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?

Also Homebirths are statistically SAFER and with better outcomes OP as the mothers have frequent monitoring. Instead of like in MWLU where they have checks every few hours and then need sudden medical intervention for problems that should've been detected hours earlier.

I had my homebirth with One to One midwives (free - they're funded by the same pot as the NHS but they follow much stricter guidelines).

You science and stats are totally off and sound entirely out of date.

Thrrr are no supervisor of midwives anymore

And if you want this much control over a swab test your mind is going to fucking BLOWN when your labour and birth plan goes to shit.

Like 9/10 womens probably does.

If you're picking fights over simple medical advice and things that could help your baby before it's even born then you're going to find the next 12m exceedingly difficult.

Pick bigger battles.

Let's put the GBS thing to one side.

It's perfectly normal for your healthcare professionals to consult one another about you, your care, and your understanding of the decisions you're making. They should talk to each other; operating in a bubble isn't helpful. You've said yourself that the GP changed their mind after consulting the midwife, and coming to a better understanding of both the facts and of your position. That's good practice. You don't come across terribly well in the way you describe your feelings here, which doesn't necessarily mean that you haven't made an informed decision - but a responsible HCP should be consulting another HCP, who knows you better, to check that what's happening really is in yours and the baby's best interests. It's quite right that they should speak to each other about your care. YABU.

Oh bless.

Have you had seven+ years of medical training and then beyond seen many many babies sadly die? No?

But your right to choose to decline a test means a brilliantly qualified and experienced doctor who has seen babies die can't even check with you that you are sure about the dangers?

Mmmm.

I wish you knew me. Mother of a baby who died. Maybe you'd choose to listen.

Just to be clear home births are not safer. Only low risk pregnancies generally have home births so obviously you remove all the statistics of people who were more likely to ave negative outcomes but for a first time mother you are three times as likely to have complication during a home birth than in hospital.

when the researchers focused solely on women planning to have their first baby at home, they found they were almost three times more likely to suffer complications than if they went to hospital.

They found that women having their first birth at home had a greater chance of complications leading to injury in the child than women who had planned to go to an obstetric unit in a hospital. This risk was almost doubled

This was a large scale study based in the uk see here

There was actually a high rate of complications with 4.3 out of 1000 suffering serious complications (very high for a first world country). I think people should still have the choice however they should be aware they are increasing the risks of injury to their baby and they should be prepared to transfer immediately to hospital. Even if just as a precaution if they need to.

@BonnieandHyde NO homebirths are not statistically safer. See my above post. They have double the risk of injury to the baby and three times the risk of complications for a first time mother in the UK.]

I'm not suggesting you shouldn't do it, perhaps being more relaxed might help some people with anxiety based around hospitals for example but don't lie about the facts.

I tested positive for GBS when swabbed for thrush. Didn't know anything about it, or that it would be tested for, and spent a lot of time researching, and agonising, and considering the statistics just like you. In my case, I was worried about the impact of antibiotics on the baby's fauna. In the end, I got tested for 'thrush' again at 35 weeks, so I would know my status, and went with the antibiotics in labour.

It turned out to be a very calm midwife led waterbirth, using hypnobirthing and no further medical intervention. I barely noticed the drip, I was too out of it from the pain!!

In the end, I realised that I was making one of the first of many decisions about risk that will impact another person, my baby. I couldn't in good conscience refuse the antibiotics, as I would not have been able to live with the consequences had anything gone wrong. This wasn't about me, but about this other being, and regardless of any reading or analysis, I needed to know I had minimised the risk.

@Deadbudgie I completely get how being in that situation would compelle you to educate others and that's perfectly reasonable, but a lot of people on here find it completely appropriate to call people silly and stupid for not aligning with their opinions and that is not how you go about trying to convince people, especially if you're trying to succeed. The point of my post was to ask if others would be miffed by the doctors actions, and the way she had gone about it saying she would contact my MW about my codeine prescription to then find out she had contacted her about the GBS test, and the way she said it just seemed really belittling, not about whether I was deciding to test or not.

For low risk pregnancies they are safer and have much less medical intervention. We were given the stats from our local women's hospital FFS.

Also interested in codeine in labour. Never heard of that one... contrary to your earlier post, codeine =/= pethidine though they are both opioids.

Anyway, all the best for your birth

@MammaSchwifty I didn't mean codeine and pethidine were the same just that it was the only opioid available for home births so that way on par. TBF when I was originally planning a MLU birth months ago I was dead set against pethidine so I'm hoping not to use the codeine for the same reasons, but would like it there just in case

Yabvvvvvu unreasonable to refer to GBS as a virus when it is in fact a bacteria and makes me doubt the level of knowledge of both you and your midwife that you get the very basics about GBS wrong

Honestly you sound more concerned about having your ideal birth plan than the health of your baby.

Also your doctor has every obligation to follow up if she has concerns. I have done this numerous times on behalf of patients when I believed the care they were receiving was misplaced/inappropriate by other clinic teams, most of the time there's no cause for concern but occasionally people will stop and go "hey yes you have a point, I shall amend my approach now!" Having a doctor who questions things they aren't sure about or disagree with is a very very good thing, people make mistakes and not questioning other healthcare professionals if you have concerns is negligent - Doesn't mean there is always a genuine concern at play but if there is any doubt it should be questioned just in case.

Careful Solasshole she went mad when the mixup was pointed out before, although it obviously isn't a typo or whatever, being as viruses and bacteria are completely different and require completely different treatment.

I found the GBSS website very informative. Yes, they’re campaigning for routine screening to be done by the NHS but the information on their website is accurate and up to date. Having read up on it after my experience with DS1, I would advocate having the screening (imperfect as it is, I still think it’s useful to know) and then asking for antibiotics in labour if you showed any of the risk factors. With DS1 I had a long time between my waters going and getting into established labour (known risk factor for GBS) so at that point, had I been better informed, I would have asked for antibiotics and maybe avoided him getting it. With DS2 we were already at greater risk of it happening again because DS1 had been affected so I opted to have antibiotics without even getting tested for it (in hospital but it was a natural birth, only complicated by him being enormous!). As I said, it is useful to know and then you can be more vigilant for both known risk factors in labour and for signs of infection in your baby - DS1 did this grunting thing that the midwife was concerned about but it was really subtle and I certainly wouldn’t have noticed anything amiss at that point as a first time parent.

I don’t think your GP did anything wrong as such but it is a bit patronising for them to think you can’t research and make up your own mind.

I think you’re lucky that you we’re offered the GBS test tbh. I had to pay for it privately. Why on earth would you refuse it and put your baby at risk?

For low risk pregnancies they are safer and have much less medical intervention. We were given the stats from our local women's hospital FFS.

NO they are not I posted a link and I'll post it again here.

Why the FFS? Why would you think people will accept your random statement with no proof over a large scale study conducted by researchers and based in the UK (which is what is most relevant to those of us in the UK).

A first time mother is 3 times likely to have complications during a home birth and her baby is twice as likely to suffer injury during her home birth. The rate of serious complications is 4.3 per 1000 which is pretty high for a first world nation. with good healthcare. You can't just post incorrect information with no link or proof of your data and expect not to be contradicted.

@MrMakersFartyParty

Honestly if I had a midwife who mixed up bacteria with viruses I would be extremely concerned and be asking for a new one as it shows an absolutely fundamental lack of understanding of the pathogenesis of the condition.

But then I have also dealt with midwives who can't even grasp the basics of blood groups which is also highly worrying to me.

I guess the point is there is a fair amount of fairly mediocre HCP out there and it's the role of other HCP to question things that look suspicious. Not saying OPs midwife in particular is bad but once you've dealt with a few who are crap in your career you learn not to put absolute blind faith in other HCP. Also people make mistakes sometimes, I know I've made plenty and have never been upset if another HCP has pointed out I made a mistake. I would be horrified if a colleague didn't point out that they suspected I had made a mistake even if in the end it turns out I didn't actually do anything wrong.

I'm not against home births for low risk first time mothers but they should be aware they're increasing the risk and they should be prepared for transfer to hospital and interventions if needed. If they decide, knowing all this, that home birth is right for them (as I said some women are very anxious about hospitals and the might feel more comfortable at home) then fine.

I don't think woman have to be matryr's and I do think the comfort and mental health of the mother has a place in decisions about risk. Mothers are important to and should have choices as much as possible. But it should be an educated choice.

And for what it’s worth I do understand deciding not to have the test, it’s what I decided with DS1 but that turned out to be the wrong choice (probably).

Surely you need to repeat the test every couple of days through the pregnancy in case you go into labour. Also doesn't it take 72 hours to culture GBS or is there a better testing method.

Ffs it’s not belittling you for your gp to confirm with your mw you are fully aware of the risks and benefits.

I gather you’re absolutely determined to have a home birth and this has swayed you towards not getting the test.

One thing I’ve learnt, never say never and never be too rigid. That’s when things can become muddled.

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.

I know absolutely nothing about the GBS testing So not getting involved in that but I do know about pain relief in labour.
While Pethodine is not used for home births its sister drug Meptid it’s. It’s from the same family but has hardly any of the same side-effects, you also do not need the antidote as it does not make the baby sleepy. It has been in use for a long time and used to be the drug of choice for home births. Not all hospitals use it but if yours does the pain relief would be far superior than the tablets you have been given.

She was making sure your decision was informed and understood, not that you were telling each person the other one knew. She's clearly a terrible doctor more worried about yours and your daughters physical wellbeing and doing her job ahead of your feelings about being checked up on.