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Old Jan 9th, 2011, 08:47 AM   1
PeanutBean
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Group B Strep Support Thread


This is a thread for those ladies who have been told they are carriers of Group B Strep. Having talked with some other ladies we thought it would be a good idea to have a common place to post links, advice, guidelines etc to help us get the homebirths we want went faced with negativity from the medical profession (and others) in light of our new special status shared by only a third of the whole population.

I've only just started looking into this but what I'll do it update this post with the most useful and up to date information as and when we find it. So here are some links that I have found useful so far:

This site has a wealth of information and links and I believe reads in a fairly balanced way, not denying the risks of infection in newborns but realistically assessing the liklihood and the pros and cons and evidence surrounding common treatment protocol.
http://www.homebirth.org.uk/gbs.htm

This is the FAQ page of Group B Strep Support. This site has current guidelines and recommendations for the UK and as I was given a leaflet from the group by my MW I assume is accepted by the NHS too.
http://www.gbss.org.uk/content.php?s...ction_id=3#q20

If I was to pick a single article that I found extremely helpful at present it would be this:
http://www.aims.org.uk/Journal/Vol15...roupBStrep.htm

This is the summary of guidelines by the Royal College of Obstetricians and Gynaecologists, there is a link to the complete recomendations.
http://www.rcog.org.uk/womens-health...disease-green-

This is from KandyKinz who found this review of the ancient and sparse data used as the basis for Iv antibiotic administrtion:
Quote:
PeanutBean - I found a Cochrane study you may find of interest.
http://onlinelibrary.wiley.com/o/coc...467/frame.html
http://www2.cochrane.org/reviews/en/ab007467.html (summary of the above)

Apparently while the antibiotics has been shown to decrease the risk of GBS infections it has had no impact on mortality rates or long term morbidities. When the potential risks of wide spread utilization of GBS prophylaxis is considered the end conclusion is that giving IV antibiotics to all colonized women in labour is not supported by conclusive evidence.
The review gives very short shrift to the methodology of these very old studies. Well worth a read.

Thought I'd add some basic statistics here:
*Number of live births in 2009 in the UK = 790,200
*Given 25% of women carry GBS in their vaginas that means 197,550 live births to GBS carriers
*At a 1 in 1000 rate of GBS infection there will have been approx 790 cases of GBS infection in babies (less in reality as the rate is slightly less than 1/1000)
*A mortality of 10% means 79 deaths from GBS (out of 790,200 births)
*80% of GBS cases are early onset, therefore 20% are not caused by maternal GBS, so that's 632 cases that can arguably be linked to maternal GBS.
*Obviously it's not possible to say how many deaths are linked to early onset/maternal GBS, but about 80% of deaths are linked to prematurity (before 37 weeks) so that's about 16 deaths in 2009 in term babies. Give or take. Out of 790,200 births. That wouldn't even be significant...

9/4/11
I'm at a loose end and have access to the literature so here are some of my findings from the most recent research I can access (note I can't be bothered to put the very full references and most people won't have access to the papers anyway):

Neonatal infections in England: the NeonIN surveillance network, Vergnano et al 2011
A three year study of neonatal infection in England 2006-2008 findings:
GBS was the most frequent cause of early onset (<48hrs) neonatal infection (50%). Incidence averaged 1/2000 over the three years. GBS was responsible for 8% of late onset. 82% of ALL infections occurred in babies born before 37 weeks 71% of these were born before 32 weeks. Overall infection rate was 4.1/1000. The discussion makes reference to there having been no change in GBS incidence from a study in 2001, unlike research in the US and Australia which show a decrease. It attributes this to the lack of a rigorous screening/antibiotics programme in the UK. It notes that with reduction of GBS in the US there is a rise in ampicillin-resistant E.Coli infection.
So my own summary of the data:
*So if there are 1/2000 GBS cases, approx 80% of these are in 7 week neonates which means the risk for GBS infection in term babies is 1/10,000. Approx 70% of those that are premature that are infected are 2 weeks so that puts the risk for them as approx 3/10,000. So a baby 32-37 weeks has a risk of about 1/10,000 also, bearing in mind I'm rounding up.. I'm struggling a bit with percentages of fractions but I think this is right!!
*It seems to me that those babies that suffer an early infection are probably predisposed for whatever unknown reason and that treating infection such as GBS en masse means that those vulnerable babies instead get an infection from a more antibiotic-resistant bacterium.
*It should be noted that maternal GBS status was not researched so these are the general risks for unknown status of carriership (is that a word?!).

Another study showed that preterm infants didn't have the same level of immune response as term infants which could be an explanation for the particular risk to premature babies.

Randomized study of vaginal and neonatal cleansing with 1% chlorhexidine, Pereira et al, 2011

This showed that 2 vaginal washes of 1% chlorhexidine during labour (something mentioned in the above homebirth.org links) is 86% effective in clearing all cultures - this presumably means getting rid of the entire vaginal flora during childbirth - 4% of mums had vaginal burning but that seems to have been the only side effect. In 8 of 508 babies a wiping reduced their axillary temp by 1 degree, 2 had a rash from it.

Group B streptococci colonization in pregnant women: risk factors and evaluation of the vaginal flora, Rocchetti et al, 2011
This study concludes: The prevalence of GBS is high in pregnant women and is associated with sexual intercourse frequency, previous spontaneous abortion and the presence of candidosis or cytolytic vaginosis. There is another article I saw a while back that linked sexual activity with positive swabs too. so maybe abstain if you're worried or have a test coming up!


This post contains a regimen for natural removal of gbs culture that might be of interest: http://www.babyandbump.com/home-natu...l#post11849819



 
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Old Jan 9th, 2011, 08:55 AM   2
PeanutBean
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So having started the thread I'm going to set the scene for my own situation as briefly as I can!

My first birth 2 years ago was a planned home waterbirth than became a 35 hour labour with epidural and ventouse delivery. A journey of consideration and discovery over two years has led me to the conclusion that the whole experience could and should have been different, by which I mean a lot better!

Following a tiny bleed recently I agreed to an internal at hospital where a swab was taken without my knowledge or consent that showed up positive for GBS. Something a quarter of women carry as part of their normal flora in their vagina, and a third of men and women carry in their guts. I was told I'd have to go straight in for antibiotics as soon as labour started. Researching things further I find that not only is that not the recommendation for a woman carrying GBS without other more significant risk factors also in place, but that the true recommendation for GBS carrier AND other risk factors is what I was told had to be done last birth after my waters had been gone 18 hours. The one intervention I thought had been unavoidable though I knew was the start of all my troubles turns out to have been entirely unnecessary.

So I am determined more than ever to get my homebirth. My current plan is to arrange for IV antibiotics to be administered at home IF my waters have gone for more the 18 hours and delivery is not impending. This might yet change to no antibiotics but we'll see. I am to arrange a home appointment with my MW to create a very detailed birthplan in order to assure that is a different MW is in place she doesn't fall back on normal protocol. I also plan to have a debrief of my lat birth with the Supervisor of Midwives at my hospital, through which I hope to lay some of those demons to rest and most on to be able to have a relaxed birth in the way I want.



 
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Old Jan 9th, 2011, 09:17 AM   3
PeanutBean
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I thought i'd put support! DH came in asking me about what food I wanted to eat do I got sidetracked! Lol



 
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Old Jan 11th, 2011, 17:42 PM   4
Freya
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Brilliant thread! I'd love to join it and hopefully get to hear list of successful births at home, in water or wherever! Xxx



 
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Old Jan 12th, 2011, 15:38 PM   5
Kitten
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Hi

I think I have some links I got from some ladies on another forum. Just checked and you've already posted them both.

I had a homebirth with my little boy in July 2009. All went well but a week later I was admitted to hospital with a womb infection. Obviously they swabbed for everything under the sun when trying to diagnose me and discovered GBS. I was warned that whilst LO had obviously escaped early onset or whatever it's called, he had a risk of meningitis/septicaemia (I didn't really take it in) until he was 6months old and we had to be extra vigilant basically. The whole thing put me off having another but here I am pregnant again.

I have a VERY supportive midwife who is pro-homebirth and understanding of the stress that a hospital birth would put me under (I have quite a bad hospital phobia) and she considers the risks of me having a hospital birth to outweigh the risks of having a GBS homebirth. She said she's happy to teach me how to do newborn obs so I can basically do at home exactly what they'd do in hospital and said that time I could get transferred to hospital if he showed signs of issues, would be pretty much equal to the time it would take for people to get into gear at hospital. She's really laid back about the whole thing, but obviously not openly for fear of repurcussions, lol, she did joke that I shouldn't tell 'anyone' her idea, heh, but obviously the midwives attending my homebirth would have to be aware and I'm not sure what the protocol is there, like whether they would insist on transferring me because they didn't want responsibility?

Anyway, I'm getting swabbed at 36 weeks and that will basically determine everything. If I'm positive again then I have a decision to make, if it's negative it's plain sailing so I'm trying not to dwell on it.

I'm actually finding it a harder decision than I thought. Before I thought protocol was protocol and I had no option and I had learnt to grudgingly accept that but now the ball is in my court I'm not comfortable. I know I'd be better with a homebirth again, and I don't want to be hooked up to machines and IVs and have my baby treated the same way, but also, I've heard the horror stories from midwives and people about how seriously GBS in a newborn can be and I don't know if I could live with myself if I missed something and the baby was ill or worst case died. I know a couple who are very pro-natural births but due to positive GBS had all their children in hospital because they didn't feel they had a choice and they'd been basically scared into it by the horror stories. Their poor little newborns all had IVs shoved in them the second they were born and that's not what I want for my baby, but I also don't want them to go through some awful illness.

Anyway, I've blathered on enough, it's a long way off yet and I have a lot of reading to do before then, and for all I know it'll come back negative and won't even be an issue



 
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Old Jan 13th, 2011, 03:58 AM   6
Alisa F
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Hi ladies, I'm just wondering if any of you have come across GBS positive Mums or Mums to be who also have/had cervical cerclage (cervical stitch / cervical suture)?

2 out of 3 swabs taken over the space of 5 days showed I was GBS positive (e.g. Weds POS, Fri NEG, Sun POS), and now I've been told I will most likely need a cervical stitch in future pregnancy, which puts me in very high risk category for infection.... So needless to say I'm beside myself with the thought of being preg with GBS and stitch in place and would like to get in touch with other women in same situation....

I've already found one other expectant mother in same situation so hopefully someone here could intro me to anyone they know if in same situation....

Best wishes to all you expectant Mums, sending you and your bubbas loads of warm hugs!

Alisa



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Old Jan 13th, 2011, 07:55 AM   7
PeanutBean
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Hi Alisa, I'm afraid I don't know of any other mums with GBS and a requirement to have cerclage. I'm very new to this GBS world! There might be some information at the homebirth site mentioned in the first post. Also, if you read the third link there are various figures about rates of GBS infection in newborns which seem to really be very low and very much linked to prematurity (even when antibiotics are given). Presumably the extra risk is from uterine infection through the compromised cervix? If you try posting in other pregnancy areas such as second or third trimester or in pregnancy club you will find other women who have needed a stitch and it may be that some of them are GBS carriers (ignoring the fact that a quarter of them most likely are whether they know it or not!).

Keep in touch with us on the thread, it's very new so might take a while to grow but we'll continue to add resources as we find them and you are welcome to contribute too as you find more out.

Hi Kitten. Thanks for sharing. I hope your test comes back negative. I'm curious was it actually confirmed that your uterine infection was caused by GBS or just assumed as you tested positive for that? To me that would be relevant not only because the GBS might not be the culprit and thus less of a concern but also that there might actually be some other reason that could've been missed.

I know what you mean about not being comfortable. Once we are given the choice we are given the responsibility which is quite scary, especially when thinking of what could go wrong however unlikely. But I guess we need to try and be pragmatic. We choose to make the babies and choose how they are brought up but we don't ever get everything right. It's easy to feel empowered when everything goes beautifully but more scary when there are new risks added.

I am determined that if circumstances are in my favour and I choose not to have antibiotics during labour then there is no way my baby is having them on the basis of precaution. I read in one of the links above that often swabs of the baby's skin are taken to test for GBS and if present ABs are given but this is ridiculous as colonisation of the skin makes them the same as a third of the population, not infected.



 
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Old Jan 13th, 2011, 10:57 AM   8
KandyKinz
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Lovely yet highly controversial thread!

From what I have heard GBS is managed VERY differently here.

Here it is recommended that every woman gets a swab between 35-37 weeks. That is because GBS is a transient bacteria (it comes and goes) and studies have only shown bacterial cultures to be predictive of GBS infections for a period of 5 weeks..... So getting the swab done between 35 to 37 weeks would yield the most accurate results... (So based on that it seems completely and totally bizarre for them to recommend GBS prophylaxis in your labour based on a positive swab you had at 20 some weeks....) Anyways, even this 5 week predictive window isn't 100% and many women who swab negative at 35 weeks will be positive when they give birth and vice versa......

Then there's GBS bacteriuria. Here if a woman tests positive for GBS in her urine at any time in pregnancy she will be advised GBS prophylaxis. This is because she is now deemed as being abnormally excessively colonized with the bacteria.... Which I suppose is similar to the UK protocol to treat regardless of the timing of the positive vaginal swab... I have never been able to findany strong evidence supporting the fact that a woman with a UTI caused by GBS in the first trimester will have a higher risk of having a baby with GBS disease despite having the UTI treated and testing negative for GBS at 35 weeks... But I imagine that data must exist as it's a very strong recommendation here.

Then there's the prophylaxis protocol. It has become standard practice to treat everyone who is GBS positive (eg those who fit the criteria above.... gbs positive swab at 35-37 weeks, GBS bacteriurea at anytime in the pregnancy as well as for things like premature births and if the mother has had a child in the past who developed GBS disease of the newborn). The risk factor approach is just not utilized here.... At least not by OB's or GP's which make up the majority of the maternity care providers... Many of our provinces don't have midwives and in the provinces that do like mine the midwives only serve approximately 15% of the pregnant population....

So essentially the doctors rule the world and they have their own special unique way of doing things.... And they seem to think that it's okay to swab woman for things without even telling them what the swab is for or what the consequences of a positive swab will be.... I've known women who had absolutely no clue what GBS was, had no clue they were even screened for it, and then when they got to the hospital in labour and was given IV antibiotics just assumed that that was just normal protocol and thought everyone received them!!!!!! Which is actually kinda close to being true... Around here rates of GBS has been seen to rise to and even beyond 40% depending on the time of year which means almost half of all women having babies get antibiotics prophylactically..... Alternative options tend not to be presented.... Often if you say no to what a doctor recommends you'll get the "BUT your baby could very likely die if you don't!" Stats are often not used nor is adequate non biased resources provided to help enable the woman to make an informed decision. Ofcourse there's good doctors who don't practice this way.... but in my personal experiences they sadly don't make up the majority.

Midwives operate somewhat differently.... They work using an informed choice model of care so women are given lots of info about GBS, the stats, the swab, the accuracy of the swabs results at the time of birth, the standards of care in the community, what's choices they have if they swab positive (including the risk factor approach), the potential side effects of the prophylactic antibiotics, the dangers of GBS and alternative things they can do to help decrease the chances of having GBS..... And since every woman is different so are their choices and among midwifery clients there's a wide range in how GBS is managed. Some swab, some don't. Some who are positive will get antibiotics, some choose the risk factor approach.... Doctor's don't tend to like that.....

But can giving nearly half of all labouring women prophylactic antibiotics be a good thing??? There's definitly the short term risks both common and minor to severe from the discomfort of an IV, to a dramatic increase in yeast infections to anaphalactic shock..... But there's also the long term issues like super bugs!!!! And that is definitly an issue when you are dishing out antibiotics to such large populations of people! With that in mind it's important to be aware that with antibiotics for GBS in labour the intention is not to treat the woman's GBS... it's meant to go to the baby and prevent any infection from forming (not one that's already active and present)..... So essentially, we're giving woman antibiotics for a relatively short period of time and then we discontinue them before the bacteria/infection is completely erradicated.... Given all we know thus far about the creation of super bugs and the importance of finishing courses of antibiptics etc etc I find the current practices regarding GBS management here in Canada extremely extremely concerning.....

Then again.... GBS disease of the newborn is certainly a concern as well.....

I'm really torn between what's right and what's wrong..... It's a hell of alot easier to present women with information and get them to make a decision then to have to make one for yourself.......



 
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Old Jan 13th, 2011, 11:18 AM   9
PeanutBean
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Thanks for your post Kandy, it was interestingly non-committal! Everything you said ties with what my research has so far yielded. The positive urine test I was told is considered as evidence that the GBS is a most aggressive form and therefore potentially more likely to cause infection in the baby. Whether or not that theory is backed up by evidence...

There was quite a bit i my readings that have shown prematurity to be a huge risk factor, in fact being behind almost all GBS deaths according to a two year study in the UK (see the third link):
Quote:
* The prevalence of early-onset GBS sepsis was 0.57 per 1000 live births. Put another way, one in every 1754 women had a baby with GBS disease.
* Premature babies accounted for 38 per cent of all cases of GBS disease, and 83 per cent of all deaths from GBS disease during the time of the study.
* Of the 39 (out of 62,786) babies who developed GBS disease, three were stillborn and six died soon after birth. Five of the six babies who died were born prematurely (before 36 weeks of pregnancy).
* Four of the mothers of the babies who contracted GBS disease had been given antibiotics in labour.
These figures to me look extremely small. Obviously if I went into labour prematurely I would be up for the antibiotics because why the hell not? The nightmare of treatments potentially necessary would mean IV antibiotics would only be the thinnest end of the wedge.

But this issue of mass medication is a serious and valid one. From the same link (sorry for my lack of diversity):
Quote:
In other words, 1116 of the women who have risk factors in this study would have needed to take antibiotics in labour to prevent one baby dying from GBS - but nevertheless without a solid guarantee that this hypothetical baby would be saved.
There was absolutely no choice given to me nor were there any side effects of risks mentioned. I know that about 90% of our gut bacteria is inherited through the birthing process with the remainder forming up to 6 months of age by which point it is effectively impossible to alter the gut flora (the reason the probiotic drinks are a bigp pile of balls). There seems to be evidence about babies being colonised with penicillin resistant bacteria which could potentially be problematic in future and that they are at increased risk of penicillin-resistant infections such as E.Coli and that's before we get on to the overuse of antibiotics altogether. How does the risk of E Coli in treated babies relate to the risk of GBS I wonder?

On a personal note, I am debating about the swab in late pregnancy. I know that by having it and it coming up negative it will do away with the medical concerns in the professionals and I suppose go some way to alleviating my own concerns, but I absolutely do not want any more internals again. Ever. They have always always hurt me, even since first getting smears a decade ago; they were more agonising that all of the rest of labour; my trust has now been destroyed after having a swab taken and tested without my knowledge. However, I know some UK women who are concerned have done the private testing and I think sent a kit, so does that mean I could potentially do the test myself? I might be prepared to do that, given that my birth plan is being based on the positive test anyway. Kandy - I think we are supposed to be offered the proper culture test at 35-37 weeks if we've had a positive swab earlier in pregnancy. Otherwise it's not offered on the NHS.



 
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Old Jan 13th, 2011, 11:22 AM   10
Sunflowers
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Great thread!

I'm also a gbs carrier, both dd1 and 2 were born by section but I'm hoping for a vbac this time. I was told I wouldn't need iv antibiotics in labour as neither of the girls had shown any signs of gbs infection at all so the baby will just need regular temps for 24 hours and then usual observations after that!

Oh - you can get free gbs tests here too http://www.bluehorizonmedicals.co.uk.../7?shop_param= you just pay the lab fee when you send the swab in, just because you've been positive to gbs in the past it doesn't mean you'll always have it and therefore if you get a swab to check towards the end of your pg it might not be active at that point anyway thereby reducing the risk even further to the baby! Sadly though you can't routinely request a test on the nhs and they use a different test (or something) and it's not as accurate, it's all on the website anyway..



 
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