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?

GBS rest aside.
You’re in for a shock when you’re in labour and pop a couple of codeine expecting them to take the pain away. I have had 2 babies, and the one where I had no pain relief and was in the pool went far better then the one when I accepted drugs early on

The test is totally your prerogative but I think YABU just because I always think its a good thing that a doctor goes beyond their job to make sure a patient gets the possible care

Tbf purple I don't think OP has said at any point she expects it to just take the pain away.

I had a midwife that was pro home birth / anti doctor, hospital etc, and she gave me poor advice to encourage a home birth rather than send me to hospital where I should have been. By the time I ended up in hospital it was too late for them to do much and my baby died (not GBS).
Health care professionals can all have their own personal opinions that are not necessarily best practice or best for the patient, even if they sound lovely and reassuring and are telling you what you want to hear.

I had planned to be tested 23 years ago when pregnant with dd as had seen friends babies struggle, but like you found it wasn't that useful as test only have definitive answer for that moment in time and there are risks to giving antibiotics

It doesn't sound like NHS advice has changed much in all that time.

I had GBS and knew about it at 36 weeks and had a plan in place for labour and antiobiotics, but I didn’t get my 4 hours of antibiotics in time (labour too fast) my son spent the first two weeks of his life in neonatal intensive care - worst thing ever!

My midwife was ferociously against me having a GBS test when I was pregnant when I mentioned it, saying it was a social media fad and I would be unnecessarily medicalising my birth if positive and quoted what I now know to be incorrect information and statistics at me. My daughter developed sepsis and spent the first 10 days of her life in NICU with numerous antibiotics, cannulas, blood test, spinal taps etc. The NICU consultant asked if I'd heard of GBS testing and recommended I do it for future pregnancies, saying she'd pay for all her relatives and friends as she sees the fallout daily. I've never forgiven the midwife for making me doubt myself.

Why cannot it not be tested for in labour? So if woman does have it she can have the antibiotics (or if labour is too quick then baby has AB after) but only if required

@emzw12

As horrible as a neonatal stay is, imagine if you hadn't known you had GBS?

@crunchymum it can be tested in labour but the NHS use a cheap non specific version of the test which isn't reliable. Most trusts will do the NHS test if a woman presents once their waters have gone but standard advice is to stay home until contractions are regular (3 in 10mins or something) and by then it's too late to get the required doses in.

Thanks for the reply @Squeaksalot

Surely testing in labour is better than nothing though? And if GBS is present then baby can be treated if mother's labour is too fast? GBS is only a real issue during delivery so labour is the best time to test?

Crunchymum, they’re working on a test to do that apparently but at the moment it takes 24 to 48 hours to get a result back hence the need to do it beforehand. They recommend doing the screening around 35-37 weeks as results are highly predictive of GBS status 5 weeks after.

I was never offered this test whilst pregnant in 2016. Is it universal?

It takes too long. You can test in labour but in general wouldn’t get results until after the baby was born so not possible to give preventative antibiotics.

I wish I'd been asked about testing for strep b, my daughter was born 10 weeks premature due to the infection and has must of contracted the infection through the birth canal, she's now severely disabled with cerebral palsy , I really wish it had been mentioned to me 10 years ago or my daughter's life could be very different. I'm not trying to scare you op I just wish I'd had this option

The reason the NHS doesn’t routinely test for GBStrep is not ‘because of the low risk’ to the child. It’s becaue at an epidemiological level (society) it’s better not to give antibiotics (abx) to all the people that test positive (to avoid the death of some children and expensive and stressful ICU care of others), because the bacteria then has a greater chance of mutating so that it becomes resistant to the abx. A sensible decision as a government, overall.

But on an individual basis, being tested and having the abx is very likely to prevent death and serious harm to your baby, if your baby does actually contact the infection in the uterus on day 1 of life and become unwell. Your choice of course.

Don’t criticise the doctor for advising you on the actual medical situation. If you want to ignore medical advice and take the risk, that’s your choice afterwards. But don’t criticise the medic as if your precious bubble has been burst just by hearing the medical advice.

My baby needed NICU at birth, they suspected sepsis. I was very glad to be able to confirm that GBS has been v recently ruled out (rather than wait for the blood cultures to not grow it).

Best of luck with your baby. I appreciate it’s a very stressful time all round.

Few points here....
You will not vomit in labour because of the codeine, you will vomit because you are in labour. (unless you are allergic to it...)
Codeine is perfectly safe to take during labour (unless you're allergic to it)
I don't think you're over reacting, the GP did not respect your wishes, which was a (well) informed choice made after discussing with another HCP and doing your own research. You sound like my sort of patient!
GBS is transient, it comes and goes, you will (I hope) be tested for it if you are seen as high risk- many different reasons- won't go into all of them. GPs have very little Ob and Gyn training these days, so aren't always up to speed with the latest protocols as much as midwives are.
Im sure your midwife has dealt with many babies who are septic in the past. The person posting that comment is a fool
Please don't listen to the absolute quackery advice from some people who are trying their hardest to scaremonger here, just because their friends cousins mum had GBS once, or because they read all about it in the daily fail....
I am so pissed off on your behalf and your poor midwife who has been completely undermined by your GP.
Testing positive one day or GBS doesn't mean you will have it the next week or month, you will however expose yourself and your baby to an uneccessary dose of antibiotics. Antibiotics are a really precious resource and if we whack them into everyone with a positive at some point GBS swab then they will stop working for the GBS pos women and babies who really need it.
I have not read the full thread, only the first page by the way but some of the crappy medical advice on here is baffling!

Yes you are over-reacting

Take a few deep breaths, step back and have a think about the GBS testing, in many other countries it is offered routinely- if you could save your baby from being affected by this, then surely that's a good thing?

@user1471498837 thank you for the reassurance. Having gone through the post there are other previous HCPs who have said similar however others who believe I'm totally barmy for not going with their opinion, and as much as I get each to their own, apparently respecting each others opinions isn't something a lot of people are fond of doing. I was requesting opinions on AIBU about being angry about the GPs actions, and as much as I am still miffed, as some have pointed out it could be seen as her just being thorough, seen from another point of view which I can take on board. The fact that this has turned into a free for all based on whether people should or shouldn't have GBS testing is what's ridiculous, again I can see people's opinions, especially when they have been affected personally by GBS, and their opinions and statement are welcome, it's when every Tom, Dick and Harry decide it's appropriate to call people stupid, silly, irresponsible and whatever else because they don't agree with their opinion. I've at one point been compared to an anti-vaxer, which is completely not the case, however even though I personally agree with vaccinating I wouldn't dream of going around belittling people because their opinion differed, I may however try to sway their opinion but I know that I'm not about to do that by belittling them. I'm going to leave it there now because some of it is getting way out of hand but for all of those who have given their opinion, whether of the same or differing to mine, in a decent, unagressive manner thank you.

OP. I'm afraid you don't know it all.

This insistence on self belief, that positive thinking is the key to a successful birth and your complete belief that GBS testing is a waste of time speaks volumes about your naivity to the rest of us who have been through it before.

The difference between the theory of GBS testing and risks, labour, medical intervention and birth planning - versus -what they are really like is enormous.

Whilst you can do your best to plan, you really need to prepare yourself for the fact that things will most likely not go the way you want them to.

People are trying to tell you this.

You need to have had some experience of childbirth and GBS to really be equipped to have anything like an 'informed opinion' about the 2 things. You have neither.

Many, many people on this thread do yet you are still adamant.

Like someone else pointed out above, you need to be more goal driven about labour and pregnancy - the baby needs to arrive into the world safely. You get no medals for how you did it.

When you can see the woods for the trees after you've been through labour, you can appreciate that being linked up to a machine during it is no big deal. Neither is your baby receiving life saving antibiotics.

This all seems important to you now. So will the breastfeeding/bottle feeding debate when you have your newborn. So will your baby reaching appropriate milestones by certain ages as it grows.

In time though, you will realise that having these strong opinions were pretty futile. What will be will be. There is nothing quite like having children to make you realise that you cannot plan things perfectly and you certainly cannot control situations which are beyond your control.

I speak as a mother of 3 children, 2 of whom were born with GBS present at birth.

For more information, I would call GBSS if you really want some informed advice. On top of that, I would speak to people who love you and have given birth themselves about whether a home birth for your first child is necessarily a good idea.

I wish you all the best.

Also, best of luck with your birth, codeine is great for early labour, and yes, some areas do require a GP to prescribe drugs for use during labour.....

Regarding the transient nature of GBS:
From the GBSS website, the GBS Support charity.

Is it worth testing for GBS carriage, because it’s so transient?
Well, that depends on what you mean by transient. The result of the test specifically to detect GBS carriage – known as the ECM or Enriched Culture Medium test – is highly predictive for the next 5 weeks. This is why the time usually recommended to test for GBS carriage is 3-5 weeks before the anticipated birth date, or at around 35-37 weeks of pregnancy. So, while GBS carriage status may well change between, say, 12 weeks and 40 weeks, it’s really not very likely to do so between weeks 37 and 42

Jesus Christ almighty we are fighting for GBS testing to become routine.
My nephew almost died because he contracted it through my sister during labour.

What actual planet are you on OP??

The problem with the answers are that some posters are very emotionally invested because of previous experience, which is understandable.
Comparing you to an antivaxxer is ridiculous, also is telling you you're wrong/unrealistic for wanting a homebirth. Many first time mums have a very successful home birth, and even if you do go in (to hospital) then at least you have spent some of your labour on your own home, which is the best place for (most) women in early labour.

Comparing peoples experience over reliable scientific evidence based research is very dangerous. I guess I'm just taking the view of a HCP here and not getting emotionally involved the same as some people are.
My son suffered with sepsis after birth, but I never ever use my own personal experience as a base for advice given to people Im caring for. If I did then everyone I cared for would be on antibiotics, and would be given a section as standard.
I haven't looked at the GBS charity page but Id question the origin and reliability of the research before I thought it was worth using in practice.

I did have a sepsis baby and I'm still cynical about universal GBS screening and overuse of antibiotics. We need to keep antibiotics working.

My DD perked up after 24 hours of IV abx (needed 5 days), she wouldn't have if it had been resistant bacteria due to large numbers of pregnant women taking unecessary abx.