Help me make a difficult decision between homebirth and antibiotics for GBS

[Picante]

Hi all I'm expecting baby no.2 in August.

With DS I tested positive for Group B Strep so had IV anti-biotics in hospital during labour.

I got incredibly bad thrush in both breasts afterwards, which led to me giving up bf when ds was 5 weeks. DS also got thrush in his mouth. I'm sure now that this is due to the antibiotics.

I'm only 26 weeks so not yet been tested for GBS but the midwife has said they'd assume I'm positive anyway. I want to have a homebirth - ds's birth was epidural/ventouse and I don't want that this time.

Midwife has said that if I have a homebirth I can't have the antibiotics. I'm not sure I want them anyway as I don't want thrush again - I'm so determined to bf this time and succeed.

I guess I just have to weigh up the risks of not having the GBS anti-biotics. Midwife said she'll talk me through all the signs of GBS to look out for after the birth so that I'm well informed.

I'm really interested in your thoughts.

I'm in a similar situation

I'm a GBS carrier. Only found out when I was tested in my second pregnancy after having continuous UTI. I had AB's during labour and had to stay in hospital with baby for 48 hours after delivery as he was on 4 hourly checks for his temp, feeding, heart-rate and pulse.
They told me there was a huge chance I had it when I had ds1 and he was fine.
However, a friend of mine lost her baby at 10 weeks old because he caught sceptacimia(sp?) as a result of her not being treated for GBS. They didn't know she was a carrier until the birth.
He was her 2nd pre-term baby. He was born at 25 weeks and his big brother was born at 29 weeks.

If you are aware of all the possible symptoms after delivery, you'll know what to look for I suppose.
It's your call really, me personally, I wouldn't risk it.

Awful story lbb. So sorry about your friend.

I had gbs with my first two and refused abs because of allergies. I also left the hospital 6 hours after dc2 was born. They gave us thermometer strips and advised us to check her temperature for several days. This was fine and we were told what to watch for.

Now there's always a risk with gbs but there are particular risk factors such as premature labour or a long period between waters breaking and birth. Personally, I felt my risk was low compared to my risk from abs, but if my waters had broken early, I may at that point have decided on abs.

Personally I would also feel that gbs didn't pose enough of a risk to warrant giving up a home birth. My gbs had passed by the time I had dc3 but I wouldn't have let it stop me, mainly because I felt that hospital birth posed a significant risk to my physical and mental health.

Good luck whichever way you choose.

LBB that is a very sad story, and I hope I don't cause offense by suggesting that that poor baby's immune system was greatly weakened anyway because he was born so early? Obviously if I become a high-risk pregnancy then there is no doubt I will be in hospital with the abs.

Thanks for all your thoughts so far.

Picante You won't offend me, don't worry. Yes, if he'd gone full term, he'd have had a much better chance. Not too sure why I put that in tbh
Anyway, like Carmen says, maybe you should weigh up the risks against the benefits and decide which is higher.

I'm a bit of a worrier anyway, and the minute I found out I was a carrier, I went straight to the hospital and demanded to see a consultant and told him he had to induce me so it could all be controlled and treated from the off. I have no idea when ds1's water went. They asked me when they did an internal after I'd been pushing for 2 hours and I don't have a clue, so I was too worried about the waters going without me noticing (yes, I am that stupid!)

I haven't had to make the decision as I've never been tested to my knowledge. My starting point, however, would be that as long as I didn't have any factors that increased the risk (prem labour, maternal temperature, UTI, PROM, etc) I would choose NOT to have the ABs and stay home, but would be prepared to keep a very close eye on things in the days following the birth. There are risks in every course of action in life and it isn't always easy to make a direct comparison - at the end of the day you have to choose the set of risks that you feel most comfortable with.

I do think you're very lucky with your MW in that she seems happy to discuss the pros and cons and support you in making an informed choice rather than telling you what you "have" to do. Good luck whatever you decide

WHy would they assume you are positive?

I had GBS for my second birth. I gave birth at home, in a birthing pool, having had IV antibiotics earlier in the labour. I did get bad thrush and it was treated with fluconazole. It was a very 'safe' birth with my waters not breaking until the very end. The midwives very regulalry checked dd2's temperature for a few days after birth. She was fine.

With ds, I tested negetive, so did not have antibiotics. I had a second home water birth and ds was fine.

Oh Riven

I would also go for the ABs because I have a friend whose DD got meningitis as a result of GBS and now has quite severe disabilities.

Having said that, I would get tested though and not assume - then you'd be making an informed choice.

Ladies its also important to know that the tests are not always reliant because GBS comes and goes. You may test negative one day and positive 2 days later. So a negative result doesn't mean its not there at all just not on that day. If you've been tested positive previously you may still have it.

Is the risk of a brain damaged or dead child worth it? I'm sorry if I sound really opinionated but I can't for the life of me understand someone putting something so precious as a baby at even the slightest risk for the sake of a birth experience.

So why if it's so risky is it still not routinely offered to pregnant women? Apparently one in 3 have it.

Riven I know a little of your story and I'm so sorry. Thanks for your advice.

I'm watching this thread with great interest as am also a GBS carrier. I was thinking about doing an ECM test after 35 weeks and then deciding what to do based on the results of that.

I've more or less resigned myself to having a hospital birth with IV ABs. But after reading your post picante, I'm concerned about possible implications for developing thrush. I REALLY want to BF.

Also I am first timer, so I have no idea what having a hospital birth and being hooked up will mean. I had hoped for a fairly active birth and wonder whether this would be inhibited.

Like others say, would rather not take unnecessary risks.

Picante From what I understand, they don't routinely test for it because you could be positive 1 week and negative the next. Even if you test pos 5 weeks before due date, doesn't mean you'll be positive at time of birth.
Like I said earlier, it's your decision and no-one elses, but I know what I'd do.
Hope all goes well.

Did they give you information leaflets on GBS? Have you looked it up on-line?

I think I read if it goes untreated, it's 1 in 4 that don't survive

I am due on Monday, and have been discussing this with my MW today - I had GBS in my first pregnancy, treated with antibiotics during labour - didn't have any problems with thrush or breastfeeding.
I have had two lots of swabs sent in this pregnancy which have both come back negative. MW has discussed it with delivery suite today, and the concensus is that it's down to me whether or not I have the Anti - B's. However, my white blood cells and some of my inflammatory markers are raised on my last lot of bloods, so I think that I will be having the anti biotics - I know that the risk is tiny, but it's still a risk to my babys health, and one that I'm not willing to take.

Not having ABS also does not guarantee that you won't get thrush. I didn't have the ABS with DC1 and DID get thrush in my breasts.

Thrush is easily treatable with Daktarin available from the pharmacy which you can put on your nipples to treat you and then let baby suck it off to treat him/her.

Even so, I would rather bottle feed my baby or put up with the pain of thrush than risk baby contracting GBS related illnesses because the consequences of this can be so tragic.

Sorry to go on but this is something I feel really passionately about. These are obviously my opinions only and represent MY stance. I by no means intend my remarks to be seen as telling others what to do!!

I'm not sure that having the antibiotics administered during labour totally takes away the risk of GBS. My midwife seemed to think that there could still be a potential risk, hence checking the baby very regularly for a temperature and other symptoms.

I tested positive for GBS with DD2 (they picked it up while testing for something else). I didn't have the test for DD1. With DS and DD£ I was in Spain where they routinely test, and was negative both times. I agree with PP who says it's something that comes and goes, so you can never really know.

I do not know what the protocol on giving ABS is now. With DD2 (born in UK) they gave IV ABS during labour. However, you needed 4 hours' worth. Even though I went into hospital only a couple of hours after waking up and realising I was in labour, I still delivered her after only receiving about a few minutes of the ABS. In fact, I seem to remember shouting that she was crowning while the MW was still trying to get the drip in my hand.

So, I would also factor into my decision how likely receiving an effective dose would be. Perhaps your MW could help with this.

As a result of the lack of Abs and a slightly raised blood count in DD2 we stayed in hospital for 48 hours, but all was well. I was glad that they knew to check her and keep an eye on her.

I was postive for GBS with ds1 and had to have antibiotics (which they refused to give me until a lot later than recommended, and it meant ds1 had to have them too and stay in hosp with me for 5 days but with subsequent pregnancies, I tested negative each time so didn't have to have the antibiotics at all during labour.
Not getting the antibiotics in time would be the main concern esp as even in hosp it doesn't always happen in line with what the GBS association guidleines are - with ds1, they kept putting it off and saying to me no, it's too early but when they finally realised I needed them there wasn't a doctor to be found as it was shift change-over and so the delay meant a lot of unnecessary upset and worry about whether maybe ds1 wasn't protected.

Everything in pregnancy and birth carries a degree of risk. You could argue for a wholly medicalised birth to manage every particular medical risk, but it would introduce its own risks.

Personally, a hospital birth would have meant a C-section (not in the UK) and I found that risk to my health both mental and physical to be unacceptable. Having IV antibiotics carries a risk too. I think it's a very personal choice as to what you do. If you have high risk factors for gbs, you will probably want ABs. If you have penicillin allergy, you may not.

I have issues with home birth being seen as a luxury or a selfish decision. No mother wants to risk herself or her baby. But mental health is important. If a traumatic birth leaves you depressed, you heighten your risk for suicide and become more susceptible to physical illness. There may also be bonding or feeding issues which carry their own level of risk etc. etc.

Yes, GBS can be very serious but the actual risk of serious harm is low in normal deliveries compared to other risk factors which are not so often stated. Each woman should assess her personal choice of risk. It's not quite the one-size fits all that we are sold IMO.

Thank you all so much you have given me a lot to think about. I need to research the actual risks a bit more I think.

I've heard that a garlic clove up your fanjo every night for a couple of weeks gives you a negative result but as you say, I could test positive the week after.

I'm just wondering if I wanted to have the ABs but still have a homebirth if I was within my rights to go into hospital in early labour to have the ABs then return home for the birth?

My midwife recommended the garlic thing but luckily I tested neg so didn't have to try!

She also said swabbing with some kind of disinfectant could minimise the risk and this might be worth investigating.

I doubt they'd let you go home again after ABs but it's worth asking. Don't you have to have them every x hours through labour? Someone who knows better will probably be able to answer.

A bit of googling shows the antiseptic is chlorhexidine. There is evidence is substantially reduces bacteria but not enough studies have been done to assess whether it reduces the actual risk to babies. My midwife highly recommended it as an alternative option though. (In the USA with a very non-interventional but well qualified midwife)