Group B Strep Support Thread

[PeanutBean]

I am sure you can refuse a swab but if you've other risk factors I think they will assume a positive status. However it's still up to you if you disagree with how they want to manage that.

I couldn't get to sleep last night, so much stuff was rolling around my head about this. Going to get my phone and find the pages I found last night to update this thread.

 

[PeanutBean]

This one is about general sepsis, not just GBS: https://emedicine.medscape.com/article/978352-overview
There is a LOT of info in there so don't read on a sleepy head! It also uses US incidence which is higher than UK. I found it searching for a link with PROM.

I was interested in this:

Maternal GBS status

* The most common etiology of neonatal bacterial sepsis is GBS. Nine serotypes exist, and each is related to the polysaccharide capsule of the organism. Types I, II, and III are commonly associated with neonatal GBS infection. The type III strain has been shown to be most highly associated with CNS involvement in early-onset infection, whereas types I and V have been associated with early-onset disease without CNS involvement.

I don't know if the late cultures identify the the type of GBS but now I want to know! If there are 9 and only 5 are mentioned here does that mean the other 4 are not found to cause neonatal infection?

I also noticed that right at the start it said E.coli is the second most common infection and in the 50s was the most common. Interesting in light of what the other links have said with regards to antibiotics increasing the risk of penicillin-resistant infection such as E.coli.

 

[PeanutBean]

This one might seem a bit random as it's about Hong Kong where the prevalence is very low compared to in the West. https://www.hkmj.org/article_pdfs/hkm0912p414.pdf
I found it looking for any relationship between GBS swab results and recent coital activity for the simple reason that I had sex, spotted, was asked to come in and swabbed almost right away so the swab could've picked up stuff from DH or that had been temporarily introduced through sex. Don't read it all unless you're interested (it is quite interesting), the key bit for me was this in the discussion:

There is little information regarding differences between pregnant women who have rectal versus vaginal colonisation. Meyn et al compared subjects with vaginal and rectal colonisation in non-pregnant women and found that the former was associated
with increased recent sexual activity, whereas no such association was found for the latter. Since the majority of our carriers had vaginal colonisation (92%), in our population it may be worth investigating their sexual practices during pregnancy. In a study performed in our unit a decade ago, the frequency of coitus evidently declined abruptly during the first trimester of pregnancy, and continued to decrease as gestation advanced. In the latter study, 37% and 65% of women abstained from coitus in the first and third trimesters respectively,24 in which figures are high compared to those reported for western pregnant populations. The authors have attributed this difference to conservative attitudes towards sexual activity in pregnancy as part of Chinese culture. With the increasing westernisation of our population, it is possible that sexual practices during pregnancy have also changed. Further studies on the effects of coital
frequency on the GBS colonisation rate in pregnancy are warranted.

 

[PeanutBean]

This is quite an interesting (and more brief!) read. From the states.
https://www.themidwifenextdoor.com/?p=1189

This also says recent sex is an independent determinant of vaginal GBS colonization.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770838/

Recent sexual intercourse was associated with an increased risk of vaginal GBS colonization in this study, both in the presence and absence of rectal colonization. However, there was no association with increased numbers of sexual partners or having a new sexual partner. This agrees with a recent study which reported an association between GBS incidence and increasing frequency of vaginal intercourse and other measures of sexual activity (24). Sexual activity has been linked with increased vaginal colonization by GBS in several studies (16, 17, 24–26) while two studies reported no association between sexual activity and GBS colonization (27, 28). Male sexual partners of women with GBS have shown to be colonized by identical strains or serotypes suggesting sexual transmission of GBS may occur (6–8). Sexual activity may transmit GBS from men to women, may alter the microenvironment of the vagina in a manner that increases the persistence of GBS and/or it may enhance the transfer of microorganisms from the perineum or rectum to the vagina.

 

[PeanutBean]

FAO Kandy - When I speculated about the PCR/culture testing I did have it wrong. Here;s a link showing the three tests in the UK. Our routine was is a culture but on a rubbish one, the better test is a culture in GBS specific medium. In the States PCR is used for the new rapid testing but hasn't been validated for use in the UK. SO guessing PCR might be a test method was still good of me!
https://www.gbss.org.uk/content.php?sub_id=10&section_id=3

 

[parsley]

My very good friend has strep b and was advised she needed to have iv antibiotics during the birth of her son, and that he too would need to be on them for six months (he also had an enlarged kidney). She refused both. She breastfed and still does and he is absolutely fine. she did quite alot of research about it, as her first son was a homebirth that transferred to hospital and went very wrong in her opinion. so for second birth she stayed at home and did it her way. she firmly believes your body and the natural immunity you give the baby at birth will get you through things and they are far too eager to pump you full of unnecessary drugs during highly medicalised births.

 

[PeanutBean]

Thanks for your post Parsley. It's reassuring to here stories so similar to mine but that end how I hope mine will go!

I wanted to mention that I came to the conclusion reading on the GBS support service website that the charity was set up to support those who have lost babies or them been severely damaged by GBS infection which would explain why everything is nuts about getting antibiotics. A thing I read last night was all "as soon as you start labour go to hospital and tell everyone you meet that you are a GBS carrier and want antibiotics" and telling us to plaster bright stickers from them all over our notes so it doesn't get missed. I think a pretty different outlook from the way we in here feel!

 

[KandyKinz]

Wow! You've definitly been busy!!!

In regards to your yogurt tampon question.... It's really easy and no more uncomfortable then just using tampons regular though it is a tad cooler which wasn't necessarily a bad thing given the discomfort of the symptoms I had been experiencing. I put a panty liner on in case of a mess but the tampon seemed to contain the yogurt to the area it needed to be in.

And I have heard of the PCR testing but had always just assumed it was more theoretical then anything else as it is something that is just never practiced here. There would certainly be advantages to rapid testing and it would be lovely to only treat women who are GBS positive at the time or labour but it would come with many draw backs as well for example even a rapid test takes time and there would be women who would not get the results fast enough to get atleast two doses of antibiotics in which is the minimum amount said to be effective at reducing the risk of gbs.... and what about women planning homebirths? Also, how you found any data which compares the accuracy of these different testing methods in detail?

And that link between sex and GBS status is certainly interesting. I've tested negative twice so far. With my first there was absolutely no sexual activity occuring near the time of the swab.. With my second there was not as much as I would have liked lol. I don't at all feel compelled to abstrain from intercourse based on those findings BUT now I definitly don't plan on doing anything sexual in the timeframe leading up to my swab. There's also benefits to sex in pregnancy as well including cervix ripening and uterine toning. I have a tendency to go late in my pregnancies. Unfortunately the obstetrical community where I am is strongly opposed to postdates and I foresee alot of conflict should I go beyond 40 weeks so I am willing to do what I can naturally to get things moving but that's another tale for another thread.....

 

[KandyKinz]

https://www.springerlink.com/content/313mv1n3m8610140/

I wanted to share this study which showed that waterbirth helps to decrease the colonization of GBS on newborns. I have heard many girls on here state that they are no longer to have a waterbirth due to their positive GBS status but that contraindications seems absurd given the results of this study. But with that said the UK is still one up on Canada. At least in UK waterbirths are permitted in hospital. Here they are not regardless of GBS status

 

[PeanutBean]

Kandy the GBSS link seems to imply that the ECM (was it?) and PCR are both good tests and the other, the one we do here is the one that has lots of false negatives.

I wonder if I should try a yoghurt tampon... I'd have ot buy tampons especially though and I really dislike using them when not sensitive and pregnant. Don't think I've had one since...about 15 years probably.

 

[daisyduck]

Hi,

I understand that this thread in within 'home and natural birthing' and so had it not popped up and caught my eye on the main home page I would have never have even looked, nor commented...

However, as a mum who very almost lost my little boy to group b strep shortly after he was born 3 yrs ago I really felt that I ought to comment. (my apologies for the lack of detail by the way - i still find this very difficult to talk about even now).

I understand that all the research etc show the risks to be small and I can see how it may seem like it would never happen to you. However, please believe me when I say that if it did happen to you i'm sure that you would find it very difficult to forgive yourself for simply not having the IV in labour!

Although you may not get your ideal birth experience, it ultimately is a small sacrifice to make for the sake of your baby's health. When I had my little boy I had never even heard of group b strep. In this pregnancy I will be having a section so luckily I don't have to worry about the risk again this time around, but if I did there is absolutely no way I could put the baby at risk of having gbs - knowing what i know now!

I can see that home and natural birth is obviously a very important preferance for you ladies, but please don't put this choice above your babies well being. By being screened already and knowing that you are a carrier, you have a chance to save your baby from the potential of a very difficult start in life.

I don't wish to scare any of you but please don't be too quick to think that because the ratio is so low it will never happen to you - you can't say for certain that your baby won't be that 1 in 1000.

 

[Freya]

Hi daisyduck, thank you for sharing, I can not imagine what a traumatic time you went through with your son!

There have been a few threads going on lately discussing gbs that prompted peanutbean to start this one as the overarching one to offer support and advice in one central place. I guess you nay not have seen the others? I didn't want you to Think anyone is putting their baby at risk, I have needed to 'defend' my stance several tines now. Speaking personally, I previously had PROM where labour began 24 hrs later. I agreed to be transferred to hospital in case of infection. I began a temperature. They advised iv antibiotics. I accepted. They wanted to induce. I refused as labour was text book. They wanted to monitor baby's heart. I accepted. All normal. They wanted to screw a thermometer to babies head. I refused. All decisions based on baby's well being, evidence and instinct. A careful weighing up of my needs and baby's safety.

I think most women who have strong birth preferences would agree that baby comes first. I feel hospitals go over the top with intervention when it comes to Gbs and whilst in some cases it is essential, in most cases it is not, as a lot of research shows. There is also a great variation in how gbs status is dealt with across the uk and the world!

 

[Bournefree]

How is it going getting the IV antibiotics done at home ladies?
(Sorry, haven't read all the way through yet.. just doing it now)XxX

 

[PeanutBean]

I've not got my appointment til next Tuesday then I need to arrange a home visit so might not really get to discuss it yet. I am assuming it is a done deal. They're going to have to have some pretty strong reasons to say no! If they do, I'm switching hospitals. I'm already considering it and only didn't as I am determined not to set foot in one.

 

[Jenniflower]

Just bumping this for someone.

 

[PeanutBean]

Maybe I should update on ME while it's bumped! I've been told it's highly unlikely that I will get antibiotics at home. Oral might be offered but we can all see that they are pointless anyway. Will chase this with the consultant MW otherwise I'm just going to say no then in favour of monitoring and play it by ear. Assuming of course I have a positive test at 35 weeks AND my waters are gone for over 18 hours with no sign of delivery yet.

 

[KandyKinz]

Daisyduck - While I'm sorry you had to go through that awful experience I just wanted to comment that my reluctance to support mass usage of GBS prophylaxis in labour is not at all based on my desire to have a natural home birth (as mentioned prior, that is not an issue for myself as in my area IV antibiotics can be administered at home) but my reluctance stems primarily from concerns for the long term health my children as well as for the future health of our society as a whole.

PeanutBean - I found a Cochrane study you may find of interest.
https://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD007467/frame.html
https://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.

 

[PeanutBean]

Thanks Kandy. I had seen in my travels that the antiBs don't help reduce the risk of mortality. As far as I could tell this seems to be pretty much totally linked to prematurity. I will read your links with interest and if they show that the evidence does not entirely support antiBs then all the better for me as I'm now not likely to be able to get them!

 

[HannahGraceee]

I didn't think you could have home births with strep b? X

 

[PeanutBean]

I didn't think you could have home births with strep b? X

Hannah my love read the thread! lol The things I've been hearing, like you have to have a section and allsorts, absolute bollocks! There's loads here if you want to find out more. Were you a GBS carrier?

Kandy - I just had a squiz through the Cochrane review. I CANNOT believe all these guidelines are on the basis of 3 ancient studies involving 500 women that hardly showed much significance and did not follow the gold standard double-blind clinical trial. Blimey! And there was I thinking that generally these days we were more careful about this sort of thing in medicine. Of course it doesn't mean that IV ABs don't do anything, just that there is no evidence they do. That really helps with my decision. Thank you. I'm going to put that link in the first post as it's a really significant one. Hope you don't mind me pasting your comments in.