Setting your limitations (previous strep b infection)

[xarlenex]

I had a planned homebirth with our little girl and when she was 4 days old I found that I'd had group b strep, thankfully she was born in her waters which would have helped protect her from the infection too. I'd like a home birth this time around but if I have a positive strep b test at 36/37 weeks I will go to hospital instead and have the antibiotics, I'm happy to do so.

My query comes from my last appointment where my consultant asked me about my limits with a homebirth and a negative result , at which point would I be happy to transfer to hospital. I agreed if my waters had gone for 18 hours or more I'd go to hospital. She asked me about a raised temperature of 38c , I feel like a slight temp raise alone wouldn't be enough for me to transfer, anyone have any information on this? I can't help but feel like a slight temp raise in active labour in a birthing pool would be perfectly normal, I cant imagine someone in the later stages of labour who would maintain a perfect 37.5c temp! So I'm just looking for some information relating to a slight temp raise to see if my thinking is correct or if I'm being naive?

Thanks in advance!

 

[ReadynWaiting]

Our MW in Canada will administer the antibiotics at home after you give birth, is this not an option for you?

 

[xarlenex]

Our MW in Canada will administer the antibiotics at home after you give birth, is this not an option for you?

Sadly it's not, my NHS trust won't agree to it. I've completely accepted a hospital birth if my gb test is positive. It's just my limitations to set in the event that I have a negative test and have my homebirth, because obviously things like waters being broken for a long period of time increases the risk again. But I don't think I agree with a transfer on the basis of a slightly raised temp alone.

 

[ReadynWaiting]

I think you need to do what is best for you. I declined the GBS test because it is protocol for them to administer antibiotics right after birth which means IV port during labour and delivery which I don’t want. I’m planning a water birth and no intervention if I can manage it. In my reading the % of babies that actually contract it during birth are minimal.

 

[xarlenex]

IV antibiotics are given during labour yeah, we aren't routinely screened here. I just happened to end up in hospital with a urine infection at, 8 days overdue with my little girl and they found it in my urine then, meaning I also had a high colonization of the infection.

I know and fully understand that it's highly unlikely the baby would actually contract anything, I know I can refuse the test and birth how I want, I know it's all in my favour, but I'm not risking it. I've been that one in so many thousand that their baby become extremely ill and almost died after I contracted parvo virus and passed it on to him in utero despite every odd being in my favour so I'm happy to take the antibiotics. I also know personally a mother who lost their baby when gbs hadn't been detected.

My dilemma comes from the understanding I have a negative test and do birth at home, on what grounds would I decide to transfer, if any. As I said previously I've agreed with my waters gone 18 hours or more I would transfer to hospital, but she asked about a raised temp alone, with no other risk factors. I don't think this would be enough to concern me though.

 

[loves_cookies]

I've had infections with both my labours (Dr's aren't sure whether infection caused labour or labour triggered infection) but both times the only symptom from me was a raised temperature, I didn't feel unwell with either. My eldest was also in distress, but my son was too premature to get distressed. I'm also group b strep positive.

 

[xarlenex]

Thank you for sharing your experience. I think the middle ground would be to say if my temp was high I'd come out the pool and see if my body temp comes down itself, if not then perhaps transfer then.

 

[kittylady]

I'll be testing for GBS this time as I was positive with #2 and negative (tested); they would class me as positive if I refuse the test. I wont be having the antibiotics anyway, I birth too fast for them to be effective, I'm allergic to penicillin and GBS is becoming resistant to the antibiotic they use as an alternative, and I want a home waterbirth. I did agree to transfer for observations for 24 hours with my second. I did a ton of research and wrote a paper, the senior consultant agreed with my reasoning, and all was fine. As someone said, the risk is small and antibiotics increase the risk of antibiotic resistant infection.

Unfortunately all of that was on my old computer and the guidelines have changed since then (though not in regards to my previous reasoning), I've printed off a stack of papers including guidance and research and I will be writing a letter to explain my reasoning.

 

[xarlenex]

Would love to have the excuse I birth too fast my first was back to back, contractions never regulated 48 hours and 20 mins later. With my daughter I halved my time at 24 hours. Fingers cross I half it again and it's only 12 hours

 

[kittylady]

All of mine have been back to back. They thought it would take me a while but it didn't. They had to catch the baby twice. Only with the middle child did the midwife believe me when I said baby is coming.

 

[NDH]

I know a lady who was Homebirthing and gbs positive. Antibiotics weren't an option at home, so she went to hospital every 4 hours for another dose and then back home! But she also only lived a couple minutes from hospital.
There are protocols one can also go in the final weeks prior to gbs test (and then continue through to birth) to eliminate gbs.

Specifically regarding the slightly elevated temperature you asked about, no, that would not be a cause for me to transfer at all (but full disclosure I'm also one who would only transfer if a cesarean is necessary)

 

[kittylady]

That seems like such a lot of effort, but then I don't like moving whilst pregnant and I'm the only person who can drive in my immediate family.

 

[NDH]

Yeah there's no way I'd be doing that either! But happy for her to have found a way to homebirth that made her feel safe.

 

[xarlenex]

I would do trips to hospital for the antibiotics if I were closer , but we're 40 mins away. I'm waiting for an appointment with a birth choices consultant, I'll see where my head is at after this. Thanks ladies!