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#31 of 43 Old 01-11-2012, 02:09 PM
 
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KT, that link didn't work for me. http://www.cdc.gov/groupbstrep/guidelines/guidelines.html  should take you there.


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#32 of 43 Old 01-11-2012, 02:30 PM - Thread Starter
 
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Originally Posted by KTinSeattle View Post

Maybe I can help -- I'm a hospital pediatrician, and although I don't agree with your plan to avoid prophylactic antibiotics, I can assure you that the hospital providers have no reason to do lab tests on the baby for "inadequate prophylaxis" (that's what we call it when you are GBS unknown, or you get antibiotics less than 4 hrs before delivery) as long as there are no signs of active infection, the baby is term, and your membranes were ruptured (water broken) for less than 18 hours.  Unfortunately some providers still follow outdated guidelines that required CBC (complete blood count) and blood culture for inadequate prophylaxis, but the 2010 CDC guidelines (http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf, see page 22 for specifics to your situation) do not recommend blood tests.  HOWEVER, if your baby is showing any signs of sepsis (infection) such as high or low temps, breathing fast or hard, low blood sugar, etc, OR you have signs of chorioamnionitis (infection of your uterus/amniotic fluid) then they will absolutely do blood tests and likely start IV antibiotics on the baby.  And no, you can't "decline" those -- you have rights as a parent, but if you refuse medically necessary treatment, the care providers have a responsibility for the baby's health.  

Thank you SO much!  I really appreciate you providing this, despite disagreeing with me.  THAT's what more doctors should be like.  Give me your opinion, present current medical recommendations, but respect my ability to use my brain to make my own decisions.  Thank you.

 

And, if there was ANY reason to expect that there was an actual infection, I would not hesitate at all to have the baby or myself treated.  I just really feel like there's a good chance that the baby and I would be exposed unnecessarily if we do the prophylaxis.  I'd rather save the antibiotics for when there is an actual problem, not just the small possibility of one.  
 

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Originally Posted by Katie8681 View Post

KT, that link didn't work for me. http://www.cdc.gov/groupbstrep/guidelines/guidelines.html  should take you there.

Thanks!  I'll be printing this out to bring with me.
 

 

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#33 of 43 Old 01-11-2012, 06:59 PM
 
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No problem.  I am totally on board with avoiding unnecessary intervention.  Where we might quibble is on the definition of "necessary."  (I mean no disrespect; that comment just comes from painful conversations with parents who refuse various tests and treatments believing that they know better -- they may know their child better than I, but I know neonatal sepsis and meningitis better.  If you had ever seen GBS sepsis or known an infant who was affected, you might weigh differently the risks and benefits of a dose or two of antibiotics.)

My link included my sentence punctuation, a comma, which is why it didn't work.  Delete that and it should be ok: http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf

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#34 of 43 Old 01-12-2012, 10:41 AM - Thread Starter
 
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Originally Posted by KTinSeattle View Post

No problem.  I am totally on board with avoiding unnecessary intervention.  Where we might quibble is on the definition of "necessary."  (I mean no disrespect; that comment just comes from painful conversations with parents who refuse various tests and treatments believing that they know better -- they may know their child better than I, but I know neonatal sepsis and meningitis better.  If you had ever seen GBS sepsis or known an infant who was affected, you might weigh differently the risks and benefits of a dose or two of antibiotics.)

My link included my sentence punctuation, a comma, which is why it didn't work.  Delete that and it should be ok: http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf


I understand that GBS can be very serious, and I appreciate your concern.  Where I really feel like this is unnecessary, or pointless, is that I don't expect it's very likely that we'd get the abx 4+hrs before birth anyway.  So then we've been exposed, but it won't "count" anyway.  In that case, and especially in the absence of other risk factors (I have short labors, ROM within minutes of birth, no vag exams ever, etc.), I would rather just have the baby and I observed and treat accordingly.  Again, I really appreciate the link.  I've printed several copies and plan to discuss it with my mw, ped, etc.  Thanks!!

 

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#35 of 43 Old 01-12-2012, 03:39 PM
 
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I will share my story:

 

To be perfectly honest I am pretty cautious regarding this issue and have no problems with the IV and antibiotics. In fact, I quite love the IV and the boost of energy that the extra fluids gave me. However, I have a history of precipitous labors and I have never had a full dose of antibiotics for either one of my labors. Because of this, after I had DS2 the hospital did in fact test him for sepsis even though my labor was very quick and the membranes did not rupture until 5 min before I pushed him out.

 

They took blood from his foot and because of the coagulation issues mentioned by others they had to do it a few times. The results showed + that a cluster was growing. A cluster is more typical of a contaminate. Baby looked good, was nursing great, perfectly healthy. However because of the lab results they admitted him to the NICU and pumped him full of antibiotics. In the end, the test had been contaminated. He did not have sepsis. He was treated unneccesarily and we were sent a big fat bill. He also had thrush as a result and they overlooked a severe tongue tie during his stay which we had to return to the hospital for surgery and by then our nursing relationship suffered. It was awful. I understand that the hospital was following protocol and being very conservative but it was not a good experience I feel that they did not take everything into consideration when making their verdict to admit him.

 

 We have decided to have a homebirth this time, so I won't even be tested but I will assume that I will be GBS+.  I also plan to begin treatment for GBS now, regardless of our birth plans because even if I wanted to pursue a hospital birth, the likelihood of getting even a full round of antibiotics is pretty slim so it is a moot point for someone with precipitous labor to rely on antibiotics.

 

I have also been reading that if a baby truly has sepsis that the antibiotics given during birth may interfere with treatment as the baby may have built up an immunity making their systems resistant to the antibiotics--and that really scares me.

 


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#36 of 43 Old 01-14-2012, 10:43 AM
 
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Originally Posted by xnwife View Post

I have also been reading that if a baby truly has sepsis that the antibiotics given during birth may interfere with treatment as the baby may have built up an immunity making their systems resistant to the antibiotics--and that really scares me.

 


This is a misunderstanding of "resistance". When people talk about antibiotics and resistance, it means, briefly, this: When bacteria are exposed to an antibiotic, particularly for a short period of time, the bacteria that are very vulnerable to that antibiotic are killed, but some, due to their genetics, are not as vulnerable. Those bacteria stay alive and become dominant because they no longer have competition from those vulnerable bacteria. They are "resistant" to the antibiotic and now they can cause an infection that can't be treated with that drug. They can also go on and share the part of their genetics that make them resistant to the antibiotic with other bacteria. But the person himself isn't resistant. Just a little FYI. 

 


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#37 of 43 Old 01-16-2012, 12:43 PM
 
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Quote:
Originally Posted by KTinSeattle View Post

Maybe I can help -- I'm a hospital pediatrician, and although I don't agree with your plan to avoid prophylactic antibiotics, I can assure you that the hospital providers have no reason to do lab tests on the baby for "inadequate prophylaxis" (that's what we call it when you are GBS unknown, or you get antibiotics less than 4 hrs before delivery) as long as there are no signs of active infection, the baby is term, and your membranes were ruptured (water broken) for less than 18 hours.  Unfortunately some providers still follow outdated guidelines that required CBC (complete blood count) and blood culture for inadequate prophylaxis, but the 2010 CDC guidelines (http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf, see page 22 for specifics to your situation) do not recommend blood tests.  HOWEVER, if your baby is showing any signs of sepsis (infection) such as high or low temps, breathing fast or hard, low blood sugar, etc, OR you have signs of chorioamnionitis (infection of your uterus/amniotic fluid) then they will absolutely do blood tests and likely start IV antibiotics on the baby.  And no, you can't "decline" those -- you have rights as a parent, but if you refuse medically necessary treatment, the care providers have a responsibility for the baby's health.  


see, reading this makes me MAD. Not at you, KT, but at the hospital peds who basically scared my husband to death and forced him to consent to the culture when my son Aiden was born Oct 2010. I was 42+4, he was healthy, and my water was broken for less than two hours. My entire LABOR was less than two hours. I had planned a home birth but when I went so postdates I had to transfer to the Army hospital in Seoul Korea for AROM. They told me that because my GBS status was unknown (and I obviously had not labored close to long enough for abx) they needed to do a culture. I refused, so the Captain pediatrician pulled my husband into the hallway and scared him with dead babies and issues at work (my husband is a soldier), and also told him he had NO choice in the matter. Non negotiable, is the language I believe he used. They put a tourniquet on Aiden's arm, and drew an amazing amount of blood...then forced us to stay in the hospital for THREE DAYS until the results came back. We could not check out AMA due to issues with my husband's chain of command, I wasn't about to do anything that could possibly get him in trouble, so there I sat, with my 9 pound, 5 ounce baby, perfectly healthy after a 2 hour unmedicated labor and birth, for three miserable days. Even the attending OB was baffled by their treatment of us...but the peds wouldn't budge. One told me we could go after 48 hours, then the other came in and retracted that, saying we had to wait the full 3 days for culture results. Not a very good ending to what had been a perfect birth.

 


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#38 of 43 Old 01-16-2012, 06:56 PM
 
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Other than the prophylactic antibiotics, I agree and believe this advice to be evidence based.

 

The part that makes me angry, as well (again, not at you, KT), is that women just don't have the choice about it.  It's like vaxing.  I'd be okay giving my kids a few here and there...but if I do that, then I loose my right to a religious exemption.  So, really, instead of free (as in polictically) healthcare, I have to weasel my way through to follow my conscience.  THAT is infuriating.   If the OP tests, she looses the right to make her own decisions.  If she doesn't test, she may far a bit better.  The problem, as I see it, is not the tests or the vaxes, but the lack of freedom.
 

Quote:
Originally Posted by KTinSeattle View Post

Maybe I can help -- I'm a hospital pediatrician, and although I don't agree with your plan to avoid prophylactic antibiotics, I can assure you that the hospital providers have no reason to do lab tests on the baby for "inadequate prophylaxis" (that's what we call it when you are GBS unknown, or you get antibiotics less than 4 hrs before delivery) as long as there are no signs of active infection, the baby is term, and your membranes were ruptured (water broken) for less than 18 hours.  Unfortunately some providers still follow outdated guidelines that required CBC (complete blood count) and blood culture for inadequate prophylaxis, but the 2010 CDC guidelines (http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf, see page 22 for specifics to your situation) do not recommend blood tests.  HOWEVER, if your baby is showing any signs of sepsis (infection) such as high or low temps, breathing fast or hard, low blood sugar, etc, OR you have signs of chorioamnionitis (infection of your uterus/amniotic fluid) then they will absolutely do blood tests and likely start IV antibiotics on the baby.  And no, you can't "decline" those -- you have rights as a parent, but if you refuse medically necessary treatment, the care providers have a responsibility for the baby's health.  



 


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#39 of 43 Old 01-17-2012, 12:22 PM
 
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Mesa, that sounds like a really frustrating experience.  For what it's worth, the peds were following the correct guidelines at the time.  The ones I wrote about were written in late 2010, probably not publicized well until mid-2011, and as the thread-starter has indicated, are still not followed by everyone.  Standard of care is a moving target, as you know.  But that's a whole 'nother topic.  We do the best we can with the info that we have in the healthcare system that exists.  Alternately, as some of you choose, you avoid the system altogether, and accept the repercussions.  I work in the system with the firm belief that the system, as frustrating and constraining as it can be, is in place to provide the best and safest care that we know how.  

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#40 of 43 Old 04-25-2012, 07:40 AM
 
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Quote:
Originally Posted by KTinSeattle View Post

Mesa, that sounds like a really frustrating experience.  For what it's worth, the peds were following the correct guidelines at the time.  The ones I wrote about were written in late 2010, probably not publicized well until mid-2011, and as the thread-starter has indicated, are still not followed by everyone.  Standard of care is a moving target, as you know.  But that's a whole 'nother topic.  We do the best we can with the info that we have in the healthcare system that exists.  Alternately, as some of you choose, you avoid the system altogether, and accept the repercussions.  I work in the system with the firm belief that the system, as frustrating and constraining as it can be, is in place to provide the best and safest care that we know how.  

 

 

this is what bothers me. the system thinks it knows everything but yet they dont have all the most recent guidelines. so they force parents to submit to their care. either by coercion or by flat out not telling them all the repercussions of the treatment. they are being told its ok, we know what we are doing, there are no bad side effects, this is best etc. most parents havent done their own research to make their own decisions and just go along with what the hosp or doc wants. then if something goes wrong, it is just something that happens. when it was actually one of the bad things that could happen from the treatment. then you get parents who have done their research and know what they are talking about and refuse treatment, knowing what the side effects are and what could go wrong. those parents have to worry that their baby or child will be taken by child services for refusing treatment. even thought their research has shown that the treatment is ineffective or has more neg side effects than they would be ok with. the system is a bully. i am not convinced the system is the best and safest care. even my own kids pediatrician will agree with me. she is the one who suggested a homebirth, not circing, bfing, and doesnt think all vaxes are neccessary. she did her own research instead of just believing what she was taught in doctor school. when i go to the hosp i feel like i have to be constantly on guard against them violating my child. they are not in charge. i am the one paying them. they need to do what i ask them to do and respect my rights to make my own decisions for me and my child. we are intelligent people here. we take the time to ask questions and research our options to figure out what is needed and what is not. and my research has shown the system to be the last place i want to take my children's health.


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#41 of 43 Old 05-01-2012, 07:16 PM
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This was mentioned above but I would like to reiterate- CDC guidelines do not call for bloodwork, they recommend observing baby.  Print off a copy and take them in with you.  It's hard to argue with the CDC.  Maybe you could talk to the director of peds before your delivery and bring this up just to see how they react?

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#42 of 43 Old 05-05-2012, 02:23 PM
 
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There has been research showing that you only need ONE hour after ONE dose of IV antibiotics for the baby's antibiotic level (and that's what's protecting the baby) to reach its maximum level. After that, it's all pointless, unless your labor is longer and you need another dose. The baby does NOT get more protection from longer exposure to the antibiotics. Their blood levels peak one hour after you get the antibiotics. Really, it's true. I don't know that this will sway anyone at your hospital if you're interested in getting the antibiotics, but if you look for the study, you should be able to find it. I did, and I wasn't even trying, lol. (I also have a history of precipitous labor and am trying to decide what to do about it.) Unfortunately, I didn't save it, because I'm planning a home birth and while IV abx are available to me at home, my last birth was 52 minutes, so it's unlikely I'll even have one hour. Ugh. Anyway, perhaps with that study in hand, you may be able to convince someone that you don't need to get the antibiotics 4 hours ahead of time, and you certainly don't need two full doses, but rather ONE dose given ONE hour before birth. Then maybe they'll leave you alone. It's worth a try, if nothing else works. Good luck.

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#43 of 43 Old 05-05-2012, 08:13 PM
 
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I'm adding this study because I got on my laptop and it was already open. It's not the same one I mentioned, but it discusses IM penicillin injected ahead of time in cases where it's expected that the mother might deliver without receiving IV abx during labor. This is much less effective than IV penicillin, but there was a significant reduction in GBS colonization of the newborns of mothers who got the injection. It's something I've been considering.

 

http://www.redorbit.com/news/health/191814/efficacy_of_intramuscular_penicillin_in_the_eradication_of_group_b/

 

I'm really not sure if you even want to do any sort of prevention, so if not, I'm sorry to give you info you aren't really interested in. However, if you are, and if you are looking for ways to avoid drama with the baby, this might be another option to consider. Of course, whoever decides these things at your hospital might not care, but it doesn't hurt to have options.
 

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