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 had this problem with dd1. I managed to persuade a GP to prescribe the antibiotics (don't forget you need water on the prescription) to be administered intra muscularly (rather than the usual IV route). I then had to find a MW willing to administer the injections. All horrifically stressful in my last weeks of pregnancy but I was desperate to have a home birth.

MrsFogi was it worth the stress?

Carmen thanks for that I shall investigate.

I have researched this lots but cant type much (feeding baby).
Friend's baby nearly died from gbs.
In your position OP, I would only have the antiBs if

1. baby was going to be born b4 37 wks gestation. Or @) I was + at about 36 wks (you can test at home for this) and I met one or both these risk factors: waters breaking before labour established or if I was running a temp during labour.

I didn't feel antiBs were advisable, otherwise.

I wanted a hb with DS2 (would have been a HVBAC). However, my waters broke, and I didn't go into spontaneous labour. They did a swab the day they broke, which came back GBS +ve 96 hours after my waters broke. At that point, there was no hesitation, I went straight into hospital for induction and antibiotics.

As it was, DS2 stopped breathing at birth, and ended up in NICU for lumbar punctures and a couple of days of IV ABs himself. Everything came back negative thankfully.

However, if I'd had a straightforward pg and delivery, knowing in pg that I was GBS +ve, I would certainly have considered getting ABs prescribed for the HB. For me, it was just all a bit too last minute, and I'd already had a big fight for the HB (previous c/s, DS2 had kidney problems diagnosed at in utero which required prescribed medication and arrangements to go in for tests, I had PE with DS1.......), I just couldn't face any more conflict, and place DS2 at any more risk.

Just to add - my DD1 had two weeks of 12 hourly antibiotics because she got meningitis from GBS.

If they even suspect your baby has a GBS infection, they will treat it with ABs. That means a canula going into your baby's hand, through which they push the meds. This is very painful for the baby. They will also consider a spinal tap. Your baby will also have daily heel prick tests and be in special care.

That is the reality.

Sorry to be blunt but I would not risk my baby's health just because i wanted to give birth at home.

And I certainly wouldn't want to spend the first few weeks with a newborn wondering if they have a GBS infection.

my friend's DD had meningitis at 10 days old which led to severe special needs/ ASD, friend had GBS which was not detected before giving birth. I have GBS and got given ABs during labour, I wouldnt have considered any other option. My 3 DC's health is much more important than birthing experiences. I brestfed all 3 with no problems.

If you have to take anti biotics when breastfeeding then its worth taking acidophilus (probiotics) capsules.

The problem with any anti biotic is that they destroy the good bateria as well as the bad. This is why that women on anti biotics are more subsceptible to thrush.

Swallowing acidophilus (probiotics) capsules helps to reintroduce the good bateria into the gut.

As far as homebirth goes, I think you need to research the risks and make up your own mind.

Thrush is a bloody nightmare. I had it without taking antibiotics.

But Daktarin is great. Use plenty at the first sign of thrush and it kills it off pretty quickly.

Just to add, they say you should have a corse of AB's at least 4 hours before delivery, not 4 hours worth, so they will put you on 4 hourly courses. When I went in to be induced they hooked me up and gave me a course every 4 hours. Each course lasts 20 minutes.
How I understood it, was that the AB's would travel through the placenta and 'wash' the baby clean.
They took swabs off my baby after birth, they came back positive for GBS as he had it on his skin from delivery. If I hadn't been treated, would he have caught a related infection? Would he have been left with severe medical problems or even possibly dead? Or would they have had to put him on IV AB's? Neither of these, I wanted to see.

Although there is no guarentee your baby won't still become infected, being treated does lower the risk a huge amount. But unless you know a family who have lost a baby to this, and haven't seen the devastation it brings, it may not seem as big a problem than if you had iyswim.

Thanks all. I didn't have thrush on my nipples I had it deep inside the breast which was far far more painful than the horrifically wounded nipples. Anyhow Reallytired I had forgotten about the acidophilus - will definitely get some of that.

I don't think I can make any decision until very late on in the pg when I can get a test which is annoying for a planner like me, but I think if it comes back positive I will - having read through your thoughts - take the abs, although I will try to somehow get them at home.

Thanks again.

Goodluck.
Hope all goes well, and you find the way that is best suited to you and baby. x

I tested positive in my first pregnancy. Baby did not get it and was not ill. And tested negative with my second (did the GBSS 'recommended' test at 37 weeks not the NHS one).
I decided that if I met any of the risk factors - prematurity, raised temp, ruptured membranes etc. - I would go into hospital for IV antibiotics even with the negative result. But not if I didn't.
There are risks to ABs too. This is not about 'the birth experience'. This is about weighing up risks for the baby. I spent a lot of time reading and pondering and feel confident with my decision.

I don't think any of us are putting birth experience over the health of our baby. It's all about weighing up the risks, and trying to get a good birth experience and a healthy baby. It should not be one or the other.

As other posters have pointed out, there are potential problems with antibiotics in hospital - for a start- making sure you get them on time and that someone is available to administer them. And antibiotics is stiall no guarentee that the baby will be healthy.

My midwives in Belgium are trained to administer IV antibiotics, I don't understand why NHS midwives aren't.

hackneybird - as pps have said taking a course of lacto acidophilus (from the fridge at the health food shop) will really help prevent thrush. Change breast pads regularly. Keep on top of latch and find latching advise asap if needed (as damaged nipples are at greater risk). Consider grapefruit seed extract supplements if you have a strong history of vaginal thrush. It's really not inevitable with ABs if you are careful.

Not much weighing up to be made in my opinion.
GBS infection in a neonate, I would lower the risk of that however I could

Thrush is unpleasant (had it with both mine despite no antibiotics).

But if I had to weight that against the risk of a seriously ill/brain damaged baby, I don't think there would be any competition really.

Thrush is at the most about a few weeks in your life.

People are being very simplistic about this.

There's a lot of 'A baby with GBS? That's the worst thing that could happen and I'll avoid that at all costs.'

But you could argue the same with a lot of other outcomes.

A mother commits suicide or develops psychosis or has serious PTSD? No competition, I want to minimise that risk.

Anaphylaxis? Absolutely not.

Blood clots from an emergency c-section? No thank you.

Thrush infection in my breasts screws up breastfeeding with depression risk factors for mother and loss of immunity for baby?

etc. etc.

Now I'm not trivialising the risk of GBS+ - it has a potentially very serious outcome, but in a normal delivery, the risk of that outcome is very small. Just like the risks of any of those things I've listed above.

But given certain factors, that risk increases rapidly. Just like the risks above.

Now depending on your medical history, your risk for any of these outcomes will vary. But they're all /possible/. And risks have a tendency to spiral. A thrush infection could effect breastfeeding could effect bonding could trigger PND could trigger suicidal feelings. The risk of each step increases with each previous step. Risks have a tendency to spiral. That's why a 'birth experience' is important and not just a luxury.

There /is/ weighing up to do. If I had opted for a hospital birth this time round, I would have needed a C-Section for several reasons. My first birth was an emergency C-Section, I needed a general anaesthetic because the epidural wouldn't take properly. I'm hard to anaesthetise.

There are considerable risks involved in an emCS under ga ranging from the physical risks of surgery to mental illness. PTSD almost ruined my life the first time round. I avoided them with a home birth and would have opted to do that even GBS+ but with a watchful eye on the situation and possibly a change of plan if I'd developed other risk factors (PROM etc.)

Please, please don't insult us by saying 'You're putting a birth experience in front of a baby's health!' - no-one is doing that. But a birth 'experience' can have very, very serious outcomes, mentally and physically which CAN in extreme situations spiral to very unpleasant outcomes including maternal or infant death.

We all want what is best for both our baby and ourselves. I'd die for any of my children. And I did considerable research to manage my risks in all my deliveries.

But that's what it is - it's risk management. Just by getting pregnant, you're risking your life. By putting your baby in a car, you're risking the baby's life. It's a very small risk, but it's there. The key is to manage the risks and to make the very personal decision as to what poses the biggest risks to you and what is most likely to give you the outcomes you want and avoid the outcomes you really don't want. This is why you can't just say 'well, obviously I don't want my baby to die so I'll take antibiotics.' It's /not/ that obvious.

I wish that health professionals could personalise their care to that extent but realistically they can't. There are political reasons that they have to follow the NHS guidelines (why hasn't more research been done into the use of chlorhexidine when initial studies are so promising?) and there are practical reasons - they just can't spend that much time personalising and tailoring care to every individual woman so set general guidelines that suit the average woman.

Carmen has a point. You need to weigh up all the different risks.

And some of them are going to be totally dependent on your own situation.

It is not the case that everybody is more at risk of trauma from a caesarian for instance. I had an emergency section and was far less traumatised by that than by my vaginal birth. I also found breastfeeding much easier to establish as did not have to sit on the infected scars from combined tearing and episiotomy. Riven is obviously still suffering from the effects of her disatrous homebirth, since her dd is permanently disabled and with a severely reduced life expectancy.

Otoh we also have many posters who are still struggling with the fallout of things going badly wrong in hospital. Or who are traumatised by bad birth experiences in hospital.

So yes, there is no one safe way.

It might be worth looking into the statistics of all the options: how common is it for the babies of GBs carriers to develop medical problems and of what severity? How common is it for PND to develop after different types of births? How common is it to get thrush a) with antibiotics b)without antibiotics (most women I knew seemed to get it anyway, without antiobiotics)?

Once you have all the figures, it's going to be easier to weigh up the risks.

All we can supply is anecdotal evidence, and that is naturally be going to point in all different directions.

Absolutely, Cory. That's a really balanced way of looking at it. Taking the statistics and adjusting as best you can for your own circumstances.

I think it is perfectly natural for people who have suffered a traumatic birth experience to want others to avoid it if they possibly can.

Maybe it's hard for me to see it objectively but I feel it is important to let people know about the reality of what happens if your newborn has a suspected GBS infection.

It's hard to look beyond the birth, sometimes, and it's important to know what will happen.

I'll say this. It's bloody hard to BF a baby in special care with meningitis. It's bloody hard to watch them screaming at all the unpleasant things they have to go through and know that the outcome is not certain.

Bald facts and figures do not give you an idea of this. You could look at the 'facts' and think; 'well the chances of my baby dying are very small,' but it gives you no idea about the treatment or its consequences.

I'm sorry, my viewpoint is not objective but every time I see a thread like this, I cannot let it go because I would hate anyone else to have to go through this for the sake of a few antibiotics.

Why is there no national screening programme if one in four women are carriers for Group B Strep. I have to admit that I had never heard of group B Strep before this thread.

This link is quite interesting

group B Strep

Just to quote part of the article.

"These adverse effects make some doctors more cautious about using antibiotics if there is not a clear need to do so, particularly for newborns. Some prefer a "watch and wait" approach for the first 12 hours after birth before starting a course of antibiotics that may not be needed (RCOG 2003:7-10). "

It states there is a 1 in 2000 chance of transmitting to the baby. Certainly if you are in a high risk group then you need the anti biotics.

However antibiotics are not without their risks. For example if you baby is allergic to pencilin then that could be dangerous.

Picante - for me there's no doubt that the home birth would be so much better. GBS comes and goes in carriers so there's no definite way of knowing it's active when you go into labour.

Probably the most important thing is to watch your newborn. If there's the slightest doubt about a high temp, take him/ her to A&E immediately.

Lots of people are saying 'I wouldn't risk it' but I did, having weighed up all the pros and cons of home birth. There are many more things that can go wrong in hospital once you start down that route.

As a parent, you are in the best position to decide on yours and your new baby's health. (try getting any 2 health professionals to agree on anything, and it's clear there's never ONE right way)

Good luck

There's no screening programme in UK because it costs money the vast majority of women who are gbs+ at some time in pregnancy, their babies are unaffected or only slightly ill with it. So not screening means avoiding a huge amount of unnecessary & invasive treatment (which has become routine in the USA for women who have ever been gbs+ in any pregnancy(!)), with all the risks that a high-intervention birth entails.

It's a very complicated thing to risk assess.

This is obviously a v difficult issue for lots of people. I am pregnant with no4. With no1 I didn't know that I was gbs+. She was sick lots, we had to rush her to a&e more times in her 1st couple of months than I can remember. She had a menigitis type rash each time and was one of the most frightening periods of my life. Although I hadn't had any antibiotics at all I still got thrush in both boobs - I struggled with it for 6 months before I was finally diagnosed with thrush in my bnreasts and treated. I went on to feed her for 13 months when she self weaned. With dd2 and my ds I had the antibiotics in labour. The knowledge that I wouldn't have to go through the fear and worry of a gbs+ baby again made it a positive birth experience for me on both occasions. I still got thrush whilst breastfeeding both of them so it would seem I'm inclined to get it anyway, at least I knew what it was and got treated v quickly on both occasions.I fed dd2 until 18nths and am still feeding my ds.

I am intending to go into hospital to have baby no4 and I am hoping that they will give me the antibiotics, ironically there is no guarantee that they will even tho i've had a child test positive and then tested positive twice in subsequent pregnancies.

Its a tough descision to make, but I know I am hapy with my descision. I have had a totally natural labour twice now other than the antibiotics and in spite of them both being in hospital I have had v positive experiences.

good luck with your decisions everybody...

Gosh. I think I'm going to have to read this thread again and again. I'm seeing a midwife in a couple of weeks and I will have a good long chat with her.

Obviously I would never risk my baby's life if I could do something about it...