To be angry at doctor over GBS testing.

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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?

I'm not a troll...there are just much better options for pain relief at home than codeine.

Another one here for whom a loved one's life was changed beyond measure due to GBS.

I understand it can impact on the type of birth you want, especially as it can clear prior to birth, but for me it was non-negotiable.
I am however delighted to hear that you are being offered this test by your GP. When I had my DC I had to pay privately.
I'll never forget an interview I heard on R4 years ago by a very eminent obstetrician campaigning for these tests to be routinely offered. It wasn't just the babies who died due to GBS, but those, such as in my experience, who are left with severe disabilities and chronic illnesses.
You are within your rights to refuse, but I think your GP is doing a very thorough job. No one has forced you, your GP was just verifying that you were making an informed decision. Which you have, and your midwife confirmed. I really don't see the problem.

Yes, you're overreacting. You're are also definitely being unreasonable with regard to GBS testing. I know a lady who lost her son at 3 days old as a result of GBS which was entirely avoidable with a dose of IV antibiotics - which would have been given if she'd been tested.

Contrary view.

I'm a doctor.

I wouldn't agree to be Screened for GBS in pregnancy. There is no evidence that carrying out testing routinely in asymptomativ women makes any difference to pregnancy /baby outcomes and can contribute to worm having much more medicalised births, early exposure of infants to antibiotics etc.

However, if Inhad risk factor I would agree to be tested.

Same test - different indications.

And yes, I have looked after babies that have died of GBS but most had risk factors that were missed during pregnancy and delivery eg. Prom, positives tests

www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-gbs-pregnancy-newborn.pdf

Health care professionals do not have to ask your permission to share information that may make your pain safer... getting a codeine prescription from Gp to use in labour sounds like really odd practice to me but I no longer routinely do any obstetric stuff so might just be out of date.

So, you don't want a test that could possibly be life saving for your baby because you want a home birth? That's the basics here right?

If, and it's a big if as odds are low, you had GBS and your baby needs medical care then I'm sure you'd be here blasting the doctors for that too. It's your decision but yabu complaining about a doctor acting ethically and trying to provide you and your baby with information gained from education rather than google.

YABU the chances might be slim, but so are your babies chances of you do have strep B. It sounds to me the real reason you don't want to test for it is incase you do have it and have to give birth in hospital.

Worm = women.

My touch keypad hates me.

I declined GBS testing in my last pregnancy because in order for the antibiotics to have any effect they need to be given at least 4 hours before birth and my previous 2 births had been under that. DS2 has been practically instant, which is why I was planning a home birth for DC6. There was no point testing, I knew I had previously been positive and educated myself on the signs and symptoms, the MW's knew too. Not being tested but being very aware of what to look for and when to get help is far better imo than being tested and assuming there wont be any further problems. Getting antib's in labour doesnt mean a baby wont be affected but parents may think it does and not educate themselves.

As it was, there would have been no point as again it was a very short labour so the antib's wouldnt have been able to take effect.

However.....you are over reacting. The doctor is just doing her job, and there has been a real push for gold standard GBS testing to be standard in pregnancy in recent years.

We have fought in this country to have awareness of gbs raised and you decline it and think its not useful? Fwiw I'm a midwife and I've seen the effects of gbs, and I've never declined the test. I guess you have seriously good reasons though.

YABU, healthcare professionals do not need your permission to discuss you.

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.

How is it scare mongering to tell you that your baby could become seriously ill. You're entitled to make your decision but you should at least be prepared to own it and admit that you're increasing the chance of your baby becoming seriously ill. Yes the chance is fairly small but if everyone had the test it would save thousands of newborn babies becoming seriously ill.The chances of me getting in a car accident next time I drive to Sainsburys is even smaller but you can bet I'll be putting both my children in their car seats.

I totally agree with you and on the advice of a number of my midwives and maternity doctors over the years, and my sister who is also a doctor, I’ve never had GBS testing. Ignore the scaremongering and righteousness above, you and I both know there is a small risk of the infection being passed on and a smaller risk again of it not being treatable, which is a risk we are choosing to take. But with the test there is an extremely high risk of a positive result leading to unnecessary medication and limitations on your labour choices. It’s not about being belt and braces here, there are pretty big (albeit non critical ones probably) implications to having the test.

GBS kills babies. Get tested and do anything to prevent your baby contracting it.

Oh and if it is soooooo critically important to all the posters above who wished they could have had it (because it’s so important), you could have it for £100 but it mustn’t have been worth £100 to you.....

I too can't help thinking it a bit odd to want to use codeine (!) in labour, but not have a non-invasive test in case it ends up getting you one of those evil medicalised births. A bit, shall we say, selective.

I do agree that GBS testing can be a bit of a blunt instrument (like many other tests and interventions we happily accept). I took the line, in all my pregnancies, that I wanted the knowledge, so was tested (it's standard here).

I also do not understand why if you were offered the test, you rejected it. It is a test that has no risks for the baby whatsoever...
You were lucky you were offered the test as it is not routinely done on the NHS. That test is done routinely to all pregnant women in most developed countries, it is difficult to understand why this is not the case in the UK. I had mine done privately, I didn't want to take the risk, even if small...

To add....codeine won't touch the sides. Good luck with that.

Whats this test for GBS that people think women are turning down? We don't have a test, there isn't one sensitive or accurate enough. Add to that the transient nature of GBS and screening is so much more complex than just doing a swab.

I wouldn't have it done either, unless I had risk factors. And knowing that any form of screening for GBS is fairly useless in detecting late onset GBS which is the one that can be fatal.

I think you sound quite naive, codeine for your first Labour? You will probably need pethidine. There seems to be this "earth mother" movement where people decline tests, vaccines, and medical help just for the sake of it, and it doesn't always go well.

My friend almost lost her little girl due to Strep B infection. She was in intensive care for several weeks after birth.
I tested positive during a trip to A&E for some bleeding. I didn’t even know they’d tested for it and had never heard of it but am extremely thankful and grateful they did. My ‘medicalised hospital’ birth was actually amazing, and more importantly resulted in a healthy baby.
Really depends on what is more important to you, I could not care less about my birth experience as long as my baby is ok.

I d8nt think anyone on this thread is qualified to be able to JUDGE your decisions. Saying that you know xx whose baby contracted the illness doesn’t make your POV more or less valid than the one the OP came to (amd that the MW and the NHS agree to - that’s why the test is NOT available on the NHS where the OP lives).

I think the sharing of information with your MW is common practice, the same way that a GP would share your details with a consultant. Bearing in mind the GDRP stuff, I’m unsure if it was ok for her to talk about the test with the MW didn’t agree to it (you only agreed for her to talk to your MW about the codeine).

What is absolutely NOT acceptable is the PA moment ‘as long as you know all the risks you are taking’ when she hadvtalked to the MW who said thé same thing than you! (So she basically disregarded the MW pov). She also has no right to impose her choice/POV on you by making you feel guilty. The right way is to have a discussion with you, talk about the pros and cons and then leave you decide what is best for you.
The problem is a lot of doctors and consultants seem to think it’s an ok way to communicate with patients....

You're hard work

If the test is offered I'd take it, and also it's a bacteria not a virus!

This isn't about whether The OP should accept testing.

The OP wasn't offered the test, and so she didn't decline it. She raised it with the midwife and was presumably considering getting it privately.

Her GP has basically told her she's being irresponsible for only undergoing testing that is recommended and provided by the nhs.

To be fair I think the gp did the right thing based on his incorrect understanding of the situation. Hopefully now he's educated it won't happen again. And it shouldn't have happened in the first place, but it's not the gps area of expertise.

I had gbs on my first pregnancy it was discovered as my waters broke 2 days before labour and a swab was taken when I was in labour. The results came in after I had given birth so no antibiotics in labour. My child was fine luckily. I had to fight tooth and nail to be tested on my 2nd no one wanted to know. My swabs were clear at 36 weeks. When I went into labour I discussed this with midwife who was amazing. She got me antibiotics administered in labour, they automatically gave me antibiotics in labour on my 3rd unfortunately I delivered while I was still on the IV. My baby ended up in scbu with antibiotics being given through a vein in her head as they couldn't get an Iv in anywhere else. She is fine and healthy. My fourth child my GP wouldn't do swabs, my midwife was dissmive and the hospital dragged their feet in labour so yet again my antibiotics were not given in time. I was lucky baby was fine with no infection. Swabs taken in labour came back negative that time.
My friends baby was not so lucky. She died from GBS. I don't understand why you wouldn't want to know of a potential problem that could save your baby's life?