Precipitate labour and Group B strep - help

[Indecision2020]

My first labour was really fast - 2.5hours from first contraction to baby being born. I’m due again and had planned a home birth as I’ve been advised that the second will likely be quicker.

However, I’ve just found out that I’ve tested positive for Group B strep (picked up in routine urine test), and they now recommend that I have IV antibiotics in labour, and will need to go to hospital for these (so no home birth). From what I’ve seen online the antibiotics ideally need to be given 4 hours before birth, if it’s less than 2 hours before they are much less effective if at all.

I don’t know what to do! I doubt I’ll make it to hospital on time - we live a 25 min drive away but don’t have a car. DH would likely have to stay with our toddler as no time to make other arrangements. I’m terrified I’d end up giving birth alone in an Uber and missing out on the antibiotics anyway, but that’s effectively what hospital are advising me to do.

Any advice or experiences would he gratefully received!

Bump!

I do know someone who had a home birth with GBS, it was against advice, but they couldn’t refuse. Probably a planned homebirth is better than an unplanned one.

GBS is a difficult one because not all hospital trusts routinely give antibiotics. If you don’t have antibiotics then baby will need to be monitored closely, so you may well transfer to hospital for that, which is an option.

Maybe have a chat with your midwife to find the least worst option.

My first labour was precipitous, contraction to birth was an hour. My second labour (12 months & a day later) was 4 hours from start to birth. I was advised it would be very fast and to get to hospital as soon as contractions started but it wasn’t as quick. My 3rd & 4th we’re quick though but inductions.

We live a 35-40 minute drive from the labour ward so understand your anxiety about getting there. All you can do is get there as soon as contractions start, it may not be as quick this time, all labours vary.

This is probably the most balanced information on GBS:
evidencebasedbirth.com/groupbstrep/

But do chat with your midwifery team and see what they think is best now.

Thanks so much for the replies. They’ve just told me to come in and get the IV antibiotics. Haven’t addressed the fact that I might not make it in at all/in good enough time to get them at all. I’m due to speak to my midwife in more detail but would like to have as much info as I can before then if possible. I think it’s going to be a gamble of one kind or another. Really not ideal 🙁

I think probably the plan that they would like is for you to come to hospital. But maybe just ask them what to do if things are happening too quickly. If you want the home birth because the speed is worrying you more than the infection then ask whether you can still have it.

I think (but am no expert) that the main concern with gbs is longer labour where baby has more chance to catch it. And maybe they could do a swab in labour? To see whether you have active gbs

Can't advise on the GBS I'm afraid but I've had 2 precipitate labours. For the sevond, they said that the on call community midwife could follow our car in to the hospital if needed. Didn't need it in the end as we were able to dash for hospital pretty sharpish.i phoned maternity at the first hint of a tummy twinge and said very clearly that I had a history of precipitate labour. They were fab and said go straight in.

Just ask your midwife what they suggest.

Hey, my first labour was an hour and ten minutes. After we found out I ahd Group b strep. They tested me at 35 weeks in my second labour and it was negative but was still to go get antibiotics. Anyways I had her in 45 minutes and there wasnt time so instead we were kept in for 48 hours to keep an eye on us both..it was almost 11 years ago so I'm not 100% sure but I think they did a heel prick a couple of times and swabbed me in labour too to check and I didn't have it..

Third time I got a swab at 35 weeks and it was negative so was told I didnt need it that time anyway.

Do NOT go against their advice and have a home birth. You and the baby need to be kept a close eye on you especially if you dont get the antibiotics which you likely wont have time for.

I’d probably argue my case for a home birth with a hospital stay for observations afterwards, but do your research. There’s a Sara Wickham book called group b strep explained (but I haven’t read it)

@Scbchl

Do NOT go against their advice and have a home birth. You and the baby need to be kept a close eye on you especially if you dont get the antibiotics which you likely wont have time for.

I guess I might not have a choice though, depending on the speed? And if I can’t have the antibiotics anyway does it make a difference whether the baby is born in the hospital/en route to hospital/at home as long as I go straight in for observations afterwards? I’d be happy to go in if I knew my labour would be long enough to get the right dose, but I don’t think there’s any way of knowing unfortunately. I’m going to have to decide whether to risk going in and not making it or risk not going in and miss out on the chance of the antibiotics it seems.

I think if you’re really fast then even at the hospital it’s not guaranteed they will get the abx sorted in time. Option of home birth and hospital monitoring seems most pragmatic.

From this article it seems that fast labour reduces the risks anyway www.sarawickham.com/articles-2/the-war-on-group-b-strep/

There is no easy answer but antibiotics are not a “no risk” option. Just a different risk.

They can give the newborn antibiotics if they don't get to give them before birth.
Two of mine were given them as neonates, the third I had them in labour instead.

I have some experience - last labour I was GBS positive and labour was v fast (under 1 hour) - I was in hospital already because I was 33 weeks and they got the cannula sited but didn't have time to get the ABs in before delivery. In my case baby had to go to neonatal and have IV ABs himself anyway and that would have been the case regardless of my GBS status. That doesn't really help your situation though... Are there any sort of prophylactic oral ABs you can ask for as a precaution?

I don't know what I'd do about the home birth issue, I've had two precipitate labours but in both cases waters had gone prematurely and I was in hospital anyway which was kind of ideal!

@BwanaMakubwa did your babies show symptoms or did they give them the antibiotics purely because you hadn’t had them? (And did you need them because you were GBS+ or was there an additional factor?)

@FraterculaArctica yes in some ways it would be easier if my waters went first as I’d go straight to the hospital and feel like the antibiotics were more justified. Similarly if the baby was preterm or I had a temp in labour. It seems strange that having GBS in urine at any point in pregnancy is an equivalent risk factor to those ones, where the logic seems much clearer to me.

Is it because if it shows up in urine it means you’ve got loads of it? I’m being treated with oral antibiotics now to clear the UTI and my understanding is that the GBS can come and go, so it may not be present by delivery, or is that not possible in my case?!

Hi
My first 2 were for risks in labour - extended srom and high temp in me.
3rd where I had antibiotics in labour was because of that history in first 2.

@Indecision2020 that’s a difficult and complex question to answer. It’s entirely possible that you will be GBS free (or not detectable) during labour, but the turnaround time for the swab is too long to be useful in the decision making.

The antibiotics policy is a blanket one - it’s to further reduce the already small chance that a baby might contract GBS and become seriously ill from the mother. My understanding is that the chance of passing it on is already quite low, but of all the babies who get GBS only a small proportion become seriously unwell (the numbers are in those links above in this thread - it’s a while since I looked at them). But whilst the likelihood is quite low, the severity of that event is quite high (some babies do die, and some have lasting health issues). Blanket antibiotics reduces these risks at a population level, but sometimes there are other options that are appropriate, at an individual level. Ultimately, these are decisions that only you can make - and you need to make them with your healthcare team. You don’t have to follow standard protocol if you want to do something different, but the protocols exist for a reason.

I think the main point is that if the situation escalates and antibiotics aren’t an option (because of the speed/location of the delivery), there are ways of dealing with that. Good luck!

I think I would want to be heading to hospital in your shoes - you might get there in time for the antibiotics to give some cover and if you / baby were to become unwell you’d be in the right place / on the way to the right place.
I am biased though having developed group b strep sepsis myself in my first labour. I went from well to ITU level sick very very fast. GBS is usually just a bacteria you carry and not an issue but it also causes horrendous illness in babies and mums.

They need to be helping you make a plan here, them telling you to get to hospital at least 4 hours before delivery without taking your circumstances into account is not good enough. I hope your talk with the midwife gives you some clarity but if you don't feel you've been listened to I would call pals or someone higher up the chain - is there still such a thing as a supervisor of midwives? One option could be a planned induction so that you're definitely in hospital in time but they need to listen and help you

Thank you @DFAMA that’s exactly what I feel like. I hope the conversation with the senior midwife provides some clarity. My own midwife basically just said you have to come in to hospital, no home birth, that’s that. Of course it’s totally possible this labour will be longer which would make things a bit easier.

I’ve considered asking for an induction but I know that carries its own risks. I felt so lucky with the birth of my son - it was so fast and straightforward - and I feel like I’ve let my daughter down already that her birth isn’t gping to be like that. I know GBS is common but I feel horrible for having it 😢

If your first labour was 2.5 hours there is no way you are going to get 4 hours of antibiotic coverage with your second labour. You might get a bit of coverage, which is better than nothing, however if you are having a fast labour the risk of the baby getting GBS disease is vanishingly low. The main risk factor for GBS disease is prematurity. The others are prolonged rupture of membranes and fever in labour. The trouble with a blanket policy is that although it's the best thing on a population level, it might not be the right thing in your individual situation. Monitoring the baby for signs and symptoms afterwards is another option (or knowing the signs to look for if you're at home).

I had GBS in both pregnancies. My second was born en route to hospital an hour after I’d been told not to come in as they didn’t think I was in established labour.

The ambulance crew who attended took me and my newborn into hospital to be checked over and then we were admitted for my newborn to have a blood test and antibiotics via cannula every four hours until the test came back negative.

@Medra did you give birth in the car or in the ambulance? This is my big fear!

And did your newborn show any symptoms or did they give the antibiotics as a precaution? I’d much rather have them than my baby if I had any choice in the matter at all, but it’s quite possible I won’t.

Aww op it's so frustrating. I had a fast labour with my first. Didn't have contractions just a sudden huge bleed and went into hospital. Started contracting on the way and had her twenty minutes after arriving. I'm pregnant again and nobody seems to have any real suggestions about how to manage it. It's really worrying and that's without group b strep in the mix. It's not good enough at all. Could you ask to be induced maybe? So you could definitely be in hospital?