Who do you ask for advice if you think your midwife gave you wrong information?

[CheeseFondueRocks]

Just that. Saw my midwife today and she gave me some information about the Strep B protocol at my hospital but I'm pretty sure she's wrong. I always see the same community midwife so don't really get the chance to ask someone else to clarify.

I got a leaflet this time about 'Supervisors of midwives' who are meant to do just that - information or a point of call if you don't get on with your midwife. There should be something in your notes and a number to call?

The thing is, it's not like I don't get on with her. I just don't believe what she said. So I'd like to find out anonymously if possible so I don't look like an annoying cow, if that makes sense.

Could I phone up without giving my name?

What did she tell you?

You could just ring the labour ward and ask them, I doubt they'd even ask for your details.

Look it up on the NHS/other reputable website to check if you're in doubt. Or cord-source info on MN.

sorry, crowd-source

I can't find the info at the moment but am sure I read about it somewhere before.

I'm a Strep B carrier so will need IV antibiotics in labour. There's also the possibility that I have a penicillin allergy (I had a reaction as a child) so would need the alternative antibiotics. While the Penicillin is given every 4 hours, the alternative is only needed every 8 hours and due to this being DC2, the midwife thinks i's very unlikely that I will have enough time for more than one dose of the alternative antibiotic. She also said that I would need at least 2 doses of whatever antibiotic before the birth in order to protect DC2 from the Strep B.

Now, I'm pretty sure that I read that while 2 doses of Penicillin are needed, it's only 1 for the alternative antibiotic (given I give birth before the next dose is due of course). If this was true, it would safe me a lot of hassle as I'm planning a water birth so having a venflon in will be somewhat of a pain.

What did she tell you and what is your doubt?

When I asked my MW about group B strep she said that it is a well-known point of contention as OBs and MWs tend to have v different approaches to it. She said that many MW are sceptical of private tests and dislike the additional interventions needed in the case of a diagnosis. Don't know if this is relevant to the advice you've received.

I found the Strep B Treatment guidelines for my hospital and this is what is says about adequate antibiotic treatment:

"Treatment of Babies
Following delivery, it is necessary to assess the adequacy of the intrapartum prophylaxis.
Intravenous antibiotics starting at least 4 hours before delivery is considered adequate."

"Mothers wishing an early discharge who have had one dose (or more) of antibiotics 4
hours prior to delivery, may go home, ensuring the baby has fed well and shows none of
the warning signs in the time up to discharge, with advice given as necessary."

Would this not suggest that even 1 dose of ABs is adequate as long as the actual birth follows no earlier than 4 hours later?

Sorry, cross-post

It'll be clindamyacin that you need. It is eight hours apart and I'm not 100% sure but I think your midwife is right about you needing at least two doses.

cheesefondue your info just shows how much difference there is between different hospitals. Where I work if mum only got one dose of penicillin baby would be on Iv abx twice a day for five days or until a swab result came back as GBS free.

Thanks Viva! What do you think about the statement in the hospital policy of 1 dose being considered as adequate? Does that only refer to the Penicillin then or is it a bit of a grey area of what different hospitals define as adequate?

I know you're a midwife, Viva, so you might be interested to see the whole document.
It's the current version and I have been surprised to read about so many different protocols on MN.

www.nhsforthvalley.com/__documents/qi/CE_Guideline_WCDLabourWard/PreventionofEarlyOnsetGBS.pdf

rcog guidelines don't mention how many doses

Just be aware that you may not be allowed a water birth if you have group B strep; that's the protocol at my local hospital.

Strep B is not a contraindication for a water birth and I know that my hospital has no problem with it.

There's some good information here if you are being refused a water birth just because of Strep B, Tiger.

www.gbss.org.uk/content.php?sub_id=15&section_id=3

Thanks cheese ill read that in a minute.

I think where I work we go a bit OTT to be honest. Rcog guidelines say no need to give healthy babies antibiotics but to observe for I think 12 hours.

We don't follow this. If mum hasn't had at least two doses baby gets abx. Also even if mum has had six doses if she's prolonged rupture of membranes then the paeds insist on iv abx for the baby. And paeds also insist that prolonged is 18 hours or more even though all evidence says 24 hours.

But it's difficult when the paeds say its their area of expertise.

That's good to know thank you!

I had a lovely water birth but my sister has been told she has group b strep and so can't use the birth pool. Will be passing that info on, thank you!

The interesting thing in the Forth Valley guidelines is,

Intravenous antibiotics starting at least 4 hours before delivery is considered adequate

So anything less than 4 hours is inadequate. If they get to 4 hours then they should have the second dose. So I think those guidelines are saying you need two doses. If you get to 4 hours and don't have the second dose then the regime hasn't been followed.

The grey area is clindamycin.....as it wouldn't be given again at 4 hours. Mmmmm, I'll have to look at our protocol at work tomorrow as I can't remember.

I was "officially" a GBS carrier with DC3 (because I had GBS show up when I had a UTI at 10 weeks; I had a private GBS test done at 37 weeks (not the NHS test, which has a high false negative rate) that showed no GBS so I'm reasonably certain I wasn't actually a GBS carrier) and I had a quick labour so no time for any antibiotics. At my hospital they would just have wanted to observe for 12 hours (as it was, there was meconium in my waters so they needed to observe for 24 hours anyway).

Tolliver, how can you not actually be a Strep B carrier though if thy found it in your urine?

Same story here btw. Strep B was found in my urine at 12 weeks and was meant to be treated with oral antibiotics as per protocol. However, my GP doesn't like to prescribe ABs in pregnancy if avoidable and because I was pretty sure I had given a contaminated sample (only a few dribbles due to dehydration and no symptoms of a urine infection), she wanted another culture. So I handed in more pee and that sample came back clear. It would still mean the Step B was in my vagina or otherwise it couldn't have contaminated the sample.

When I had DS, they told me I had tested positive for gbs as they discharged us from the hospital, and said I didn't need antibiotics, but to keep an eye on DS 'in case he looks odd' like that is useful advice with your first child! So clearly different trusts have different policies!

Yes, Viva I see what you mean. I's not a massive issue in the grand scheme of things but it would be lovely if one dose of clindamycin was enough because then, I could go into hospital, have my ABs and if it looks like I will give birth within 8 hours I could just have the venflon removed which would mean I wouldn't have to stick my arm out of the water. That's my thinking anyway.