gonorrhea nor chlamydia (for one, I had those screening tests at the beginning of pregnancy as per public health norms here, and for two, DH and I have been together for 10 years now, I haven't been with anyone else, and I'm as sure as I can be that he hasn't either) it's one of those things where it isn't possible to have, as the author put it, "zero risk." The risk may be small, but it's there. Test results can be wrong. People whom you never thought might cheat, do. Plus, on this one, in some places, it is such a massive pain to refuse it due to legal requirements. And the downsides of the treatment are incredibly low. Wow, a newborn with slightly blurrier vision for a short period of time, imagine that.

Note: My view here is influenced by the fact that, in retrospect, I think I declined some things during DS' birth just to exert some control. I was overcompensating for the fact that I was accepting some other things that I didn't want (namely, an induction.) In doing so, I think I ended up making things go worse than they had to.
 
#9 ·
I agree with this completely!

Just like a lot of us don't take "mainstream" information without educating ourselves we shouldn't do the same with more "crunchy" information. Everyone has different medical histories, different risk factors, different beliefs, etc. You can't base what someone did or did not do during pregnancy or labor and birth as the right choice for you and your baby. Educate yourself, learn the pros and cons and make it a personal decision.

Quote:
Originally Posted by ~pi View Post

However, I think it's important to have a clear sense of what you are declining, and why. Just because it's on the standard crunchy list of things to decline doesn't necessarily mean it's wrong for me, if you know what I mean.
 
#10 ·
Thanks for your replies, everyone! It's given me something to think about.

I live in little backwater Middle GA, so I have a feeling that in declining a lot of these procedures, I would either jump through hoops or be treated as if there is a problem anyway (like many of you said about declining the GBS). FWIW, I did have ALL of these done with my first baby and had no ill side effects from any of it.

I guess my main fear is that I might actually HAVE GBS this time around, as I had a horrible yeast infection this pregnancy that had to be treated with oral meds after multiple rounds of the cream (though it's under control now, I'd be surprised if things weren't crazy-out-of-wack down there). And as someone else stated, I really don't want to deal with the possibilities of thrush while breastfeeding. I was thinking the risk of the baby becoming infected with GBS is pretty low w/o abx, but if I'm positive and am given abx there's a large chance the yeast will get out of control again.

But I definitely need to check the hospital's policy on all these things.
 
#11 ·
I will do the GBS test, and accept antibiotics if positive.
I believe the accuracy rate for the test is 99% over 6 weeks - it does change over time, but typically over the course of a year, not over days.

To me, in my opinion, it's just not that big a deal. I don't hate needles. My midwife will do the antibiotics if necessary. I don't have to an IV or even a saline-lock to get them, as she'll do an in-and-out (like a blood draw). I don't react poorly to antibiotics (other than penicillin, but she's got other stuff).

I felt the same way about the glucose screen. The drink didn't taste bad. The blood draws weren't painful. It didn't cost a lot. I didn't feel icky afterwards. The chairs at the lab hurt my back, but I lived. I passed both tests. But if I didn't, I would just go to the diabetes counselor, prick my finger a lot, change things as necessary, and still have my homebirth as planned.

I've never had a client get thrush that was likely to be linked to the antibiotics. The amniotic fluid is anti-yeast. Post-partum bleeding is anti-yeast. The doses are pretty low compared to those you'd get for a UTI or something. I always recommend pro-biotics starting a few hours post partum, or at least some good yogurt.
Most thrush I see showing up at 2-3 weeks post partum, most likely not really related to to the birth.
I have seen it show up immediately after birth for women who are allergic to the adhesive in the paper pads and they get diaper rash and then BAM yeast. But those unlucky souls didn't get antibiotics!

I haven't decided what to do on Vitamin K and eye ointment. I will probably do Vitamin K if I am GBS positive, because the antibiotics will slow down gut colonization, potentially, so I'll want the extra coverage. If I'm GBS negative, I'm not sure. Eye ointment, I haven't a clue. Maybe I'll make my husband decide.
 
#12 ·
I should add, I wouldn't fight the eye ointment. I look at it from the public health POV: plenty of people do have multiple partners, and a lot of them are not honest about it, leaving their partners at risk. They don't know me from Adam, and why should they trust me? Next time, they could trust someone who IS at risk and either lied or doesn't know it.

I did the GTT because I am at risk for diabetes and I do want to know if my glucose tolerance is declining, since GDM is a warning sign for future T2.
 
#13 ·
I declined with my last pregnancy and this pregnancy. My OB in my last pregnancy was just like "Okay" and it was never mentioned again. I expected more of a fight and was pleasantly surprised by how nonchalant he was about it. My MW this pregnancy doesn't see the point in the test so when I told her I didn't want it she had no issues either.

No reason for the eye goop since I'm in a monogamous relationship. No vit k unless for some reason we experience a traumatic birth.
 
#14 ·
Quote:
Originally Posted by AlexisT View Post

I should add, I wouldn't fight the eye ointment. I look at it from the public health POV: plenty of people do have multiple partners, and a lot of them are not honest about it, leaving their partners at risk. They don't know me from Adam, and why should they trust me? Next time, they could trust someone who IS at risk and either lied or doesn't know it.
IMHO it's not a matter of them trusting you. Who cares what they think? Your decision to follow standard procedure doesn't make any difference to someone else who is at risk of passing on an infection and still declines the goop. They can't force it on anyone, whether they trust them or not.

That said, I was initially inclined to decline eye goop but ~pi's response kinda has me leaning the other way now. I can't GUARANTEE I don't have gonorrhea, although I've been tested multiple times since I had sexy contact with anyone who wasn't DH - maybe the test were wrong or something. The downside to eyegoop seems pretty minimal I guess. So, maybe we'll accept the goop.

We are likely to accept the Vit.K as well, but are still leaning towards delaying the Hepatitis jab by a couple months.

I'll get the GBS testing and the antibiotics if they think I need them.
 
#15 ·
I guess the GBS testing is like pretty much every other decision you have to make during pregnancy. I ask myself this question:"Can I live with myself if I turn out to have made the wrong choice?" If the answer is yes, I decline. If the answer is no, I take the test. I am a bit of a chicken, so so far I am planning on doing the GBS testing just like I did the glucose screening (and that was a good thing, because I turned out to be glucose tolerance impaired), and I will also do the eye goop and the vitamin K shot. I don't believe the hospital has the right to make you feel bad about a decision you have made as an informed patient. It annoys me that medical people (doctors and nurses much more so than midwives) tend to view every non-medically-trained person as an idiot. By the same token, I think we all have the duty to be informed. Don't just willy-nilly accept anything they throw at you, but read up and make sure you know what's going on. And on the flip side of that, don't just turn down everything simply because you feel it doesn't mesh with your personal view of your ideal birth. Make sure you know what you are saying no to, and make sure you can live with the consequences if you turn out to be wrong.
 
#16 ·
No way do I want the eye goop, no thanks. We declined it last time and will be doing the same this time. I don't want some prophylactic antibiotic mess on my newborn child's eyes just because men have established a reputation for introducing gonorrhea and syphilis and chlamydia to their pregnant partners via clandestine relationships, and now we have this procedure because of it. We've had our STD testing. We have a monogamous relationship. I'd like my little one to see us as best he can with his already foggy newborn eyesight. I don't want him to have that feeling of goop in his eyes, and I don't want antibiotics be one of his first out-of-the-womb bodily experiences.

The incidence of opthalmia neonatorum (aka infection during birth or shortly after -- correct me if I'm wrong here, Jane) in North America is 0.3/1000. For us -- a couple of homebody ***** -- I know that our babe is not at risk. As for transmission of infection post-birth, if we end up in hospital again with a full term baby who is allowed to stay with us until we leave, the chances of another health care worker passing on an infection to him is very small. I would reconsider the goop if we have a baby in the NICU.

Last time, though, we were at the hospital for less than 24 hours last time, and baby was with us the entire time after she was resuscitated.

We also declined the vit k last time, but after a traumatic delivery, we opted for it in the end because baby's don't produce it themselves it until about day eight.

And (because we were risked out of our hospital birth) we also declined the standard-issue newborn bath that they like to do on infants, for some reason. No thanks to that too ... I'll be the one to bathe my child when and how I see fit. Keep your hands and your soap off my baby!

I have done the GTT both times, and passed. I'd want to know if I had gestational diabetes.

I do get the GBS screen too, because GBS can cause blood infections and meningitis and pneumonia in newborns, and I don't mind taking on anitbiotics to avoid that. Last time I was GBS positive, much to my dismay. The IV wasn't horrible, but it wasn't pleasant to labour with. Especially in the tub. I jacked up my probiotics, ate tonnes of yogurt, and managed to avoid the yeasty beastie.

From one of our hospitals here:

Refusal of Prophylactic Treatment
• Mother (or parents) must sign a written statement of declination, stating that she (they) understand the
benefits and risks of the treatment as explained by the midwife (2).

• Benefits to Treatment
o Decreases incidence of ON and complications of ON
o Protects infant when CT and GC screening tests in pregnancy are falsely negative
o Protects infant when CT and GC or other infections are asymptomatic
o Protects infant when maternal CT and GC status is unknown
o Protects infant when if fidelity/sexual health of client or her partner are at question or not certain
o In areas where bacterial opthalmia is prevalent, routine prophylaxis may be useful

• Risks to Treat:
o May cause inflammation, redness, and swelling of eye area
o May negatively affect bonding between infants and parents due to possible inhibition of visual
functioning and decreased eye openness
 
#17 ·
Absolutely find out your hospital's procedures. I was GBS+ and my labor was very quick with my first. I didn't get the abx they required in time for their protocols. They kept my son for observation for 4 days, and boarded me in with him. My good friend, in a different hospital, same issue (quick labor). They put her son on IV abx for 4 days, and they sent her home and kept him there. He was perfectly fine and it was a really awful start of motherhood for her (and I am sure it was not optimal for him either- a perfectly healthy baby separated from his mother 12 hours a day and on IV abx!)

I had a HB the second time and plan a HB again. The MWs are very different about how they handle this. But by all means, if I was going to give birth in a hospital, I'd go for the test hoping it was neg, rather than risk having my baby "treated" for something that is a very remote possibility.

I declined eye goop and did the vitamin K.

I was screened for GD (my mom is type II so I am high risk). Neg with my first, positive with my second, and this (my third) didn't do testing and just self monitor. I am really glad I did, I had absolutely NO "symptoms" but my blood sugar, while not rediculous, was higher than normal and in my understanding, there is growing evidence that this is, in fact, a risk for the baby (in the short term, the stuff they go on about, I think is mostly if you have very high numbers. Which could also be asymptomatic. But in the long run, even somewhat elevated blood sugar is highly correlated to a greatly increased risk of typeII for that baby in the future, to me that is a big enough deal that I will prick my finger a couple of times and day and radically change my diet. Which was, BTW, very healthy to begin with).

I think the key is to be informed about all these things, and make a decision together with your health care provider. I do think they have expertise that I lack, and I work with them b/c I value their input too. Its also a good idea to know what the hospital protocols are, sometimes you might choose some testing if it avoids more interventions down the road.

Quote:
Originally Posted by AlexisT View Post

If you're giving birth in hospital, find out your hospital's procedures if you decline GBS testing. Some hospitals have fairly invasive procedures for unknown GBS status--either they assume you're positive anyway, or they put the baby under extra observation. Tbh, I'd rather have the test and maybe get unnecessary antibiotics than subject the baby to more tests/meds/procedures. Although I may not even need the test as I'm probably having an RCS and will get abx anyway. (I was admitted to the hospital this week and the resident wanted to do a GBS test in case I had to deliver--I pointed out that I was a previous-CS patient, so they couldn't induce me [never mind that baby was transverse that day!] and asked if they needed to do it for an RCS. No, they don't, which is what I thought.)

I do the Vitamin K shot. The research I've seen has been positive on outcomes. It's done in other countries (unlike some procedures that seem to be unique to the US), the cancer link got debunked, and oral Vitamin K is apparently less effective at preventing late-onset disease.

I get tons of u/s as I am a high risk pregnancy (I'm also on 2x/weekly NSTs). Eye goop isn't a concern for me, for the same reason as GBS.

As for prenatals: Folic acid is only part of the problem. Many women are also deficient in iron and Vitamin D. I can't tolerate prenatals so I take kids' gummies with extra D and iron (SlowFe) as I have known deficiencies in both.
 
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