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.

This is also from the GBS society UK and suggests 1 does is adequate or am I reading it wrong?

"Babies born at increased/high risk to mothers who HAVE received antibiotics for more than 2 hours before delivery should be:
Carefully assessed by an appropriately trained Paediatrician or Advanced Neonatal Nurse Practitioner.
If completely healthy, no antibiotics for the baby are required.
A period of monitoring (12-24 hours) may be appropriate for those at highest risk of infection.
Parents should be made aware of the early signs of infection and given a handout about GBS.
Babies born at increased/high risk to mothers who HAVE received antibiotics for less than 2 hours before delivery should be:
Examined thoroughly and investigated by a Paediatrician as appropriate.
Observed for a minimum of 12 hours, ideally 24 hours.
If completely healthy, no antibiotics for the baby are required (antibiotics should be administered if there is any doubt)."

Hotair - some women do and as a midwife you're stuck between understandably angry, confused parents and immoveable paeds.

I may be using "carrier" in a non-entirely-accurate sense (although I seem to be using it in the same way as GBSS as they refer to "being a carrier at delivery"). 30% of women carry GBS in the gut and 25% in the vagina at any given time.

GBSS say "Research has shown that, whatever the result of a sensitive test for GBS (ideally ECM), then your GBS status is hugely likely to be the same for the next 5 weeks [...] if performed within 5 weeks of delivery, an ECM test giving a negative result is 96% predictive of GBS not being carried at delivery (4% of women acquired carriage between testing and delivery)", and "if the positive result was early in your pregnancy, you may have lost carriage by the time your baby is born."

I had a sensitive test done at 37+something (37+2, I think, so 16 days before delivery) that showed no sign of vaginal GBS. That means I had a 4% chance being a GBS carrier at delivery, while the average woman (who won't have been routinely screened for GBS) would have a 25% chance. I feel comfortable saying that I was almost certainly not a carrier of GBS at the time of delivery with DC3 and if hospital protocol had been to automatically give baby antibiotics even though I'd had the negative test then I would have resisted in favour of observation. I had the test specifically because I knew that the labour was likely to be fast and there was no way they'd get "enough" antibiotics into me in time, so I wanted an accurate picture of risk levels.

Yes, that's what I was hoping for, Tolliver. That I could get tested privately at 37 weeks and then come back negative and not need ABs at all.

However, the source you quote continues with:

"And a woman who has had any positive test result (from the urine, vagina or rectum) during the current pregnancy should also be offered intravenous antibiotics from the onset of her labour or membrane rupture until delivery."

So, it's not really clear.

What did your midwife say about your strategy? Where they happy enough with your reasoning?

Also, the risk of a baby getting infected with Strep B if no ABs are given are 1:300 if Strep B is present at birth and 1:400 if present in pregnancy but not at birth, so the risk isn't that different at all.

"If the positive test was from the urine, this means that the GBS was more
invasive, and so antibiotics will be recommended even if a vaginal swab is subsequently negative."

Ah, this seems to be the crux of the matter. As soon as Strep B was in your urine, AB's are indicated even if swaps are later negative. So it looks like I'll need the ABs anyway.

The question remains about how many doses. Will do some research now about what happens if you live in Germany, for example.

"Should be offered" is different from "really ought to accept". If you're operating entirely within NHS, bear in mind, you won't get an accurate GBS screen because their test has a high false negative rate (so would be very risky to rely on it as any kind of evidence of not being a carrier) so assuming still an active carrier would seem the best policy.

I mostly saw consultant because I was officially "high risk" for other reasons - her official line was that decision on ABs vs. monitoring would be made on consideration of all the factors, but that monitoring was their normal course anyway. I just wanted as much information as possible to be available under the "other factors" (plus you never know who you're actually going to see on the day and what their individual foibles are). In the event once we had the meconium everyone more-or-less forgot about the GBS, at least in terms of any discussions when I was present, and because of the clear 37-week screen it wasn't something I felt the need to drag up.

(Then paediatrician got something else wrong - completely unrelated to either possible infection source, but backs up my view that you should be as well-informed as possible yourself. In that case I relied on Dr. Actual-Doctor rather than Dr. Google, which was a mistake as Dr. Google was spot-on)

(Also, I was 90% positive I wasn't going to get ABs in time, so I was very focused on "what happens if when we don't?". Medical staff when I was pregnant saw that as more of a vague possibility that we'd deal with if it came to it)