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 possibly being really stupid here - but for those of you who have had + results, is this because you have self-tested? Even though I have heard of GBS before it was never ever something that my midwife discussed with me and i'm curious...

They tested me (without my knowledge) because I was having recurring UTI's through my pregnancy. AB's wasn't shifting it, and when I was 34/5 weeks, I got a letter through the post telling me I was GBS+ and should speak to my mw and gp asap.

Chunkamatic
I ony found out I was psitive for GBS in qst pregnancy when I had a swab for another reason (query leaking waters I think) and even then no-one told me until I was chatting to a MW about homebirths and she said "Oh well you can't anyway because you've got Group B Strep!"
At the time I had NO idea what it was and was really upset thinking it was something really awful, so that's how I found out!

I haven't read all the way through, but I think the message from the GBS website is that given that your baby did not go on to develop GBS last time, there is no need to assume that you are positive again this time - you need to get the reliable private test at around 35-36 weeks. This will solve all the issues really - either 1) you will not be a carrier and can happily go ahead with a homebirth, or 2) you will be positive and if you then present with other risk factors (listed on the site) you should probably opt for hospital and IV antibiotics. As a measured approach, you should try and discuss with your midwife what the key issues are if 3) you do test positive but present none of the other risk factors (early or prolonged rupture etc) - I have to say that for me I would still try and push for a homebirth in this situation, whilst being prepared to transfer if indicated at all (maternal temp rise, prolonged rupture etc). But if you start labour with any of those other factors I would think long and hard before still being at home.

First time, I was tested because I thought my waters had broken early (nope - just peed myself!). They took a swab as routine.

1st pregnancy I was never tested, Second pregnancy my lovely lovely midwife tested me several times because of the absolute dread I had of a repeat of another gbs+ baby. Third time round I had a really, realy bad upset stomach at about 8 weeks gestation. The gp was worried it was salmonella or something else dodgy and so I had to provide lots of "samples" one of them came back positive for gbs so it was a done deal.

This time round I foolishly assumed I would be tested as a matter of course. I had a routine appt with a consultant very early in the pregnancy and asked If I would be given ab's in labour and was told only if I tested positive, I then asked when I would be tested and was told I wouldn't unless it was necessary

errm don't really get that??? so I told the consultant no problem, but can you please write your full name and contact details on this piece of paper? He said sure, but why so I explained that it was so I could sue him personally if my baby had gbs.

Funnily enough he booked me back in to be tested later in the pregnancy. Of course I may not test positive but at least i'm being tested...

I've been told that if I ever get pregnant again, they may not actually test me for it, but because I have had a positive result in the past, they will always automatically treat me with AB's through any future labour and delivery, regardless of test and result. Even if they did test after 35 weeks, and it was negative, they'd still treat me

I think you need the AB every four hours during labour.

Wow at that consultant kitkat. I would totally assume that with a history of a GBS+ baby you would be tested without question. It seems everyone is getting such variable treatment.

I found out I was gbs+ during my first appointment with my MW. I had an MC last year, and had had an infection afterwards. The GBS came up then and was marked on my notes but noone ever told me.

These notes were added to my file, so when I saw my MW for the first time she told me I was a GBS carrier, not to worry, but that I would have to be treated with ABs. We didn't talk about it at length, but we bloody well will do when I see her at 20 weeks!

In the USA women are tested routinely and offered antibiotics. It has not decreased the rate of babies that have problems or die.

In the hospital I work in the policy is to offer antibiotics to someone who has it in a current pregnancy, and they can be tested if they have had it in a previous pregnancy, if they want to, but they are not routinely offered antibiotics.

GBS is known to be transient, so it is stupid to assume once a carrier always a carrier. Also if you were a carrier first time around and your child is ok, then that reduces the risk of the next child having problems.

There are minor side effects to antibiotics and for some people major risks, it is not something that should be done as a just in case, unless really necessary.

However,It would be strongly recommended in the case of someone who has had a previous child who has been ill with GBS, a known carrier in labour before 37 weeks of pregnancy, a raised temp in labour, or someone who has had ruptured membranes for more than 18 hours. (although would prob only give abx if over 48 hours unless known carrier.) different hospitals do different things.

This is helpful information here

homebirth information regarding GBS

littleboyblue, they told me the same after dd1, but it seems to totally depend on what consultant you see as to what info you are given and what descision is made. Unless "someone" actually writes "antibiotics in labor" on your notes then you don't get them. (thats what consultant for pregnancy no3 told me)

Oh right kitkat Good job I'm not planning anymore dc's then. Had my lot now. Never again

Thanks Mears I'd seen the second link not the first already - will check out the first.

i wasn't tested for dd but was for ds and was positive. Ds was very ill with scepticemia due to GBS despite antibiotics during labour (thanks to an unexpectedly fast labour) but thanks to the VERY swift actions of the midwife ie.he was sent up to the neo natal unit within 5 minutes of being born, he was fine after 5 very traumatic days.

I can't help but think that if I had given birth at home and it had taken that extra time to get him to the hospital, things could have been much worse. A little bit of research later let me know just how lucky he was.

My advice would never underestimate the severity of GBS. Yes it's unusual but the effects can be devestating.

Mears just found this paragraph from that first link:

When antibiotics are not necessary

If you carry GBS in your vagina, you should not need antibiotic treatment:

• if GBS was detected in your vagina in a previous pregnancy and the baby was not affected
• during pregnancy, unless you have a symptomatic infection (for example, a urine infection) though you may require antibiotics in labour.
• if you have a planned caesarean section before you go into labour and before your waters break.

The reason why antibiotics are not usually needed in these situations is that the risk of your baby becoming infected with GBS is so low and because antibiotics do not reduce your chances of carrying GBS at the time of the birth.

So that would mean that I didn't need them? Am v confused!

Forgive me for not reading all the posts but with ds1 i was tested positive with GBS and had antibiotics in labour - but because they refused to take me to the delivery suite because they didnt think i was in labour i didnt get the antibiotics in time - therefore ds was given loads of antibiotcs as a precaution - turned out he was fine BUT the antibiotics can cause deafness - they didnt tell me this until 3 or 4 days later. They were giving him 3 lots of antibiotics a day and after each injection they were taking blood to check the "levels" these went really high meaning he could have been deaf - thankfully all was fine.

The Hospital then changed policy and do not routinely screen anyone anymore - they say there are too many possibilities and therefore its pointless - as a result i went on to have 2 hb with no antibiotics and tbh it wasnt even mentioned the 3rd time.

I think if you are aware of the symptons of GBS in lo then you will be fine - they can always take bloods and get cultures which will tell them straight away if baby has it

Picante - that is correct, you wouldn't need antibiotics. I certainly think we are over treating in labour and the current NICE guidelines also state that treatment should not be given unless there are definite risk factors such as preternm membrane rupture, high temp etc.

Excellent. Thanks so much for that link mears I will show it to my midwife.

Reading with interest. This is my second pregnancy and I have tested positive for Strep B. I live in Spain and the tests are routine here. My DS was born in Scotland at 41+2, waters broke 15 mins before he arrived and the birth was a quick one. I didn?t have a fever and he was fine. Here you have no choice about having the Abs in labour. That in itself makes me very uncomfortable because I have read up about GBS and given my past experience, the risk of this baby contracting GBS is likely to be low and I am concerned about the impact of the Abs on a baby that probably would not need them. I am allergic to penicillin so will be given something else but on the whole I tend to have issues with Abs. I would rather have them all myself rather than see a new born baby with a canula but I am worried I won?t have time for that as DS1?s birth was a fast one. I do have real concerns about the impact of Abs on a newborn

Picante - there was a section on the GBSS site about homebirths and the ability of having an intramuscular penicillin injection sorry I can't remember more of the detail as it didn't apply to me.

i was tested for gbs in first preg, because I had DS in Belgium and they test all women. So had antibiotics in labour.

second baby in Holland 8 weeks ago, I mentioned first experience and they said they wouldn't test and a homebirth was no problem.

I read up on the risks and had a home water birth with no probs.

just my personal experience but I just went with what the midwives here said, and they said they're not going to give antibiotics to so many women...

Found out i had GBS after giving birth to my first,i had a high temperature during labour so they tested me and gave us both anti-biotics,so glad they did as my dd tested positive as well,had to stay in hospital for 9 days while dd had anti biotics,second time round they just gave my anti-biotics as soon as i went into labour and we came home the next day,would like a HB next time,hoping i could just be given AB either at hospital and come home or MW could give them,or have baby at hospital then come straight home,hate being in hospital!