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?

In answer to your question - yes, you’re being angry defensive and hormonal. However, pregnancy can do that to a person! Good luck with your labour and baby

Sorry but YABU.

I had to beg for the GBS test during my induction (and this is in Ireland as it’s not mandatory here!).

Having seen my child go through lumbar punctures at 24 and 36 hours old, the test is something I’d also recommend women to have.

The iv antibiotics my dd was on were not fun, nor was having several canulas.

It’s a simple swab, no harm to anyone and I think it’s good the dr was actually aware of it and the risks to the baby. Many aren’t.

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

I love, love how people feel it's ok to give totally uninformed judgement on what a poster HAS TO do.

Despite the fact that, if the test was efficient and was actually saving baby’s life, it would be available routinely on the NHS and it’s not.

Fgs, do your research first!!

I tested positive for GBS before becoming pregnant and practically begged the hospital to test me again before my baby was born. They refused and he developed the infection when he was born and was taken to hdu a few hours later, had a spinal tap, iv antibiotics for a week, twice daily blood tests, tube fed etc. It was horrible. He's a thriving toddler now but when I had DS2 I had iv antibiotics during labour to prevent it happening again (it didn't) and it was no issue at all. It's really not worth the risk.

I love, love how people feel it's ok to give totally uninformed judgement on what a poster HAS TO do.

Without outing, I do know what I'm talking about. Any risk is too big a risk for me.

On the plus side, the effects of the antibiotics would probably counteract the constipation from the codeine . Worth being prepared for this if you are going to take it.

Basically, op doesn't want to find out if she has gbs as it will prevent her homebirth.

my friend didnt have the test done before she went into labour, she passed it onto baby and now the baby is very poorly in nicu, if my friend had known about this she would have been tested and this could have been avoided, personally i would have the test for your babys sake, i wouldnt want anyone else to go through what my friend is at the moment is heartbreaking for them.

Thank you for your responses. My opinion isn't formed on a "Google search" and is formed on both what my midwife said along with NHS (and other) statistics. I'm now definitely glad I didn't approach Mumsnet for advice when making my decision as it appears very one sided and with a lot of how I'm obviously "ridiculous" for not agreeing with other people opinion on the matter. As previously stated it's not just the low statistics that I'm taking into account, it's the fact a negative would give no indication as to what the status would be at birth and the same goes for a positive. Why wouldn't I just test? Because testing can give false reassurance, and can also cause unnecessary antibiotics requirements at the time of labor, and if the labor was too quick then the baby would need to be on antibiotics for 48 hours after. I'm avoiding a hospital birth because of the increased risk of interventions which are not clinically necessary and due only to NHS implied timescales for non-progression of labour however I have made it clear through the my birth plan that I am fine with any intervention and monitoring which is deemed 'clinically' necessary.

I'm aware that GBS testing is standard across Europe and America, and was completely all for it which is why I spoke to my midwife about it. My mind changed once I looked into it further and realised that all that testing provided was a definitive answer to your GBS status specifically at the time of testing.

Just to be clear I'm not miffed that the doctor has a different opinion than mine, I'm miffed she has taken it upon herself to go speak to my midwife, without my consent and basically imply I had made an ill informed decision based on Dr Google which is simply not the case. The fact she came away from the conversation with my MW having changed her own opinion on GBS testing, which she could have done with her own research instead of undermining my decision is what's bothered me. She took my midwifes details to contact her on the pretence that she was enquiring about the prescription for codeine and nothing to do with GBS testing.

@Rolypolybabies what do you think pethidine, given regularly in hospital to women in labour is .

Sounds like a thorough and attentive gp who wants the best for their patient, you should think yourself lucky.

There is a lot of scaremongering on this thread in all sorts of ways!

I think you sound quite naive, codeine for your first Labour? You will probably need pethidine

Probably? Why? I had gas and air for my first labour. Not because I was trying to be an Earth mother, just because that was all I needed. If you need more pain relief then that’s absolutely fine, but I think telling people they will need it because it’s their first labour is unhelpful.

With regards to the GBS test, you’re not u treasonable to decline OP. You’ve done your research.
I don’t see why you’d want/need to complain though?

What is the thinking behind the codeine? Won't it make both you and the baby a bit sleepy?

Over reacting and it is perfectly usual for medical professionals to discuss a case together

YABU

Yanbu.
I totally get your reasons for not wanting the test too.
If it was a brilliant test that could prevent passing it onto babies then it would be available everywhere on the NHS. It's not. I wasn't even asked about it, it wasn't mentioned or discussed.
I don't think there's much to be done about the GP buy I've experienced first hand scare tactics to try and stop me having a homebirth as I was "high risk" by their definition. I was not high risk at all but it was a lack of continuity of care that led to consultants labelling me as such without taking the time to get to know me.

It doesn't sound like GBS screening is that useful given that it's a bacteria that comes and goes. I tested negative and went on to have a newborn treated for sepsis anyway.

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?

That isn't what the OP said. GBS testing has a poor track record for accurate results and no evidence that it improves outcomes for babies in asymptomatic women.

A false positive can result in unnecessary medication to mother and child and a restricted labour which can itself lead to complications.

This isn't a reliable and simple positive/negative test and nor are the outcomes neutral. I wouldn't have it based on the evidence unless I had one of the other warning signs.

Oh sorry, cross posted. I've never had pethidine; tens machine all the way for me. I'm not good with drugs.

@SoyDora I'm not basing my opinion on my personal experience, I did not have pethidine. I am basing it on my experience with 100s of labours.

Also the "false reassurance" point is wrong, if it was detected that's good and it can be treated, if it goes undetected then it doesn't give false reassurance... You wouldn't say "oh this woman is symptomatic of infection but the swab came back negative so let's not give any antibiotics".

@TinklyLittleLaugh the codeine I was told is there if I need it, I have every intention of getting as far as I can without but it's there if needs be.

For everyone giving stories about how they had a child/knew someone who did who had a GBS infection, how you you have felt if four weeks prior to the labour you/whoever had the test and it came back negative which is a real possibility. This is precisely why I don't feel the test is worthwhile.

I didn’t know the nhs tested for gbs routinely, most women I know have paid to have it done privately. I understand why the nhs don’t test routinely but why would you blame a doctor for trying to persuade you to have it if it’s on offer?

@MrMakersFartyParty what I'm saying is given a negative, great let's go ahead with a home birth, all well and good, baby develops GBS infection because the day after the test was done you develop it? That's what I mean by false reassurance.

I’m totally baffled by some of the replies. This test isn’t routinely available on the NHS because (cut and pasted from the Tommy’s website):

^Testing for GBS in pregnancy is often debated and these are the reasons given by the UK National Screening Committee and RCOG as to why testing is not currently offered as a routine to all pregnant women in the UK:
Currently there is no clear evidence that routine screening would do more good than harm
Many women carry the bacteria and, in the majority of cases, their babies are born safely and without developing an infection.
Screening all women late in pregnancy cannot predict which babies will develop GBS infection.
No screening test is entirely accurate. A negative swab test does not guarantee that you are not a carrier of GBS. In other words, you may be given a negative result when in fact you do carry GBS.
The majority of babies who are severely affected from GBS infection are born prematurely, before the suggested screening test would have happened.
Giving all carriers of GBS antibiotics would mean that a very large number of women at very low risk would receive treatment they do not need.
There is a risk to the general public from overuse of antibiotics leading to strains of bacteria becoming resistant.
The long term effects of antibiotic treatment in labour on the baby are unknown.
The amount of babies affected by GBS in the UK is the same as that in countries in which testing is a routine part of antenatal care.^

I understand the OP’s story to mean that she voluntarily raised the issue with her midwife (the OP doesn’t indicate that she has any particular risk factors for GBS) then, after researching it, she decided against it. Given the pros and cons, that’s hardly an unreasonable decision. The doctor has then castigated her for ‘declining’ a test which isn’t actually universally available on the NHS anyway, and which the OP raised with the MW (not the other way round!)

So if I’ve understood the position correctly, OP, I don’t think YABU in the slightest.

But that wouldn't affect the outcome negatively would it? The intervention of the test wouldn't have had an impact and neither would "false reassurance"? You would just hope that it was picked up by normal newborn observations.

You should make a formal complaint about your MW sending you to the GP for codeine to be used in labour. GPs aren't insured to prescribe for during labour and it's absolutely unacceptable for your MW to ask the GP to do that. If it's for a home birth then you shouldn't need opiates and if it's in a MW centre or hospital then it's for them to sort out. Disgraceful behaviour by the MW.

Wow.