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Discussion Starter · #1 ·
Talk to me about Group B Strep. We declined testing with our last pregnancy and I was planning on declining again. My midwife wants me to research it further so I figured this would be a good place to get more info.

I am getting a little frustrated by the midwives this time (for various reasons). Mainly because I had such wonderful care last time and they were open to what I wanted. This time it seems that they are talking down to me and not treating me as someone who has already educated herself on pregnancy and birth.
:

At almost 35 weeks, I still haven't received a birth supplies list because the student midwife decided to complicate things by just e-mailing them. (which was supposed to have been done 3 weeks ago) Now I'm stressing that I will only have a few days to gather everything I need or be lectured by the midwife about how I'm not prepared. *sigh* Maybe I'm just being hyper sensitive this time.
 

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For whatever reason you decide no to be tested is up to you. I agree that you should do all the research you can because GBS can have a very serious outcome.
Sounds like your stress has more to do with your midwives then GBS. I'm sorry you feel like your care hasn't been as top notch as last time.

Here is some stuff on GBS I hope it helps.

http://www.gentlebirth.org/archives/gbs.html
 

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Okay, here's the skinny as I understand it:

It used to be that ACOG recommended that medical providers handle Group B Strep in one of 2 ways:

(1) Forgo screening and give IV antibiotics in labor to all women with risk factors such as prematurely ruptured membranes, premature labor, membranes ruptured for 18 hours or more, newborn group B strep in a previous birth, or fever in labor.

OR

(2) Screen everyone between 35 to 37 weeks of pregnancy. Offer all colonized women IV antibiotics in labor. Prescribe IV antibiotics to group B carriers with membranes ruptured for 18 hours or more or those who develop a fever in labor.

Then a little while back ACOG changed it's tune and said they recommended that all providers follow the second strategy. So that's why many medical providers push you to get screened.

The down side of this second approach is they end up giving IV antibiotics to a lot of people that don't have risk factors such as laboring for more than 18 hours after their water breaks.

I am still deciding whether to get screened or not. The argument for not getting screened imo is if I test GBS+ and a complication develops and I end up having my baby in a hospital, I will get A LOT of pressure to have IV antibiotics right away if I am at my local hospital (though some people are luckier--a month or 2 ago someone in another MDC pregnancy forum said she is GBS+ and birthing in a hospital, but her OB/midwife recommends antibiotics only if she's gone past 18 hours with broken water or has some other risk factor
).

The argument for getting screened as I see it is that if I test GBS negative, then I don't have to worry about doing IV antibiotics at home if my water breaks and I labor past 18 hours.

My midwife says there is a topical treatment/preventative against GBS infection of the baby they can do, which she feels very comfortable doing in lieu of IV antibiotics (she has only had 2 clients choose to do IV antibiotics). I forget what this is called though! Maybe someone else here knows. I would also be happy to ask her and get back to you if you like. I do remember her saying there is research (from other countries, not the US) to support that this other treatment has good outcomes. I could also ask her about this if that would be helpful.

I think there are some natural/holistic things you can do as preventatives against GBS infection, but I don't know what they are.

Good luck with your decision-making on this!
 

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Discussion Starter · #4 ·
Thank you both for replying.
I will be slowly but surely reading through the link you provided mom2four.

A little background on why I decided to forgo testing. I tested negative with my first (which I know means very little). When we came into the care of a midwife, I had read some, knew the risks, and opted not to test. She said she would prefer to but it was my choice. My water broke at 10cm and my baby was born a half hour later.

This time around I have read much more and still choose to decline the testing. I will talk more to my midwife at my next appointment about the 'what ifs'. If I do test and am positive, is she comfortable with alternative treatment vs antibiotics. If I don't test, what protocol would she like to follow in terms of extended ROM.

Thanks again!
 

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The % of babes becoming seriously ill with group b strep when they are born to mothers who test positive AND have risk factors is still astonishingly low, something like 0.2% (or 2 out of 1000), and it's lower still for mamas who test positive and have no risk factors or who test negative.

For us, we were comfortable with the low numbers and educated ourselves on signs of group b strep infection in newborns so we could take action should our baby need further care.

And as for the supplies list, take pen and paper to your next appointment and write out a list of supplies in front of them since they seem less concerned about it than you are. There should be no judgment from your care providers about your lack of planning when they are limiting your ability to plan by not being timely. And get all your thoughts and feelings out in the open, mama, so you can birth unencumbered and free of preoccupying thoughts...

peaceful end of pregnancy to you...

~claudia
 

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Since you are in Canada and the GBS recommendations have just changed here in September 2004, I though I'd give you some canadian links to look through....

go the SOGC's website :
http://www.sogc.org/sogcnet/sogc_doc.../index_e.shtml
Look for the document entitled:
The prevention of early-onset neonatal group B streptococcal disease.
I think the direct link is:
http://www.sogc.org/sogcnet/sogc_doc...fs/ps149_e.pdf

Also check out the Canadian Task Force on Preventative Health website (their guidelines are from 2002):
www.ctfphc.org/
the document you want is
Prevention of early-onset group B streptococcal (GBS) infection in the newborn.

GBS is a hard topic for most people...what to do? Remember to ask them to explain the change in recommendations because they may be different than during your last pregnancy (and why they changed them, based on what information/studies).
If you are planning a homebirth, will you be able to receive antibiotics at home or would it mean a hospital birth?

If you choose not to screen (it is a screen and is not 100% perfect), what would happen in the hospital (ie would you be treated as a positive woman anyways, would they treat you if you developed risk factors only?

What would happen if your baby had an elevated temperature after birth - would they do a full work up because they didn't know your status?

If you choose to screen what does it mean if you are negative and develop risk factors?

What if you screen positive (hospital protocols ie if your waters break and you have no contractions - would induction be recommended right away?) Remember it is YOUR CHOICE!!!!!!!!!!!!!!

Also remember to ask them about the incidence of anaphylactic reactions to antibiotic treatment. It is rare but serious and they should share this freely with you.

....sorry if this is overwhelming post or if you know most or all of this already
. I also wanted to add that if you are uncomfortable with your student you have a right to ask her not to attend your birth. Good luck...I'm sending you positive, strong woman vibes for your next visit and for your birth.

Kelli
 

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The risk of transferring groub B to the baby is extremely low. Unless you have ruptured membranes for more than 12 hours, I think it's 12, it could be longer but anyway..I chose not to test even though I have been positive in the past this time I didn't test and everything came out just fine
 

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Quote:

Originally Posted by ZeldasMom
My midwife says there is a topical treatment/preventative against GBS infection of the baby they can do, which she feels very comfortable doing in lieu of IV antibiotics (she has only had 2 clients choose to do IV antibiotics). I forget what this is called though! Maybe someone else here knows. I would also be happy to ask her and get back to you if you like. I do remember her saying there is research (from other countries, not the US) to support that this other treatment has good outcomes. I could also ask her about this if that would be helpful.

I think there are some natural/holistic things you can do as preventatives against GBS infection, but I don't know what they are.

Good luck with your decision-making on this!
I think the topical you're thinking of is called Hibiclens (sp?). I've just gone through this decision making process and decided not to test, we'll assume I am positive (was positive w/ #1 & #2), and only treat if one of the risk factors that others have mentioned comes up (i.e, fever, 18 hours+ ROM). If we treat it will be with the topical hibiclens, which my midwife carries with her (planned home birth). Also, she recommended garlic (crushed clove or oil on tampon) inserted over night for 1-2 weeks before birth - haven't done that part yet.
 

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Discussion Starter · #10 ·
Wow ladies, I truly appreciate the info!!
I was a little worried about posting because I wasn't sure how much support there would be for someone who declined the test.

I really hate to be stubborn but I hate even more to be pressured into something I don't feel necessary. Last time around I allowed them to administer 1/2 a vit k shot because there was a slight bruise on Adam's forehead even though I was very clear that I didn't want it done. I also had some issues about the PKU but they offered to do it at home when he was 3 or 4 days old. I was still pretty uneducated about it, was offered nothing on their part, and decided it was very important to my midwife so I should do it. It was awful. The student midwife couldn't get enough blood to fill in all of the circles (to which I blame the vitamin K).

I felt so absolutely sick because she poked him 3 times in the same foot. And then we had to go to a lab to get it done in the end. This time around, I am firm...NO VIT K. We will wait until 1-2 weeks to do the PKU testing. (probably around the 10 day mark when he has natural blood clotting)

Thank you Kelli for the wonderful questions to ask the midwives. I was actually wondering a few of these things myself (like what a positive would mean for my homebirth plans) but that was a great list!!!
 

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something to think about as well (although i dont know the situation in canada):
the majority of peds in my area will refuse (yes, refuse!) to see babies if moms are GBS+ and refuse antibiotics, or moms who have an unknown GBS status and refuse antibiotics. so i did a garlic clove suppository for the 3 days prior to my test, and (since i tested myself), i only did my vagina, NOT my anus. the midwife i work with said when she has a baby she's just going to take the test swab, wave it in the air, and put it in the tube, lol.

the point being- i decided it was better to test negative than to not have a result.

also, GBS is transitory, so if you test +, it might go away by delivery, and vice versa
 

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GBS is 2 per every 1000 babies. Only 10% of those 2 babies per thousand become sick or die from GBS. Some of those cases were with the mother taking antibiotics in labor... So 0.02% is accurate.
 

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Actually those stats are not accurate. That is combining the mothers who take antibiotics with those who do not. In mothers who are + for GBS and refuse antibiotics the risk of the baby developing a GBS infection is 1 in 200 babies, if mom takes the antibiotics the risk drops to 1 in 4,000. And the 10% stat is how many of those 1 in 200 will DIE, another 25% are left permanently damaged.

Trust me, my daughter died from a combo of a GBS infection and the Hep B Vaccine (I was an uneducated momma about vaccines)

Quote:
a pregnant woman who is a group B strep carrier (tested positive) at full-term delivery who gets antibiotics can feel confident knowing that she has only a 1 in 4000 chance of delivering a baby with group B strep disease. If a pregnant woman who is a group B strep carrier does not get antibiotics at the time of delivery, her baby has a 1 in 200 chance of developing group B strep disease. This means that those infants whose mothers are group B strep carriers and do not get antibiotics have over 20 times the risk of developing disease than those who do receive treatment
From the CDC website http://www.cdc.gov/groupbstrep/
 

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Wow, I just read my stats from a book that I am using to become a midwife. It was just updated in 2004. I guess they must vary depending on where you get them.
 

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Well your first Stat is correct if you COMBINE the mothers receiving antibiotics with those who decline or didn't receive them because they didn't know they were positive, but since the OP is talking about not receiving antibiotics she should know that that increases her risk to 1 in 200 that the baby will get a GBS infection and will get sick. How sick is dependant on the babe, 10% of those who get sick will die and another 25% will have lasting disabilities.

Fast labors, minimal vaginal exams, and an intact bag of waters for most of the labor are great protectors but not fool proof. In a mom with high colonization it is possible for the GBS to pass through intact membranes and cause the babe to be stillborn. This is very rare but can happen, one of the indicators for this is GBS in the urine.
 

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I wonder how much we should take into account the massive amounts of vaginal checks being done at the hospital. Or the AROM that is so common. Or the IFM. Plus so many other meds and interventions that are just increasing the likelyhood of it happening.

This is very rare but can happen, one of the indicators for this is GBS in the urine.

So what you are saying is that we should test everyone for GBS, and if they have it, they should have antibiotics in labor. Even though the chance of getting a severe yeast or thrush infection is much much more common. And with new mothers, thrush can very easily threaten the already fragile breastfeeder...

Adding: you can test positive and be negative and birth, and you can test negative and be positive at birth...
 

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Well, I did find that the mortality rates are decreasing they now say 6% will die, however if babe is early they percentage is drastically higher

Quote:
Full-term babies are less likely to die; 2 to 8 percent of them suffer fatal complications. Premature infants have mortality rates of 25 to 30 percent.
I guess what I would do is be tested so you can make an informed decision. There are many natural ways to decrease your colonization levels and decrease babe's chance of infection. Also you would know to watch much more closley in the hours/days after babe's birth for any signs that they may be sick.

I delivered in a hospital, received antibiotics and was sent home with a "healthy" infant. My concerns about her lack of appitite, snorting, lethargy, jaundice, etc were played off by the medical staff as first time mom jitters. 14 hours after discharge I was holding my dead daughter in my arms at home wondering how life could ever go on. No one needs to suffer that unnesicarily.
 

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Quote:

Originally Posted by DoulaSarah
I wonder how much we should take into account the massive amounts of vaginal checks being done at the hospital. Or the AROM that is so common. Or the IFM. Plus so many other meds and interventions that are just increasing the likelyhood of it happening.

So what you are saying is that we should test everyone for GBS, and if they have it, they should have antibiotics in labor. Even though the chance of getting a severe yeast or thrush infection is much much more common. And with new mothers, thrush can very easily threaten the already fragile breastfeeder...

Let me think, thrush or dead baby? No contest!

Still I am not saying that everyone should have antibiotics that tests positive. I said before there are ways to minimize risk. I do think everyone should be tested and yes, if it is present in the urine then absolutely mom should accept the antibiotics as the risk of infecting the baby increases substanitally, this is also the feelings of my midwives who do not believe in antibiotics for all GBS+ moms but do absolutley if it is present in the urine.

Also, if you are tested and are + then you know to watch babe closer in the days after birth. If you are neg then you can be fairly certain that babe will be okay. I know colonization can come and go. After being highly colonized in my first 5 pregnancies (only 2 made it to delivery) loosing Sierra to the infection, having GBS in my urine with Maia, I was negative at delivery with Sage. However, based on my history, Sierra's death, and the fact that Sage was arriving 7 weeks early we did choose to treat me with antibiotics durring labor.

Oh, for what it is worth, My water broke on its own, I labored for 4 days with it broke in the hospital, only had 5 total vag exams over the 4 day period, no internal monitors, and she still died
 
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