Group B Strep

[Raebo]

Anyone here decline or not have a GBS test? I have care provided by a
midwife so the option is mine. Women getting care from an OB here do
not have a choice.

The statistics seem to support my thoughts that this test is
unnecessary (I've declined most of the tests offered thus far) with
only 30% of women having GBS, only 1% of babies from these women will
have GBS and 90% of that 1% respond to treatment. Also, from what I've
read treatment doesn't change the death rate of infants at all.

The only reason I'd consider declining this test is that I do not want
to have an IV for 4-6 hours of my labour. I'm having (all things going
well) a homebirth.

Thanks for your opinions.

[Rebecca Jo]

"Raebo" > wrote:

> Anyone here decline or not have a GBS test? I have care provided by a
> midwife so the option is mine. Women getting care from an OB here do
> not have a choice.
>
> The statistics seem to support my thoughts that this test is
> unnecessary (I've declined most of the tests offered thus far) with
> only 30% of women having GBS, only 1% of babies from these women will
> have GBS and 90% of that 1% respond to treatment. Also, from what I've
> read treatment doesn't change the death rate of infants at all.
>
> The only reason I'd consider declining this test is that I do not want
> to have an IV for 4-6 hours of my labour. I'm having (all things going
> well) a homebirth.
>
> Thanks for your opinions.

I'm one of the people who took the GBS test. I tested positive and opted to
have the IV during labor. I did NOT have to have an IV hooked up for 4-6
hours. The way my midwives did it is to hook me up to the IV just until the
fluid necessary drained into my body and then they unhooked me. I was told
they had to do one dose every 4 hours.

Just FYI. :)

rj

[alath]

Raebo wrote:
> Women getting care from an OB here do
> not have a choice.

Where is here? What you are suggesting goes against medical ethics. Our
job as medical professionals is to recommend what we think is in your
best interest, but we can't impose a test or treatment on you against
your will.

Is the IV your only objection? If so Rebecca Jo has a good suggestion
above.

> have GBS and 90% of that 1% respond to treatment. Also, from what I've
> read treatment doesn't change the death rate of infants at all.

Read again, or read from different sources (try
http://www.cdc.gov/groupbstrep/ ) In the pre-prophylaxis era, the case
fatality rate for early onset GBS disease was nearly 50%. In 2000-2003,
the case fatality rate was 6.5%. The incidence of early onset GBS
disease has dropped dramatically as well. And death is not the only
outcome of concern here; sepsis and meningitis are not things I would
wish on anybody's baby. GBS screening and prophylaxis has been a major
public health success story.

Can you get away with not screening? Very probably you can. I also
could very probably get away with not wearing my seat belt when I drive
in to work tomorrow. But I'm not going to test it. The downside of
wearing a seat belt is negligible. The up side is potentially huge. I'm
wearing my seat belt.

[Circe]

"Raebo" > wrote in message
ups.com...
> Anyone here decline or not have a GBS test?

I declined the test in my third pregnancy, opting for risk-based management
instead. I'd been GBS- with both previous babies, so I thought the chances
I'd be positive the third time around were slim, anyway.

The protocol for being GBS+ is not to have a continuous drip for 4-6 hours,
but to have doses of antibiotic by IV every four hours during labor, with
the goal being at least two doses prior to birth. My concern with #3 was
that I'd only been in the hospital 90 minutes before giving birth to my
second (though my total labor was about 28 hours from start to finish), and
I thought there was a high likelihood that I'd not be in the hospital long
enough to get those two doses with #3 if I *did* test positive. Better under
those circumstances to go with RBM, which means getting IV antibiotics if
you develop a fever or have ruptured membranes for 18+ hours.

As it turned out, I wound up being induced by ROM, so if I'd been positive,
they could have gotten in the two doses by giving me one before the ROM and
one four hours later. But labor was actually only 3h50m, so if they'd waited
until after I was in labor to give me the first dose, we'd have run into
some issues!

I think I made the right decision, and I definitely think opting for RBM
over testing is an absolutely valid and perfectly sensible choice.
--
Be well, Barbara

[Ericka Kammerer]

Raebo wrote:

> Anyone here decline or not have a GBS test? I have care provided by a
> midwife so the option is mine. Women getting care from an OB here do
> not have a choice.
>
> The statistics seem to support my thoughts that this test is
> unnecessary (I've declined most of the tests offered thus far) with
> only 30% of women having GBS, only 1% of babies from these women will
> have GBS and 90% of that 1% respond to treatment. Also, from what I've
> read treatment doesn't change the death rate of infants at all.
>
> The only reason I'd consider declining this test is that I do not want
> to have an IV for 4-6 hours of my labour. I'm having (all things going
> well) a homebirth.

I wouldn't go so far as to say that treatment doesn't change
the death rate. Early onset GBS disease was one of the most common
killers of otherwise healthy babies, and treatment makes a pretty big
dent in that. However, that doesn't necessarily mean that screening
is the only way to go. Studies did show that screening produced
better results than risk based management, but closer inspection
(last time I checked--might be new info now) suggested that much
of the difference was due to not following the risk based management
protocols. In other words, women who turned up with risk factors
didn't go ahead with antibiotics as recommended at that point.
When risk based management protocols are followed, the difference
in results between screening and risk based management largely
disappears.
Another thing to consider is that the 30 percent figure for
colonization in the US is an aggregate figure. There are significant
variations by region and race. If you are in one of the lower risk
categories, this might argue even more for risk based management.

Personally, my choice was to go with risk based management.
If I'd had prolonged membrane rupture, preterm labor, or fever, I
would have gone with antibiotics. Otherwise, I went without.
No screening. I would do that again. It probably doesn't
eliminate the maximum amount of risk, but it got it down far
enough for me to be comfortable.

Best wishes,
Ericka

[Jenrose]

"Raebo" > wrote in message
ups.com...
> Anyone here decline or not have a GBS test? I have care provided by a
> midwife so the option is mine. Women getting care from an OB here do
> not have a choice.
>
I declined. Our risks of a) having GBS and b) having problems from GBS were
lower than the risk of possible prophylactic antibiotics due to allergies in
our family. The GBS was a big fat "maybe tiny chance of"... allergies are a
huge concern in our family.

Jenrose

[Chookie]

In article om>,
"Raebo" > wrote:

> Anyone here decline or not have a GBS test?

I was never offered one in either of my pregnancies, so I presume it is not
standard care here (perhaps it's less common or less dangerous here?).

--
Chookie -- Sydney, Australia
(Replace "foulspambegone" with "optushome" to reply)

"In Melbourne there is plenty of vigour and eagerness, but there is
nothing worth being eager or vigorous about."
Francis Adams, The Australians, 1893.

[Raebo]

I should have been more specific, it is 'legally/officially' an option
with OB care, however few women are told this. In fact, in my area the
OB's treat all types of testing as mandatory and leave little argument
for a woman to disagree. I live in a Canadian city where the rate of
interventions, circumcisions, and c-sections are higher than national
average.
If you ask uninformed women about their care with an OB they will tell
you that they did not have an option and often the 'risks' were not
fully advised.
It is unfortunate and the reason why I sought midwifery care.

[Cathy Weeks]

Raebo wrote:

> The only reason I'd consider declining this test is that I do not want
> to have an IV for 4-6 hours of my labour. I'm having (all things going
> well) a homebirth.

I am/was GBS+ and I had a homebirth. I would imagine that your midwife
can administer an IV at your home. Mine did.

The protocol is for them to install a heplock on your wrist, and to
give you a an IV for only as long as it takes to get the meds into you
(about 20 minutes) then unhook you. Then repeat the process in 4 hours.

I only had one dose - the second dose would have occured toward the end
of the pushing stage, and I think everyone was a bit too busy to think
about it then!

However, I guess I'd get screened there's no risk to it as far as I
know (they swab your vagina with a sterile Q-tip) - and then decide
from there what to do.

The incidence of GBS illness wasn't all that common, but when it did
occur, it was very, very serious - leaving babies permanantly
handicapped or dead. The incidence - I THINK - was around 5 babies in
1000 births. Now, it's been dropped to maybe 1 baby in 1000 births.

Cathy Weeks

[Raebo]

Anyone familiar with natural treatments? I've heard that if you take
garlic, acidophilus, and fish oils for four weeks prior to the test
that you're more likely to test negative.

I also heard from one woman that tested positive but rather than have
the antibiotics she is self medicating naturally including the above
and some additional stuff like tea tree oil suppositories.