GBS+ and poss induction if waters break

I've found out that I am GBS+ve this time and so will need the antibiotics, which I am fine about. However, following a discussion with my mw, I'm a bit concerned about what happens if my waters break spontaneously and labour doesn't get started. She has said that some of the doc's in the hosp may want to give me the antibiotics and then induce me, which I really don't want. Now I'm going through the birth centre and my mw is 100% behind me not being induced in this situation, will advocate for me and is going to talk to a like minded doc and get it written in my notes, plus I've put it in my birth plan. However, the problem is if she isn't on if this happens. I'm just wondering what are the benefits of inducing in this situation - does waiting for labour to happen increase the odds of the baby getting the infection? I'd just like some facts so that I can stand my ground if induction is unneccesary?

I know that chances are that labour will start around the same time as my waters break, but with DD I had SROM and then nothing for 15hours, when things started on their own -so I know my body will go into labour eventually if I again have SROM which is why I don't want to be induced.

Anyway, sorry for the long post!

Hey there,

I find this a little odd - my knowledge of GBS+ isn't the greatest, I only know what my sister went thru with DS a few weeks ago.

The way she explained it to me was that she needed to have at least two doses of the ABs before DS was born and the two doses needed to be four hours apart.

As it was her second bubs, her concern therefore was labour happening too quickly - because if bubs didn't get two doses of ABs via mum intravenously, before making his grand arrival, he would have needed to go into the special care nursery and be put on an IV to receive more ABs.

So based on that info, I would have thought they would be happy for you if you had an SROM, then a bit of time elapsing before labour starting? That way they could definitely get your required two doses in before bubs was delivered. Possibly the risk is if the labour goes too long, you'd need more doses? Not too sure on that point.

Of course they could be pushing for induction because it gives them more control - once your membranes rupture, there is nothing protecting the baby from the GBS which is living in the birth canal. So possibly they are worried about infection if left too long?

I'm sorry I haven't been much help - is there a Dr you can talk to at the birth centre? Can you get another MW (or two, or more!) on board with the plan, JIC your MW isn't on when you go into labour?

Good on you for sticking to your guns and wanting to be educated and informed.

The only other thing I should add is that they performed an AROM on my sister and then were quite happy for her to have a few hours to chill out and try and kick start labour naturally!

So there is hope for you yet!

My OBS never tested for GBS. Aparently it can change - you can be positive then you can be negative. I don't see the reason for intervention given it can be cleared up via antibiotics (exactly what OceanPrincess has said).
Also, if it is in your birthing plan, why wouldn't the hospital staff follow this?! Surely if they let you 'submit' a birthing plan, then they should follow it?! (maybe I am just naive)

You may be GBS+ now, and not at the time of birth. For this reason I really dislike antenatal testing as it leads to so many problems, such as IV abx during labour and the restrictions in movement that come with that.

If you fully research GBS and are still happy to have the abx, then your doc may well want to induce in the case of prolonged rupture of membranes. Please remember they cannot force you to accept any treatment, only make recommendations. If you are uncomfortable with induction you can ask:

What are the risks?
what are the alternatives?
what happens if I do nothing?

And remember take some time to make any decision pre labour as a rushed decision is often a regretted one.

Good luck

T
xx

In the natural therapies forum, check out the thread on treating vaginal infections with a clove of garlic. Its magic stuff :)

I was GBS +ve with Sam - and I'm pretty confident that the results were the same at the time of his birth as my waters broke and labour started less than 12 hours after the swab was taken.

I guess different hospitals do things differently. I was given a canula as a "just in case" thing. My GBS results hadn't come back through most of my labour - when they did, I was given one dose of antibiotics. Sam was born about an hour afterwards. He did have to go to SCN, but that was down to his prematurity and blood sugars and nothing to do with the GBS. He wasn't given any further antibiotics after birth, but they did monitor his temperature closely - once again more to do with his prematurity and blood sugar issues than the GBS.

BW

I was GBS+ with Lachlan and this happened to me. Waters broke and nothing happened. Waters broke at 2am and we went into hopital at 7am and i was given till about 2pm till we decided with my midwife that it was time to induce. It was at this point that she was getting quite concerned about the risk of infection and i decided to induce as i had spent a day pacing the hospital trying to get labour going with absolutely nothing happening. As you know i went through the SMGP also. TBH i am in two minds about having the GBS test this time around. This is my experience but another friend of mine was GBS+ and her waters were broken whilst she was in labour so she got to labour at home etc. It just depends on what your body wants to do.

Thanks everyone!

As it turned out, my waters broke spontaneously on Sunday morning at 1.15am so off we went to hospital - with no contractions happening, they hoocked me up for antibiotics - but no drip needed just a canula, and my backup midwife came in, and they were happy to give me to Monday morning - I think I also happened to luck out because they were very busy so I was given a room on the antenatal ward, rather than staying in delivery and were just left to get on with it. Contractions happened 24hours after my waters broke. So, in the end, no need to worry - had yet another great birth experience. Bailey was in neonates for antibiotics but that was because he had raised markers in his blood test.

Glad it all went well for you SammyRo and congratulations on the arrival of Bailey (gorgeous name!).

Just thought I would share my experience for anyone with the same question in the future.

My OB didn't test for GBS for reasons already mentioned. I had a hind water leak which started on the Thursday morning (I was 40 wks). The hospital confirmed my leak and told me that I was likely to be induced that day. But then I was able to speak to my OB who knew how much I wanted a natural birth. He gave me the option of going on strong oral AB's and waiting 96 hours (4 days) to see if I went into labor naturally before inducing. Of course during this time I had to check my temperature every 4 hours and go into the hospital for monitoring every day to make sure all was okay.

I'm no expert on GBS, but I can't see why this option wouldn't be available to someone who had tested positive, after all I was never tested so who knows if I had it or not...

HI,

my first birth was very similar to what everyone else has described, positive gbs, waters broke and nothing happened. Is there any correlation between the 2? eg waters breaking but labour not starting?

for DS I was induced and given antibiotics, which turned out ok for me, but agree the drip impeeds having an active labour, and they have to monitor you when induced, thankfully the day was quite and I ended up using every single one of the telemetry monitors they had at the hospital, until we found one that could work, and had a student physically holding the monitors on me so I could stay mobile.

in the end labour was only 4 hours and I only had one course of antibiotics, and all they did was monitor ds afterbirth for any signs of infection. He was in perfect health.

going to check out this garlic business now.

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Is there any correlation between the 2? eg waters breaking but labour not starting?

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This is often a sign that the baby is not yet in the right position for birth, but is trying to sort it out (eg posterior baby). Not always though.

Yup I see that in most births where waters have broken and labour is very slow to start - possie babies or not in the right spot. Especially when your waters break pre-dates, and no labour, you wanna get moving as much as possible to help the bub turn because chances are he's not in the right spot. Getting moving, stairs, walking is the best thing you can do to help him move.

This may have changed but I don't think it has but the CDC (Centres for Disease Control), in America issue guidelines about treatments for infectious diseases. As GBS is one of the most dangerous infections a newborn can get they advise that once a pregnant woman has tested positive for GBS she is always considered positive for GBS. This may explain why some doctors do not retest at the time of the waters breaking. That and it can take at least 24 hours to get the result back and by then bub may have already been born. Regarding antibiotics the hospital where I used to work and gave birth in liked to start antibiotics as soon as the waters broke for those who knew they where GBS positive or for those whose status was unknown. I know in the antenantal clinic they tested everyone. As a bare minimum, it is great if Mum could have had a dose of penicillin or a substitute via and IV at least 4 hours prior to birth. If this can't happen some peadiatricians may want bub to have IM injections of penicillin as a cover.

You can find this document on the CDC's website and they give rationales for their guidelines as well, as well as references to other articles on this.

And on the other side of the equation in the UK they do not routinely test for GBS as it is a transient infection so only a test in labour would be accurate. Also the transfer rates from mum to bub are so tiny, that the negative effects of the abx on a newborn's immune system, (plus the extra interventions required for the mum during labour and the potential for that to start a cascade of interventions), are not worth the risk when the GBS status is unknown.

I might be biased but having worked in a NICU for 8 years, I have seen GBS infections in babies and they are and can be very very nasty very very quickly. I understand if you don't like antibiotics as a precaution only but I couldn't take that risk. But that is just me. I have known parents take their bub to a naturopath after antibiotic therapy.

Glad the labour went well Sammy.

I would strongly suggest you get onto some high-dose probiotics the counter the effects the antibiotics will have on diminishing probiotic supply in your digestive tract, your breastmilk, and subsequently your little one. (Ask at your nearest health food store). I would also suggest getting some powder-based infant probiotics which you can add to some expressed breastmilk to boost his supply and put back what the antibiotics would have taken out. Without re-population of probiotic (friendly) bacteria following antiB use - there is a much higher risk of feeding difficulties, colic and reflux and allergies.
Unfortunately you wont get this advice at a maternity hospital, unless you get a midi who has studied nutrition or naturopathy!

For future reference, taking probiotics during pregnancy can prevent GBS infections quite easily, and a daily dose of fresh garlic and freshly squeezed lemon can also help to guard against it. Make sure you keep your probiotics in the fridge.

Enjoy your little one.

XX

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I might be biased but having worked in a NICU for 8 years, I have seen GBS infections in babies and they are and can be very very nasty very very quickly. I understand if you don't like antibiotics as a precaution only but I couldn't take that risk. But that is just me. I have known parents take their bub to a naturopath after antibiotic therapy.

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my own child was saved by antibiotics following newborn sepsis, but I still do not see his condition as a reason to treat all babies regardless. The risks are too big.

Also he did not have GBS, there are many many infections that can affect a newborn. I feel very strongly that more monitoring of babies and educating parents in how to spot an infection would be more helpful than mass abx treatments.

I agree with you traveller that more education about the signs of infection in newborns should be offered. I am not saying that every woman in labour should have antibiotics either. I totally agree that everyone has the right to refuse or accept any treatment offered to them. I was just pointing out where the evidence behind this practice comes from and why it has been instituted so people can make an informed choice. I know there are studies currently underway to help determine which babies are more susceptible to infection which may help narrow the treatment group even further. I believe there has been a drastic overuse of antibiotics and that they can cause some problems. But sometimes they are necessary as well.

I am sorry that your little one developed sepsis. That must have been hard on you and your family and I hope everything turned out well.

He is perfect now, thanks, but it was a terrible time. I have so much respect for hospitals, drugs and NICU staff now. I think in fact my raised respect for abx and how powerful they are and lifesaving they can be is affecting my opinion on their routine use. Possibly this is a subject I need to step back from to avoid my own personal situation affecting my opinion, it is all a little too close to home.

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For future reference, taking probiotics during pregnancy can prevent GBS infections quite easily, and a daily dose of fresh garlic and freshly squeezed lemon can also help to guard against it. Make sure you keep your probiotics in the fridge.

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JellyBean i was GBS + with my last preg and would really like to avoid it if poss this time around so will be taking your advice. DS was a happy chucker for his first 6 months, do you think this could be attributed to the antib's he had during labour? Also how should i take the daily dose of garlic and freshly squeezed lemon? Also in what quantity?

Thanks Traveler & kelly,

my bubs like to be in the right position for the entirity of the pregnancy it seems, what they don't like to do is decend!!

Last time after my waters broke, I was up did a load of washing, did the dishes, walked around a lot. Not to mention the amount of walking I did in the weeks leading up to, I swear I went hiking one day, I was so intent on having that bubs in the right position, and got it all except the decent.

I'll cross my fingers this time see if that helps more, although on occasion I feel this bubs slipping down occasionaly.....

Hi, bubs arrived last sunday morning.

As GBS positive again, I was given antibiotics, this time I didn't need to be induced so had the first round of antibiotics which takes about 20 mins, and then drip taken away, but I had the line in so the next course could be administered later.

had to be monitored, due to having mechonium this time, but went with telemetry, which worked fine until bubs moved down. They had just started talking about putting a probe on her head to monitor better when the unbareable downward pressure started and I could no longer concentate on using the gas, and could only manage to bite down on the tube.

needless to say this bubs took less time than the first one and was under 4 hours from when waters broke to bubs tearing her way out. (litterally) so the second course of antibiotics was never received.

Then the real fun and games started where we wern't allowed to leave the hospital until they confirmed she was ok, and 2 heal blood tests and one from a vein, and me explaining to the registrar how time worked and yes we had been in the hospital for more than 48 hours post birth, my little girl was fine.

The one thing I would really like to know is why no one tries to treat you for the gbs prior to birth.

If your tested at 36 weeks, should you then treat and re-test at say 38-39 weeks - presuming that you last that long.

Congratulations on your new baby!

To try to answer the question I think it is because GBS can be classed as skin flora, or normal flora sometimes. Like staph aureus (golden staph) is present on just about everyone but does no harm unless it goes somewhere it shouldn't, it is next to impossible to eradicate it prior to surgery. GBS is the same. The antibiotics are more to prevent infection then to eradicate its prescence from you. To attempt to do so would require a much longer course and all the side effects that go with it. I suppose there is also the risk that if there treatment was successful, if you happened to live with someone who was also a carrier and if they weren't treated that you would just get recolonised anyway.

A bit rambling I know but I hope it made sense.

Congrats on the new arrival!

GBS can come and go during pregnancy according to your levels of probiotic 'friendly' bacteria - and it is even influenced by diet. Eating lots of fresh garlic, alkaline foods and taking a probiotic supplement (oe - Inner Health Plus) in the weeks leading up to your GBS test will eliminate any GBS bacteria overgrowth and almost certainly guarantee you a negative result. Unfortunately you wont hear this from a doctor/Ob and so many women and their babies are exposed to the effects of antibiotics uneccessarily.

The risks associated with antibiotics are that they further diminish your probiotic stores (the reason most women develop GBS in the first place), and are passed on to bubs - wiping out babies beneficial bacteria stores too, and also reducing the amount of beneficial probiotic bacteria they receive in your breastmilk. Newborns exposed to antibiotics have a much lower count of beneficial bacteria present in their stools and digestive tract, meaning that their digestion and assimilation of nutrients is compromised, and therefore ultimately their immunity is diminished.

If you or your baby has been exposed to antibiotics, either directly or via breastfeeding, you can replenish your probiotic stores by taking a good quality probiotic supplement (like In-Liven) which will be passed on via the breastmilk, or if bottle-feeding, add some of the Baby-Biotic 0+ Probiotic powder (by Bioceuticals) to their milk. Avail from health food stores. Personally I would be doing both. The greater the number of probiotic bacteria, the stronger the immune system, and the better bubs will react to vaccinations and illness.

HTH!!

Thanks,

That was realy good information.

I might try the pro biotics while bf, and will definetly try it next time, If I'm allowed another bub :)

couldn't handle many alkaline foods during this last pregnancy though, the heart burn was too severe.

Bubs seems to be absorbing nutrients just fine though, no ill effects there, she has already surpassed her birth weight at 8 days old, and I can see her skin filling out, and she is very alert.

Thanks again