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I am 33 weeks pregnant and I have tested GBS +. I have read quite a lot on it both from mainstream sources and NFL sources. What I want to know is if you had it and didn't do anything about it? My midwife (having a home birth) says that its definetly a disease amd serious, but that taking antibiotics has the same risks for other serious diseases because of the bacteria the antibiotics kill. She cannot give me IV antibiotics during labor so I would have to start taking them orally my last weeks of prednancy. I also have a weakness against yeast and I take GSE and a probiotic every day. Im terrified to take the antibiotic and scared not to. PLease those of you with experience with this...what should I do? What did you do? What were the results?

Note: Im not considered high risk I don't think, from what I have read. I had my first child in 10 hours from water breaking through L & D at home.

Thank you in advance for your help.

Jennie
Middle Mamma
 

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Isn't 33 weeks really early to test? If it were me, I would try some natural remedies to get rid of the bacteria, and then ask to be retested after 37 weeks.

From what I have read, the oral antibiotics have not been proven effective. So I think if I wasn't going to have the IV antibiotics, I'd just go with not taking anything rather than oral antibiotics.

There is an alternative I have read about--using a very strong antibacterial wash during labor, called Hibiclens. I think there are some old threads on it here; maybe check with your midwife?
 

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So GSE can be a bit strong and knocks down probiotics as well. Many natural or synthetic things that are antibiotic are not friendly to natural bacteria. So one strategy may be to use the GSE to knock down the yeast and GBS or you could use something else topically and systemically like garlic. while you are doing this, get organized on diet and other things that may be contributing to a problem- like thong underwear-or synthetic even if it has cotton lining- what you want to avoid is the critters from your bottom flourishing in your vagina or urinary tract. Then work at
re-colonizing, if you are having an on going problem then maybe you need a different probiotic supplement- for what ever reason it might not be working for you. In your diet include natural sour dough bread, yogurt with live cultures- I like Nancy's its been around a long time and seem to really be alive- they also have other fermented-live products like cottage cheese and cream cheese. I don't know what the brands would be in the East. also fermented things like kimchee, sauerkraut. One thing i have been looking at lately- the kind of chair many of us are sitting in daily if you have a synthetic computer chair you may want to put some sort of breathable material between you and it. like a double thickness of a fat bath towel or maybe a cotton rug. Discovered this one with a case of skin fungus on a boy I know. Anyway the main focus is to try and really get your natural flora in a healthier balance, this will be you and your baby's best protection- GBS and yeast can happily co-exist but GBS does not like an acidic environment, the more lactobacillus you have and lactic acid producing bacteria the less GBS will be able to thrive. There are some other recent threads on the subject- on one I sent some abstract on long term effects of abx. The info on the use of hibiclens is interesting as well , because it tends to not harm lactobacillus while definately working against GBS and E coli. a diluted peribottle wash every 6 hrs and a bath for baby is what the European studies have shown to work as well as abx/risk factor treatment.
Take care
 

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Everything I read when researching GBS was that oral antibiotics don't help. Also, unless it was your urine that tested positive, 33 weeks seems kind of early.

I ended up opting for IV antibiotics (in the hospital - planned hospital birth), but if I had to do it again I'm not sure I'd make the same choice.
 

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I am torn about this as well. I am only 25 weeks pg, but last time, I was + for GBS. A midwife told me that there was a way to get a RN to come in and give me an injection of Pennicilin when in labor at the birthing center, anyone have experience or hear anything about this method of "treatment"?
 

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I tested + w/both pgs at 37wks, but I also had a GBS-related UTI w/dd#2. I chose to have abx (IV) during labor w/both of them and my girls were fine. I think 33wks is way too early to make any decisions, though- the bacteria content in the vagina can vary a lot and by the time the baby is born, you may not have any active GBS bacteria present, kwim?

And everything I've read has said that IV abx are the only way to protect the baby during birth, as taking them orally before labor will mean they are out of your system by the time the baby is passing through the birth canal, anyway. But I'm sure someone else has more comprehensive knowledge on that than I do.

That said, I'm going to be receiving IV abx again this time if I'm GBS +. My OB said that after you've had your urine cultures positive for GBS during pg, it's more likely that you will have an active, high bacterial count in subsequent pgs. It was no big deal for me, I didn't even get a yeast infection from it either times (and I get them EVERY time I take oral abx
). I was given Ampicillin, if I remember correctly.

Good luck! I would ask to be re-tested closer to term, though.
 

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Quote:

Originally Posted by KayleeZoo
And everything I've read has said that IV abx are the only way to protect the baby during birth, as taking them orally before labor will mean they are out of your system by the time the baby is passing through the birth canal, anyway. But I'm sure someone else has more comprehensive knowledge on that than I do.
Does that mean that oral abx or an injection in the buttock while you're in labor would be just as beneficial as IV since any of those would have the GBS out of your system by the time baby passes through?
Or... am I not getting something?
 

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Allie, I'm not sure whether it has more to do with getting rid of the GBS in your body just before delivery, or making sure the abx gets to the baby to protect them in case they do come into contact w/the bacteria. I'm going to ask my OB next week about that. I know that IV abx will get to the baby faster than oral or IM injection, though, so maybe that's why?
 

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Bandi, will you let us know what your OB says?
I am so confused about all of this! I don't know what's not getting through my head.....
Does this mean that abx orally or injected while in labor kills the GBS bacteria in YOUR system but the baby could still pick it up?
If it is not in your system, how would the baby get it?
Maybe I need a abx and GBS for dummies handout :LOL
Sorry....
 

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Allie, my appt is next Wednesday (the 12th) but I'll be sure to report back. I'm going to do some looking around before then, too. I know I knew this stuff front and back with my last 2 pg, but with my crazy preschooler and toddler chasing around all the time, and being pg, my brain doesn't always feel like it's connected to the rest of me :LOL
 

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Oral won't help in labor because your body is focused on labor, not digesting the drugs, and the dose is MUCH less orally than you can put through an IV.

I don't know about the injections, I just know the dose is still less, and the hospitals prefer the IV. With the IV they can guarantee how much is getting in to your body.

The idea behind the drugs is to kill as many bacteria in your body as possible before sending baby through the vagina where the bacteria are hanging out. Less bacteria is less risk. You can't kill every single one!
 

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Have you read any of the studies that are coming from Europe with regards to using Hibiclens (chlorohexadrine) washes in the last month and in labor? They seem really promising.

Here's more information:

J Matern Fetal Neonatal Med 2002 Feb; 11(2):84-8. Chlorhexidine vaginal flushings versus systemic ampicillin in the prevention of vertical transmission of neonatal group B streptococcus, at term. Facchinetti F, Piccinini F, Mordini S, Volpe A. Department of Gynecology, Obstetrics and Pediatric Sciences, University of Modena and Reggio Emilia, Italy. OBJECTIVE: To investigate the efficacy of intrapartum vaginal flushings with chlorhexidine compared with ampicillin in preventing group B streptococcus transmission to neonates. METHODS: This was a randomized controlled study, including singleton pregnancies delivering vaginally. Rupture of membranes, when present, must not have occurred more than 6 h previously. Women with any gestational complication, with a newborn previously affected by group B streptococcus sepsis or whose cervical dilatation was greater than 5 cm were excluded. A total of 244 group B streptococcus-colonized mothers at term (screened at 36-38 weeks) were randomized to receive either 140 ml chlorhexidine 0.2% by vaginal flushings every 6 h or ampicillin 2 g intravenously every 6 h until delivery. Neonatal swabs were taken at birth, at three different sites (nose, ear and gastric juice). RESULTS: A total of 108 women were treated with ampicillin and 109 with chlorhexidine. Their ages and gestational weeks at delivery were similar in the two groups. Nulliparous women were equally distributed between the two groups (ampicillin, 87%; chlorhexidine, 89%). Clinical data such as birth weight (ampicillin, 3,365 +/- 390 g; chlorhexidine, 3,440 +/- 452 g), Apgar scores at 1 min (ampicillin, 8.4 +/- 0.9; chlorhexidine, 8.2 +/- 1.4) and at 5 min (ampicillin, 9.7 +/- 0.6;chlorhexidine, 9.6 +/- 1.1) were similar for the two groups, as was the rate of neonatal group B streptococcus colonization (chlorhexidine, 15.6%; ampicillin, 12%). Escherichia coli, on the other hand, was significantly more prevalent in the ampicillin (7.4%) than in the chlorhexidine group (1.8%, p < 0.05). Six neonates were transferred to the neonatal intensive care unit, including two cases of early-onset sepsis (one in each group). CONCLUSIONS: In this carefully screened target population, 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.

BMJ 1997 Jul 26;3 15(7102):216-9; discussion 220 Comment in: BMJ. 1997 Jul 26;315(7102):199-200. Effect of cleansing the birth canal with antiseptic solution on maternal and newborn morbidity and mortality in Malawi: clinical trial. Taha TE, Biggar RJ, Broadhead RL, Mtimavalye LA, Justesen AB, Liomba GN, Chiphangwi JD, Miotti PG. Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore MD 21205, USA. OBJECTIVE: To determine if cleansing the birth canal with an antiseptic at delivery reduces infections in mothers and babies postnatally. DESIGN: Clinical trial; two months of no intervention were followed by three months of intervention and a final month of no intervention. SETTING: Queen Elizabeth Central Hospital (tertiary care urban hospital), Blantyre, Malawi. SUBJECTS: A total of 6965 women giving birth in a six month period and their 7160 babies. INTERVENTION: Manual wipe of the maternal birth canal with a 0.25% chlorhexidine solution at every vaginal examination before delivery. Babies born during the intervention were also wiped with chlorhexidine. MAIN OUTCOME MEASURES: Effects of the intervention on neonatal and maternal morbidity and mortality. RESULTS: 3635 women giving birth to 3743 babies were enrolled in the intervention phase and 3330 women giving birth to 3417 babies were enrolled in the non-intervention phase. There were no adverse reactions related to the intervention among the mothers or their children. Among infants born in the intervention phase, overall neonatal admissions were reduced (634/3743 (16.9%) v 661/3417 (19.3%), P < 0.01), as were admissions for neonatal sepsis (7.8 v 17.9 per 1000 live births, P < 0.0002), overall neonatal mortality (28.6 v 36.9 per 1000 live births, P < 0.06), and mortality due to infectious causes (2.4 v 7.3 per 1000 live births, P < 0.005). Among mothers receiving the intervention, admissions related to delivery were reduced (29.4 v 40.2 per 1000 deliveries, P < 0.02), as were admissions due to postpartum infections (1.7 v 5.1 per 1000 deliveries, P = 0.02) and duration of hospitalization (Wilcoxon P =0.008). CONCLUSIONS: Cleansing the birth canal with chlorhexidine reduced early neonatal and maternal postpartum infectious problems. The safety, simplicity, and low cost of the procedure suggest that it should be considered as standard care to lower infant and maternal morbidity and mortality.

Int J Antimicrob Agents 1999 Aug;12(3):245-51 Vaginal disinfection with chlorhexidine during childbirth. Stray-Pedersen B, Bergan T, [email protected] A, Normann E, Grogaard J, Vangdal M. Department of Gynecology and Obstetrics, Aker Hospital, University of Oslo, Norway. The purpose of this study was to determine whether chlorhexidine vaginal douching, applied by a squeeze bottle intrapartum, reduced mother-to- child transmission of vaginal microorganisms including Streptococcus agalactiae (streptococcus serogroup B = GBS) and hence infectious morbidity in both mother and child. A prospective controlled study was conducted on pairs of mothers and their offspring. During the first 4 months (reference phase),the vaginal flora of women in labor was recorded and the newborns monitored. During the next 5 months (intervention phase), a trial of randomized, blinded placebo controlled douching with either 0.2% chlorhexidine or sterile saline was performed on 1130 women in vaginal labor. During childbirth, bacteria were isolated from 78% of the women. Vertical transmission of microbes occurred in 43% of the reference deliveries. In the double blind study, vaginal douching with chlorhexidine significantly reduced the vertical transmission rate from 35% (saline) to 18% (chlorhexidine), (P < 0.000 1, 95% confidence interval 0.12- 0.22). The lower rate of bacteria isolated from the latter group was accompanied by a significantly reduced early infectious morbidity in the neonates (P < 0.05,95% confidence interval 0.00-0.06). This finding was particularly pronounced in Str. agalactiae infections (P< 0.0 1). In the early postpartum period, fever in the mothers was significantly lower in the patients offered vaginal disinfection, a reduction from 7.2% in those douched using saline compared with 3.3% in those disinfected using chlorhexidine (P < 0.05, 95% confidence interval 0.01-0.06). A parallel lower occurrence of urinary tract infections was also observed, 6.2% in the saline group as compared with 3.4% in the chlorhexidine group (P < 0.01, 95% confidence p interval 0.00-0.05). This prospective controlled trial demonstrated that vaginal douching with 0.2% chlorhexidine during labor can significantly reduce both maternal and early neonatal infectious morbidity. The squeeze bottle procedure was simple, quick, and well tolerated. The beneficial effect may be ascribed both to mechanical cleansing by liquid flow and to the disinfective action of chlorhexidine:

Lancet 1992 Jul 11;340(8811):65-9. Comment in: Lancet. 1992 Sep 26;340(8822):791; discussion 791-2. Lancet. 1992 Sep 26;340(8822):792. Prevention of excess neonatal morbidity associated with group B streptococci by vaginal chlorhexidine disinfection during labor. The Swedish Chlorhexidine Study Group. Burman LG, Christensen P, Christensen K, Fryklund B, Heigesson AM, Svenningsen NW, Tullus K. National Bacteriological Laboratory, Stockholm, Sweden. Streptococcus agalactiae transmitted to infants from the vagina during birth is an important cause of invasive neonatal infection. We have done a prospective, randomized, double-blind, placebo-controlled, multi-centre study of chlorhexidine prophylaxis to prevent neonatal disease due to vaginal transmission of S. agalactiae. On arrival in the delivery room, swabs were taken for culture from the vaginas of 4483 women who were expecting a full- term single birth. Vaginal flushing was then done with either 60 ml chlorhexidine diacetate (2 g/l) (2238 women) or saline placebo (2245) and this procedure was repeated every 6 h until delivery. The rate of admission of babies to special-care neonatal units within 48 h of delivery was the primary end point. For babies born to placebo- treated women, maternal carriage of S. agalactiae was associated with a significant increase in the rate of admission compared with non-colonized mothers (5.4 vs 2.4%; RR 2.31,95% Cl 1.39-3.86; p = 0.002). Chlorhexidine reduced the admission rate for infants born of carrier mothers to 2.8% (RR 1.95, 95% Cl 0.94-4.03), and for infants born to all mothers to 2.0% (RR 1.48, 95% Cl 1.01-2.16; p n 0.04). Maternal S. agalactiae colonization is associated with excess early neonatal morbidity, apparently related to aspiration of the organism, that can be reduced with chlorhexidine disinfection of the vagina during labor.

Eur J Obstet Gynecol Reprod Biol 1989 Apr;31(1):47-51 Prevention of group 8 streptococci transmission during delivery by vaginal application of chlorhexidine gel Kollee LA, Speyer I, van Kuijck MA, Koopman R, Dony JM, Bakker JH, Wintermans RG. Department of Pediatrics, University Hospital, Nijmegen, The Netherlands. In a prospective study in 227 parturients, carriership of group B streptococci was established to be 25%. In carriers, transmission of streptococci to the newborn occurred in 50%. 10 ml of a chlorhexidine gel containing hydroxypropylmethylcellulose was introduced into the vagina during labor in 17 parturients, who were known to be carriers of group B streptococci from the first trimester of pregnancy. In none of the newborns from these mothers colonization by group B streptococci did occur. Vaginal application of chlorhexidine may prevent transmission of group B streptococci, and serve as an alternative to intrapartum prophylaxis using antibiotics. A large multicenter randomized controlled study should be performed to confirm this hypothesis.

Eur J Obstet Gynecol Reprod Biol 1985 Apr;19(4):231-6. Chlorhexidine forprevention of neonatal colonization with group B streptococci. III. Effect of vaginal washing with chlorhexidine before rupture of the membranes. Christensen KK, Christensen P, ***** AK, Kahimeter G. A single vaginal washing with 2 g/l of chlorhexidine was performed before rupture of the membranes in 19 parturients who were urogenital carriers of group B streptococci (GBS). Two (11%) of the infants became colonized immediately after birth, in contrast to 16 of 41 (39%) infants to controls (P= 0.02). A significant reduction of GBS colonization of the ear (P= 0.02) and umbilicus (P = 0.01) was noted. Taken together, 2 of 57 (4%) cultures obtained at birth were positive in the chlorhexidine group, in contrast to 30 of 123 (24%) among the controls (P less than 0.01). These findings raise hope for the design of a simple washing procedure which might prevent serious infections in the early neonatal period with GBS but also with other chlorhexidine-sensitive organisms.

Vaginal disinfection with chlorhexidine during childbirth.
Stray-Pedersen B, Bergan T, Hafstad A, Normann E, Grogaard J, Vangdal M.
Int J Antimicrob Agents 1999 Aug;12(3):245-51

"Vertical transmission of microbes occurred in 43% of the reference deliveries. In the double blind study, vaginal douching with chlorhexidine significantly reduced the vertical transmission rate from 35% (saline) to 18% (chlorhexidine),. . . . This prospective controlled trial demonstrated that vaginal douching with 0.2% chlorhexidine during labour can significantly reduce both maternal and early neonatal infectious morbidity. The squeeze bottle procedure was simple, quick, and well tolerated. The beneficial effect may be ascribed both to mechanical cleansing by liquid flow and to the disinfective action of chlorhexidine."

I offer all my clients full informed CHOICE about doing GBS screening. I haven't had any client choose to screen for it. I have had a couple who transferred to my care at 37 weeks knowing she was GBS+. She chose not to treat herself prenatally or in labor. We did no vaginal exams prenatally or in labor and her water broke spontaneously four hours before birth.
 

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Anyone know if you can use anything besides chlorhexidine? I can't use it and I'd love to be doing something at home prior to the 37wk test that will decrease the bacterial count.
 

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There aren't any studies out there using other stuff - BUT maybe H2O2? Watered down of course, but hydrogen peroxide kills bacteria and when my grandfather had oral surgery and the wash they gave had chlorhexidine too, the dentist said he could do peroxide at like 10%.

In the meantime, get some acidophilus capsules (the ones in the fridge) and take 2x the dose, the "good" bacteria will crowd out the strep and make your numbers go down. Eat as much vitamin c (grapefruit, oranges, bell peppers) as you can.

I *think* when they culture, negative is under 50,000 bacteria in the growth medium after 2 days, and positive is over 50,000, so you can have some strep living there that isn't considered a risk.
 

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Kaylee, you said you had ampicilin with both of your dc. Just FYI, some studies recently have shown ampicilin to have a higher frequency of resistant strep and ecoli (over 5%) while the resistant kinds to penicilin are less than 5%.

You CAN ask your ob, midwife, whomever, to put on the lab sheet to not only test FOR the gbs, but to culture and do a sensitivity, this will guarantee that you will know the antibiotic you get WILL be effective against the strep you have.
 

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I had a horrendous allergic reaction to Chorhexidine and my GBS went from moderate to abundant and ended up using antibiotics in labor as my whole vagina and bladder were inflamed. I was really upset as do not use antibiotics and did use probitotics and Vit C, and other things as well and wish I had just stuck to them and not the Chorhexidine it was nasty. Just FYI.
 

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Here are some ideas, Brandi:

GBS Positive Treatment Plan
-by Karen Ehrlich, CPM, LM

This is an anecdoatal experiment, designed to see if the following both treats GBS infection in the mother, and prevents the baby from getting infected/sick. If someone is trying to use this for prevention, I think that doing simple probiotics is a better idea. Please let me know what results you have if you choose to use this experiment.

This was designed for women who choose to be tested late in pregnancy (the current protocol is 36 weeks- I test at 34 weeks so there is time for the treatment to work if it is positive), whose culture is positive, and who are interested in getting clinical proof that they have eliminated the GBS from their system so they don't have to deal with medical alarmism about being GBS positive. However, if someone does test GBS positive, I recommend staying on the treatment through the rest of the prenancy, since GBS is known to come back when conventional antibiotic treatment is discontinued.

The plan was developed by a pregnant woman in San Francisco who tested positive for group beta strep. She was planning a homebirth, and wanted to avoid hospitalization and antibiotics. She successfully eliminated the bacteria from her genital/anal tracts. Her midwife has used it successfully with two other mothers, and is currently working with a fourth woman who is using this plan. That midwife tells me that it took about 3 weeks to obtain negative cultures, but that she could see that it was working after weekly tests because each subsequent culture showed less GBS growth. I tried it once, but the woman went into labor before she had the time to rid her system of the GBS.

I have added grapefruit seed extract, on the suggestion of another midwife who has used it successfully.
Twice a day, with breakfast and dinner:

•acidophilus - 4 billion cells per dose (The first time I heard a naturopath speak about preventing this infection in babies, he stated that using high doses of probiotics- acidophilus, bifidus, etc.- in the last weeks of pregnancy would prevent the problem.)
•echinacea - 350 mg capsules - two capsules (Note that some people are allergic to echinacea!- this is best used in the last couple of weeks of pregnancy only.)
•garlic - 580 mg capsules - two capsules
•vitamin C - 500 mg with 200 mg bioflavonoids
•grapefruit seed extract - 15 drops

A culture is done every week, to see if the bacteria are decreasing. Whatever the reading is closest to delivery is supposedly the most reliable.

If this regimen is successful at eliminating GBS, I would suggest staying on it until birth, to give the mother the best possible likelihood that it will not be present in her vagina at the time of birth

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Quote:
You CAN ask your ob, midwife, whomever, to put on the lab sheet to not only test FOR the gbs, but to culture and do a sensitivity, this will guarantee that you will know the antibiotic you get WILL be effective against the strep you have
Lisa, she did this w/my last dd- because of the UTI. I took oral penicillin and it didn't get rid of it, so that's why I got Amp. during labor, after the culture came back. Maybe my bacteria are reversed, resistant to the normal abx and succeptible to the others? :LOL
 

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Thanks Pam!


Is there still a chance that someone treated at 34 wks will still have an abundent GBS colonization at 40 wks? Do the probiotics "last longer" than abx? Thanks and I hope I'm not asking dumb questions :LOL
 
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