GBS - What would you do? - Mothering Forums

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#1 of 43 Old 01-04-2012, 08:54 PM - Thread Starter
 
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I am planning a hospital birth in a few weeks.  I LOVE my mws and they are cool with whatever I want to do.  This is my 4th birth, and my 2nd with these mws.  But, here's my dilemma: with my other pregnancies I have always tested positive for GBS.   With my last birth, my labor was too quick, so even though I had the IV, it was less than 4 hours before birth, so my poor baby had to have the blood work up done.   
 
Even though I have tested GBS+, I have never had any other risk factors that would cause concern for the baby.  My water has never broken until I'm pushing, my labors just keep getting shorter, baby and I have never had fevers, my mws don't do cervical checks in labor unless I want them to, etc.
 
I would really like to avoid all the GBS nonsense all together this time.  But here are my options.
I can do the testing and hope for a negative result.  Then they'd leave me and baby alone.  
Or, get a positive result and have to likely do both the IV AND blood cultures on the baby, since I don't expect to be at the hospital for very long. 
Or, I can decline the test, thus avoiding the IV, but then still subjecting my newborn to blood cultures.
 
I just can't decide which is my best option.  I'd love to just test negative, but I'm worried that's not going to happen.  I'd be willing to try garlic and hibiclens before the test (which I haven't done previously), but if it doesn't work then I'm stuck.  I'd love to have a way to find out my test results and then decide if I should share it with the hospital.  But that's not an option.  :)  
 
So, thoughts? 
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#2 of 43 Old 01-04-2012, 09:39 PM
 
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I would refuse the test altogether and try to refuse the workup, or at least express your desire for it to be postponed and just keep refusing to hand over baby. I tested GBS positive and then had simply refused IV abx and refused to hand over my baby until/unless I was able to be with him (3 hours), and then nursed him nonstop afterwards.

 

Next time? Assuming I ever do forget the joy of birth and agree to do it again...

I will refuse the test and hire a hb mw. Good luck mama. FWIW I couldn't get the Hibiclense before the test, adn didn't realize at the time that they sell the stuff at Target eyesroll.gif

 

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#3 of 43 Old 01-05-2012, 07:06 AM
 
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Well, with one of mine, I was able to do the test myself in the bathroom.  I rustled my skirt, and then put the swab from the package to the test tube and gave it back.  Obviously, I tested negative...

 

I don't hold very much with this sort of testing.  I would far rather watch my baby, than poke and prod and assume I can predict the future from a test I took 4 weeks prior (or more!) to birth. Especially of something that can change on a daily basis.

 

And, in the absence of risk factors, I would refuse all blood testing, etc. 


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#4 of 43 Old 01-05-2012, 07:08 AM - Thread Starter
 
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That's what I'd like to do too, but unfortunately that part falls more under hospital policy, so it's not something my mw could help me out with. After the birth, on the way to the pp room, we stop at the nursery.  What they usually do, is send mom to her room while they bathe the baby and then leave him/her under a warmer for a couple of hours.  Once the baby is warmed up, they return him/her to mom's room.  Rooming in is an option, but you can leave your baby in the nursery too.  I'm refusing the nursery bath (i'll do it myself in my room - or not) and refusing to leave the baby in the nursery at all.  But, we'll all have to stop there on our way to the pp room and that's when they do the blood draw.   Also, I'm birthing at a hospital an hour away, so the baby will be seen by a ped there, and not our usual one.  So, it's not like I'l have a ped in my corner either.  And, our home ped is pretty mainstream, though she tolerates my delayed/selective vax schedule, so I don't think she'd agree to write me a note or anything even if she could.  

 

And, my mw does the test.  I would so love the option of "testing" myself!  :)

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#5 of 43 Old 01-05-2012, 11:45 AM
 
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I don't know why you can't just refuse the culturing on baby. If you want to know about your own status you can always ask your midwives for a swab for a vaginal culture, do it yourself, and then get the results. A vaginal culture here in So. Cal is about $20. 


...I read that it's hospital policy. Why not just refuse?


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#6 of 43 Old 01-05-2012, 11:48 AM
 
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Ugh, my hospital was Baby Friendly...I forget sometimes that not all hospitals are, or are ven trying to be. Sorry. Hard decisions. You absolutly can refuse IV abx though, that is well within your rights. Hospital policy is just about liability, an if you staunchly refuse certain things and agree to sign waivers you can absolutly get away with anything. I allowed the blood cultures only because my DH was worried, but refused EVERYTHUNG else, an like I said,I made them wait until I would be with baby.

 

Good luck, I might do the test (make sure do follow hibiclense procedure before the test, I think it's a full cleanse within 6 hours of the test?

 

Good luck mama

 

FWIW, I had a Designated Bitch for the labor, as I knew I wouldn't be able to be quite as pushy as needed during labor. My sister fended off administrators, obnoxious nurses, and made sure nothing happened that I didn't want...she was amazing. Do you have anyone like that who could be with you?

 

 

 


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#7 of 43 Old 01-05-2012, 12:14 PM
 
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from what i remember the test for gbs isn't a heel stick, it's a spinal tap? 

if that's the case, i would do the test and the iv if that's the hospital policy.

fortunately it wasn't for me with dd and with this one, i refused the gbs test with dd, but ended up having the abx anyway due to waters rupturing.

but no matter what, i would take abx (no matter how unnecessary) over a spinal test for the bebe.  if it's a heel stick, then i would have a different opinion.


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#8 of 43 Old 01-05-2012, 12:29 PM - Thread Starter
 
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With my last baby, he got a blood draw to test for GBS.  It wasn't a heel stick - they took a lot of blood, but no spinal tap.  If I knew for sure I could avoid any testing of him, I'd do the IV, but last time, I got the IV, and they still did the blood draw because he was born less than 4 hours after the IV was started.  Then he ended up with a dairy sensitivity for the first 8-9 months of his life.  I wonder if that could have been partly due to the unnecessary antibiotics exposure.

 

And, waitingforkiddos, I can do the vaginal culture if I want.  I'm just not sure I want to risk it.  If I test negative, we're both in the clear.  But if I test positive, then I definitely get the IV, plus the baby will probably still need the blood draw since my labors just keep getting shorter.  There's a good chance that the IV won't been in for 4+ hours, and so won't "count."  Then the baby gets a blood draw AND unnecessary antibiotics exposure.  If I don't do the test, only the blood draw happens.  

 

I have another mw appt on Monday, so I'll probably ask some more about all of this, but so far it doesn't sound like I really have a too many options.  :(

 

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#9 of 43 Old 01-05-2012, 01:09 PM
 
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Wish I could have refused the test but it was required to birth at the birth center.  MWs told me that in the past, counts below 10,000 didn't even qualify as GBS positive, but CDC changed the rules and any amount is now considered positive.  I had counts around 1,000 which wouldn't have been anywhere near enough to count as positive in the past but now they are... I got the IV antibiotics, and despite taking acidophilus as a preventative measure we came down with thrush and, nearly 4 months later after numerous treatments, we still haven't kicked it entirely...Lesson learned: do everything you can to avoid those IV antibiotics


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#10 of 43 Old 01-05-2012, 01:47 PM
 
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Will the hospital settle for Hibiclens while in labor?  I believe that's been shown to be more effective than IV antibiotics anyway.  You might have to fight for it, but if you can get that, I'd go ahead and consent to the test with the understanding that if it's positive you're still not going to be doing the antibiotics, but the Hibiclens instead. 


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#11 of 43 Old 01-05-2012, 01:55 PM
 
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Now, I'm coming from a place of having declined everything at the hospital and also forcing them to be baby friendly through my cesarean ...but I still don't get why if you don't want to do one of those things you can't just say 'no thanks' and sign the release waver. 

The GBS swab...no one but you will have the results. Labs accept personal drop offs, you just need the swab. They'll call/fax you, and only you, about the results. 

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With my last baby, he got a blood draw to test for GBS.  It wasn't a heel stick - they took a lot of blood, but no spinal tap.  If I knew for sure I could avoid any testing of him, I'd do the IV, but last time, I got the IV, and they still did the blood draw because he was born less than 4 hours after the IV was started.  Then he ended up with a dairy sensitivity for the first 8-9 months of his life.  I wonder if that could have been partly due to the unnecessary antibiotics exposure.

 

And, waitingforkiddos, I can do the vaginal culture if I want.  I'm just not sure I want to risk it.  If I test negative, we're both in the clear.  But if I test positive, then I definitely get the IV, plus the baby will probably still need the blood draw since my labors just keep getting shorter.  There's a good chance that the IV won't been in for 4+ hours, and so won't "count."  Then the baby gets a blood draw AND unnecessary antibiotics exposure.  If I don't do the test, only the blood draw happens.  

 

I have another mw appt on Monday, so I'll probably ask some more about all of this, but so far it doesn't sound like I really have a too many options.  :(

 



 


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#12 of 43 Old 01-05-2012, 03:10 PM - Thread Starter
 
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Originally Posted by mum2sarah View Post

Wish I could have refused the test but it was required to birth at the birth center.  MWs told me that in the past, counts below 10,000 didn't even qualify as GBS positive, but CDC changed the rules and any amount is now considered positive.  I had counts around 1,000 which wouldn't have been anywhere near enough to count as positive in the past but now they are... I got the IV antibiotics, and despite taking acidophilus as a preventative measure we came down with thrush and, nearly 4 months later after numerous treatments, we still haven't kicked it entirely...Lesson learned: do everything you can to avoid those IV antibiotics


This is what frustrates me so much.  IV antibiotics are not without risk, but so many mothers and babies are exposed for no reason. Makes me so angry.

 

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Will the hospital settle for Hibiclens while in labor?  I believe that's been shown to be more effective than IV antibiotics anyway.  You might have to fight for it, but if you can get that, I'd go ahead and consent to the test with the understanding that if it's positive you're still not going to be doing the antibiotics, but the Hibiclens instead. 


I don't know if they will, but I doubt it (though I will ask).  It's so stupid, since, from what I've read, it's more effective anyway.  Also, I'm not sure what I'm up against as far as being able to deny things since the hospital is in IL, which is a pretty bad birthing climate.  


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Now, I'm coming from a place of having declined everything at the hospital and also forcing them to be baby friendly through my cesarean ...but I still don't get why if you don't want to do one of those things you can't just say 'no thanks' and sign the release waver. 

The GBS swab...no one but you will have the results. Labs accept personal drop offs, you just need the swab. They'll call/fax you, and only you, about the results. 



 

 

I guess I hadn't thought about having the GBS testing done somewhere else.  If I do it through my mw, then they automatically get the results.  If I test positive with them, then I'm officially positive.  I'll have to look into other testing options.
 

 

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Is there just some reason you can't give a blanket NO to everything?  No, I will not be getting the GBS test.  No, you do not have my consent to blood test my baby.


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#14 of 43 Old 01-06-2012, 09:49 AM - Thread Starter
 
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Is there just some reason you can't give a blanket NO to everything?  No, I will not be getting the GBS test.  No, you do not have my consent to blood test my baby.


That's what I'll be asking at my appt on Monday.  I'm worried since I will not have a ped in my corner on this.  I'm already declining everything else they want to do (hep vax, eye goop, bath, etc.), so I'm already the crazy lady.  I'm ok with standing up for myself, I just don't want big trouble, yk?

 

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#15 of 43 Old 01-06-2012, 01:39 PM
 
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I know this will seem extremely managed to some, but just wanted to put out another option.  When I was a student, this is a protocol my preceptors offered to women in your position: Take the test and if it comes back positive, induce with rupture of membranes after two doses of antibiotics.  They would do this at home, so that a woman still had the option of home birth and baby was surely covered by the 2 doses of antibiotics. 


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#16 of 43 Old 01-06-2012, 03:27 PM
 
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What do you think about offering to stay longer after the birth, as in, the full 2-ish days insurance covers, so they can take the baby's vitals and watch closely for signs of sepsis? 


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What do you think about offering to stay longer after the birth, as in, the full 2-ish days insurance covers, so they can take the baby's vitals and watch closely for signs of sepsis? 



I would be fine with that. I'll have to ask about that too.  Plus, my home ped wants to see us as soon as were home, so I can offer that too, I guess.  Just so annoyed to have to be thinking about any of this, yk?

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Untreated neonatal infection can kill or end in days in the NICU. I know you've seen your 3 babies be healthy with no infection after you had incomplete courses of the antibiotic, but peds and nurses may have seen hundreds, if not thousands, of babies, and some of them have died that way. I know you're annoyed but that's where they're coming from.

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#19 of 43 Old 01-06-2012, 05:35 PM - Thread Starter
 
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Untreated neonatal infection can kill or end in days in the NICU. I know you've seen your 3 babies be healthy with no infection after you had incomplete courses of the antibiotic, but peds and nurses may have seen hundreds, if not thousands, of babies, and some of them have died that way. I know you're annoyed but that's where they're coming from.


I understand that GBS CAN be a problem, and I'm not against treating an actual infection when it's called for.  But, I really feel it's not in anyone's best interest to be prophylactically treating so many women with IV antibiotics when antibiotics are not without risk themselves and we have such an issue with antibiotic resistance.  I think it would be much more reasonable to test for the presence of GBS, but then wait for the appearance of additional risk factors/symptoms before deciding on a course of treatment.  If mom is positive, but labor is short, the membranes remain intact until close to birth, there is no fever, baby is full-term, and the birth attendants can manage to avoid cervical checks, and then baby is observed for a period of time for symptoms, I see no reason to treat as though there is an infection.  Of course if those things change, then I'd be all for treating.  The problem is that if I test positive, baby and I will be subjected to all of this no matter what else happens.  Plus, the US treatment protocol has not improved overall outcomes anyway.  

 

Also, GBS can come and go, so a test at 36wks doesn't guarantee anything about the mom's status at the time of birth.  Another reason that treating based solely on the result of a swab seems like a bad idea.

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#20 of 43 Old 01-06-2012, 06:03 PM
 
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I tested positive for GBS, despite doing a hibiclens protocol and taking probiotics before the test.  My doctor basically said refusing the antibiotics was not an option.  I looked into trying to fight the protocols as well as trying to bring home the baby AMA.  While you are within your legal right to do these things, hospitals can and sometimes do involve CPS.  I decided that I wasn't going to fight any of it because I didn't want my birth environment to be any more hostile than it had to be.  It ended up that I had a super fast labor, and even though the hospital was 5 minutes away and we left as soon as my water broke (which is when I hit active labor), I was pushing by the time they tried to get the IV placed.  So, while things overall didn't go great, at least I didn't have antibiotics.  Due to the Vitamin K shot we had to get because of some (unnecessary) birth trauma, the blood draw was a little traumatic because my son's blood was clotting so fast it was difficult to get the amount of blood they needed.  I think though, that it worked out for the best in that respect.  I would prefer the blood draw to the possible effects of antibiotics.  So I guess my only advice, which may not be possible with how far your hospital is, would be to get there too late for the antibiotics if you can't refuse them.  Also, as far as having a "designated bitch," if a doctor thinks someone is impeding medical care, they can have them removed from the room. 

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I tested positive for GBS, despite doing a hibiclens protocol and taking probiotics before the test.  My doctor basically said refusing the antibiotics was not an option.  I looked into trying to fight the protocols as well as trying to bring home the baby AMA.  While you are within your legal right to do these things, hospitals can and sometimes do involve CPS.  I decided that I wasn't going to fight any of it because I didn't want my birth environment to be any more hostile than it had to be.  It ended up that I had a super fast labor, and even though the hospital was 5 minutes away and we left as soon as my water broke (which is when I hit active labor), I was pushing by the time they tried to get the IV placed.  So, while things overall didn't go great, at least I didn't have antibiotics.  Due to the Vitamin K shot we had to get because of some (unnecessary) birth trauma, the blood draw was a little traumatic because my son's blood was clotting so fast it was difficult to get the amount of blood they needed.  I think though, that it worked out for the best in that respect.  I would prefer the blood draw to the possible effects of antibiotics.  So I guess my only advice, which may not be possible with how far your hospital is, would be to get there too late for the antibiotics if you can't refuse them.  Also, as far as having a "designated bitch," if a doctor thinks someone is impeding medical care, they can have them removed from the room. 


It's odd, but it seems if I refuse the GBS test I can refuse the antibiotics, but if I test positive I can't.  That's why I'm leaning towards just not testing, since at least that would help us avoid the antibiotics.  But I just feel awful about subjecting my tiny newborn to a huge blood draw if it's not truly needed.  Like I've said, if there were actual reasons to suspect the baby was in danger I'd be all for testing/treating.  But it just doesn't seem justified to do all this automatically.  

 

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#22 of 43 Old 01-06-2012, 07:27 PM
 
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Are you getting the PKU test at 24 hours?  I have many mom's who refuse the CBC at 4 hours of age will are ok with them sending one when they prick the heel for PKU (since they are pricking anyway).  Our peds group doesn't love this option, but at least you will get some numbers for them and a little peace of mind for yourself.

Breast feed your little one while the prick.  Sucking is a natural pain reliever and I have stuck many baby heels on the breast who barely flinched.

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#23 of 43 Old 01-06-2012, 08:06 PM
 
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I did garlic (whole clove, pointy ends cut off) vaginally overnight for 6 nights before the test (should have done it for 8 just didn't start early enough), and it worked, I got a negative after testing positive my last two pregnancies.  I proceeded to do garlic vaginally as much as I could up until birth to be on the safe side.  Just my story- what a relief it was to a get a negative! 

 

and to add- I couldn't sleep the first night I did the garlic, you will instantly taste garlic in your mouth and it's gross.  But you get used to it!  And it's worth it.  My midwife noted I did NOT smell like garlic at my apt's, which was a relief lol!

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#24 of 43 Old 01-07-2012, 06:16 AM - Thread Starter
 
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Are you getting the PKU test at 24 hours?  I have many mom's who refuse the CBC at 4 hours of age will are ok with them sending one when they prick the heel for PKU (since they are pricking anyway).  Our peds group doesn't love this option, but at least you will get some numbers for them and a little peace of mind for yourself.

Breast feed your little one while the prick.  Sucking is a natural pain reliever and I have stuck many baby heels on the breast who barely flinched.


I'll have to ask about that too.  I just remember with my last baby that it was a BIG blood draw (not a heal stick) and it took a long time to do it.  And they wouldn't let me hold him while they did it.  :(

 

 

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Originally Posted by lovebeingamomma View Post

I did garlic (whole clove, pointy ends cut off) vaginally overnight for 6 nights before the test (should have done it for 8 just didn't start early enough), and it worked, I got a negative after testing positive my last two pregnancies.  I proceeded to do garlic vaginally as much as I could up until birth to be on the safe side.  Just my story- what a relief it was to a get a negative! 

 

and to add- I couldn't sleep the first night I did the garlic, you will instantly taste garlic in your mouth and it's gross.  But you get used to it!  And it's worth it.  My midwife noted I did NOT smell like garlic at my apt's, which was a relief lol!

I've used garlic for yeast before, so I'd totally be willing to do it.  I'm glad to hear that it work for you. I just wish I could know for sure that it would do it - I'm worried that it wouldn't work and then I would be stuck with a positive result on file.  
 

 

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#26 of 43 Old 01-07-2012, 07:17 AM
 
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Jumping in late here, but the title caught my eye...

 

I tested positive for GBS with DD, had the antibiotics, & fully believe it contributed (or maybe completely caused) her many GI issues after birth that persisted until she was almost 3. The first year was extremely difficult, but we continued to have some issues even until she was around 3. She had severe reflux, ended up on an antacid medication (which I now know also probably made things worse, but I was a newbie then...), multiple food intolerances, & had to use a very expensive hydrolyzed formula until she was over a year old (I was unable to breastfeed after 10.5 weeks, which devastated me).

With DS I was really hoping to avoid all that, so I did the garlic for a couple of nights in a row, I think about a week before the test, & that time I tested negative - YAY! So I did not have antibiotics, & DS did not have the GI issues DD have (although at 10mos he was diagnosed with peanut/tree nut/coconut allergies...). Coincidence? I think not.  Let me also mention that with DD I did take prenatal vitamins & DHA, but I had no knowledge of Vitamin D deficiency at that time. I was probably severely deficient, & I'm sure that didn't help me avoid being colonized with GBS. I don't know if that's related or not, but by the time DS was conceived, I had read about Vit D & been supplementing for several months. My levels were finally up to where they should be, so perhaps that also helped my general immunity.

Anyway, also about the hospital --- I'm a hospital L&D nurse myself, & you absolutely can refuse antibiotics. That is regardless of which state or which hospital you deliver in. You always have the right to refuse any medical intervention, no matter what they try to say to convince you. Sign whatever refusal you need to, but you do NOT have to have antibiotics against your wishes.
 

If you test positive & refuse antibiotics, of course they will want to do the blood tests on baby. You absolutely can also refuse those, although personally I would rather consent to that plus observation for any signs of infection (fever, or inability to maintain temperature, etc) than have all that comes with the antibiotics, like you said. The blood test is not just for blood cultures, but also a blood count, looking for an elevated white blood cell count specifically, which would indicate infection, regardless if that came from GBS or some other source. The blood culture would say if it was GBS or not, but those take a day or three to come back.

Anyway, that's just my two cents, sorry for jumping in halfway through. Good luck with everything! =)


~Mamagrove --- Wife to DH, & Mama to DD joy.gif (2006), DS bouncy.gif (2010), & two Angel-babies angel.gif (2008)  angel3.gif (2012)

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#27 of 43 Old 01-07-2012, 07:23 AM
 
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I'll have to ask about that too.  I just remember with my last baby that it was a BIG blood draw (not a heal stick) and it took a long time to do it.  And they wouldn't let me hold him while they did it.  :(

Uncool.  No wonder you are having so much trouble with this :(  There is no reason for them to collect a CBC any other way than heel stick.  Perhaps they were drawing blood cultures?  I think I would start there.  Would they settle for "just" a CBC?  If so, would they be willing to collect from a heel stick using neonate collection tubes?  Then, if there is reason to suspect GBS, they can proceed with blood cultures?

I'm a postpartum nurse at the largest local hospital.  For babies with a GBS positive or unknown mom our protocol is a temp every 8 hours and a CBC (via heel stick) at 4 and 24 hours of age.  A babe without any symptoms and a normal white count has no other testing done unless there are breathing difficulties.  If the white count is elevated then we may draw some cultures or check a chest x-ray in extreme cases. 

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#28 of 43 Old 01-09-2012, 12:05 PM
 
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I think that because you've tested positive in the past, I would test again if it were me. That way, you have the information available to you to make the best decision at the time. If you decide not to use abx, then decline. It is your right to do so.

 

In my situation, I tested positive and then began a protocol by my MW to reduce/get rid of the GBS. Unfortunately I went into labor before I could complete it, but I had originally decided to decline abx anyway. But I ended up having a pretty long labor after my water broke, so I changed my mind and decided to go for abx.  But I am grateful that I had care providers who supported all this, and I understand that if you don't, then you'll need to make other decisions.

 

If you do decide to get abx, please be sure to have some probiotics ready ASAP. In the craziness of the birth, I totally forgot about the abx and ended up with thrush a couple days later... not a great way to begin a breastfeeding relationship.


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#29 of 43 Old 01-10-2012, 12:03 PM
 
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OP, I think we must be twins of some sort; this is exactly my story and my big dilemma with this pregnancy.  My mw's and birthing center (hospital based) aren't quite as rigid as your hospital seems to be, so I feel that I can refuse without and harassment, but I'm very worried about a possible infection in my tiny baby.  This worry has always persuaded me to choose IV antibiotics, but getting to the birthing center last time in time for them caused everyone so much stress and needless transitions and I wound up there twice before I was really in labor just because I was so paranoid that I wouldn't get the whole 4 hour dose, never mind that they recommend 2 doses. Sure enough, I didn't, so I'm very curious about other options this time, though still terrified of infection.  


Mama of 4 beautiful little ones

 

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#30 of 43 Old 01-11-2012, 01:07 PM
 
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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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