Group B Strep / IV During Labor - Mothering Forums

Forum Jump: 
 
Thread Tools
#1 of 19 Old 05-04-2008, 02:07 PM - Thread Starter
 
alli437's Avatar
 
Join Date: Oct 2006
Posts: 164
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Hi. I'm a childbirth educator and I'm going to be talking about GBS in my next class. I know all about the actual rates of GBS (.5%) and how taking antiobiotics during labor could lead to antibiotic-resistant bacteria, allergic reations to the penicillin, etc.

A couple of questions:

1) Is there anything women can do before getting tested at 35-37 weeks to help reduce their chances of testing positive for GBS?

2) How much will having an IV during labor restrict freedom of movement? (I've had two homebirths, so I'm not that familiar with stuff like this.)

Thanks!
alli437 is offline  
#2 of 19 Old 05-04-2008, 02:27 PM
 
nashvillemidwife's Avatar
 
Join Date: Dec 2007
Posts: 2,717
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by alli437 View Post
1) Is there anything women can do before getting tested at 35-37 weeks to help reduce their chances of testing positive for GBS?
Yes, there are lots of suggestions, if you do your own google search you will fid them. But is the goal to test negative or to protect the baby? Because if you're doing it to actually rid yourself of GBS you will need to continue whatever regimen until birth.

Quote:
2) How much will having an IV during labor restrict freedom of movement?
It really should not have much effect as the IV pole is portable. It's a matter of being conscious not to get tangled up in the lines.
nashvillemidwife is offline  
#3 of 19 Old 05-04-2008, 02:35 PM - Thread Starter
 
alli437's Avatar
 
Join Date: Oct 2006
Posts: 164
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
[QUOTE=nashvillemidwife;11134096]But is the goal to test negative or to protect the baby? Because if you're doing it to actually rid yourself of GBS you will need to continue whatever regimen until birth.QUOTE]

I think a big part of the goal is just to get them to test negative, because I don't see GBS as being a big risk to the baby and I think that antibiotics used during labor are a much bigger risk.
alli437 is offline  
#4 of 19 Old 05-04-2008, 04:32 PM
 
JessicaE's Avatar
 
Join Date: Oct 2005
Posts: 306
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by alli437 View Post

I think a big part of the goal is just to get them to test negative, because I don't see GBS as being a big risk to the baby and I think that antibiotics used during labor are a much bigger risk.

As an instructor, I'd be careful about how you talk about this to your students. I always stress that the purpose of any of these measures is not so much to "fool the test," but to protect the baby. What if they passed the test, stopped the measures, and then their baby was the 1 in 200 that got GBS? It may be a small risk, but it's a risk they ought to consider. And what if they felt that YOU had told them to do these things because they wouldn't want the IV, and GBS was "not a big risk to the baby"?

I think I probably agree with you in terms of the risks of antibiotics outweighing the risks of GBS. However, those are *MY* opinions, and I try not to force my opinions on my students, but rather lay out some pros and cons, present some balanced evidence, and empower them to decide for themselves. I think that GBS is one of the more difficult issues to decide on, but I trust my students to weigh the pros and cons and decide what's best for them and their baby.

That's not what you asked though, of course. You will find lots of helpful info in the Gentle Birth archives:

http://www.gentlebirth.org/archives/gbs.html

Also search GBS on Mothering.com, there have been several helpful articles in Mothering that outline alternatives to abx.

Best wishes for your class tomorrow!
JessicaE is offline  
#5 of 19 Old 05-04-2008, 04:50 PM
 
Jane's Avatar
 
Join Date: May 2002
Location: Kenmore, Washington
Posts: 7,110
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I think you've always got the issue of 1 in 200. For some people, that is a huge risk, for others, a small risk - yet it's the same number. For the OB who delivers 600 babies a year, and for whom 1/3 of his patients are GBS+, that's one very sick, perhaps deathly sick baby per year and that's a lot for somethings that's totally preventable. For the mama who'd have to live 10 lifetimes to have 200 babies and have a sick one, it seems different.

I prefer people to live healthy lives and not do anything to fool the test. Most will test negative and need to do nothing else.

I think the biggest issue with testing positive and planning a hospital birth is that they want to rush, rush, rush you in to the hospital to get that first dose of antibiotics. Best protection happens after two doses. If you knew the moment of birth, you'd want to start the first IV dose 5 hours before birth. There is substancial effect just 1 hour after the first dose. But two doses is best and prevents the pediatrician from wanting to keep the baby on a sepsis protocol for 24-48 hours.
Anyway, I wouldn't want to see a mama on an IV for 48 hours with 12 doses of antibiotics after she arrived at the hospital way prior to contractions, all puffedup on fluids by the time the baby is born. This is a good reason to do a heplock.
I'm sure as a CBE you know all the problems associated with arriving too soon.

Homebirth Midwife biggrinbounce.gif

After 4 m/c, our stillheart.gif is here!

Jane is offline  
#6 of 19 Old 05-04-2008, 07:55 PM - Thread Starter
 
alli437's Avatar
 
Join Date: Oct 2006
Posts: 164
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
[QUOTE=JessicaE;11134926]As an instructor, I'd be careful about how you talk about this to your students.

I think I probably agree with you in terms of the risks of antibiotics outweighing the risks of GBS.
QUOTE]

No, I was just talking candidly in this forum about how I feel. I do think that the risks of antibiotics outweigh the risks of GBS. So, what if that mother, instead of being the 1 in 200 that lost a baby to GBS instead was the 1 in 200mother who loses a baby to antibiotic-resistant bacteria or an allergic reaction to the penicillin? The risks are the same, so it doesn't make sense to me to blanket that 30% GBS population with automatic antibiotics.

But, yes, to clarify, I will present both sides of the issue. But it is this other side that I am concentrating on (questioning the use of antibiotics) because that is the side that they don't know about yet.

And, yes, of course the best interest of the baby is always what comes first.
alli437 is offline  
#7 of 19 Old 05-04-2008, 08:44 PM
 
3cuties's Avatar
 
Join Date: Mar 2006
Location: Chicagoland
Posts: 996
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
[QUOTE=alli437;11135934]
Quote:
Originally Posted by JessicaE View Post
So, what if that mother, instead of being the 1 in 200 that lost a baby to GBS instead was the 1 in 200mother who loses a baby to antibiotic-resistant bacteria or an allergic reaction to the penicillin? The risks are the same, so it doesn't make sense to me to blanket that 30% GBS population with automatic antibiotics.
Is this true, statisticially the risks are the same? Do you have a cite?
3cuties is offline  
#8 of 19 Old 05-04-2008, 10:29 PM
 
mommyminer's Avatar
 
Join Date: Aug 2006
Location: IL
Posts: 303
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Just to point out ~ after the antibiotic is in, the RN could disconnect the tubing and leave the saline lock for the next round of antibiotics.

Janel ~ wife and mother of 4, L&D RN, midwifery student
mommyminer is offline  
#9 of 19 Old 05-04-2008, 10:34 PM
 
Belle's Avatar
 
Join Date: Feb 2005
Location: Vancouver, (Not BC) WA (Not DC)
Posts: 2,996
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I think that a test that can be so easily fooled is not that valuable a test. We opted not to even bother with our home birth. It was not presented as optional at our hospital birth. You may want to mention to your students that the have the right to opt out if they wish.

Heather Mike Married 8/1/99 Mom to Charlotte Aug 04, Nov 06, and Katherine Oct 07
Belle is offline  
#10 of 19 Old 05-04-2008, 11:37 PM
 
JessicaE's Avatar
 
Join Date: Oct 2005
Posts: 306
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
[QUOTE=3cuties;11136314]
Quote:
Originally Posted by alli437 View Post

Is this true, statisticially the risks are the same? Do you have a cite?
Just to clarify, I was not the person who posted this. It says the quote is from me, it was actually from the OP. I think the quotes system at MDC may be a bit mixed up right now.
JessicaE is offline  
#11 of 19 Old 05-05-2008, 09:15 PM
 
blissful_maia's Avatar
 
Join Date: Feb 2005
Location: Alberta
Posts: 3,573
Mentioned: 22 Post(s)
Tagged: 0 Thread(s)
Quoted: 6 Post(s)
First I wanted to add 2 pieces of information to the discussion:

Firstly, The 1 in 200 risk is of your baby developing GBS disease (infection). Of these babies, between 5 and 10% die. So 1 in 2000 to 1 in 4000 die.

Secondly, GBS disease is not completely preventable, as a pp said. The common antibiotics are becoming increasingly resistant to GBS, there needs to be a certain number of hours of coverage, etc. etc. I believe the number needed to treat to prevent one death from GBS is somewhere in the neighborhood of 60 000.

Another issue often overlooked that I find of importance is also the increase in aggressive infection due to gram - bacteria (for example, E. coli) that is seen as the universal screening/treating rates go up.

Peaceful mama to three blissfully-birthed and incredible small people: dd10, dd7 and ds5. Always awed and so thankful to be a midwife.
blissful_maia is online now  
#12 of 19 Old 05-06-2008, 05:27 PM - Thread Starter
 
alli437's Avatar
 
Join Date: Oct 2006
Posts: 164
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
[QUOTE=3cuties;11136314]
Quote:
Originally Posted by alli437 View Post

Is this true, statisticially the risks are the same? Do you have a cite?
Here is the article I read from mothering.com:

https://www.mothering.com/articles/p...n/group-b.html

An excerpt from the article:

CDC estimates that 0.5 percent of babies born to GBS-positive mothers with no treatment will develop a GBS infection, and that 6 percent of those who develop a GBS infection will die. Six percent of 0.5 percent means that three out of every 10,000 babies born to GBS-positive mothers given no antibiotics during labor will die from GBS infection. If the mother develops anaphylaxis during labor (one in 10,000 will), and it is untreated, it is likely that the infant, too, will die. So, by CDC estimates, we save the lives of two in 10,000 babies-0.02 percent-by administering antibiotics during labor to one third of all laboring women. We should also keep in mind that this figure does not take into account the infants that will die as a result of bacteria made antibiotic-resistant by the use of antibiotics during labor-infants who would not otherwise have become ill. When you take that into account, there may not be any lives saved by using antibiotics during labor.
alli437 is offline  
#13 of 19 Old 05-06-2008, 05:32 PM
 
3cuties's Avatar
 
Join Date: Mar 2006
Location: Chicagoland
Posts: 996
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
[QUOTE=alli437;11152837]
Quote:
Originally Posted by 3cuties View Post

Here is the article I read from mothering.com:

https://www.mothering.com/articles/p...n/group-b.html

An excerpt from the article:

CDC estimates that 0.5 percent of babies born to GBS-positive mothers with no treatment will develop a GBS infection, and that 6 percent of those who develop a GBS infection will die. Six percent of 0.5 percent means that three out of every 10,000 babies born to GBS-positive mothers given no antibiotics during labor will die from GBS infection. If the mother develops anaphylaxis during labor (one in 10,000 will), and it is untreated, it is likely that the infant, too, will die. So, by CDC estimates, we save the lives of two in 10,000 babies-0.02 percent-by administering antibiotics during labor to one third of all laboring women. We should also keep in mind that this figure does not take into account the infants that will die as a result of bacteria made antibiotic-resistant by the use of antibiotics during labor-infants who would not otherwise have become ill. When you take that into account, there may not be any lives saved by using antibiotics during labor.
Thank you for posting this. Your post stated that the risk was the same -- and there is no citation stating that the risks are the same.
3cuties is offline  
#14 of 19 Old 05-06-2008, 07:48 PM - Thread Starter
 
alli437's Avatar
 
Join Date: Oct 2006
Posts: 164
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Yes, I thought I cited it right here:

...So, by CDC estimates, we save the lives of two in 10,000 babies-0.02 percent-by administering antibiotics during labor to one third of all laboring women. We should also keep in mind that this figure does not take into account the infants that will die as a result of bacteria made antibiotic-resistant by the use of antibiotics during labor-infants who would not otherwise have become ill. When you take that into account, there may not be any lives saved by using antibiotics during labor.

So, the rates of babies that die are the same, they are just dying of different things (GBS, compared with allergic reaction to the penicillin / antibiotic-resistant infections).
alli437 is offline  
#15 of 19 Old 05-06-2008, 08:36 PM
 
nashvillemidwife's Avatar
 
Join Date: Dec 2007
Posts: 2,717
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
That's not a citation, that's someone's speculation. What are the rates of babies that die from non-GBS antibiotic-resistant infections and antibiotic-induced anaphylaxis?
nashvillemidwife is offline  
#16 of 19 Old 05-06-2008, 11:45 PM - Thread Starter
 
alli437's Avatar
 
Join Date: Oct 2006
Posts: 164
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I posted the link to the whole article, so you can read all about it there. I don't think it is just someone's speculation. In this very well researched article, she actually has references to the stuides if you look at the end of the article.

Will this excerpt help clarify:

Up to 29 percent of GBS strains have been shown to be resistant to non-penicillin antibiotics. For women not known to be allergic to penicillin, there is a one in ten risk of a mild allergic reaction to penicillin, such as a rash. Even for those women who have no prior experience of a penicillin allergy, there is a one in 10,000 chance of developing anaphylaxis, a life-threatening allergic reaction.

Maybe I'm not understanding what you want.
alli437 is offline  
#17 of 19 Old 05-07-2008, 12:18 AM
 
3cuties's Avatar
 
Join Date: Mar 2006
Location: Chicagoland
Posts: 996
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by alli437 View Post
Maybe I'm not understanding what you want.
A statistical comparison of risks to the newborns, which the excerpts you posted do not demonstrate. I am sympathetic to your opinion, but to state it so definitely it is more persuasive to have equivalent statisical comparison and from what I have seen you post it isn't there.
3cuties is offline  
#18 of 19 Old 05-07-2008, 01:30 AM
 
nurturedbirth's Avatar
 
Join Date: Jul 2005
Location: Northern Colorado
Posts: 150
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I'm going to link a previous post by Ironica as well as the thread in which she posted it. She did a good job summarizing the CDCs risk assessment on GBS.
nurturedbirth is offline  
#19 of 19 Old 05-07-2008, 04:10 PM
 
tabasco's Avatar
 
Join Date: Dec 2007
Posts: 86
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by alli437 View Post

Here is the article I read from mothering.com:

https://www.mothering.com/articles/p...n/group-b.html

An excerpt from the article:

CDC estimates that 0.5 percent of babies born to GBS-positive mothers with no treatment will develop a GBS infection, and that 6 percent of those who develop a GBS infection will die. Six percent of 0.5 percent means that three out of every 10,000 babies born to GBS-positive mothers given no antibiotics during labor will die from GBS infection. If the mother develops anaphylaxis during labor (one in 10,000 will), and it is untreated, it is likely that the infant, too, will die. So, by CDC estimates, we save the lives of two in 10,000 babies-0.02 percent-by administering antibiotics during labor to one third of all laboring women. We should also keep in mind that this figure does not take into account the infants that will die as a result of bacteria made antibiotic-resistant by the use of antibiotics during labor-infants who would not otherwise have become ill. When you take that into account, there may not be any lives saved by using antibiotics during labor.
First of all, death is not the only risk related to early-onset GBS infection.

I have real problems with some of the arguments set forth by the author of that MDC article. I don't have time to provide a thorough analysis now. But to give you one example, she states that some studies have shown that abx are not effective in preventing GBS infection, but then she cites two older articles, from before the testing protocol changed, in support. They were testing women earlier at that time, so they were likely missing some women who would become colonized later in their pregnancies. Please note that I'm not saying that I'm necessarily supportive of routine chemoprophylaxis for all GBS-positive women, or a fan of the way testing is done in general. I wish there were a stronger evidence base surrounding the decisions regarding intrapartum prophylaxis, but I feel very strongly that the research cited should be presented accurately.

To the OP: IMO, the best thing you can do for your students is present the risks and benefits claimed by those on both sides of the issue. That's going to mean a lot of research--which I hope will include reading entire journal articles (not just the abstracts!). The issue of risk is a funny thing, and everyone has a different level of comfort. By presenting both sides, you will help your students to make the right decision for them.

SAHM to DD (8/2006) and DS (7/2008)
tabasco is offline  
Reply

Quick Reply
Message:
Drag and Drop File Upload
Drag files here to attach!
Upload Progress: 0
Options

Register Now

In order to be able to post messages on the Mothering Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
If you do not want to register, fill this field only and the name will be used as user name for your post.
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



User Tag List

Thread Tools
Show Printable Version Show Printable Version
Email this Page Email this Page


Forum Jump: 

Posting Rules  
You may post new threads
You may post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off