Group B strep and antibiotics in labour

[Toomanytoomany]

I found out at my 28 week check up that a swab they did at 10 weeks showed I was positive for group B strep (nice of them to let me know - they told me all my tests came back normal!).

I am looking into my options as the hospital's policy is, as everywhere, to administer IV antibiotics four hourly once labour begins.

If I can avoid it I want to do this, as I don't want to be hooked up to an IV (I need to pee every ten minutes when I'm in labour and dragging the IV around is a pain in the butt, and I don't like how it restricts my free movement.) I also have two children who are allergic to various antibiotics and have other issues, I have one child who has had major gut problems through her life from overuse of antibiotics during her first of life, and I am concerned about my baby developing penicillin-resistant bacteria such as resitant e-coli.

The other issue is, my pro dromal labours last a long time - up to a week - and there's no way of judging "the start" of my labour, and I can see immense pressure on me for labour augmentation, and the resultant risks to me and the baby involved in that.

I also get thrush every time I have antibiotics, and I don't want thrush on a healing perineum!!!!

I'm considering a compromise position - that I will consent to IV antibiotics if my waters have been broken for twelve hours, or I go into labour before 37 weeks, or I develop a fever before or during labour. After looking up the incidence and risks of streptococcal sepsis for neonates, this is a significant set of clinical risks which contribute markedly to the 0.2% chance of the baby becoming infected by GBS.

In the meantime I'm embarking on a course of garlic, grapefruit seed extract and probiotics to improve my internal flora and hopefully reduce the colonisation so that it's negative at my 36 week screening anyway.

Does this seem reasonable? Has anyone else dealt with these issues outside the normal protocols? Does anyone have any research beyond the inadequate cochrane review and the health service propaganda to help me make a truly informed decision? Given how bureaucratic and process driven the hospital is, I am anticipating a fight if I insist on treatment outside the norm.

[Oorki Galoorki]

i think you are up for a fight just simply because "its not how we do it"......
but it seems like a great plan
i might recomend they check it again at around the 37 week mark(it comes and goes) so you might not have a positive reading by then with all the natural products you are using.

[Schmickers]

I think that sounds like a sensible plan. You are basically exploring the difference between treating based on risk factors (prolonged rupture of membranes, fever, etc.) and treating based on pathology; if you'd like, I have a link somewhere to an Australian study that compared the two and found that neither strategy better than the other. Might be useful to have at your next appointment.

We had a positive swab for GBS when we were pregnant with Olivia; we did many of the things you are doing with probiotics, and we also had a douche prepared by our naturopath, can't remembe exactly what was in it, but I'm sure there was garlic. We were negative on our second swab.

[diannescruffy]

Hope it all works out well for you and your next swab will come back negative. Obviously different hospitals have different policies, I was positive with two of my pregnancies and neither time had an IV thankfully. I was given an injection at a certain time during my labour and that was it.
Good luck with it all.

Regards,
Dianne

[Kazmar]

Hope it all works out for you! Just thought Id let you know. I had this IV. I found it made no difference to the birth. In my birth plan I wanted NO needles what so ever, is a massive fear of mine. But I knew it would help so much If you do have to take the IV dont stress. As I said it made no difference to Annabelle's birth

[Toomanytoomany]

Hope it all works out for you! Just thought Id let you know. I had this IV. I found it made no difference to the birth. In my birth plan I wanted NO needles what so ever, is a massive fear of mine. But I knew it would help so much If you do have to take the IV dont stress. As I said it made no difference to Annabelle's birth

I've had IVs too for four of my other deliveries - that is the least of my concerns but I do know that I don't like them. My major concerns are to do with the impact of large doses of antibiotics on the baby and me, and weighing that up against the actual risk.

Thanks for the good wishes, everyone.

[Toomanytoomany]

if you'd like, I have a link somewhere to an Australian study that compared the two and found that neither strategy better than the other.

Yes please - I would like to have any info at my fingertips that is available! The only Cochrane Review info available was pretty brief. I also note that the studies in favour of the routine administration of a/biotics are based on poor samples - and there doesn't seem to be much info on the instance of checking for resistant bacteria and other types of sepsis in neonates. It's like, "We can test for this one, so this one's the bogeyman!" when of course it isn't as straightforward as that, is it?

[Tegam]

I tested positive for my 1st. Had the AB but delivered too soon so they had no affect.

I tested positive for my 2nd. New baby was going to come too quick so said no to AB in hospital. Labour was 2hrs so i was right, the AB need over 4 hrs to work...

Didnt both getting tested for baby number 3 as i was guessing i would be positive. I had done my research and was happy that i knew the pros and cons well enough to make this decision....

I cant remember where my research is, ill have a look for you

but i do remember that in one of the studies it suggested that the babies that do get GBS from their mothers are the ones that are put under undue stress at the time of birth, eg. being made cold in a operating theatre, or being "Checked" by the Dr. Weighed on those horrible scales or even given needles........

So they suggested that skin to skin, 1st bf and the deley of "checks" and weighs.....

Something for you to think about...

Also i have to say that there are some people that think that i took an risk by not taking the AB.....Well i have nursed VERY sick babies and i have watched some die of it - yes scary - BUT if we added up all the risks then we wouldnt get pregnant... There is no possible way to take all the risks out of babies and births..... And Like you AB have their own risks, All of my children are yet to have AB so why would i want to introduce them to them when they are so young....

Also the AB can be administered in one go so while you how have to have the needle in you shouldnt have to have a pole?????

[Toomanytoomany]

Milly thank you for that, it is very helpful. It's funny - I'd been feeling this pregnancy that the skin to skin thing after birth was feeling much more important to me than it has done before.

I have shortish labours, too, four to six hours, and as quick as two hours, so I doubt they'd have much opportunity to get them in before the baby was born.

I am assuming about the pole - they can just have a bung in and not the other apparatus? That would be good to know if the other risks are present and I do agree to have them.

[Me+him+bub]

hi there! IV's are awful! i prefer giving them to having them, but most docs will insist, although you DO have the right to say no. even if not being administered antibiotics often you will still get a line in as a precaution, something may go wrong in labour and may need emergency C sec and if they are spending precious time finding a vein there could be trouble! in medicine something is only done if it outweighs the risk of not having the procedure, the less that has to be done the better so if they feel its necessary there must be a reason y. i wish you luck! plus strep b is nasty you dont want bub having it. strep B is very common too!

[Toomanytoomany]

In medicine something is only done if it outweighs the risk of not having the procedure, the less that has to be done the better so if they feel its necessary there must be a reason y.

Thanks for your well wishes - however, I think a lot of medicine as it is currently practised is not evidence based, and I've had too many doctors do things to me for convenience to trust that they are always doing things with good reason. At this hospital, even more so!!

[Me+him+bub]

i agree! thats why im a nurse haha! you would be surprised at some of the malpractice i have seen, best to go with your gut, thats what i do when i meet a doctor!

[Tegam]

Yes Yes Yes there is no need why they can not give you the AB's by slow push, this takes about 5-10mins (depending on how good the nurse is - some push them too quick!)

Another thing you can do is get to the hosptal late, like when you feel bubs is no too far away and then just say "hey there is no way those AB will do anything if i have the bub in the next 2 hrs, is there?"

Follow your gut and yes always question WHY a DR wants what they want. There is far too much intervenion in this country.....because it suits the Dr not the mother!

And like i said, yes GBS in bubs is scary and no mother would choose it to happen to their bub - but that does not mean that you have to introduce AB in labour to the unsuspecting bubs....'


I also forgot to say the delay washing baby for a few days, you dont want it to get cold getting dressed etc so maybe disposible nappies for the first few days to minimise changes????? Just a thought!

[Pandora]

im undecided on whether to be tested for GBS or not.
Its not common, but its not uncommon - in Australia is about 15% or people who have it at any one time.
The info I have read in the '3 centres' documentaton says that there is little difference in effectiveness in pre testing for it as opposed to checking for warning signs and symptoms in labour.

I also dont understand why some popel get a shunt put in and have the ABs via IV, when I know of at least one hospital in melbourne that just give the mums to be aregular injection every 4 hours.

Im very torn about what to do. I dont want unnecessary ABs and I know the risk of passing it o is low even if I am positive, but i also know what can happen to bubs who it does get passed on to.

[Tegam]

Rayray there is so much info to sort through...It may be an idea for you to go herbal?? This means that you can try to make your body as healthy as poss before labour and also there are herbal washes you can do while you are in labour... Just something for you to think about



Also there are so so so many things that CAN go wrong but it doesnt mean that they WILL happen and there is just no possible way cover everything...

Try to keep in mind every time you are at the shops or see the news or even the sydney cricket ground...All those hundreds, millions of people were born and are happy healthy people now....

Some times in our medical environment one can start to feel like its 1:100000000 chance that it will ALL be ok!

Birth is natural, normal and wonderful

[Schmickers]

Sorry guys, been busy.

This link is to the 3 Centres Collaboration review on prevention of early onset GBS disease.

[tan32]

i tested positive in my last pregnancy.
I had a short labour and there was not enough time for me to have the antibiotic.

I had an hour of skin to skin contact with bub after he was born. Then the only thing was to be monitored in hospital for 24hrs to see if bubs temp rose at all. it didnt so we could go home.
Perhaps the hospital will let you go without having the iv if you agree to satying in for obs for 24 hours after birth.

[paradise lost]

I'm always interested in this because of my experience.

In the UK they don't test gor GBS because the test is unreliable and the infection can come and go. Instead they administer AB's if the waters have been broken more than 18 hours before the birth. Some babies still get GBS (though all those who i know were induced and AROM was done at some point) and some still die of it.

When i was in labour my midwives checked m went to see the paed before coming back to me and said "her waters broken at 3am, she's still labouring, she's booked for home, they both look good...?" and he gave them PILLS, yes, oral AB's to take! And he was not at ALL worried about us. So i do wonder how much of the IV AB push is about convenience (no drug trolley or supervision) than necessity.

I was to begin taking AB's at 9pm, but i delivered at 6.20pm. DD was fine.

Bx