GBS and home birth?

[lucy123]

I probably should be posting this on the "anyone contemplating a home birth..." thread, but that thread is v long and I thought this was quite specific.

I have just been talking to my midwife about the possibility of having a homebirth. And apparently there is a private midwife in the area who does homebirths (haven't checked out how much it will be though! ). But she (my midwife, not the private one) thinks there may be problems due to my being GBS positive. Does anyone know anything about this?

Lucy, I was thinking I ought to add a post about this in qualification to my posting on the Homebirth thread. Have you seen the Strep B Thread quite a way down under the Health topic?

I planned a hb, and made it...except for the last 15 mins!!! In terms of birth experience I would be v happy to go for hb again....BUT not if the same thing happened again, i.e my waters broke (leaking)almost 70 hrs before DS was born. It wasn't until 12 hours before he was born (i.e 58 hrs since waters broke)that the MW's did a swab for Strep B (GBS). I was horrified when told that DS would have to stay in hospital for 5 days on IV antibiotics. Had I known anything at all about this beforehand, I would have done what I could to insist that they intervene as much as possible (inc ceasarian if necessary) to get him born before the risk set in. I understand from reading the Strep B thread, and the GBS suport site, that if the mother takes antibiotics before the birth, then that reduces the risk to the baby...So, as I understand it, you should be fine to give birth at home if it is quick once the waters have broken, and / or if you are given antibiotics in advance.

I think this is something you need to discuss in detail with the consultant....I do feel slightly jaded about this, so apols if the following stirs up a hornets nest, but I did find that the MW's I had, homebirth specialists, were, like the NCT classes, so very campaigning about homebirth that they did tend to gloss over anything seriously medical...no-one mentioned Strep B to me, and for all the talk of womens' choice, I would have chosen intervention to the max for a quick delivery if I'd known.

Don't all hospitals or NHS area trusts provide some form of provision for a homebirths? You shouldn't have to pay, should you?Good luck.

thanks Blu and sorry to hear about your experiences!

Can't have an NHS homebirth as I am in Spain (see comments about the NHS being marvellous on the patriotism thread! ).

Last time I had IV antibiotics in hospital during labour but they didn't really tell me much so I don't know if they did a swab or not.

Still thinking about it. Luckily we are only 15 mins drive from the maternity hosp.

Aha! Sorry, missed it that you are in Spain!
Have you looked at the GBS support site?
I wonder whether you could have antibiotics at home?
I have to say I was quite freaked out when I read the Strep B thread: I had come away from hospital thinking they had just inflicted some unnecessarily over-medical procedure on my DS, and more worrried about the filthy state of their Dan hospital than anything DS could have caught from my body...now I realise how serious it could have been, and felt even more angry that they hadn't tested me even tho' my waters had broken so early.

How did they find out that you were GBS positive when they gave you antibiotics last time?

Hi Lucy

I know from the past that you have contributed to the Strep B thread and are aware of some of the issues. If I also remember rightly, the Spanish medical system are one of those who do routinely test for and treat GBS (good on them!!), so as such, they probably feel it is important for a birth to be in hospital when the mother has Strep B as they can administer antibiotics. The most effective way of doing so is intravenous, and this is unlikely to be available for a homebirth.

The question of homebirths and Strep B has been asked on this and other parenting sites, but, as yet, I have not seen any positive answers. Even the homebirth sites seem to be vague on the issue.

As Blu has suggested, please do contact GBSS group as they are best placed to give you information. Meantime, it would probably be a good idea to find out from your midwife what testing etc is carried out in second (or more) pregnancies and indeed if they have a Spanish equivalent of a support group.

Let us know how you get on.

butterfly

Blu -were you positive though ????
The protocol tends to be that if your waters have gone for more than X (24) hours then you should stay in hospital... it is a preventive measure.
It's nothing to do with HB.
If you know you are GBS negative then you can have a leak for days.
This is a controversial topic generally anyway.... as the tests are not 100% accurate, in some countries you are automotically tested.
Also some will say that if you are not having any vaginal examinations from the time of the leak, the infection risk is very very low (I don't think they can say inexistant).
Best practice says that once you have a leak you should not be routinely examined anyway.

Thanks everyone. And sorry for lazily not searching the site properly before posting a new thread!

As the others say, they do routine blood tests for GBS in Spain (and a million other things - I am a pin cushion). In my case it is almost 100% positive too as my mum says she remembers us getting streptococcus infections when we were little (my sister was extrememly ill and was tested at the time).

I somehow didn't think that antibiotics at home would be a problem but that's several people who've told me that now so perhaps I should listen. Sigh.

lucy123, I carry Strep B too, I wanted a home birth with DS2 but was told that it was not possible to have the antibiotics at home as the midwives in my area were not able to administer them. As far as I understood from my discussions at the hospital if someone had been able to give me the antibiotics in labour at home there would have been no problem. All the best.

Good luck, whatever you decide to do, Lucy123. I think I could go for the homebirth, but only because my Spanish friends just had their first and the father simply wasn't allowed to be present at the birth; hospital policy=no fathers. If your local hospital were like that, I simply wouldn't trust them to know what they are doing.

thanks zebra. As far as I know, fathers are allowed at this hospital, but I have just spoken to someone who gave birth there 2 years ago and she said they put all the babies in a nursery and she had to fight to breastfeed.

It does turn out that midwives routinely administer antibiotics here so I might be OK. I'm still thinking - the big downside is the fact that traffic is terrible here and I don't know how long it would take to get to the hospital in an emergency. I think we should do a timed journey at rushhour to find out.

Pupuce: YES! I had never heard of this, the MW did a swab 48 hours after my waters started leaking, (without explaining what for, and I was too busy breathing to ask) DS was born 12-14 hours after that, and then the hospital told me that the swab was positive later that morning. WE had to stay in hospital for 5 days with DS on IV antibiotics. I would have done anything necessary to avoid that, including Cesaerian, or interventions to speed up birth....even tho' I had a v happy labour at home (until DS got stuck), so I can v much understand the nature of Lucy's dilemma.

I would have thought that the job of a good midwife is to know when to transfer you, if you do need transferring, to get you there in time. Issue to discuss with the IMW, maybe?

Aha blu- I understand your comments on the other thread now- and why you are so cross. It's so difficult to make an informed decision when you aren't given all the facts isn't it.

Exactly, Jimjams! As I understand it, there is no risk to babies of Strep B/GBS mums if the birth is within 24 hours of waters breaking, OR the mum is put on antibiotics 4 hours before birth.
I wonder if I should write a letter pointing out how unhappy I am with what happened? I don't ant to get into a formal complaints procedure, but do think they should tighten up their practice...
Sorry if this is highjacking your thread, lucy - how are you getting on?

No worries Blu!

Still haven't spoken to the private midwife so don't know.

But how does the 4 hours before birth thing work? Does that mean if I can't have a home birth I need to get to hospital sharpish (rather than when I'm chewing on the mantlepiece as somebody suggested on my other thread (preparing for birth in a dark ages hospital)?

I must say though, your experience has made me realise that neither the Spanish nor the UK systems get the balance between medical risk management and patient choice right. Things are very heavily medicalised here and, as I say, GBS testing is routine.

Also I think a letter would be a good idea, but it may be better to write it to the local paper rather than the hospital - I think in many cases with these things you have to make a formal complaint or be ignored (damn litigous society).

I was also under impression that if you have the baby too quickly, like in less than 4 hours, than there is no point in antibiotics, they won't have time to work.

Blu, to clarify a few points (and based on GBSS support literature)there is still risk to those babies born less than 24 hrs after the waters breaking, albeit a much reduced one. Also, the giving of antibiotics for four hours does not mean there is no risk, but very thankfully it has been shown to be effective in stopping most GBS infection in newborn babies.For these reasons, a baby should still be assessed as well. Hopefully this makes sense to you.I hope you don't mind me posting this but much as I support information/testing/treatment, it is important that people realise there is still a small risk and that babies do need monitored. Why not have a chat with the support group about your possible letter, they may be able to help advise you on this as well. Good idea though, in my opinion, to help raise awareness and hopefully standards. Good luck.

Lucy123, hope you are well and that all your planning is not tiring you out. It is good that you are giving this plenty of thought, well in advance and hopefully you will get the best birth situation possible for your circumstances.

butterfly

Hopefully you are

This might be helpful
here

Got interrupted earlier. To add to the info on the link, homebirth is discouraged where I work as intravenous antibiotics are not given in the community. One of the reasons for that is the risk of anaphylaxis - the mother may have a severe allergic reaction to the antibiotic therefore it is safer to be administered in hospital. Oral tablets are not effective. There is a belief that if the group B strep has been detected in the mum but that a previous baby was not affected, then the risk of infection is low. If the baby is term and the membranes have not been ruptured over 48 hours, and the mums temperature is normal then the risk of infection is low. However, babies have died from this infection without those risk factors. I don't think I could choose not to have antibiotics in labour.

Thankyou, Mears. That certainly clarifies things!

Think perhaps its best to go with a hospital after all - I did have GBS in my last urine sample (says on that site ths is a big risk factor, although the lab report just said "Contaminated, need another sample" ). Dd was not affected, but then I did have intravenous antibiotics last time.

Must find out if there are any other hospitals...