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?

It is perfectly reasonable for the GP to speak to the midwife. I work in the NHS and it's really important to have a multidisciplinary approach to prevent one professionals view being the only one. Your GP did the right thing.

GBS testing is your choice but, despite the responses you've had on this thread, that wasn't the unreasonable point you were raising.

You are massively over reacting.
As for the GBS testing YABVU. Sepsis kills babies.

Having looked after many babies who have been very,very poorly due to maternal group B strep,I think you are being a little unfair on the doctor and midwife who are trying to ensure the best outcome for your baby. Yes the chances may be low,but why even take the risk if they are offering the test....

I would imagine the minority sepsis babies will have worse outcomes if large numbers of women take unecessary antibiotics and resistance increases.

My (very good) GP herself pointed out the recent evidence that intravenous antibiotics in labour don’t actually prevent the baby contracting group B strep, so did not recommend the private test.

She made the point that anti biotics in labour aren’t just risk free ‘belt and braces’, as they wipe out the baby’s ‘good’ bacteria which can have other impacts on immunity and health. If it’s not actually going to prevent the infection, and will mean otherwise healthy babies are dosed with antibiotics ‘just in case’, it seems a pointless exercise. I do know our local midwife still pushes the test but the GP practice contradicts this.

There’s a reason it isn’t offered on the NHS. The results aren’t that useful. Monitoring baby after birth and treating as needed is now seen as best practice.

you are totally overreacting and in my opinion being rather foolish as well

Of course the risk of GBS affecting the baby is small, yes of course you could develop it the day after the test. BUT if your baby is the one who dies from GBS sepsis ...

Testing is offered even though the absolute risk is small because the consequences can be catastrophic ... You sound smug, self involved, and definitively very precious

This all sounds a bit confusing to me, it sounds like the testing is like trying to find a needle in a haystack, you might be asymptomatic on the day of testing but test positive the day after but it won't be picked up? Can you ask for IV antibiotics during labour to be on the safe side?

?is it codeine tablets compared to pethidine injection? Wouldn't the reactions be quicker by injection & the effect stronger & immediate? (had pethidine for first dc)

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

That test is routinely done to all pregnant women in most developed countries, that it is not done in the UK doesn't mean that it is the right thing to do. Gestational diabetes testing is also done in a lot of countries to all pregnant women whereas in the UK is only done is you have risks factors (family members with diabetes for example), there is no risk in having that test done and it can only be a good thing to catch that on time. Also, in a lot of countries, babies and kids are seen by a paediatrician when they need to be seen by a doctor, not a GP.
What I mean is that a lot of things that are done (or not done) are a result of funding (or lack of), do you think other National Health Services in other countries like to waste money in tests that are, as you say, not effective?

I talked to my MW about the test, she explained that it was not offered on the NHS but she did agree with me that it was idea to have it done privately, and I did.

Sepsis kills babies

Dramatic phrase. However the drama doesn't alter the current evidence that GBS testing does bugger all to prevent problems in asymptomatic women. Which is presumably why the NHS doesn't waste money on it.

I don't think the OP was being unreasonable in her decision. I shared my experience and reasons why I paid privately because the thread is also about GBS. I do think you are being unreasonable re the GP. You have to understand that the number of patients she will see who make decisions based on proper research are few and far between. You are in the minority. She is just being thorough and didn't obtain your MW details by "deception" - if she wanted them for underhand reasons she could have easily obtained them through other means - she no doubt was calling to discuss the prescription but decided to talk about the GBS test also. I really think it's a non-issue. Have you had to "defend" your choice to have a home birth much? Friends who have had them djd. Could it be that is influencing how you are feeling?

piscis same is true for end of 2nd trimester placenta ultrasounds. My obstetrician in Germany described the NHS antenatal care I'd received in a busy densely populated area of England as "third world" when he looked through my notes (I moved when 7 months pregnant).

@C8H10N4O2 not a dramatic phrase, an accurate phrase.

I've cared many babies who were otherwise well, who have died from sepsis or meningitis.

FirstTimeBumps

it doesn't matter that it doesn't give a definite answer. A definitive answer makes parents feel happier but doesn't affect the baby. There is a non-trivial risk of your baby becoming seriously ill and there is an effective means by which you can mitigate that risk. The fact that you can't completely eliminate the risk doesn't matter.

Now you have the right to decide that the risk is small enough that you prefer to prioritise your birth experience over reducing the risk but you can't get angry and people correctly stating to you that there is a risk there and your decision has increased the risk. That's just a fact and if you think your research has disproved that fact you're incorrect.

Your doctor was correct to point this out to you.

Wow, hysteria much on this thread? The risk is very very very low and the test isn't very useful - I wasn't offered it when pregnant, most people aren't I don't think.

Why would you want a highly medicalised labour, including probable induction, which has much more real and present risks to your baby, if you didn't need to have it?

To be fair the urine dipstick would flag glucose and could potentially lead to a diabetes screen if necessary

@mumsastudent pethidine is available at MLU/hospital, as I'm planning a home birth codeine is the alternative as they can't give it at home. It's the same situation with pethidine so shouldn't be given top close to labour as can make baby sleepy.

For the record the GP questioning me declining testing, I don't believe she was offering it "free of charge" and I'm an absolute imbicile for declining as it's been so kindly put. She was questioning my decision, not even knowing I don't think that it was something I would have to have done privately. And for anyone quoting the "earth" movement or whatever else airy fairy, I've had all the standard tests and all reccomended screening and vaccines. I came to this decision about GBS after research and was originally planning for a MLU birth but changed my mind after looking into unnecessary intervention

@lilybetsy for Christ sake get down off your high horse. It's people like you who make comments like that which are the reason people don't ask for advice on here.

I'm not sure people are reading the OP.

The doctor changed her mind.

The test is not offered on the NHS in the OP's area anyway.

Basic comprehension test, this thread.

OP I don't blame you for being annoyed but I would say that it would be worse if GPs assumed all their patients were able to read and digest the information about the tests (c.f. this thread) and so an over-explanatory approach is probably best, if irritating. I expect the doctor pulled a face at herself for giving you dodgy advice when she got off the phone having been a bit crap herself.

Even if the op did complain about the gp, nothing would happen and they'd all do a massive eye roll. I often speak to social workers, health visitors and GPs without the woman's permission, why the hell would I need that? Its a multidisciplinary team.

Opinionatedfreak did you need to intubate the babies with GBS sepsis you cared for?

I’ve never met another doctor who has done that and refused the swab. I’m in paeds ICU so fortunately have had limited exposure to GBS sepsis during NICU rotations. As a neonatologist (I presume given your experience) I suppose you have seen more cases.

YABVU regarding complaining about two health professionals discussing a health plan for you. YANBU regarding making a decision about what you'd like to do with the information and options provided to you.

Yes, over reacting. You've made a choice which I do hope all works out in the end. I paid for a private GBS test (the DIY one that you do after 35 weeks), the NHS urine one was negative but the private one was a positive from both swabs.

This meant I did have the antibiotics in labour, it also meant I was very reluctant about sweeps and decided to refuse which meant DD was induced. As my waters were trickling a midwife examined and my waters broke proper while she was up there. DD seemed fine when born but just wanted to sleep and not feed. Come the evening we felt something wasn't right and by 1am she was in NICU; thankfully a bit of oxygen and a 5 day antibiotic course and she was good to go.

I can't obviously say what may have happened had I not had the antibiotics in labour and agreed to a sweep because I didn't have the testing, but I'm bloody glad I did, was worth every penny, but that is my own opinion.

@MrMakersFartyParty bollocks does op sound naive, labour was totally manageable for me with a tens machine and gas and air, I had some prescription codeine afterwards for after pains and it would have worked like a dream! All labours are different and going in with a well prepared( lots of reading of different birth stories, breathing techniques and affirmations to avoid adrenaline/fear and promote oxytocin) realistic and POSITIVE attitude helps immensely.

I've cared many babies who were otherwise well, who have died from sepsis or meningitis

But with respect this does not change the actual evidence on the value of GBS testing which is not a neutral test. It can have a negative impact on outcomes as well.

You presumably also know that a restricted labour from a false positive is more likely to lead to birth complications for no value to mother or child. Increased use of unnecessary antibiotics is also a massive issue.

So dramatic phrasing about "sepsis kills babies" just reinforces an emotive response rather than an evidence based response. Its also a standard tactic used to control the behaviour of pregnant women, however that is probably another thread.

Just to take some awareness. I had the GBS test and was negative. However when I went into labour they broke my waters, they then left me in labour over 24 hours, and despite my temperature going up and having the other symptoms of having acquired GBS in labour. No antibiotics were administered as is best practice.

My daughter was born with GBS, and was in SCBU for 10 days fighting for her life, thankfully she pulled through, but it was close. Don’t think because you test negative it can’t happen. And if you do test positive make sure you get the right treatment in labour.

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