[sarahwebb]

Dear Midwives,<br><br>
I tested positive for GBS with my first pregnancy, took an oral course of ampicillin and tested negative at 38 weeks. I was planning to do this again, but have read that taking the oral antibiotics may put my baby at higher risk than not taking any antibiotics before labor. I live in an alegal state for homebirth midwives, so my midwife can't administer IV antibiotics at home, and I have a lot of concerncs about antibiotic use.<br><br>
I've asked several midwives and the incidence of babies developing GBS disease seems lower in their practices than in the general population although the midwife client samples are small. I'm wondering several things:<br><br>
Do babies born via midwife attended births have fewer incidence of GBS disease?<br><br>
Does allowing the birth process to proceed naturally with few internal exams and interventions reduce the incidence of GBS disease in newborns?<br><br>
Do you test your mothers for GBS? If yes, how do you treat them?<br><br>
How many GBS+ mothers have you delivered without antibiotic treatment during labor? How many of the babies developed GBS disease?<br><br>
If you don't test your mothers, how many babies have you delivered and how many have had GBS disease?<br><br>
What would you advise an expectant mother who has tested positive for GBS but not had an infant infected with GBS disease in a prior pregnancy?<br><br>
Currently, I'm considering not being tested and requesting treatment based on risk factors (<37 weeks labor, prolonged rupture of membranes and fever during labor) or being tested. It would be great to test negative and not worry about it, but I'm very concerned about testing positive and then being faced with the choice of doing nothing, taking oral antibiotics or choosing to deliver in a hospital....<br><br>
I am not asking for medical advice for my situation, but I would like to know how you would advise/treat a client under similar circumstances and what your experience with GBS is.<br><br>
Many thanks,<br>
Sarah

 

[Carmel]

I'm not quite sure where to start answering your questions- I will try to give you my clearest advice, which is hard because GBS is one of the most confusing issues in pregnancy care right now.<br><br>
I would only get tested if you are going to do something about it. If you are going to go by risk factors regardlesss of the test you won't really be getting any information you need.<br><br>
If you are going to get tested I would try to create a healthy vaginal flora to begin with. This is actually a good idea regardless if you are testing or not because it reduces your risk for all types of infections. You can so this by adding acidophilus and garlic to your diet and trating any preexisitng yeast/vaginal infections.<br><br>
Now to the confusing part,<br><br>
If you choose to get cultured you might want to request a vaginal culture only, as opposed to the routine vaginal/anal culture. This is becuase so many women have GBS in their rectum, but the baby doesn't pass through the rectum.<br><br>
Oral antibiotics are not considered an effective treatment. The time the baby is at risk is during the time of birth, not prior to labor and the effectivity of oral antibiotics drops off so quickly after usage that you wouldn't be covered in labor.<br><br>
In Europe, and sometimes now in the US, and both in and out of the hospital some practioners are doing either a Hibiclens douche or washing the baby off after the birth. Hibiclens apperantly kills any GBS... I can't tell you a comparsion between Hibiclens and antibiotics.<br><br>
Have you done a Medline search on GBS? You night want to ask you question on the midwifery today website- you might get some great alternative protocols for treatment.<br><br>
I give my clients the choice of whether or not test, and hey also choose how they want to treat it (I don't do IV antibiotics in labor). Most people decline testing, and most who test are negative. Of the few who do treat it is usually a combination of herbal suppositories and nutritional therapies.<br><br>
I've never seen a case of GBS myself, I do think it is pretty rare.<br><br>
Good Luck.

 

[lisamarie]

I am going to move your thread over to the Midwives and Doula board.<br><br>
Good Luck~<br><br>
Lisa:bf

 

[pamamidwife]

<b>Do babies born via midwife attended births have fewer incidence of GBS disease?</b><br><br>
I would think so, since the general homebirth population is healthier, on average, and low-risk in many other categories. In addition, we do not do pre-term deliveries.<br><br><b>Does allowing the birth process to proceed naturally with few internal exams and interventions reduce the incidence of GBS disease in newborns?</b><br><br>
YES YES YES YES. Internal monitoring, vaginal exams, routine rupture of membranes - these all increase the risk of GBS.<br><br><b>Do you test your mothers for GBS? If yes, how do you treat them?</b><br><br>
I offer the test but most of my clients (all of them to date) have not taken the prenatal test.<br><br><b>How many GBS+ mothers have you delivered without antibiotic treatment during labor? How many of the babies developed GBS disease?</b><br><br>
Hard to say who was GBS+ and who wasn't, since I don't test. I haven't had any GBS sick babies, but it's not rare to find that with homebirth midiwives - even those that have been practicing for years.<br><br><b>If you don't test your mothers, how many babies have you delivered and how many have had GBS disease?</b><br><br>
I've done about 130 births. None have had GBS disease.<br><br><b>What would you advise an expectant mother who has tested positive for GBS but not had an infant infected with GBS disease in a prior pregnancy?</b><br><br>
I would offer her all the information I can - from the CDC to Mothering Mags article...and offer her alternative treatment choices and allopathic choices. She can make the choice on her own. I would support her either way, since I don't feel like it's a huge risk.