Anyone switch to a hospital birth just because of being GBS +? - Mothering Forums

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Old 05-02-2011, 04:38 PM - Thread Starter
 
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I'm considering it...

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Old 05-03-2011, 06:38 AM
 
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Do you have a midwife? What does she say?

 

Honestly, GBS is one of my "things"  because a baby in our area did die from early onset while I was having DD1 so you might want to take this with a grain of salt. If I was GBS+ I would also consider switching to hospital birth. If I developed a fever, went into labor before 38 weeks, or had broken waters for a long period of time I'd definitely switch. It's my comfort zone.  That said, a vast majority of babies born to GBS+ mothers do not develop GBS syndrome.


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Old 05-03-2011, 08:54 PM
 
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No way. The risks of baby contracting GBS, let alone dying, are so incredibly low, especially in the absence of risk factors (prolonged ROM, prematurity, fever) that I would be (and was) totally comfortable HBing if I were GBS+ (as I was the first time around). Treating with hibiclens is as effective as abx, in any case, so you could always do that. The protocol is here, and you could do it at the onset of labor and every couple hours throughout, if you were seriously worried.


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Old 05-04-2011, 03:38 PM
 
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I was also GBS+ with my first, and my HB midwife was totally comfortable with me using the Hibiclens protocol (thanks, PP, for digging up the links on that one) before & during labor.  In fact, after testing + the first time, I used Hibiclens for a week, then went back and re-took the test, and got a neg. result.  The Hibiclens wiped out the GBS bacteria in the area -- so it wasn't "cheating" the test, it was actually eliminating the problem.  I continued using it up till and during labor, just to be on the safe side.  Very simple.  This was a good idea, in my case, because when I ended up transferring to the hospital from my HB, I had the negative test on file with the hospital and was able to avoid abx when I got there.  Since I'm highly allergic to a lot of abx, this was a very very good thing indeed.  I think GBS is NOT a reason to have a hospital birth -- in fact, I'd say it's one more reason to AVOID a hospital birth, since if you go, you'll be hooked up to IV abx that raise your (and baby's) risk of e. coli and other infections (somebody find the links for that one?  I know the research backs that up).  And if you refuse the abx, you end up with the baby getting all sorts of crazy interventions -- prophylactic abx, mandatory NICU stays, extended separation from you right after birth for 'monitoring', extended hospital stay, etc.  Hospitals get pretty freaked out about this one.


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Old 05-04-2011, 03:43 PM
 
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I would consider it if i had other risk factors as well as a positive swab. 


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Old 05-05-2011, 02:58 PM
 
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Well, my own nephew died at 10 days old of a massive, systemic infection. His mom, my SIL, labored for just a few hours after ROM before going to c-section. Her GBS status was unknown at the time. He was one of the rare late-onset cases.

 

So while there are links that indicate antibiotic treatment after birth in GBS+ babies does not improve outcomes, prophylactic antibiotics do, and I find it to be a reason to give birth in the hospital.


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Old 05-05-2011, 04:21 PM
 
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There are two older studies that show use of IM Penicilin G 4.8 million units, covered moms for 30 days. Theraputic range was maintained for atleast that length of time. This style of treatment would avoid any of the last minute misses that occur. A possible option for those who want antibiotics and also stay out of hospital.
As for LATE onset GBS labor IV treatment is to protect against EARILY onset. Late onset can come from anywhere, hospital flora, anyone's hands basically environmental exposures, it is rampant in elderly populations and in people who have diabetes.
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Old 05-05-2011, 04:25 PM
 
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Quote:
Originally Posted by BarefootScientist View Post

I'm considering it...

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Just curious...can your MW not give antibiotics at a homebirth?  I ask because mine can if it was needed. 


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Old 05-05-2011, 06:32 PM
 
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As for LATE onset GBS labor IV treatment is to protect against EARILY onset. Late onset can come from anywhere, hospital flora, anyone's hands basically environmental exposures, it is rampant in elderly populations and in people who have diabetes.


That's right--late onset GBS is as likely to have been contracted in the hospital as via a colonized mother. And the point is that hibiclens works as effectively as abx to eliminate GBS (without all the nasty systemic effects), so if you're worried about GBS enough to treat, why not go with hibiclens?

 


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Old 05-05-2011, 10:53 PM
 
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That's right--late onset GBS is as likely to have been contracted in the hospital as via a colonized mother. And the point is that hibiclens works as effectively as abx to eliminate GBS (without all the nasty systemic effects), so if you're worried about GBS enough to treat, why not go with hibiclens?

 

 

Do you happen to have evidence or studies to prove the bold statement?  Or is this just your opinion.... I'm currently of the opinion GBS+ should have anti-b's, but I'm open to change and would like more information.
 

 


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Old 05-06-2011, 12:08 PM
 
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Don't have time to dig up the others, but here's one study that concluded that "intrapartum vaginal flushings with chlorhexidine in colonized mothers display the same efficacy as ampicillin in preventing vertical transmission of group B streptococcus. Moreover, the rate of neonatal E. coli colonization was reduced by chlorhexidine."

 

http://www.ncbi.nlm.nih.gov/pubmed/12375548


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Old 05-06-2011, 12:15 PM
 
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The hibiclens studies showed effectiveness at about the same level as treating risk factors, and it killes ecoli which was the second biggest cause of infection.but cochrane gave it a pass cuz it isnt the same as iv antibiotics. If infection is already in the chorion or in the uterus or if mom has urinary tract colonization then hibiclense will not be effective.
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Old 05-06-2011, 07:48 PM - Thread Starter
 
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Just curious...can your MW not give antibiotics at a homebirth?  I ask because mine can if it was needed. 


Nope, sure can't. Would be nice.

We've decided to go with the hospital birth and have a wonderful family doctor, very natural birth-friendly, but please, continue the conversation! I am finding it interesting.

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Old 05-07-2011, 03:27 PM
 
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Don't have time to dig up the others, but here's one study that concluded that "intrapartum vaginal flushings with chlorhexidine in colonized mothers display the same efficacy as ampicillin in preventing vertical transmission of group B streptococcus. Moreover, the rate of neonatal E. coli colonization was reduced by chlorhexidine."

 

http://www.ncbi.nlm.nih.gov/pubmed/12375548


 

Excellent, thank you!!!!

 


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Old 05-14-2011, 02:59 PM
 
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You've already made your decision, so maybe you don't want to think about other possibilities...but with my MW, it's against state law for her to give abx (even though she has training to do so), so our option was to hire a home health nurse to do it.  That might be an option for others who are reading this thread and are in the same boat.   Luckily my Mom is a nurse, so if we test positive, she'll do the iv. 

(It's also state law in AR that if you choose to be tested and you test positive, you have to follow the cdc protocol on GBS, which is IV abx.  So oral or injected abx aren't an option.  Except that you have the option to fill the prescription for the IV but then not use it.)


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Old 05-21-2011, 09:34 PM
 
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The study being cited is an extremely small study group, and anyway, it has since been proven wrong by subsequent, larger studies.  The ONLY effective treatment for GBS is IV antibiotics during labor.  Not garlic, not hibiclens, not oral antibiotics, not IM abx.  Just IV meds.  And they are extremely effective.

 

GBS is serious and it hits hard and fast.  It's one of those things that once the baby has it, it's really hard to treat it, even with our modern medicine.  The best way is to prevent it in the first place.  I work in OB, and one of the nurse friends I work with came in a couple years ago in precip labor.  Her water broke in the car on the way to the hospital.  She delivered less than 10 minutes from walking onto the floor, and there were no vaginal checks before her delivery.  The fact that her membranes were intact and there were no vaginal checks would make you think she was "safe".  However, her baby quickly became severely ill with GBS and spent 3 weeks in the NICU.  It was her 3rd baby, and she often jokes that her birth with the least interventions gave her the sickest child (her other births were IND, epi, etc)

Just saying that even the best scenario (as far as risk factors) does not protect you as well as IV antibiotics have been proven to.

 

There is a lot of information on

http://www.groupbstrepinternational.org/index.html

 

And here is a GBS homebirth story to consider (family treated with "alternative" treatments....garlic, etc)

 

http://hurtbyhomebirth.blogspot.com/2011/03/wrens-story-on-1st-anniversary-of-his.html

 

Additionally, a word on hibiclens:

http://skepticalob.blogspot.com/2011/05/wash-your-vagina-out-with-soap.html

 

Just wanting to put an alternative opinion out there.

 

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Old 05-22-2011, 03:30 AM
 
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So the link to the garlic treatment, homebirth loss, mom had urinary tract colonization. This is important to note because the majority of babies who get sick from gbs it is from the resistant strains that can colonize the urinary tract big warning sign, , second and 3rd 36 weeks and a boy baby additional risk factors, no result obtained before birth but despite using garlic the lab test came up positive.
In cases of quick labors Im antibiotics would work either given to mom prenatally or given to babies in the postpartum, Parkland hospital has had the highest #of births in the US and they have treated all bsbies with Im antibiotics for years instead of treating moms and they have a pretty good prevention rate, possibly one of the best.
The newest studies how ever are showing that because of treatment of GBS a few other bacteria have become primary causes of illness, ecoli and another coliform...so the rate of infection in neonates has not changed , just the type of infecting bacteria. And unfortunately ecoli has a thriving resistant strain(s).
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Old 05-22-2011, 09:24 AM
 
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The mother had a urine infection with it earlier in the pregnancy, for which she was given a course of antibiotics.  It's very possible the GBS could have re-invaded the urine again, but we don't know for sure whether she had that heavy of infection again when she gave birth.

I absolutely agree with you that when it's in the urine, the risks go way up, but this certainly doesn't mean you should feel much safer just because you don't have it in your urine.

Also, many places do not ever check for GBS in pregnant women's urine.  The facility that I work doesn't (not unless you have signs of a uti) since the treatment during labor is the same regardless.  So really, most women don't know if they "just" have gbs in their vaginal colony or if it's also in their urine. 

 

I do understand that some places give IM antibiotics especially in cases where there is no time for an IV course.  I'm just saying this route isn't as effective (but it's better than nothing).  Also, I would assume that most people on this board would rather have the IV given to mom and only travel to baby indirectly, rather than have to have the baby get poked and given antibiotics directly to them because of the mother's failure to be treated. (that's just an assumption though)

 

E coli--  E. coli is a distant second in causing death from neonatal sepsis. As the absolute numbers of sepsis deaths decrease because the absolute numbers of GBS cases goes down and the absolute number of E. coli cases remain the same, the proportion of neonatal deaths attributable to E.coli rises. That is the inevitable and entirely predictable outcome of treating the most common cause of neonatal sepsis.

 

"but despite using garlic the lab test came up positive."

 

That's because the garlic doesn't work.

 

 

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Old 05-22-2011, 09:29 AM
 
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Sorry, I'm not trying to be argumentative just for the sake of arguing.  I'm just trying to put an alternative view out there besides the "GBS is no big deal, just give these natural treatments and everything will be fine" prevailing opinion on MDC.

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Old 05-22-2011, 10:50 AM
 
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OP--You may want to research these other preventative measures even though you are planning a hospital birth.  I had a planned hospital birth with GBS+, and wanted to get there in plenty of time for my 4 hours of antibiotics.  I labored at home briefly, then left immediately left for the hospital when my water broke.  The hospital was about 5 minutes away.  By the time I got there, they checked me and I was at 7cm.  (My monitrice thinks I was at around 4cm when my water broke, although she didn't check me.)  They immediately tried to get an IV in me, but at that point I was already complete and pushing so abx were abandoned.  Since I had a 24 hour labor with my first and my second was much larger, I was certainly not expecting to go so quickly.  I had treated with hibiclens previously and rinsed with it a couple of times in early labor before my water broke just in case. It worked out for the best for us, since DS was fine and we didn't have to deal with the consequences of abx, but you may want to be prepared for the possibility that you may not be there long enough to rely on abx.

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Old 05-23-2011, 05:06 AM
 
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The info on Detection in urine from the cdc
"GBS identified in clean-catch urine specimens during any trimester is considered a surrogate for heavy maternal colonization and also is associated with a higher risk for early-onset GBS disease" 
     from the Current CDC recommendations also-
"Although some women receive antibiotics to treat GBS bacteriuria during pregnancy, antibiotics do not eliminate GBS from the genitourinary and gastrointestinal tracts, and recolonization after a course of antibiotics is typical (71,131,132). Studies have found that some women with GBS bacteriuria during the first trimester might not have vaginal-rectal colonization detected at 35--37 weeks' gestation (130) or at the time of delivery (133). However, maternal GBS bacteriuria at any point during pregnancy is a recognized risk factor for early-onset GBS disease and therefore has been included as an indication for intrapartum antibiotic prophylaxis since 1996.

Subsequent observational studies have found the effectiveness to be 86%--89% among infants born to women who received intrapartum GBS prophylaxis

In reading over the higher dose 4.8m  IM penicillin the studies were small but promising with no heavily colonized patients ... Highest levels of antibiotics if within 4 weeks of shot, 

i know that the CDC guidelines was recognizing there is something up with other flora but nothing  solidly proven other than greater incidence of resistant ecoli strains...
There are 2 very recently published studies that point to other flora taking the lead in infections.

J Perinatol. 2011 Apr 28. 
Early-onset neonatal sepsis: rate and organism pattern between 2003 and 2008.
Sgro M, Shah PS, Campbell D, Tenuta A, Shivananda S, Lee SK.
Canada"
Skipping intro and basic birth population numbers
"Result:A total of 405 infants had positive blood and/or cerebral spinal fluid cultures over the study period. The EONS rate was 6.8/1000 admissions (n=24969) in the earlier cohort compared with 6.2/1000 admissions (n=37484) in the later cohort (P=0.36). Rate of clinical chorioamnionitis was higher in the later cohort (38 vs 26%; P=0.02). For term infants, coagulase-negative Staphylococcus (CONS) (2.4/1000) followed by group B Streptococcus (GBS) (1.9/1000) were the most common organisms identified. For preterm infants, CONS (2.5/1000) followed by Escherichia coli (2.6/1000) were the most common organisms identified. There was a significant reduction in GBS EONS over time (P<0.01) and a trend toward an increase in other organisms.Conclusion:Although the rate of EONS among neonates admitted to NICUs has not changed, the pattern of infection has changed over the past 6 years. With the increased use of prophylactic antibiotics to mothers, careful surveillance of the changing trend of bacterial organisms among neonates is warranted.
.Journal of Perinatology advance online publication, 28 April 2011; doi:10.1038/jp.2011.40."

Pediatr Neonatol. 2011 Apr;52(2):78-84. Epub 2011 Mar 16.
The Changing Face of Early-onset Neonatal Sepsis After the Implementation of a Maternal Group B Streptococcus Screening and Intrapartum Prophylaxis Policy-A Study in One Medical Center.
Lin CY, Hsu CH, Huang FY, Chang JH, Hung HY, Kao HA, Peng CC, Jim WT, Chi H, Chiu NC, Chang TY, Chen CY, Chen CP.
Division of Neonatology, Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
"The GBS screening rate increased from 10.11% in 2004 to 65% in 2008 and the IAP rate increased from 40% in 2004 to 90% in 2008. The most common EOS pathogen in Period 1 was GBS (45.4%), which decreased to 20% in Period 2 (p=0.081; trend p=0.009). The percentage of EOS because of Escherichia coli in Period 1 was 40.9% but increased to 70% in Period 2 (p=0.059). E coli EOS increased in extremely low birth weight premature babies weighing 500-1000g from Period 1 to Period 2 (p=0.031). The incidence of ampicillin-resistant E coli EOS was relatively high, but no significant change (88.9% vs. 92.9%) after implementation of GBS screening and IAP was noted."
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Old 05-23-2011, 07:31 AM - Thread Starter
 
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puddle, thank you. I did pick up a bottle of hibiclens to use at home should the need arise. I don't plan to labor at home very long, but I've already had one episode last week when I went in to the hospital with what was either not real labor, or it was stalled out by the hospital, so I can't go in at the first contraction either. The scenario described above where the mom showed up pushing, her water having broken on the way, was pretty much my previous birth (I was GBS- that time though) so I figure there is a non-insignificant chance I won't make it in time for the antibiotics.

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Old 05-23-2011, 10:44 AM
 
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If you don't happen to make it to the hospital in time, they can always give antibiotics directly to baby afterwards, which is very effective.

The unit I work on doesn't automatically do this, unless there are some increased risk factors (premature, previous GBS infected baby, GBS in urine). 

Instead, what we do is admit baby as a "Step-Up" in the nursery.  It basically just means that we watch the baby extra close.  Check vitals more often, etc.  Baby is allowed to stay in mother's room, but when mother wants to go to sleep and there isn't going to be an awake adult in the room, the baby comes to the nursery until mom wakes up again.  Also baby is not allowed an early discharge and has a 3-4 day checkup with the Ped. 

There is also a blood test that you can do on baby shortly after the birth to see if an infection is brewing.  (the homebirth midwife that I use has all of her GBS moms take their baby in for this blood test shortly after the birth, since she cannot administer antibiotics in our state)

Another option, some people choose to have their labor induced so that they can be certain to have antibiotics on board.

 

 

Just giving you a bunch of different things to consider and to talk with your provider about.  At the very least, I recommend that you memorize the symptoms of GBS infection in a newborn.

 

Good luck with your birth and congrats on your upcoming bundle of joy!

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Old 05-23-2011, 12:54 PM
 
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Ryleigh's Mommy, thank you for the great info. I was GBS positive for my first two births and expect I will be for my third, as well. In both my previous labors, I wasn't in labor long enough to receive the full course of abx, so your suggestions are very helpful!

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Old 06-01-2011, 05:13 PM - Thread Starter
 
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Just wanted to update this thread with what happened, in case anyone is interested. Like I said, I had a couple of false alarms - irregular but fairly strong contractions so it was a bit of a mind game for me to figure out when to go to the hospital. This happened again starting about 11:45 Sunday night, they didn't seem to be getting stronger or anything so I decided to go to bed, but before bed I did a Hibiclens just in case. Felt a little pop and started leaking water at 1:45, woke up DH, called the hospital, got dressed, called my MIL, started pushing! Very precipitous birth - he was born at 2:20 am. and my DH said the waters broke as his shoulders came out. We had an agreement with our HB midwife that she would come help out if things went fast, even though we'd officially switched care to our family doc. So she came and helped us cut the cord and stitch my tear and everything. No signs of GBS and we are doing great 2.5 days later other than lots of nipple pain while nursing!

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Old 06-01-2011, 07:31 PM
 
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Yay, congrats mama! Glad to hear everything went so well and that the GBS wasn't an issue. Hope the nipple pain passes soon--lots of lansinoh, air drying, and labor breathing to get you through these rough first days


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