Home birth and Group B Strep- anyone positive went on to have a HB?

[needahand]

I might be Group B Strep positive and am very disappointed as I was planning a HB. I was wondering if anyone had the same sort of experience.

[belgo]

Me. I live in Belgium though, so it's slightly different, I paid for private midwives (or rather my insurance did).

They only found out I was GBS+ two days before the birth, but because these midwives always work on their own, they have their own supply of antibiotics.

They gave me an antibiotic drip once I was in established labour (can't remember when exactly), and it didn't bother me at all.

After the birth, they came back to my house regulalry to check on the baby, they also informed my GP so if there had been a problem it would have been picked up on quickly.

No problems in the end, my waters didn't break until dd2 was born, making the birth very safe. She was fine.

[needahand]

Thanks for sharing your experience Belgo.

I have IMW too and one of them suggested going to hospital to get one dose of antibiotics, but I am not sure whether this is enough as guidelines recommend having them every four hours. Also I am irrationally worried the hospital would keep me in (I would have to go to a crappy hospital near me, and if that is the case, I would rather give up on the HB and go to the nice hospital which is further away).

Glad to know your DD was safe.

[belgo]

How long do they think your labour would be (going by your prvious labour - I know it's not that accurate to predict).

Keep this bumped up, I'm sure there may be other options open to you - I'm sure I can't be the only one to have had a home birth with GBS.

[ILikeToMoveItMoveIt]

Have you looked at the homebirth.org website? They have info about GBS and probably a birth story involving it.

There was also a thread on here last week about getting rid of GBS. I'm sure it had something to do with putting garlic up your fanjo - but I may be wrong!

Good luck with the choices you make.

[beanbearer]

I was a bit worried when I first read about needing antibiotics if you were GBS positive as a smear test I'd had done before I was pregnant had been positive. But when I spoke to my midwife about it, she said it was hardly worth bothering testing, particularly if you wanted to avoid having a drip, because apparently about a quarter (or 10%-30%, depending on source used) of mothers DO have it, it's just most don't know they do so take no action and because the worse case scenarios occur in so few cases this is usually fine. Obviously it's worth knowing what can increase the risk of your baby contracting it and all the possible signs your baby may have picked it up and watching for them like a hawk. I felt the risk was acceptable but everyone's view on this will be their own. To help you make up your own mind, try these sites: homebirth.org, NHS direct or about.com.

[belgo]

The actual drip didn't bother me at all (although I did get a thrush infection afterwards - antibiotics always give me thrush).

But I can understand why you wouldn't want to go to hospital, and the home again.

[needahand]

Thanks Iliketomoveit. I did look on the homebirth website but didn't really found was I was looking for. I just wanted to see if some "real people" had had this type of experience. I started the other thread and will definitely try the garlic, but I am trying to assess what my options are if the test comes back positive.

There is not much on the gbs site either apart from "you must take antibiotics" so I am just trying to get a braoder range of info really.

[Tangle]

Are you waiting results? If you're concerned and planning another test, make sure you use the private Enriched Culture Medium test at the relevant time (I think its 35-37 weeks) - the test available on the NHS is less accurate, and if you test too soon your body may have cleared the infection before you deliver.

Have you joined the homebirth UK mail list (there's a link off the homebirth.org homepage)? I know that there are women on there that have dealt with this issue and could discuss some of the pros and cons.

There are implications to, and risks associated with, taking IV antibiotics beyond potentially having to stay in hospital rather than having a homebirth. For me, I'd probably decline them unless I had additional risk factors - but like beanbearer says, everyone needs to evaluate the different risks and reach a conclusion they're happy with.

Would your IM be unhappy/unsuportive if you are GBS+ve and declined IVAB's altogether?

[needahand]

belgo my previous labour was 36 hours, so not sure one dose would really be enough, although I am hoping this time round things will be quicker! Aboput the drip, did it last long?

beanbearer thanks for the links. Couldn't get the "about.com" one to work though. I know it is a small statistical risk and most people don't know that they are positive, but it is a little hard to ignore when you know you actually are positive isn't it.

[belgo]

My drip was through quite quickly (10 minutes or less) - and I'm fairly sure they can give in all in one go , but you'd have to check that with your midwife. It may be different in England to in Belgium.

[needahand]

Tangle yes I am doing the ECM test next week (will be 36 weeks). It is the NHS one that came back positive at 28 weeks, but as you said it is not very accurate and I am keeping my fingers crossed the other test will come back negative whilst preparing myself to the eventuality it might not.

I think my IMW would be supportive of whichever decision I make. I am just finding it hard to make my own mind up with all the conflicting information there is about ranging from "don't do anything" to "it would be criminal not to take the AB). So hard to find balanced information isn't it?

[ElizabethBeresford]

If you do have strep b, then please don't risk it.

[Rolf]

Hi Needahand .

The unreliability of the NHS test is its negative results - it can give quite a few false negatives. I'm afraid a positive result is very reliable.

One suggestion on the homebirth website is to decline the antibiotics but change your mind if another risk factor presents itself (eg prolonged rupture of membranes, high temp etc). If your labour is straightforward the risks are much lower.

In the UK they stick a cannula into a vein on your hand and leave it there. It's fairly uncomfortable having the cannula sited and I found it quite inhibiting during labour. I couldn't weight-bear on that hand, for example. I don't know if you are supposed to keep them dry but if you are it may make things difficult if you want to use water for pain relief. When they need to administer the abs they just shove them in the cannula - it takes seconds. I am thinking about putting on my birth plan that I'd like the cannula removed after the first dose - but that is partularly suitable for me as I have short labours. It may not suit everyone.

Don't forget the guidelines about recommending abs are hospital guidelines. The RCOG guidelines are that in the absence of other risk factors you should merely be offered abs.

Having said all that, I strongly suspect that when it comes to decision-time I'll be as risk-averse as possible and opt for the abs. Good luck with your decision - it's very difficult isn't it?

[belgo]

My cannula was removed after the antibiotics. But it didn't bother me at all anyway - I would have still have gotton into the birthing pool with the cannula.

If you have difficult veins and the midwife has trouble finding one, I think they're best left in especially if there's a possibility of you needing another dose.

[needahand]

Elisabeth I probably won't risk it. I am a very risk adverse person and think I would be too worried anyway. I am really trying to look at all avenues but deep down I kind of know the test will be positive and funny enough I think I have since I first read about Group B Strep as it is the one thing that has stressed me throughout my pregnancy.

Rolf yes I think you mentioned that on the other thread. I have my booking in appointment with the other (the nice one) hospital tomorrow. I think I will talk to them about it as even if I have to give up on the HB I don't really want to give up on the waterbirth and I can't have one if I have a cannula. so I would have to insist the remove and reinsert the cannula as needed. I hate these cannulas anyway, find them very painful. I guess I will have to polish my birth plan and add that in. I know what you are saying about them merely offering the antiBs, but I think I too am not risk taking enought to decline them. But yes, it is a very difficult decision especially since after researching options and places to give birth I had settled on HB. I am so glad though that I had the guts to go against my NHS midwife and doctor and insist on being booked at the other hospital as a back up plan. Because it looks like my back up will now be the main plan and otherwise I would have ended in the awful hospital.

Thanks to all for the advice very much appreciated.

[ElizabethBeresford]

Oh good needahound. Sorry if my post sounded rude. I'm like you. I just avoid the risk. Good luck!

I thought pregnant women weren't routinely tested for strep b in the UK. Are they now? Americans are all routinely tested.

[needahand]

Not rude at all Elizabeth and everyone is entitled to their opinions!

Pregnant women still aren't routinely tested for Strep B here. Mine was only discovered because I went in hospital and had a swab and 28 weeks.

Saw my second IMW and hospital consultant today and both were of opinion that it would be best for me to go to hospital. I think I have come to terms with the idea of not having a HB. The consultant was very supportive and agreed to me trying to have a water birth in hospital so I feel a little better about it.

[pregnabrain]

Hi there

I'm due in a week's time and may well end up having my baby at home. I'm with a team of midwives who specialise in homebirth.

I am also Group B Strep positive. The midwives are attached to my local hospital and the hospital has recently started allowing them to administer IV antibiotics at home. I've been to my GP and got a prescription for them. They're currently sitting on a shelf in my kitchen .

I need to call my midwife as soon as either my waters break or regular contractions start. She'll come out and put in the canula and give me the first dose of ABs. If I'm still in labour four hours later, I'll get another dose. I've got enough for a few doses but, the problem with the IV antibiotics (which applies whether you are at home or not!) is that they have to have been in your system for four hours before you give birth in order for them to provide effective cover to the baby. So it may end up being a waste of time anyway...

Anyway, they know i'm Grp B Strep positive and want the ABs, and will also look out for any warning signs in the baby so I think that's all that can be done. I think it's important to keep the level of risk in perspective.

Hope this helps.

[belgo]

That's interesting pregnabrain. Keep us updated - and good luck for the birth!

[Rolf]

That's really interesting Pregnabrain. I think it's quite unusual for community midwives to administer abs at home?? Lucky you - wish our area did that. Are they going to do 4-hourly obs on the baby post-natally?

My consultant has been very supportive about a natural delivery in hospital. She's written to the MLU and is happy for me to use the birthing pool. She's also put in my notes that the baby and I can stay on the low-dependancy post-natal ward for the 24 -48 hours observations post-natally. It really helped me get my head around not having a homebirth.

[needahand]

Lucky you pregnabrain! My MW aren't allowed to administer IV antibiotics. Good luck with your birth!

Rolf the consultant I saw yesterday was supportive of me having a waterbirth too, so at least it is not so bad (still have to return my pool though!). We would have to stay 12 hours for observation (except if labour is so quick we can't get two doses of antiB).

[pregnabrain]

No, there's been no mention of 4-hourly observations afterwards. I've got one more appointment with them on Friday so I'll ask them about it then. I presume they must have a plan of action for the post-birth period...

How long have they said the baby will need observations for in your case?

I have a feeling it's going to be one of those situations where every hospital/community area has a different policy

[belgo]

pregnanbrain - my baby was born at 1pm, the midwife at about 3pm, then came back in the evening at about 9pm. Then she came back at 7am the following morning.

Everytime she checked dd2's temperature,and I think we checked it too in between.

[Yorky]

Watching this thread with interest. I am 14 weeks pg and went to Dr about somethign unrelated to pg but she loked at my notes on the computer and said "You had a swab" which I hadn't, but somehow I've got a +ve GBS result, can they get it from blood or urine samples?
Seeing MW this pm so hopefully more info then.
With DS my waters went the day before he was born and I remember MW swabbing his nose and ears to check but nothing was said so i assumed he was all clear.
I had a lovely home waterbirth and want to do it again

[maxbear]

I had a gbs + swab with my first pregnancy, decided after much deliberation that I would not have IV abx. Did deliver in hospital though just in case. The fact that many women have it and don't know about it but end up being fine, plus the fact that there are serious risks associated with having IVabx were the deciding factors for me.

My consultant was not even happy for me to have IV abx in a midiwfery led unit close to the main hospital in case of a reaction. Your risk of a mild reaction is 1 :1000, a severe reaction 1 :10,000 and a fatal reaction 1 :100,000. The risk of a term otherwise healthy baby dying from gbs is slightly higher than the risk of having a severe reaction to antibiotics. If you have a severe reaction to antibiotics, your baby might well die or be brain damaged anyway.

My personal opinion after finding out all of these statistics was to not go for it, but women have to make their own informed decisions about it, as their labour may not progress if they are worried about some aspect of it, such as that they wish they had stayed at home, or that they wish they had gone in for abx.

Anyway everything was fine with me, went on to have a homebirth second time round not even considering having abx. Had there been any probs at all or had I been less than 37 weeks, then I would have gone for them though.