tested positive for strep b and considering refusing antibiotics in labour

[snowangels1]

Tested positive for strep b during a routine swab for thrush. Mws now all up in arms about me having antibiotics through IV in labour.

I've been reading up on it and it seems lots of people refuse antibiotics. When I tried to discuss this with my mw last week (who is newly qualified and is lovely but can be a bit unsure about anything other than the obvious) she looked as if it was extremely unusual thing to request not to have in my situation.

Has anyone been in this situation? Were their mws supportive of them?

From what I can find out, chances of anything nasty passing to baby because I have strep b is very unlikely anyway (but, if it does, it's very serious). It also seems that having antibiotics in labour doesn't eliminate the risk, infact, side effects such as thrush in nipples (mw hadn't heard of this though) can casue problems with bfing.

I'm just not sure what to do. My reasons for not wanting antibiotics are as my body hates them - I always get lots of side effects accociated with taking them and the last thing I want is having to cope with that and post birth issues and a new baby. I'm also very suseptable to thrush (have it pretty much permenantly in pg) so the thought of having trouble establishing bfing due to having it in my nipples is not a nice thought. I also want as few medical interventions that I can manage without.

I am aware that I may have to stay longer in hospital afterwards because of monitoring the baby, which I'm ready to cope with (I hate hospitals).

If anyone has anything they can add or any thoughts it'd be so welcome as I'm feeling a bit pressured into having antibiotics but with a mw who can't really explain the statistics/reasoning behind how useful they are.

I'll add my story.

I tested positive at 37 weeks, was devastated as had opted for a home birth. researched it VERY thorougly and discussed with my midwives. As it was my second birth there was the potential that I wouldn't get to hospital in time anyway. I asked for the option of having ABs at home (some midwives allow this), but was told not possible (in case of serious reaction). However my midwives were supportive of me continuing with the home birth, as long as everything stayed within safety margins. The greatest risk is:
bith before 37 weeks, prolonged rupture of membranes, fever in mother, any kind of vaginal intervention or examination (plus some others)

We went ahead with the home birth and DS arrived safely and speedily (there was indeed no time to have had the ABs). The midwives were great and gave us instructions for doing hourly observations for the first 48 hours.

Like you I was wary of the whole AB thing, however would have accepted them should it have been deemed necessary by any HCP. I'm glad I knew about the GBS because it allowed me to manage the risks. As others have pointed out, up to 1/3 adults are carriers, so many births must occur with GBS present. I took an informed decision, based on what seemed best for me and my child. Other people will have their own perception of acceptable risk.

Hope this helps

I tested positive in hospital, and only had time for 1 lot of antibiotics. My waters had partially broken and then - nothing - for another 36 hours. Because of that delay between the waters breaking and labour my DS needed to have antiobiotics, twice a day for 4 days.

They don't just keep your baby in 'for observation'. Only 1 in 30 (from vague memory) babies actually need the abs, but they give it to all who meet the risk factors. If they did wait, by the time the test results came back the babies that did need antibiotics would be seriously ill.

So your choice, do you take it or do you turn your baby into a pin cushion, sitting there holding him and sobbing your heart out when they poke and prod him? Also, my DS managed to knock his catheter out on the last day, and they then had to try with his other hand, and then both his feet. He was so bruised and battered - I would have hated myself if I had inflicted this on him deliberately!!!!

i dont want to add to your worries, but seriously, if you have group b strep then take the antibiotics. I know how you feel because antibiotics cause all sorts of problems with me and thrush (it may not be so bad as I think you will onyl have to take them during labour not for weeks), but in all honesty - chnaces are slim I know - but if something went wrong for the baby you would never ever forgive yourself.

I have paid for private screening, as I know its rare but it is the most common cause of life threatening infections in newborn babies in the uk.

Retest and if positive take the antibiotics. There is a real risk to the LIFE of your child - just get it dealt with. I am very anti-intervention but if I was positive I would have had the abs.

Can I hijack this - why do they not routinely test for GBS?? I thought they did - is it part of the blood tests they do at 28 weeks or is it always a vaginal swab? I am 28 weeks with DC2, was swabbed with DS but only because I thought waters had gone (they hadn't) and they did a swab for infection. It came back negative so would this mean I don't have it? Grrr, another thing to worry about!
SNowangels it sounds like a difficult decision. Although if it were me, I would go with the anti-bs, and I am not one for intervention.

It's a swab. They don't test for it because of cost I think - as has been said lots of women carry it and have no problems. The policy is to swab those with symptoms and then treat. If you are swabbed and are clear that still isn't a guarantee you'll be clear by the birth. Status can change.

I see there are other here who've had GBS and more than one child. Do you routinely get swab for it second time round if you had it first time?

I gave birth to 2 babies in the UK ,not tested and not given the option to be .

I had my 3rd child here in the US ,(it is a routine test) and I was positive .

My OBGYN was a really down to earth guy ,said I could have been positive with the boys also but like others have said it comes and goes . (no problems though )

But ...If the test is available and you test positive closer to the end of your pregnancy -TAKE THE AB please :)
Better to be safe then sorry .

Are you going privately for your care ?
Do the NHS do this as routine now ?

I last had a baby there in '03 .

Good luck ,it WILL all be fine .

I genuinely don't understand why you WOULDN'T take the antibiotics if offered? Surely you'd do everything to help your child? Is there a reason NOT to dose with AB's? (other than thrush)?

I had AB's in labour with Dd and yes, I suffered with breast thrush (lost count after 12 times) for over 3 years (am still feeding Dd at almost 4 years old), but I wouldn't go back and not have the IV AB's. I wouldn't want to risk my baby at all.

My baby was born with an infection after prolonged rupture of membranes. The treatment protocol was the same as it would be for strep b infection. I had IV antibiotics, that ought to have knocked the infection on the head but didn't. We then both had whacking great doses of powerful ABs after the birth (IV Penicillin and Gentomycin for the baby, massive doses of Augmentin for me). I was expecting the worst (rampant gut problems for her and me, thrush, the lot), but bizarrely nothing happened at all. We were both completely fine.

In fact the baby's complexion was the best of any of my babies, and she was as strong and healthy as an ox once she'd got over the initial infection. I did get her some Biogaia probiotic drops due to excessive wind in the early stages, that seemed to help, but I couldn't blame that wind on the antibiotics as it happened several weeks later.

Just to say that antibiotics needn't be a disaster. If you have active strep B shortly before the birth, forgive me but I think it would be madness to decline them in fact. I can only be thankful for the antibiotics that probably saved my baby's life (she was very ill for the first few days of her life and in nicu, on cpap for some of it) and made sure that I didn't develop puerperal fever.

Thanks for the new comments

doley I'm with NHS. They don't screen routinely for strep b but my test was for thrush and they caught it on that swab. Would have never known otherwise

bats yes, I don't want to do anything to risk my baby but before posting on here lots of literature I read talked about how the NHS only need to 'offer' it to someone in my position, whereas is I had other risk factors it would be more forced upon me and some info seems to think the risks are so minimal that the side effects of anti bs can be more troublesome to more people than the small risk (I probably haven't explained that well). It's not just the thrush, anti bs make me really ill - I get terible stomach aches etc for a week or so after taking them and have been known to be stuck in bed for a few days with so much pain/upset. Of course I can put up with it and would much rather do this than have my baby seriously ill, but if it's not necessary I'd question its use as I don't want to feel unable to look after my new baby in those first few week.

ducesse that's very interesting story - thanks for sharing. Btw where do you get the probiotic drops from? Might get some just incase.

You are all making me feel insane for contemplating not taking the anti bs now. Maybe I've been reading too many hippyish natural birthing books...

snowangels1 I totally understand your reluctance to take antibiotics. Like you I suffer from thrush and the idea of getting thrush in my nipples wasn't a good one! I also lean towards hippy tendencies, and it was important for me to minimise intervention. When I tested for Strep B I did the same research I expect you are doing now.

I decided in the end to have the ABs, and I would make this decision again every time.

FWIW I didn't get thrush in my nipples, but if I had I would have coped, people do. I could not have coped if DS had become very ill.

I feel - and I suspect you may do - that it is worth questioning medial methods. They're not always necessary or the only option. However it's worth remembering that ABs are a lifesaver, and we are so lucky to live in a world with them. Many of us would probably not be alive without them. (Me for one - I got a terrible infection from a dog bite - had to have IV ABs. That would probably have finished me off without ABs!)

If your baby gets a bit sick after birth - as lots of DCs do, I suspect they'll be much quicker to give her/him ABs to be on the safe side, if they know you're Strep B positive and none were given in labour. As others say it's a really horrible experience for the baby, and for your to be a part of.

Also, you say you're up for a longer stay in hospital, but (perhaps especially if you've got hippy leanings?) you'll want to be home asap IMO! Don't underestimate the power of things like lying in bed with lots of skin-to-skin contact for establishing BF and bonding. In the hospital they don't let you fall asleep with the baby in the bed, and besides they take a dim view of you walking about starkers! Plus it's just much better to be at home.

If I were you I would instead research what you can do to support your body, to give you a lower chance of getting nipple thrush (it's not a given!). Also, to speak to your MWs about having an active labour with ABs. How will they give them to you? When I was giving birth I had a lovely MW, who was supportive of active labour despite me having to be monitored (for other things a well as this). Then she went off shift, and I got another MW who had no clue about active labour and wanted me on my back so she could monitor me .

I would urge you to write a simple birth plan detailing that you want an active labour (if you do) and make sure the MW you get on the day is onside by making sure she's read it and briefly discussing how she plans to cope with monitoring you. You can ask for a different one if you don't feel she's working with you. I don't mean to scare you - I think my MW was one rogue MW in a team of otherwise lovely and very experienced MWs. However among all the planning I did for the lovely natural birth I wanted, I did no planning around the implications of the medical bits, and I wish I'd been a bit better informed about them. FWIW despite all their interventions, I had a natural birth in the end anyway (as in no C-section) and a beautiful, healthy baby at the end of it

Sorry for the essay!

HTH

snowangels1: I don't think that you're insane. Whatever decision you come to, I think you're very wise to question what appears to be the status quo. If you decide to have ABs you will at least be clear and confident on the reasons why. If you don't, you will be informed about the risks you may be taking on for yourself and your baby.

The evidence for giving ABs to GBS positive women during labour isn't actually conclusive (e.g. see this Cochrane Review from earlier this year). In your position I would also want to weigh risk factors in the balance and decide whether it was the right thing for me and my baby.

Don't make your decision on the basis of other people's negative personal experience. These kind of stories are interesting and sometimes illustrative of broader public perceptions or trends. But they are not evidence on their own. Tragic things sometimes happen during birth. Some of them could have been prevented with intervention and some of them are caused by it.

I probably would have the antibiotics but for very subjective "peace of mind" reasons rather than because I'm intellectually convinced that it would be the best thing for baby. But it isn't true as some pps have implied that there's a cut and dried case for doing so. Without other risk factors, the case for giving ABs during labour is quite finely balanced. This is very much a personal decision.

My dd had high markers at birth and needed a lot of intervention, including anti-biotics drip, I had to sign that I understood that she might become death as a result ... It was an awful, awful time. If I could have had anti-biotics in labour to prevent all that happening I would have done it any time. My advice would be to focus on your and the baby's well being, surely it is better for you to have a drip during labour then your baby having to be on a drip for several days and potentially becoming death (it is one of the side effects of erythromycin and that is the anti-biotics your baby would probably get), is that really worth it???? Also, it is such a hard start if your baby has to stay in hospital and gets so much intervention, especially if you may reduce the risk of it by taking anti-biotics??

sorry, should have said deaf of course. Also, I don't want to pressurise you but I just wished so much I had been offered anti-biotics during labour so we wouldn't have had such a difficult time ...

I too immediately researched all that I could, even phoning a friend who is a MW. I only found out about being GBS+ after a smear test taken prior to pregnancy.

If you do decide to go with the IV AB's, a top tip is to have some mints on hand to suck, as you can taste the drug and it isn't pleasant.

Good luck whichever route you take.

Dikkertjedap, it's not a drip for IV AB's, it's a single injection via a cannula usually given every 4 hours whilst you are in labour; I had two doses which is the ideal minimum apparently.

When having DS1 i was tested positive for Streph B and i had the ABs in labour but they didnt give them to me quick enough and they then gave DS1 when he was bron - they failed to tell me that these AB can cause deafness (but thats a whole other story)

DS2 - i was not tested again but they presume you are Streph B positive - however by this point hospital policy had changed and they only gave ABs in certain risk cases - i had him at home no problem. Just told of the signs to watch for

DS3 - same Hospital and the policy as DS2 - in fact i dont actually recall them mentioning it

Firstly can I jsut say that I agree with everything Togarama said. A very well balanced, sensible and non sensationalist post!

My first baby was born GBS+ (I had not been tested and did not know I was GBS+), he was taken away at birth and given IV abx in SCBU, and remained there for a few hours. I was spared any trauma of seeing him cannulated as I was still unconcious in theatre and going into multiple organ failure, such was the severity of my infection. (My uterus was full of pus, even baby's mouth was full of pus ) Thankfully I was far iller than baby was, he was only in SCBU for a few hours and then had to return twice a day for 7 days for IV abx, but we were able to recuperate together in the post natal ward.

Am now pregnant with baby 2 and despite the trauma of what happened in my last birth I will not be accepting IV abx's in labour just becuase trust protocols say I should. As yet am undecided, although am erring toward having them I must say, but as has been said before, it's a fine balance. What happened before was a rare occurence, I have not been tested in thes pregnancy yet and will be asking my consultant about testing in late pregnancy. GBS is transient and am reluctant to give either myslef or my newborn antiobotics which are not clinically necessary. Antibiotics are not without their own risks and am sure have read there is a link between neonatal abx's and asthma.

There are some sobering stories here which certainly give a person pause for thought, but they are very emotive and can make it difficult to see the bigger picture.

Oh also I meant to say the resulting thrush in my breasts was EXCRUCIATING and made breasfeeding in the early days actually quite horrific. Had it not been for my bloodymindedness to breasfeed I would almost certainly have quit, but I was tortured by not being present when my baby was born and felt I owed it to him to make up for such a shitty start in life, what the pus and all.

This (to me) is a very imprtant part of deciding whether to take the abx or not. The (tiny) risk of baby becoming ill versus the real risk of breastfeeding problems. Formula feeding also carries risks to baby..... it's all just so complicated and not as cut and dried as 'please take the abx so you don't have to see your baby getting cannulated'

It was bloody mindedness here too IG, it is excruciatingly painful, I wonder how I didn't crumble my teeth sometimes.

Racmac, I feel sure that it's not the AB's that can cause deafness, it's the GBS+ that can cause it and many other things including the unthinkable.

I suppose the best way to decide is to think what is the worst thing that might happen if you did have the antibiotics and could you live with that

And what's the worst thing that could happen if you didn't have them. And could you live with that.

And then make your choice.