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-   -   GBS carrier - question for midwives (http://www.mothering.com/forum/228-birth-professionals-archive/883241-gbs-carrier-question-midwives.html)

mamatosaskia 04-18-2008 12:53 PM

Hi,

I was GBS positive during my pregnancy with dd. I was tested the day I went into labor so we didn't know and I didn't receive abx. My dd developed blood sepsis (she was showing signs at birth) and spent two weeks in the NICU. The outcome (after all that) was fine and she shows no signs of ever being sick.

My question is about this pregnancy...my midwives (I am in a practice with 5 of CNMs) are concerned that because of my fast first labor I won't get the recommended two doses of abx this time around. Two have now mentioned induction as a possible course of action, one suggested breaking my bags of water if my cervix looks ripe and hoping that I go into labor on my own. I had a natural, drug free labor with my dd. I hate the thought of another baby with GBS but seflishly (or not) I refuse to have interventions when I know that my body can labor on its own. I asked to be tested again at 37 weeks just in case I am not a carrier this time around.

What, in your experience, has been your stance with a GBS carrier whose baby became sick? I am supplementing with probiotics and immune boosters to try and treat my gut. I just have a bad feeling about the discussion of interventions, particularly because as far as I can tell there is no guarantee that this baby will be sick like his sister.

I'd love to hear from some other birth providers on this issue. I want to be susre to arm myself with as much knowledge as possible in case I need to fight my m/w on this one.

Thanks!

Jacqueline

paquerette 04-18-2008 01:59 PM

There is no reason to think that you will have GBS again just because you had it before. It's the kind of thing that comes and goes randomly. I think your mw's are going way overboard.

I'm just a new doula, fwiw.

majikfaerie 04-18-2008 02:18 PM

I also don't see any real reason why having one baby with GBS should increase the likelihood of a second.
if you suspect the baby has been exposed during birth, then treat with abx.

zoeyzoo 04-18-2008 02:21 PM

Not a birth professional but this sounds overboard to me too... GBS can come and go and you have every right to do the test if that's what you want.

Here's an article about GBS and the abx treatment.
http://www.mothering.com/articles/pr...n/group-b.html

Henci Goer also has a section about GBS, induction, and the important of keeping the bag of waters intact in her book Thinking Woman's Guide to a Better Birth.

FWIW, there are alternatives to abx like Hibisclens that have been shown to be just as effective with GBS prevention. You could always start a regiment before labor. Hopefully someone else can post a link to the studies.

IMO I wouldn't induce just for GBS. I especially wouldn't let anyone touch my bag of waters because while the baby is in there they are protected from all germs including GBS. Once the bag breaks the baby is suseptible to infection and if the induction doesn't work you are setting yourself up for a c/s.

nashvillemidwife 04-18-2008 07:49 PM

Having had one previous baby with GBS disease is a risk factor for having another. This baby is presumed to be at risk and further testing is not necessary; this has been the protocol for ages. If I was concerned about your labor being too fast for the IV antibiotic protocol I would be doing everything I could to be sure you aren't colonized, including oral or IM antibiotics in the last few weeks of pregnancy. You would need to take the antibiotics courses continuously until delivery to be sure you don't become recolonized.

BeckiCNM 04-18-2008 08:24 PM

If your CNMs are following the CDC guidelines for group B strep, then they should offer you antibiotics in labor - that is the CDC's recommendation for someone who has had a baby with GBS disease in the past. You might want to talk to whoever will taking care of the baby to see what they would do in your situation if you did not get the recommended antibiotics. Some may be OK with testing the baby for GBS and watching, some might want to treat the baby with antibiotics.

For me, I would not feel comfortable breaking your water to start your labor. I don't with GBS-positive women as a means of inducing. Too much risk for me.

Jane 04-19-2008 03:01 AM

Having the antibiotics on board for 45 minutes alone vastly reduces the risk of the newborn getting sick. While it sounds unlikely that you'll get 4 hours of labor, it's uncommon for people to labor and push out the baby in less than 1 hour.
I do think they should offer antibiotics to you even if you test negative, because you know that you not only had GBS, but you had a strain capable of colonizing your baby.
If you want, you don't have to wait for 37 weeks to get a re-test - you could do the test at any time, including when not pregnant. I would still advise the 37 week test - or the quick test if you go into labor before the long-test results are back, but it might put your mind at rest to know that you can clear it. Or that you should keep trying to clear it.
I wouldn't be interested in induction just for the GBS issue but I would add it to any other reasons.

BirthFree 04-20-2008 06:35 AM

Quote:
Originally Posted by nashvillemidwife View Post
Having had one previous baby with GBS disease is a risk factor for having another. This baby is presumed to be at risk and further testing is not necessary; this has been the protocol for ages. If I was concerned about your labor being too fast for the IV antibiotic protocol I would be doing everything I could to be sure you aren't colonized, including oral or IM antibiotics in the last few weeks of pregnancy. You would need to take the antibiotics courses continuously until delivery to be sure you don't become recolonized.
That seems like a lot of antibiotic exposure/use to me...

I would be pro-active to reduce/clear GBS in both your partner and yourself (as you can pass it back and forth ) and take measures to reduce exposure to baby (water intact, little to no vag. checks), and if you are abx. friendly, take during labor... but inducing to give abx., or breaking your water - that seems like a stretch to me...

Well wishes! I had a son when I was GBS "abundant" (without knowing what the results were) but he was ok, water broken for minutes before he was born... it was a worry for me the next birth but I tested clear (no GBS) so it's not "once GBS, always GBS". Good luck!


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