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.

If i remember rightly - they gave him ABs whilst waiting to see if the cultures grew anything or not.

They gave him the AB then drew blood to test it and if the results had gone over a certain limit then he was at risk of deafness - i was told this is an off hand manner " oh you will have to take him for hearing test as these drugs could have made him deaf"

It was not the GBS - he didnt have it - they chose to give him ABs anyway

racmac, they did the same with DS and just gave him AB's without waiting for the cultures to come back.

As far as I remember they never gave us a clear answer on whether he had GBS+ or not, as they said the culture wasn't clear and the lumbar puncture failed...

It is the ABs that carry a risk of deafness, which is why they keep tabs on their blood levels very assiduously. They ought to offer a full hearing test shortly after the course finishes though. DD3 was tested before we left hospital and is absolutely fine. A risk of deafness we could live with in her case, given the potential alternative...

"What Complications Does GBS Cause?"

Most often, GBS colonizes the baby during labor either by traveling upward from the mother's vagina into the uterus, or as the infant passes through the birth canal. Illness occurs when the bacteria enters the baby's blood stream. This can then lead to shock, pneumonia, and meningitis (an infection of the baby's spinal fluid and brain tissue). In certain cases, evidence exists that GBS may cross intact membranes to infect the baby in utero. All of these conditions are life threatening. This year alone:

an estimated 2000 babies will die;
large numbers will suffer permanent handicaps such as brain
damage ranging from mild learning disabilities to severe mental retardation, loss of sight and hearing, and lung damage (full statistics do not exist for the total number of surviving babies who will have these permanent handicaps);
others will survive with no long-term damage.

Thought I remembered correctly.

Information about gentamycin, which is one of the drugs in the GBS protocol.

Looks like there's a possibility of 'damned if you do, damned if you don't'.

The fact that GBS can cause deafness does not mean that ABs cannot do the same thing.

During birth a baby is colonised with bacteria from the mother. Given these are bacteria the mother's immune system is broadly familiar with, she will already have immunity to some of them (those that are internal as well as external) and will have passed that immunity on to her baby while in the uterus. If the mother is given IV ABs during labour and the are effective, the mother's vagina should be pretty free of bacteria during the birth. The baby will be colonised by something - all surfaces are - but it will be whatever bacteria are around in the hospital room. Anyone care to name any bacteria found floating around lots of NHS hospitals at the moment?

Side effects of most ABs include death to the recipient - and if a woman in labour goes into serious anaphylactic shock, the outlook for her unborn child isn't going to be too great.

After all that, I agree with Togorama's post as well (and she stayed a lot more rational than me ). The issue is far more complex than that you can avoid/minimise all risk to your baby by taking IV AB's if you've ever tested +ve for GBS.

I think YABU. If you can take AB's to prevent a potentially life threatening condition then you should. I can't believe you are even thinking about AB's. Thrush is unpleasant but hardly a big deal.

I too agree with what togarama posted here.

There are risks with AB's (fivecoldringsforsolo - yes some certain antibiotics can cause deafness, not the routine ones given for gbs but some others).

For me I did indepth reading around when I found out I was GBS+ with my third child. I ooked at the risk factors and knew that if any of them were to occur then I would accept the antibiotics. It was very likely that I had unknowingly had GBS with both my previous births. But for me I had a very fast 2nd birth and the likelyhood of another fast labour was high, and living an hour from the hospital, the likelyhood of me getting the two required doses 4 hours apart was very low. Also knowing the danger time in labour is after the waters break and that my waters broke late in labour previously, I knew that overall I would probrably be low risk. However I was ready to go to hospital as soon as labour started and accept the ab's if suggested. My child had other ideas and came so fast that he ended up being an unplanned homebirth! When the attending m/w rang the hospital to say we were ready to transfer by ambulance to the hospital if needed (for the baby to be monitored or given a/b's etc), the hospital said it was ok for me to stay at home and just watch for any signs of infection for 48 hours. (fast labour meant reduced likelyhood of baby contracting GBS)

Please don't refuse ab's if there is any of the risk factors, as you have already read from the stories on this thread the consequences are tragic. The evidence is clear in at-risk cases (clearly indicated on the GBS website, eg prem baby, prolonged rupture of membranes etc), that the use of antibiotics far outweighs the negatives from antibiotics.

However in non-at-risk cases, it is much less clear-cut if there are any clinical benefits at all, and the risks from antibiotics can be more than doing nothing. It is a difficult decision when there is no clear specific risk involved.

What shocks me is that it is not routinely tested for in the UK :(

Seriously ,it is a disgrace .

Mums should always have the option/knowledge ,some are blissfully unaware and are positive ...that is not fair .

Galwaygal, I was never told that and didn't read it when researching, but I did read about the risks to the senses if baby was infected.

Doley, it's about cost I expect although the actual cost is very small...also, just because you prove to be GBS+ or not, it can change within days, so unless you manage to have the test and results a couple of days prior to delivery, those results cannot be relied upon.

I found out when I was pregnant with ds2 that I was a GBS carrier.
It never even entered my mind to refuse the drugs.
OP, I would make an appointment with your consultant to have a proper in-depth chat about it and the risks.
I was so worried about the dangers, that I demanded to be induced so the whole labour and delivery could be as controlled as possible.
When I was in labour with ds1, my waters broke without me realising and as that is where the risk for the baby is, there was not a chance I was going to risk it knowing I was positive for GBS.
They agreed to my demands, and I was induced 6 days before due date.
We stayed in for 48 hours after birth so ds2 could be regularly observed.

Op I really understand your reservations/fears about having IV antibiotics as I felt the same leading up to the birth of DS2 13 weeks ago. I also have anxiety issues and taking medication is one of the things I find difficult unless it is tried and tested.

However having looked into the pros and cons I decided to have them, for me it was about knowing I would not be able 'forgive' myself if DS was one of the unlucky ones, unlikely as this was.

I also tend to react badly to antibiotics in general although nothing serious , but I always get sickness diarrhoea and feel generally off colour.

However, for some reason the IV antibiotics did not affect me at all !. In fact I kept waiting and waiting for the 'effects' to kick in but they never did, it might just as well have been water they hooked me up to!

I felt fine and Ds was born fine and I gaine a large amount of peace of mind knowing he would not have to have IV meds. (DS 1 needed a lot of blood tests when a babe and I literally cracked up over that so god knows how I would have coped with a baby in SCBU :-(.

During my trawl of the literature pre DS2's birth i found a paper stating that in the US where testing for GBS and giving of AB's is more widespread ther had never yet been a case of matrernal or infant mortality attributed to iv AB's and as another poster has said ther are lots of good things that can be done to counter thrush etc if you do develop it (which in all likelihood you wont!)

My baby passed away from early onset infection. The docs couldn't identify the bacteria responsible. I was never swabbed and had no symptoms.

In this preg, I will have routine swabs from 35 weeks and have opted for caesarean to avoid ABs - consultant said they aren't necessary for CS.

sh77 :( I'm so sorry.

Thanks so much for all the advice, referrals to places of info and stories (and sorry to hear all the bad stories ). I ahve just spoken to my mw who has researched the matter for me - apparently my hospital won't routinely give me abs just for testing positive unless I have another risk factor, in which case it will be strongly recommended (and in this situation I would accept willingly). I'm fine with this. I will hope to be tested again in a few weeks nearer labour to see if it's gone though.

snowangels - I test GBS+ for DD3 after being swapped for discharge in 2nd trimester. I refused to have anti-b just because I was GBS+ as 1 in 100,000 mothers die due to anaphylactic shock from the anti-bs.

As I had two other children I couldn't take the risk of me dying from a prophylactic dose of meds even if it meant DD3 died (horrific having to think that through but I'm sure my older DDs would much rather have had me than a newborn baby). I hated having to think it through like that but we all have to make choices and in this case that was the choice I made

I would have consented to have anti-bs if there was just cause (not prophylactically though) this is from my birth plan:-

Please note I have been tested positive for GBS previously in this pregnancy. I have had another test at 36 weeks and am waiting for the results. If the test result comes back negative, we will proceed with the home birth as planned.

If it comes back positive, and I have a premature rupture of membranes with no active labour following, then I will transfer in for intravenous antibiotics.

If it is positive and I go into preterm labour, then I will go into hospital for labour and delivery of our baby.

If it is positive and I haven?t had a PROM and my pregnancy has gone ?full term? then I intend to labour at home as planned, but will transfer into hospital if I have a fever.

I ended up with a hospital birth as I had had 3 weeks of pro-dromal labour and DD3 had passed mec. before birth. I didn't get any anti-bs as waters went at 2.30am and DD3 was born at 8.30am so well within the timeframe considered 'safe'. We did stay for about 36 hours post birth but had no tests or bloods drawn and DD3 didn't have an anti-bs given either. She was fine though obv. not a guarantee for your baby.

Good luck for the rest of your pg.

Hi,
I havent read all the posts so forgive me if you have had baby by now. Just wanted to tell you my experience. I am not a big believer in strep testing and although my sister in law had it, tested positive and had baby early and in scbu I still didnt think about it when i was having my 3rd baby. Day after i had my 3rd son i was discharged with clean bill of health for both me and baby, 2 days later he was rushed back in, grunting, high temp, was one of the scariest things i have seen. Discharged hours later only to be rushed back in again and put on IV anti biotics for 11 days due to strep b infection. I didnt think anything of the strep b/anti biotics at birth saga even after seeing my nephew suffer. Would never hesitate now so honey please please just be safe and have them. It is horrific seeing your child scream because their temp is so high. Please just be safe and have them x

A friend of mine just had her newborn baby, Josef, die of GBS. I also know another girl who had a little boy die from GBS a few years ago. She has never gotten over it.

It is just not worth the risk.

"please just be safe and have them"

But isn't it important to acknowledge that they don't always work?

There are no guarantees.

From Cochrane index 2010:

"This review finds that giving antibiotics is not supported by conclusive evidence. The review identified four trials involving 852 GBS positive women. Three trials, which were around 20 years old, compared ampicillin or penicillin to no treatment and found no clear differences in newborn deaths although the occurrence of early GBS infection in the newborn was reduced with antibiotics. The antibiotics ampicillin and penicillin were no different from each other in one trial with 352 GBS positive women. All cases of perinatal GBS infections are unlikely to be prevented even if an effective vaccine is developed."

And of course at a population level there are serious risks to routine use of antibiotics in labour.

It is very emotive but there are much bigger issues surrounding routine testing and prophylatic antibiotics, and it cannot be cut and dried. decent article explaining why

Personally I would decline prophylactic antibiotics if I had no further risk factors.