Strep B, a reason to have a C-section?

[Debs75]

RL friend is 23 weeks pregnant with her 4th child. She found out a few weeks ago that she has strep B and was told that she had to have intravenous antibiotics when she goes into labour and then after 4 hours, then baby has to have anti-b's then stay in hospital for a week.
She resigned herself to this but has just been told that she has a new consultant and she will be booking her in for an elective C-section. Her view is a C-section will eradicate any risk of passing it to the baby and they can be home again after 2 days.
Friend is now a tad concerned as she doesn't fancy recovering from a C-sec with other kids at home, especially as she has had normal labours.

Anyone else had this, any advice grateful

[difficultdecision]

Not a normal reason for a c-section, they would be sectioning thousands as GBS is VERY common and the risk to baby and mum is probably more with the section to be honest.

Worth your friend having a chat with the consultant again as there may be other reasons from her history that make c-section a good option.

[Tillyscoutsmum]

Sounds a bit odd to me. I was also led to believe that Strep B can come and go and therefore, just because your friend has it at 23 weeks, there's no reason why she would still have it at full term.

Perhaps she could ask to be re-swabbed at 37 weeks and take it from there ?

[difficultdecision]

the downside of that plan is that the swabs aren't 100% accurate so a negative swab after a positive swab could be a false negative and just didn't manage to grow the bacteria this time.

its much safer to assume that once it is there, there is a high chance of it being there in labour - but this is not a reason for a c-section.

[chibi]

agree about strep coming + going - better to reswab later.

from my own experience, the staying in hospital for a week is bum.

i had strep b, found out too late for antibiotics pre birth (long story). ds had antibiotics and they took blood to check if he had it, when he was cleared for it (48 hours) the antibiotics were stopped.

if he weren't prem, we would have gone home then.

[weegiemum]

Sounds ridiculous!

I had GBS in 2 pregnancies, active at birth both times.

I had IV antibiotics in labour and ds and dd2 didn't have anything.

With ds went home after 2 days, dd2 was 4 as I had health issues unrelated to GBS.

No-one ever suggested a CS. In fact, with dd2 I was induced twice and was planning a 3rd induction if the 2nd didn't work (again due to other underlying health issues).

Sounds like either there are other issues supporting a section or the OB is CS happy!

Your friend should think about contacting Group B Strep Support for some more rational info!

[Debs75]

She was told when diagnosed that strep B is something that once you get it is always present but not always positive on a test, a bit like herpes, i think. Therefore once you are tested positive they like to treat you as always positive, hence the anti-b's during labour.
She is happy to have the antib's as she feels that is a reasonable precaution.

[sh77]

Hi
The risk of a baby being infected by Strep B from c-section is not eliminated if strep b has entered the amniotic fluid (rare). My own baby passed away shortly after her birth from infection and the autopsy showed that her cord was swollen shich suggests it was in her system before birth.

In 2nd preg (ended due to MC), I requested c-section and consultant agreed to it but said strep b was not a reason for c-section (another consultant said the same). My baby's growth slowed in the last 2 weeks and said he would do it on this basis.

There is a very recent thread on strep b and many women shared their experinces. Worth looking at.

x

[Debs75]

weegiemum a nurse told her that the OB likes to do C-sec's then mum and baby won't be 'clogging up' the department for a week.

will tell her about the strep B support

[Tillyscoutsmum]

Sorry to hijack - but you sound like you know what you're talking about difficultdecision - so I wonder if I could pick your brains please ??

I'm just over 36 weeks and have been trying to get my midwife to test me for GBS. I've had a few infections over the course of pregnancy (tonsillitis, sinusitis etc.) which I believe can be caused by the Strep B virus, so I have been a little bit concerned.

My midwife has told me that

a) there's no point being swabbed until at least 37-38 weeks because things can change between then and delivery

and b) there is no risk at all unless there is a gap between waters breaking and labour starting (she mentioned 12 hour plus)

If I'm honest, I haven't got complete confidence in my midwife for a number of other reasons, so I just wondered if the above sounds right to you or whether I should be pushing a bit harder for a test ?

TIA

[Pingpong]

group B strep is not a reason to have a CS. Apparently 40% of women carry it, many of whom don't even realise.
I tested positive but was only swabbed a few days after delivery (when I thought I had thrush but it didn't go away with thrush treatment).
Anyway I'll be treated with antibiotics this time as a precautionary measure but my consultant is keen for me to try VBAC, we discussed it all yesterday, at no point did she say you must have CS as you have been group B strep positive before. Sounds like very odd advice to me.

[Pingpong]

also baby staying in hospital for a week sounds odd too! the baby will be closely monitored if they are concerned about group B strep - I have a big yellow sticker on my maternity notes but a week ! ? !

[difficultdecision]

Tillyscoutsmum - GBS testing is always going to be contreversial until we have an 100% accurate test that also predicts which babies are susceptible to becoming ill if the infection is passed on (about 1/800 if I remember rightly and thought to be possible genetic which is why a previous baby infected with GBS is a risk factor for the next pregnancy.

a) whether you are swabbed now or later makes little difference

b) the risk is mainly due to transit through the vagina where infection from the vagina passes to the baby - the 12 hour thing you midwife mentioned is not strictly correct as infection can pass before the waters go - but the longer the waters go before baby is born the higher the risk of any infection.

I would not recommend testing routinely for GBS and while tonsillitis/sinusitis etc can be caused by a strep bacteria (but are usually viral) it is a group A not group B strep so doesn't put you at any more risk.

Hope that helps.

sh77 - I'm very sorry to hear of your experiences and I hope the future holds much happiness for you.x

[difficultdecision]

smac - usually 48 hours if baby shows any signs of 'not being right' if infection is suspected the baby is started on antibiotics which continue until a blood culture has had 48 hours to try and grow any bacteria. If all seems well at that stage baby can go home.

[sh77]

Perhaps you need you should think about a second opinion. I too think that keeping your baby in for a week is on the extreme side. Have your baby checked by a senior paediatrician shortly after birth and monitored closely throughout your stay. Also, inform yourself about signs to look out for eg, low temp, rapid breathing, poor feeding, grunting. As long as you and baby are closely monitored, I think of complications to your baby are low.

[nevergoogledragonbutter]

recent GBS thread here

[Lionstar]

I tested positive for GBS at 37 weeks and still went on to have a home birth with no ABs (with full support of my midwives). We did monitor DS for 48 hours afterwards (at home).

In researching the issue I did come across cases where a baby contracted GBS even with a c-section (I think there are even MN threads about this). So not only is your friends consultant over-reacting, he is also wrong

[funtimewincies]

I've tested +ve for Strep B in my urine this time and need the Penicillin alternative which needs to be given 8 hours before birth rather than the usual 4. Only if the MW feels that I haven't had enough antibiotics in labour will the baby need them. Other factors such as how long before delivery your waters go and whether you have a temperature during labour also play a part.

The information I've been given by the hospital is that a C-Section doesn't really reduce any risk to the baby.

The information leaflets on this site are good.

[nevergoogledragonbutter]

TSM, my waters breaking was undetected (even though i went into hospital and told them, they examined me and told me i'd imagined it), so i had a lovely long infection growing 2 days before DS1 was born very sick with GBS (see other thread for the full story).

My waters broke high up in the uterus then stopped leaking.

[MavisGrind]

I tested +ve after first labour and ds1 ended up on abs for 5 days (would have been 48 hours but he did have some signs of infection). With ds2 I had abs during labour and he was then tested - came back -ve and no talk at any time of him having to stay in any longer than strictly neccesary.

A C-Section and/or week long stay does not sound right at all. The procedure depends on the individual health trust and I know of someone who tested +ve but was still sent home with baby and told to keep an eye on him and bring him back if he became unwell.

Tillyscout I was told that there was a checklist of risks and that if there were 3 'ticks' then the baby would be considered at risk and in need of abs.

With regards the OP, I think I would ask for a second opinion.

[sh77]

nevergoogle - hope you are well. When you had leakage, what was it like - was it a lot/obvious? How did you know waters broke high up in uterus? Just curious as I still often wonder why my fluid volume fell below 5th centile.

[nevergoogledragonbutter]

my waters broke when i was doing the dishes. only a little. but i knew it wasn't wee. i was 10 days overdue too.

they examined me and said everything was in tact and sent me home. i felt very silly.

when i went back to discuss the birth with a midwife 2 years later when i was pregnant, they said that is what they think happened in hindsight as they couldn't feel a tear and everything was intact on examination at the time.

DS1 was born from foul smelling mucky water. He'd pooed during labour, but the surgeon looked revolted and said to me 'when did your waters break?' very seriously. I cried and said, 'I knew it but they didn't believe me'.

Baby pooed, not the surgeon .

[smallorange]

Bit odd - dd1 had strep b infection ( meningitis) and dd2 was given abs even though born by elective section, so you wonder what the advantage of c- section would be?

[sh77]

nevergoogle - gosh you really went through a tough time. I think your labour and post-natal experience is one of the most difficult I have read about. Wonderful outcome though. xx

[sh77]

Hope you all don't mind me posting a link to a very moving article by the lady who founded gbss.org.uk

women.timesonline.co.uk/tol/life_and_style/women/article6911242.ece

[whensmydayoff]

IMHO a CS should only be given in a life and death situation.
CS does not prevent GBS being transmitted to the baby and should never be used for that reason - see the GBSS link.
I think they are giving too many woman CS for really stupid reasons like you describe.
I had one with my DS and thankfully it was life or death (previa bleeding) or id have been very upset if it could have been avoided.
I can't imagine having a major operation, a drugged sleepy baby for a week that won't feed and is struggling to breathe with all the left over mucus that would usually be expelled at birth. A week in hospital and the recovery not to mention having the amount of children you can have safely taken away from you, on the chance (and it is small) that GBS wont be passed over. Why cant she just have the Antibiotics?