The chlorhexidine should be diluted, by the way. You can find further info online on what percentage the solution should be.
We had a discussion on this in the homebirth thread. Here's one post I made there that I'll just copy and paste here:
According to my midwife, the push for GBS testing and treatment was actually initiated by a group of mothers who lost babies or had seriously ill babies after GBS infection. They wanted to do something to prevent that from ever happening unnecessarily. And, apparently the rate of GBS infection in infants has been cut in half with the current policies and practice. However, that doesn't mean it's the best method for going about dealing with GBS IMO.
Different practitioners have different policies on GBS swabbing and treatment. Some will swab every woman, and treat all those who are positive with antibiotics in labour. Some will not swab anyone, but give antibiotics to any woman who is in a "high risk" situation for transferring GBS to her baby - that is, if she's had a previous GBS bladder infection, has laboured for a long time with ruptured waters, or is pre-term. There might be one or two other risk factors as well, but I think that's most of them. I have a couple links my midwife sent me that I can go over and get back to you on. I think, personally, that looking at your own risk factors and making a decision from that is a better course.
I have opted not to test this time and last time. I have never had any of the risk factors, and generally deliver within about 30 min of water breaking. Water birth also reduces the risk of transmission, and I plan to have this baby in the bath. If you end up labouring longer than anticipated with broken water, you can have a chlorhexidine solution ready to use as an internal rinse (warm it first!) when you're labouring. Finally, the risk of GBS transmission in any case is very small, and the number of babies who have serious complications is also very small. Those complications can of course, be very serious, so like everything, it's about the risk/benefit ratio, and the level of risk you feel comfortable with. Antibiotics come with their own complications too, of course. I'm allergic to penicillin, so have to have stuff that takes longer to work, and must be in my system for 4 hr before delivering. (I don't labour that long anymore!) All my babies have had thrush, and I'm not interested in giving them something that will make that worse either! And, in our area, midwives can't give IV antibiotics at home, so that right away eliminates the homebirth for us.
Talk to your midwife about the risk factors for GBS transmission, and where you stand with that, and alternative methods of reducing your risks, and go from there!
And here's some more from that thread:
My midwife sent me the clinical practice guidelines for Ontario midwives regarding GBS. It takes a bit to wade through, but there's some good info there!
Here are a couple excerpts.
"The gastrointestinal tract acts as a reservoir for gbs and is most likely the source of vaginal colonization. Approximately 10% to 35% of pregnant
women are colonized with gbs in the vagina and/or rectum, with rates varying by study populations, specimen collection, or culturing techniques. (4)
A recent Canadian study determined the prevalence of gbs colonization in pregnant women at 36 weeks gestation to be 19.5%. (5)
When untreated, approximately 50% of infants born to gbs positive mothers become colonized and eogbsd (early onset GBS disease) develops
in 1% to 2% of these infants. (6)
This means that in a group of 1000 untreated women, approximately 195 will be gbs positive, 98 infants will become colonized, and 1-2 will develop
eogbsd."
"Early colonization and infection of a neonate is related to maternal vaginal colonization with gbs. Several other factors increase the risk of eogbsd. These include: preterm birth (< 37 weeks), low birth weight, prolonged rupture of membranes, intra-partum fever, chorioamnionitis and frequent (≥ 6) vaginal exams in labour."
"Summary of Prevalence, Incidence and Neonatal Complications associated with GBS:
10% to 35% of women are colonized with GBS
40% to 50% of babies born to colonized women are colonized when untreated (6)
1% to 2% of these colonized babies develop EOGBSD (6)
5% to 9% mortality rate in those babies who develop EOGBSD (10,11)
Using these statistics, if we take an initial group of
17 500 to 50 000 pregnant women:
5000 women will be GBS positive
2000 to 2500 babies will be colonized with GBS
20 to 50 babies will develop EOGBSD presenting as the following:
- bacteremia (64% to 83%)
- pneumonia (9% to 23%)
- meningitis (7% to 12.5%) (9,11)
1 to 4.5 babies will die due to EOGBSD (from the initial group of 17 500 to 50 000 pregnant women)
There are two tables in the article which break down the risk factors and tell you what your risk is with each one, letting you know which are more "risky" risk factors, and which are less. They might be helpful to look at.
They also said that the chlorhexidine solution may be helpful in preventing infection in the baby, but a larger study is needed for definitive proof.
Some ob's will be willing to consider alternatives, others have a standard way of doing things and will not consider other choices. You'll have to see where your's stands on the topic.
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