Q: I have Group B Strep. With my last 2 hospital births I was automatically given IV antibiotics. I am planning a home waterbirth for my next baby. What can be done at home for GBS? What are the risks to the baby if it contracts it in the birth canal?
-Sarah McKay
I was 37 weeks pregnant with my first child when I was told I had high concentrations of Group B Strep in both the vagina and anus. The nurse midwife from whom I was receiving prenatal care knew that I was planning a homebirth with a direct-entry midwife. She prescribed ampicillin, which I took for 2 weeks. My direct-entry midwife recommended a regimen of garlic, vitamin C, echinacea and bee propolis. I was taking twenty-something capsules a day! The payoff came two weeks later when a second culture came back negative. I went into labor two days later and had a successful homebirth.
15-40% of pregnant women test positive for GBS. Transmission from mother to baby occurs in 40-73% of culture positive women. Only 1-2% of the infants to whom the GBS is transmitted develop complications as a result. Factors that can increase the risk of GBS complications are: maternal age <20 yrs, heavy colonization, premature rupture of membranes, prolonged rupture of membranes, fever during labor, preterm labor, or a sibling who had GBS. Although only about 3 in 1,000 babies develop GBS complications, the consequences can include pneumonia, meningitis, brain or lung damage, loss of sight or hearing, or death. Scary stuff.
If you can persuade your caregiver that you understand the risks and develop an action plan in case one of the "increased risk" factors develop, perhaps you could receive oral antibiotic treatment and a second culture and still have a homebirth.
-Felicia Lumpkin
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In the medical community, there are currently at least three schools of thought re: GBS+.
1) All women should be screened at 34-36 weeks with a combined vaginal rectal swab (obviously you swab the vagina first and then the rectum) and if found to be GBS+, treated with antibiotics during labour.
2) All women should be screened in pregnancy as above, and those who are GBS+ should be treated with antibiotic prophylaxis in the presence of additional risk factors in labour. These additional risk factors would include: rupture of membranes for longer than 12-18 hrs (depending on local protocol); maternal fever in labour and/or fetal heart rate elevated above the baseline.
3) Not to screen but to treat all labouring women with the above risk factors.
As a practising midwife with a combined home and hospital birth practise, my practise is to encourage flexibilty and to educate clients about GBS, the issues of screening vs. not screening and the various treatment options currently medically recommended, and allow them to make an informed choice to screen or not, and to choose the treatment option they feel is best for them, or not to treat at all. It is their baby and their choice to make. It is interesting to note that people often make very different choices than you might expect them to.
If the client plans a homebirth and wishes to treat with antibiotics, in our community she can choose to go into hospital as an outpatient to receive the initial dose of antibiotic, then to return home for the duration of the labour and birth with the midwife administering the subsequent doses at home. (The first dose is given in hospital in the event of her having an allergic reaction to the drug.)
Families have made many different choices, including women who tested GBS+ and who have had waterbirths at home, all with no adverse results; some have elected for antibiotic prohpylaxis and others have declined.
As for the issue of prolonged rupture of the membranes (GBS+ or neg.), while not yet substantiated by the research, my experience clearly shows a reduced incidence of early rupture of the membranes through avoidance of unnecessary vaginal exams in pregnancy and labour. I believe it is prudent to be extra careful about avoiding vaginal exams with GBS+ women.
For more information about making informed choices in pregnancy and birth I would recommend " Effective Care in Pregnancy & Birth" by Enkins & Chalmers as a good place to start.
-M.R.
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IV can be done at home by a qualified practitioner. You can choose a risk-based approach to treatment, risks being membranes ruptured more than 18 hours, preterm labor (wouldn't birth at home anyway) and history of a baby with GBS disease. Was the growth heavy, moderate, or low? That can influence your choice also. I don't think I'd feel that comfortable with a waterbirth with GBS due to the increased risk of postpartum infection for the mom, but I know opinion varies on that one.
To the practitioners out there: Does anyone know about using IM antibiotics instead of IV for GBS moms who choose prophyllaxis? Are there any studies? Just 5 or so years ago the protocols around this area were for ORAL antibiotics in labor. It'd be nice not to have to do IVs for those folks with risk factors or for those who just want to treat.
-Kelley
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Having worked in a birth center for many years, one of our biggest concerns was GBS and how to treat it. We accomplished a multitude of waterbirths, many with GBS. But be aware of the facts:
*For every 100 women with GBS at delivery, 1 infant will develop GBS infection, and overall rate of 1 to 3 per 1,000 live births.
*Neonatal infection is a major cause of illness and death among newborns.
*GBS usually causes infant illness within the first seven day of life, causing shock, pneumonia, and meningitis (an infection of the baby's spinal fluid and brain tissue).
*These babies can and usually do die suddenly, others will suffer permanent handicaps ranging from mild learning disabilities to severe mental retardation, loss of sight and hearing, and lung damage; others can recover with no long-term damage.
While the odds are that your baby won't be the 1 in 3, is it worth the risk? Treatment according to CDC Guidelines consists of intravenous administration of ampicillin every four hours during labor. This does not require a continuous IV infusion, only a heplock, which still enables moms to move around freely and have the waterbirth they dream of. If it is not possible to do this at home, then please consider a birth center that has the ability to administer this simple treatment.
-Alyn McGee, RNC
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There is a very complete informed consent for GBS testing posted on www.goodnewsnet.org. You know you're already GBS positive, so it's the various risks associated with treating/not treating you'd be interested in. Thanks to Ina May Gaskin for the link to goodnewsnet.
-Kay Jackson, CNM
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This goes along with the B-strep question. Can anyone direct me to studies or articles on the relationship between stripping the membranes (separating the membranes) and activating a B-strep infection? I have heard that STM can make a mother B-strep+.
-Michelle Wright
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Reprinted from Midwifery Today E-News (Vol 2 Issue 5, Feb 4, 2000)
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