GBS- questions

I was negative for my DD 3 years ago .
This pregnancy it came back in a urine test as positive for GBS at around 11 weeks ...I have been told by one MW that I must have antibiotics blah blah ... And another MW that she doesn't like antibiotics given just for the sake of it and as GBS is a come and go bacteria that testing it pointless ..
I have done so much research on it all , and feel I know a lot about the bacteria , and what can happen etc , I have read up on the odds of passing it to baby and babies health risks ..
But as I am getting closer to the birth , I am 30w 5d.. I am starting to get more nervous and doubting myself and everything I have read and know..
-I don't know if I want antibiotics during labour as I don't feel comfortable dosing a newborn baby up with drugs and ruining its immune system and defense against illness
-but then I am worried if I don't have them , Bub may get it and the worst cases keep playing on my mind

I always said if my swab at 36 weeks came back negative and my waters didn't break hours early and if If labour wasn't premature then I would decline them and do the wait and watch but now I am jut worried about everything .
This baby took a long time to come and I am so worried ...

Another thing that is worst case but I know that Meningococcal is a worst case for baby who picks up gbs ,and what concerns me is my 3 year old hasn't had the vaccine for that . Could Bub pass it on to my DD? We were doing delayed vaccination , should I go as get this needle now for my DD? Is it safe to get this done while I am pregnant ? As I know some like MMR is live and not recommended ..


Sorry for the long post , if anyone has been through any of this ,if you had antibiotics during labour what happened after to Bub ? We're they sick in any way from the antibiotics ?... have you had GBS did you have or not have antibiotics , tried natural methods of getting rid of it I would love to hear from you ..
Xxxxx

I've had antibiotics both times. With first bub I tested positive. I had the antibiotics (although I only had the first dose as DD1 came quickly). She was perfectly fine. With DD2 I was induced at 36 weeks. I hadn't had the swab yet, but we agreed that I'd have them anyway just in case. Once again, DD2 was perfectly fine.

I'll be honest, I haven't done any reading on the pros and cons of having them, it all comes down to the fact that I trust my ob, she's spent all that time studying and working in the industry for years, not me. She recommended it, so I did it. After all, I felt like I was paying for her expertise, so why not use it?

Cinder,
you know where I stand on this :) I wont be having the antibiotics- in any situation. Their logic is so flawed. the risk of passing it on is less than baby picking it up because they were born in a hospital. My midwife is happy with my decision- and even said they dont push it for women who test positive- only suggest it, unless they test pos on a urine test, which indicates a higher level of colonisation. I was simply told that they keep a closer eye out for symptoms in babies whos mother didnt have the ABs.... so really you are just getting a higher level of care, because the ABs only reduce risk, not eliminate it as the baby may pick it up from the hospital not mum. My reason for rejecting them is numerous and varied, some selfish, some not. I dont want to be tethered during what I hope will be a natural water birth, the ABs wipe out all bacteria not just bad, we pass on our gut flora to our babies- where does it leave them if we have just wiped out our lovely balanced flora? There are studies suggesting links to gut and digestive issues in babies. It increases the risk of neonatal and maternal thrush, and increases the risk of breastfeeding failure. To me those negatives out weight the minute risk of GBS infection which if caught early because you are aware of symptoms is a very very unlilwly situation.


Edit; peeled garlic clove pessaries for 3 nights are meant to help you get a neg test, dosing up on probiotics, cutting out sugar is meant to help to.
in regards to the AB's- a Hibiclens douche (2%) 60mL solution every 6 hours during labour is just as effective and does not effect maternal gut flora :-) a couple of studies for you to read....also loook up the Navelgazing midwife :)

Matern Fetal Med 2002 Feb;l l(2):84-8 Chlorhexidine vaginal flushings versus systemic ampicillin in the prevention of vertical transmission of neonatal group B streptococcus, at term. Facchinetti F, Piccinini F, Mordini B, Volpe A. Department of Gynecology, Obstetrics and Pediatric Sciences, University of Modena and Reggio Emilia, Modena, Italy.


CONCLUSIONS: In this carefully screened target population, intrapartum vaginal flushings with Chlorhexidine in colonized mothers display the same efficacy as ampicillin in preventing vertical transmission of group B streptococcus. Moreover, the rate of neonatal E. coli colonization was reduced by Chlorhexidine.

Also- 1: Int J Antimicrob Agents 1999 Aug;12(3):245-51 Vaginal disinfection with Chlorhexidine during childbirth.
Stray-Pedersen B, Bergan T, Hafstad A, Normarm E, Grogaard J, Vangdal M. Department of Gynecology and Obstetrics, Aker Hospital, University of Oslo, Norway.

Thanks ladies ..
I did mention the Chlorhexidine to one of the midwifes to see her opinion on it and she wasn't to keen , she didn't feel t was safe to use in the vaginal canal ...
But I have read studies on it and from what I have read it is just as effective rather than using antibiotics . So I dunno :/

Chlorhexidine won't just kill GBS though, it will kill everything just like it is designed to do.

so do the antibiotics little chicken- they dont discriminate types.of bacteria either. At least chlorhexidine doesnt wipe out your gut flora, mouth and general skin flora like the antibiotics will

Yeah, but it could cause over growths of other nasties, like thrush, down there, and after seeing what it does to hands, I would hate to think what it would do to your vaginal lining.

yes but the Antibiotics does that too? the douche solution is no where near as strong as the hand wash solution and there is likely to be only 2 douches. I havent actually seen dermatitis or a reaction from a single chlorhex exposure- it is usually contact dermatitis from repeated exposure. I also have to have chlorhex for surgical disinfection as im allergic to iodine solution and I have never had an issue with it. Its really is an each to their own situation. To me I have done a massive amount of research and have a degree relevant to understanding it all. the studies have proven chlorhex is just as effective as the antibiotics but does not carry the need for IV injection, does not enter my blood stream or my babies, it doesnt wipe out all of my bodily flora. The use of IV antibiotics for GBS reduction was based on a now proven flawed study, however as it is so ingrained in medical practice standards and due to new ethical standards and the rarity of GBS complications it is virtually impossible for a study to be large enough to convince medical practitioners that Chlorhex is more beneficial, even though the standard they use showed much less evidence.

Yeah see it was in my urine test :/

I was GBS positive in my wee with DD. I spoke at length with my midwife friend about it and decided in the end that I would have the antibiotics. Reason being that as I was GBS positive and i declined antibiotics they would do a blood test at birth and if she showed signs of sepsis (certain raised numbers) they would want to take her to nnu for a course of antibiotics. The problem is that these numbers are raised just for the simple fact that she was born! As it happened I arrived at the hospital with 4 minutes to spare so didn't end up having time for antibiotics. The paed on the ward the night she was born decided to not do a blood test but she did have a blood test 14 hours later and sure enough she was showing signs of sepsis so ended up in nnu having antibiotics. It's a tough decision and it seems they try to get those antibiotics in one way or another!

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)

http://www.aom.on.ca/files/Health_Ca..._2012FINAL.pdf

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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I was GBS positive in my wee with DD. I spoke at length with my midwife friend about it and decided in the end that I would have the antibiotics. Reason being that as I was GBS positive and i declined antibiotics they would do a blood test at birth and if she showed signs of sepsis (certain raised numbers) they would want to take her to nnu for a course of antibiotics. The problem is that these numbers are raised just for the simple fact that she was born! As it happened I arrived at the hospital with 4 minutes to spare so didn't end up having time for antibiotics. The paed on the ward the night she was born decided to not do a blood test but she did have a blood test 14 hours later and sure enough she was showing signs of sepsis so ended up in nnu having antibiotics. It's a tough decision and it seems they try to get those antibiotics in one way or another!

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Thanks for your reply ;)
Can you tell me if she showed any signs of having problems when she was born and up until the time of her blood test ? How long was she in nnu for and what happened there ? We're there any feeding problems due to antibiotics or the sepsis ? Did you experience any problems with her at all due to the antibiotics she had ?


And thank you everyone who replied :) I appreciate it a lot

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Thanks for your reply ;)
Can you tell me if she showed any signs of having problems when she was born and up until the time of her blood test ? How long was she in nnu for and what happened there ? We're there any feeding problems due to antibiotics or the sepsis ? Did you experience any problems with her at all due to the antibiotics she had ?

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She wasn't showing any outward signs of sepsis. Her temp was normal and there were no problems with her. She didn't actually have sepsis, the problem is that the raised markers in the blood test that are a sign of possible sepsis are also raised due to the act of birth. She had a very fast birth too which further raises these markers. I found out later that her numbers were so low that it was very unlikely that she had GBS as they would be much higher if she did. They are just so cautious about this! My waters broke as she was crowning so really there was such a small chance that she would have been infected anyway.

She ended up in nnu for about 24 hours till the second blood culture came back. We then had to spend another night in hospital where she was with me just to keep an eye on her. All up we spent 3 nights in hospital, 1 of which she was away from me. While we were there she had two courses of antibiotics that were administered through a needle in her hand. The antibiotics were administered over a two hour period twice a day.

It didn't affect her feeding but she did have formula when she was down there. I decided to do this as she was so unsettled due to being away from me, waiting for my milk to come in and my stress levels. The nnu is a different world and I was so worried that they would take her unsettled behavior as a sign of something else going on (this happened with my son two years earlier) and just wanted her to be full and calm. She hasn't had any formula since and is fully bf.

We haven't had any issues yet due to the antibiotics. Hope that helps!

A baby with GBS will go down very quickly usually with in 2-3 hours of birth. a sepsis screen takes atleast 24 hours to come back as they need to grow the bugs. many drs want babes to start ABs before that result is back. just as if you dont have GBS the midwives would be taking temps and doing checks on baby through out the 24 hours. PLUS you will be staring at the babe for the next 2 yrs ;) you will notice if babe isnt coping well with life outside.
some things to think about, if you dont rupture your membranes until birth there is little chance of transmission. so dont consent to ARM, limit VE's if you do rupture your membranes as they are then pushing the bacteria up into/through the cervix.

Early onset GBS shows up quickly, and that's the one they're preventing with the abx. There's also late onset GBS, which the abx do nothing for. Just putting that out there, in case you end up with a late case and feel like you caused it because you declined abx. They would not have changed anything anyways in that case.

I tested positive for GBS at 36 weeks with my 3rd baby. We made it to the hospital with only 15 minutes to spare before she was born (1hr45min labour) and I started pushing while the midwives were out of the room getting the abs ready. Three pushes and my daughter was born in the caul. I never had the abs, and it was never even suggested that DD have any abs. We were in hospital only 7-8 hours and they just checked her temperature at the beginning of each breastfeed. Then they happily let us go home :)

New test :/ moderate levels still found .. Far out ..
I am hoping like mad my water does not break early ...

Update .. DD2 birth all up was about 1hour 15 mins .. My water leaked before hand .. I only pushed 4 times and she was born .. Very quick birth no time do antibiotics and she was fine straight from birth , perfect little girl :) who is now 4 weeks old.