To be angry at doctor over GBS testing.

[FirstTimeBumps]

I'm not sure whether to say something or complain or whether I'm just being angry, defensive and hormonal. Two weeks ago my MW sent me to the docs for a prescription for codeine to use in labour. I had discussed group B strep testing with my MW the day before and she had given me some links to take a look at and wanted me to come to my own decisions as to whether to be tested. Baring in mind that 1 in 5 women carry GBS at any time, and the instance of it causing illness in a baby is 0.57 in 1000 (so 0.057%) reduced down to 0.22% with testing and IV antibiotics, these figures seemed extremely low. In addition, testing positive one day doesn't mean you will be positive the next, and vice versa, as the virus works its way out over the course of 6 weeks, but if I were to test positive it would require a hospital birth for IV antibiotics which had a high chance of being unnecessary. Anyway taking all this into account we chose not to have the testing, which wasn't even available on the NHS in our area anyway.

So goes along to the docs for this prescription and GBS testing happened to come up. Told doctor we had looked at everything and decided against it. She says she wants to speak to the practice midwife about by codeine prescription and could she call me the next day to confirm she would be issuing it. Fast forwards the next day, the weekend, and we're on Monday and I went I to the practice as I hadn't heard from her. She then contacts me to say she will be issuing the prescription but proceeds to ask had I reconsidered GBS testing. Again informed her I had decided against it and she made a comment about how "as long as I knew I could be missing out on vital results which could result in the baby become very ill" which miffed me as it was scare mongering but I left it at that.

That was until my MW arrived yesterday for my appointment and told me that the doctor had telephoned her and said "are you aware your patient has declined group b strep testing". My midwife gave her a lesson in pretty much the same reasoning I had and the conversation finished with the doctor thanking my midwife for the education boost however I'm pretty miffed that for whatever reason the doctor found it appropriate to discuss this with my MW, without my permission, and that even before the baby has arrived I am having my decisions doubted. She's really got my back up.

To make matters worse I'm not having to wait on another prescription for codeine as she only issued 2 tablets which is only a single dose in labour. I'm expecting her to call about this and don't know whether to say something about the whole GBS issue, to fill in the NHS would you recommend this practice survey they send and mention it in there, or to say nothing. Our practice is usually really good and they run open surgeries 3 days a week which I often use rather than booking an appointment however I could be allocated this doctor at one of those and I'm really not too keen on that now.

Am I over reacting?

If you are so keen on googling medical advice I’d check out codeine in pregnancy and breast feeding if I was you.
Very bad idea.

And you being so angry at your GP is ridiculous. Dammed if they do and all that.
Advice on GBS is very variable and open to interpretation with no clear consensus. Some areas push it more than others and there is a huge campaign to have it added as screening for all pregnant women.

GPs have to keep on top of every changing guidance on literally hundreds of topics. She was trying her best.

And yes HCPs will discuss patients. Go figure.

I thought they didn’t like to give codeine in Labour as it can make the baby sleepy, slowing Labour down?

My daughter died of GBS over 20 years ago. I still think about her most days and I still talk to her.
I would not wish that experience on my worst enemy.
If my surviving daughter, they were twins, fell pregnant I would urge her to be tested. Why take the chance?

I’ve got two kids, and I’ve never even heard of this...

Exactly! Just like adult breast and cervical screening why wouldn’t you have a test for something that could potentially save your life - and it’s free of charge. Many places in the world don’t have access to such tests and other places have to pay for them. We are very lucky.

More screening doesn't always equal a better outcome on a population level

I think that GBS screening is a good idea - but I’m not convinced that just because you’re GBS positive then you should automatically have antibiotics in labour, it’s that part I find problematic as it’s such a small number that are actually affected and antibiotic resistance is a major issue. But on the other hand I don’t think the risk management approach works very well as an alternative.

@smallbutfierce I am shocked and cannot fathom why anyone would not think antibiotics should be given if someone is gbs positive!

I didn't think the UK (or US) guidance was preventative antibiotics in labour following positive GBS test? My understanding was that there had to also be other risk factors eg premature birth, infection risk due to early rupture of membranes as well to prompt antibiotic use. (not a HCP so happy to be corrected?)

If you’re GBS positive your baby has, I think, a 1 in 200 chance of being affected. It’s not really known why some babies get it when the majority are fine but there are known risk factors such as delivery 24+ hours after waters breaking, elevated temperature during labour, delivery before 37 weeks, and in those cases obviously antibiotics would be necessary. I’m not convinced that giving up to a third of women antibiotics in labour ‘just in case’ is a particularly good idea.

In my case I didn’t know I was a GBS carried with DS1. He was born about 36 hours after my waters broke but nobody seemed bothered by that at all. I’d like to think it would be different now especially as they give out information about GBS as standard whereas it was left for you to find out for yourself when I had my babies.

small I hadn't had GBS testing with DD3 but gave birth at 36 weeks. She had precautionary antibiotics because of this, and the neonatal team were suspicious of possible signs of infection. That was 7 years ago.

I had GBS testing with DD1 as I had her in the US. It was just done as part of routine 36 wk check there and not something you would notice. I was negative but on bedrest until she delivered at 37.5 weeks as I was partially dilated. There was no use of antibiotics when she was delivered.

So my personal experience is that testing doesn't lead to more use of antibiotics. In fact in the 75% of women who test negative it could lead to less.

As the research suggests it is a grey area.