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?

Ds1 almost died due to gbs.

First can I just say that I think it's great you are planning on having as little intervention as possible, but please don't build it up too much in your head. I've seen a friend end up very depressed because after all her planning she felt she'd failed/was failed by the system to have her natural birth.

Please think on having your first at home too. Labour is much worse than you think it is going to be. I say this as someone who has had four kids pretty naturally and the youngest at home. If I'd been at home for the first, I think I would have been so shocked and panicked. Having heard from plenty of tough, fit women how they came apart in labour, through no fault of their own, personally, I would have the first one in hospital.

Sorry, I hope I'm not coming across as patronising; I wish you all the best whatever you decide.

@Tinkly saying 'I'm not being patronising but...' is a sure fire way of ensuring you come across as exactly that. The OP didn't ask for your opinion of her birthing choices, and it's entirely unnecessary to undermine someone else's decisions because they don't align with your own.

For YOU, labour was worse than you thought. The OP may find it tough but manageable with good support, a relaxing environment and whatever birth preparation she chooses.

Wouldn't it have been kinder to simply say 'I hope you have a good, safe birth OP!' rather than undermining her choices?

Completely normal for GP to talk to midwife. It's a Multidisciplinary team approach and central to good care. She has now been educated from MW. Not sure what you would be complaining about?

I understand what you're saying but the GP is just doing her job. Her priority is yours and your babys safety and she is following up with your MW due to her concern. It's quite arrogant really to suggest the GP is at fault, her intentions are to provide the best and safest care, by taking the time to call your MW to discuss and follow up with you should be a good enough indicator that shes doing what she feels is best

Sorry, I'm not seeking to undermine the OP's choices.

Please think on having your first at home too. Labour is much worse than you think it is going to be. I say this as someone who has had four kids pretty naturally and the youngest at home. If I'd been at home for the first, I think I would have been so shocked and panicked.

Your perception and experience only. You know you get two midwives, plus gas and air, right? And if you want a pool you can have one, with no need to wait for it to be free?

Labour was dandy for me and the only reason I didn't deliver at home as planned was it went too fast, and it was my first too. home births are lovely, and op is clearly well informed, so I'm not sure why you're trying to dissuade her?

Also, if you're booked for a home birth but actually you decide you want to go into hospital for pain relief it's not a problem at all, distance permitting you can transfer in for an epidural and nobody will bat an eyelid. It's just you can't do it the other way round, so home births actually give you more options.

Yes I know you get two midwives and gas and air. Actually I ended up with three midwives (one trainee) and didn't require any gas and air for my home birth.

So I do know what I'm talking about.

Yes I think you are overreacting

But I also think your reasoning is fine and the doctor now thinks that too - but on the file it would simply say you refused so they probably felt they needed to follow up.

YABVVVVU

1. The test is not perfect but if it comes back positive it is an early warning sign - infections tend to reoccur / occur where there is an underlying susceptibility.

1. A hospital birth versus a home birth does not necessarily mean the home birth will be less medicalised. I had my first DC in the US in one of the most risk averse hospitals in the country. It was entirely non-medicalised with no need for or use of any sort of pain relief and no stitches etc afterwards. (The consultant stood in for the MW because my delivery was so straight forward and he was freeing up staff) I chose that route because of the number of horror stories about home births gone wrong and late transfers from MW led units when things have already started to go wrong. I have since had 2 further hospital births in the UK (both similar to first) - 1 MW led and 1 supposedly consultant led where I had actually already given birth before consultant appeared - baby was 4 weeks early and as a result had precautionary antibiotics, precautionary baby jaundice treatment but no need for SCBU as healthy weight etc - however I was very relieved to have all the facilities for me and the baby on stand-by.

as I'm planning a home birth codeine is the alternative as they can't give it at home.

still not up to your GP to prescribe - please do complain about that aspect of care. if the MW wants you to have codeine she needs to arrange a prescription from someone in the obstetric team. If your MW doesn't know that then I really worry about what else she doesn't know.

I’m sure the OP has thought through her decision to have a home birth.

firsttimebumps Instead of being annoyed that your GP spoke to your MW (which is perfectly normal and actually a good example of shared care), you should be happy your refusal has probably educated the GP further into GBS testing and opened her mind.

If you don't want it, you don't want it (its your autonomouos choice) . But atcually when most people are compaining about medical professionals your GP did a good thing. She made absolutely sure you did not want testing and verified your source of information as not google, even though she/ he thought it was a good thing.

So codeine is fine and antibiotics are the devil's work?

I know someone who's baby died at a few days old due to group b strep. Had test with both my dcs, both times positive. Antibiotics issued late in labour for 1 dc and he ended up getting ill (longer period of antibiotics, spinal tap)
It's obviously your decision but remember that statistics mean nothing to the individual.

There are very good reasons why somebody might choose to refuse GBS testing. And this is why we have this concept called 'informed consent'.

No, you're not over-reacting OP. But as you can probably guess from the mini shit-storm on here, it's not the last time in pregnancy or childbirth that you'll be told what you should do by a bunch of people whose business it isn't.

Google the BRAIN decision making model for some interesting thoughts about how to make decisions for yourself around pregnancy and labour.

@BestBeforeYesterday now who said antibiotics are the devil's work

Goodness me, how sad that you’re annoyed that your GP discussed your health care with your MW. So many complaints are about lack of communication within the NHS. Seems that in some cases the NHS can’t win, they are damned if they do and damned if they don’t!

I’m not being goady, but what exactly has annoyed you about them sharing details of your medical details? Surely it is in your best interests?

Good luck with your birth and new baby. 💐

I think that part is unreasonable. All healthcare is multidisciplinary to an extent and its lack of communication that causes the big problems

@MotherOfDragonite thank you. My issue is purely based on the fact that I made an informed decision regarding GBS testing and the fact the GP phoned my midwife and said "are you aware that your patient has declined GBS testing" seemed really undermining. If she had called and said can I enquire as to whether you've discussed this with the patient, do you think the patient has looked at X, Y and Z" even "do you think the patient is of sound mind to have made this decision" fine, but it feels like the GP was calling to try and get my MW to get me to change my mind about testing with a whole attitude of "this is the wrong decision regardless" (as apparently a load of people think is the case on here).
My original post wasn't about whether I should have GBS testing, it was about whether I had a right to be miffed by the GPs actions, and it certainly wasn't about my choice to have a home birth, I'm ten minutes down the road (without blues and twos) from the hospital and trust me I wouldn't have come to this decision if it posed a risk during labour, I am actually quite an anxious person so have covered all the inns and outs. And can I just clarify I have no intent on complaining about two health care practitioners due to them discussing, my MW answered the phone totally perplexed at the GP calling about it. I'm miffed at the GP, not my MW.

Good luck with your homebirth.

Basically, YANBU but you'll keep on getting this shit.

Best of luck with your home birth. I found a TENS machine really helpful (better even than the gas and air). Also google J breathing and humming breathing. If you have a birth pool, being in the water is also effective for pain.

@MotherOfDragonite I've got a TENS, did hypnobirthing (god bless me for the crap I'm about to get for this as this will obviously be the reason I'm declining GBS testing because I'm clearly a frigging loon who's being all airy fairy obviously), and am hopefully having a water birth providing it can be set up in time. My birth plan has "unless clinically necessary" written all over it so I'm not being a set in stone controll freak and understand the need for flexibility in case of change. I just feel that an awful lot of people are like give me all the test because they're there and all the drugs because I can and anything that's even remotely out of the normal hospital medicated birth is just wrong in their eyes. The benefits of a home birth to both mother and baby just get ignored, although I should have anticipated this. I always used to be like nope, I need to be in he just in case of everything and anything that could possibly go wrong. My midwives are currently doing a positive mentality advent calendar and yesterday's quote was about humans being the only species capable of doubting their ability to give birth and I think that just about sums it up.

"the fact the GP phoned my midwife and said "are you aware that your patient has declined GBS testing" seemed really undermining. If she had called and said can.. even "do you think the patient is of sound mind to have made this decision" fine"

But she needed to check your midwife actually knew you'd made the decision before discussing her thoughts on your decision.
The fact you'd rather have your mental capacity questioned than have the doc check your midwife knew you'd made a decision does rather make it look like you're trying to be offended.