Any experience of GBS and/or IV Anti-B's at homebirth?

[MelissaM]

DD1 had suspected (never proven) early onset Group B Strep at 21 hrs old. I had a lovely and fairly quick homebirth and would like a homebirth again. (I had a few niggles for a couple of days before contractions started more regularly at 12 noon. They kicked off properly at 2.45pm and dd born just after 5.)

I understand that in some areas IV antibiotics can be administered at homebirths by the mw's (although I think you have cannula fitted at hospital). Does anyone know which areas do this? Or of oral Anti-B's being used instead of IV? (This was mentioned as a possibility after DD born).

Also, does anyone know of any area where, or have any experience of, homebirth being supported for GBS carrier?

Hospital won't test for GBS in this pg. They assume present if suspected or present previously. They are currently rewriting their GBS policy and I have been asked to get some info to support what I want to do, before my next consultants appointment on 6th April. Am also seeing MW on Thurs (normal appointment) but hopefully we will be able to discuss some of the options too.

Any information greatly appreciated. I have also contacted AIMs and checked out Homebirth.org

Before anyone has a go at me about not taking risks into account - I am not taking undue risks. I am happy to take oral or have IV anti-b's (despite the risks to mum and baby), as I realise this is the best way to avoid GBS infection. However, I don't want a hospital birth for various reasons, including avoiding intervention, increased risk of infections, quick labour, etc etc. I am happy for baby and me to go to hospital after the birth for checking out, and even to stay for monitoring.

I had such a lovely and relaxed birth experience last time, that even given everything DD went through, she was a remarkably chilled baby.

hi, My first born had GBS and we were in a hospital, second was treated (as was I) in hospital and I had some sachets of antibiotic powder incase i went into labour at home (didnt)

not sure how this can be feasible for a home birth. Think you would need to speak to your MW about this.

Not sure if this is much help because I am in Belgium. I had a home water birth with my second despite being GBS positive at the time. The midwife gave me IV antibiotics about four hours before the birth and after the birth dd2 was regularly checked for any signs of infection. She was fine. I developed a nasty case of thrush though.

With my third birth the GBS came back negative at about 40 weeks so I didn't need antibiotics. Ds was born at home and again given all the relevant checks for the followinf few days/week after the birth.

If you want IV abs at home you will need a doctor to prescribe them and find a midwife who can administer them.

Do your research and I hope you can have a safe home birth.

I was tested GBS positive with DS1 and he was born in Hospital although they didnt get the drugs into me in the 4 hours before he was born despite me being induced there
But they were truly shocking in every sense of the word "care"

By the time i had DS2 - 4 years later they had changed the policy so that antibiotics were not given in labour at all - only if baby had actually developed infection - so they didnt test me but presumed that i was still GBS positive but that made no difference.

I had hb with DS2 - no problems - i was told what symptons to look for and keep close eye on him - i think they tested him as soon as he was born.

DS3 - dont think it was even mentioned tbh - hb - again he might of been tested but I cant remember

Would you consider getting a private GBS test nearer full term to help you decide? I had GBS with first baby (didn't know at the time and she was not affected, it was just a positive swab due to waters being broken a long time)

I was offered the option of IM antibiotics with with HBAC but I decided against as I was fairly low risk. There are some RCOG greentop guidelines on this here

My area don't offer IVABs at home AFAIK but there is no real reason they can't. No need to be in hospital to have cannula fitted as it is simple to do (I know because I can do them) However I have heard that some places want to give first dose in hospital too, in case of allergic reaction. Which is a bit mad, because if you are allergic the first dose may sensitise you then you go on to have a massive reaction to the next dose

I found the links of homebirth.org.uk really helpful too.

thanks for the quick responses!

racmac - what area were you in when you had your hb's? just so I can refer hospital/mw's to their policy if necessary.

Thanks M

have discussed testing with hospital and even if I pay for a private test which comes back negative, they will still assume it is there!

West Midlands - if you need more specific than that let me know

They dont bother testing because its one of those things that you can be positive 1 week and negative the next week

But you could decline the abx if you were happy you were negative? The NHS test is crap anyway And I am not anti medical at all! Just pro 'informed choice'.

AFAIK acc to the current guidelines, you should only be offered abx for labour if confirmed infection in previous baby or extra risk factor like GBS in urine/fever in labour/prolonged ruptured membranes.

Are they supportive of the homebirth or do you think it's all a ploy to get you in hospital?

Not sure how supportive they are to be honest. MW I saw at the hospital this week was very supportive and enthusiastic, although my community mw doesn't seem quite so enthused! The registrar was initially "you will have the baby in the hospital and be on IV abx" but then after listening to the information we had already found out, seemed to be coming round to the idea that there are actually options.

Am thinking about the private test which is much more reliable than the nhs one. Only 24 wks so have a little time to decide. Hadn't thought about declining abx. MW in my area don't give iv abx apparently.

I was offered the option of going into hospital for the cannula to be sited and the first dose of IV abs, then going home for the next 4 hours. It wasn't any good for me as I have quick labours and wouldn't have wanted all that travelling around.

Thanks all.

Had my mw app and she was really supportive. Explained that even if consultant recommends against homebirth I can still have one - just may need to sign something to say doing it against consultants advice. MW going to support me anyway.

She was also v positive about the private test and that if negative at the right time, we can discuss whether to take antibiotics.

Here's hoping the consultants app goes well on Tues

Don't know if thi helps, but I tested positive today for Group B, was told by hospital midwife that it wouldn't necessarily affect my hb, only if membranes went 24 hrs before labour got started, and if I had prem birth - but am over 37 weeks now anyway.
she said in those cases they test the baby, and if psitive, give them antibiotics.

However, least of my worries, as baby is breech and have had protein in urine (but possibly due to strep) and occasional high blood pressure (but only when midwife takes it at my home..shes a cow, and mainly concerned with parking her car if I do have homebirth...go figure!)

good luck, will be checking to see how you get on, if my baby decides to go bum up after an ECV on tuesday, will then be onto the strep issue and still trying for hb too...

Holytoast, how did you get on with your hb plans? Hope DC turned and you managed to get your hb.

If anyone is interested, I finally saw consultant on my third hospital appointment and she was happy for me to have a hb. She was of the opinion that IV antibiotics can be given too much, which causes other problems. Only need to go to hospital if pre-term, membranes ruptured for more than 24hrs, or temp in labour. Also, as had quick labour last time, unlikely to get IV abx in time even if in hospital, so no point making me leave the house where relaxed and comfortable. Not even particularly concerned that have had +'ve private test result, although redoing test this week.

Have also seen a paediatrician who was also happy for no Abx in labour. Gave me two options for after birth:

1. Baby and I go to hospital for baby to be monitored for 24 hrs
2. Stay home, and be vigilant.

Again he doesn't like just giving abx without good reason to, and theoretical risk is v low (less than 1/1000). Has never know GBS hit a family twice. He gave me a list of things to look for/be concerned about, but also said to trust my own instinct. If I think something isn't right, just to go with it. Also now have direct no for neonats, if I have any concerns after birth.

Now just got to keep my legs crossed for another 9 days, then will be 37 wks and can have my hb.