Group B Strep Testing

[fionas]

I hear what you're saying Hoobley and each to their own but personally, regardless of the unreliability of the test, the actual birth experience is just not that important to me to risk having a child with a disability. I have met parents who still have to get up hourly through the night in order to keep their teenage daughter alive. So basically they have a 15-year-old daughter who has the needs of a newborn baby. In comparison to that, a somewhat restricted labour with a drip pales into insignificance. But like I said, each to their own. We all have choices in life and as long as we are given all the facts we have to make our own choices and live by our decisions.

[paradise lost]

Yes, of course, everyone must make their own choices on that regard, but would you want the same restricted labour if you tested GBS -ve? Just in case, since the test is unreliable? I mean, shouldn't we ALL then be having the full anti-GBS intervention? It's not that i think GBS isn't a problem, it's more that i can't see how the test does anything to solve the problem.

Bx

[Ca Plane Pour Moi]

Maybe we should just give every woman a 3-week course of antibiotic pessaries to clear up an infection before birth (longer if you go overdue)... no drip and an infection that wasn't picked up or acquired later doesn't happen.

Then the Strep B gains an immunity... but that could happen with the drip anyway. It's a very tough call, but that doesn't mean the test, along with the data, shouldn't be available.

The data is slightly biased, I feel, by the fact it's from the group that wants testing to be made compulsary; I do not dispute the figures, but that's all I can really double-check right now.

[fionas]

Yep, I see what you're saying Hoobley and I don't know enough about the medical ins and outs. Presumably even though Strep B can come and go the chances of it appearing after a negative test are absolutely minimial or yes, they might as well not test anyone and give us ALL the drip. I guess having been so close to parents/families/people with a disability I would do absolutely anything within my power to minimise the risk even if that meant me having a very restricted labour. Labour is only one day and I would rather have the labour from hell and give a baby the best shot at life. Seven hundred babies a year sounds awfully high to me - I've just read figures that says 500 babies die of SIDS in the UK every year.

[Ca Plane Pour Moi]

Wow, Fiona, you had a short labour! 2 days for me (33 hours). Yup, we have lots of dead babies and it's never something that the profesionals can do anything about... maybe have midwives ask where and how the baby sleeps could catch some, but who cares that they don't? Same with outdated advice from our healthcarers and doctors.

Bec, where did you get the info on the garlic? I'd like to include that if possible, but need a reference for it (even just the name of a homeopath or whatever).

[paradise lost]

It's in my Homeopathic and Natural Medicine For The Family book Ryn but i've seen it lots of places - try googling "vaginal infection garlic pessary" and see what you get.

fionas i just found a study which says that it found that among women tested at 26-28weeks only 65% of those who tested +ve were still +ve when they gave birth and 8% of those who tested -ve at 28 weeks were +ve when they gave birth. The optimal time to test is reported to be 35-37 weeks but the study admits some women will have given birth before the results come back which lowers the efficacy of the testing programme.

The danger of treating all women with antibiotics for 3 weeks before birth is that a) in 20 years we will have SuperGBS which cannot be treated and overall there will be more deaths and b) men can be GBS +ve too and one would have to refrain from sex after the anti-b's had been given. And we ALL know how handy sex can be to either get labour started or fill time until it starts Also GBS lives in the rectum too so i think it'd need to be oral anti-b's, for the systemic effect.

GBS becteria live low in the vagina, VE's carry a very high risk of spreading infection. I wonder how much lower GBS rates would be if no VE's were given once membranes had ruptured...?

Ryn you might also want to look into prematurity. GBS is the leading cause of pneumonia and sepsis in premature babies. In fact i'd be willing to bet that quite a high proprtion of the 700 annual deaths are premmies. Prematurity is a big risk factor.

Are you also going to cover late-onset GBS? It seems about half of the 700 annual deaths would be from late-onset GBS, which antibiotics before/during labour have no effect on. That takes the preventable mortality rate by us testing significantly lower once again doesn't it?

fionas i seem to have given you the impression that my labour mattered more to me than my baby. It's not the case at all. It's just that the treatment for GBS raises the risk of intervention. Continuous fetal monitoring and inability of mum to move around (because of monitoring and drip etc.) have both been shown to increase the risk of assisted delivery and c-section, procedures which carry their own risks, some higher than that of GBS. If i DO have GBS and i'm not treated my baby has a 1.3 in 100,000 chance of dying. If i am treated for the GBS i have and the treatment results in a section, my baby has a 1 in 100 chance of dying. Thus if i MIGHT NOT have GBS i am certainly NOT going to risk my baby by having unecessary treatment which might jeapordis his/her life.

Bx

[Cricket]

Here in Ontario, Canada, women are generally tested at 35-37 weeks. I was told that they expect those results to be good for about 5 weeks, since GBS is transient. What I was told about the disease is that something like 15-40% of women will test positive, and a small percentage of those will pass that infection on to their baby. Generally, if the baby is infected, it will be a minor infection, but in a small percentage again, the disease can become serious enough to be fatal.
The testing is not completely standard, though. I think that some doctors will opt not to test you unless you are at high risk for passing the infection on to your baby. (ie. - premature baby, previous GBS infection, etc.) Women may also refuse the test if they want.
Treatment is IV antibiotics in labour. Some areas permit midwives to administer the IV at home in early labour, and other areas require the IV to be administered in hospital during labour.
Results thus far are showing apparently that when every woman is screened and every positive result is treated, the number of neonatal deaths from this infection is cut in half.

[paradise lost]

Results thus far are showing apparently that when every woman is screened and every positive result is treated, the number of neonatal deaths from this infection is cut in half.

Sorry for being the ever-present pedant! Is this compared to risk-factor only treatment or no treatment?

Bx

[Schmickers]

One of the factors that needs to be considered here, as well, is the impact on the mother (and to a certain extent, the unborn baby) of the use of antibiotics. In recent reviews of the literature surrounding GBS in Australia, it was determined that we would need to treat 20000 women to prevent one case of GBS; however, this would result in around 2 cases of anaphylaxis, a life-threatening allergic reaction to antibiotics. In addition, the widespread use of penicillin as an atibiotic for GBS leads to penicillin-resistant e. coli infection in the newborn, another serious form of sepsis. This is necessitating a switch to different antibiotics, which also have the potential to select for antibiotic-resistant flora in both the mother and the unborn baby.

It is for these reasons that it is impossible, so far, to advocate for one method or the other. I am aware of the Canadian evidence, and it was taken into consideration in the Australian review, however because the numbers in this and other studies are low (GBS infection is, thankfully, quite a rare complication) and because GBS is quite a common organism in the vagina and, as such, so many women will test positive and thus require treatment under the universal treatment approach, exposing them to other risk factors besides the GBS, in Australia, it is up to the woman and her health care provider.

[kungfubecca]

Hi,

I had my bubs only 3 months ago.
I was tested for strep B at 36 weeks here. It is routine in Victorian public hospitals. My hospital actually provides you with the swab, and tels you to do it at home and take it to pathology yourself.

As I said I tested positive, my membranes ruptured and nothing happened so I was put on antibiotics at the same time as being induced.
I was told I would have 3 or 4 courses during the labor every 4 hours, however my labor only lasted 4 hours. I was told that due to only one course our minimum stay in hospital would be 48 hours which was required for monitoring bubs, as a Strep B infection can cause Pneumonia. They took his temp every couple of hours to make sure it didn't fluctuate and become very high.

I am one of those people schmickers mentioned that can't have penicillin, and it seems to run in our family, so future generation may increase the amount of people with allergies to penicillin. I had a different anti-biotic.