Q. My wife and I are expecting our first child and would like a homebirth (preferably a water birth). My wife has tested positive for Group B Strep and she plans to avoid taking antibiotics in labor. Would labor/delivery in the water carry any increased risk?
A. Let us first recall that Group B Streptococci very rarely infect an average birth weight baby born at term. The risks are higher in the case of a premature or low weight newborn baby. Let us recall also that B Strep comes and goes, and that the test must be repeated as close to the due date as possible. It has been claimed that inserting in the vagina a crushed or cut clove of garlic during three to five nights usually makes a second test negative.
I share the point of view of your wife and I am not comfortable with the fact that a great part of the population is now exposed to antibiotics just before being born. There are already studies suggesting that early exposure to antibiotics might be a risk factor for allergic diseases later on in life. Furthermore such a widespread practice might explain the increased incidence, in some medical centers, of neonatal infections by antibiotic-resistant strains of e-colis.
There are therefore serious reasons to give a great importance to a series of studies suggesting that the efficacy of a local vaginal treatment with the antiseptic chlorhexidine is comparable to the efficacy of antibiotics in the prevention of such neonatal infections. You cannot discuss this issue with health professionals without providing the relevant references. For mysterious reasons these studies are not well known, although published in authoritative medical journals.
If the first stage of labor is long and difficult in spite of complete privacy, there is no reason why your wife would not try to reduce her level of adrenaline through immersion in water at the temperature of the body (I originally introduced the concept of birthing pool in a French hospital in order to avoid drugs when the labor is difficult). If your wife suddenly has a series of irresistible contractions and does not want (or has not the time) to get out of the pool, the baby may be born under water.
1. The Swedish Chlorhexidine Study Group. Burman LG, Christensen P, Christensen K, Fryklund B, Helgesson AM, Svenningsen NW, Tullus K. Prevention of excess neonatal morbidity associated with group B streptococci by vaginal chlorhexidine disinfection during labour. Lancet. 1992 Sep 26;340(8822):791; discussion 791-2.
2. Facchinetti F, Piccinini F, Mordini B, Volpe A. Chlorhexidine vaginal flushings versus systemic ampicillin in the prevention of vertical transmission of neonatal group B streptococcus, at term. J Matern Fetal Med 2002 Feb;11(2):84-8
3. Taha TE, et al. Effect of cleansing the birth canal with antiseptic solution. BMJ 1997; 315: 216-20.
4. Stray-Pedersen B, Bergan T, Hafstad A, Normann E, Grogaard J, Vangdal M. Vaginal disinfection with chlorhexidine during childbirth. Int J Antimicrob Agents 1999 Aug;12(3):245-51
5. Christensen KK, Christensen P, Dykes AK, Kahlmeter G. Chlorhexidine for prevention of neonatal colonization with group B streptococci. Effect of vaginal washing with chlorhexidine before rupture of the membranes. Eur J Obstet Gynecol Reprod Biol 1985 Apr;19(4):231-6
6. Kollee LA, Speyer I, van Kuijck MA, Koopman R, Dony JM, Bakker JH, Wintermans RG. Prevention of group B streptococci transmission during delivery by vaginal application of chlorhexidine gel. Eur J Obstet Gynecol Reprod Biol 1989 Apr;31(1):47-51