Strep B screening

[Kim E.]

Hi all-

I never knew how complicated pregnancy would be! I just found out at my
last appt about Strep B screening. I found some literature so I know
basically what Strep B is and the (rare) effects it can have on a
newborn...so what I am looking for is people's opinions about the
screening.
-Did you have the screening or did you decline it?
-If you were positive once, did they screen again?
-If you were positive, did you do oral antibiotics prior to labor or an
IV during?
-If you had IV antibiotics during labor, how long did you have to be
hooked up to them, and how well can you move around while hooked to an
IV?

That's all!

-kim

[Sophie]

> -Did you have the screening or did you decline it?

With #1 and #3 - wasn't offered it
With #2 and #4 - was tested, was + with #2, don't know about #4 yet

> -If you were positive once, did they screen again?

No and yes

> -If you were positive, did you do oral antibiotics prior to labor or an
> IV during?

IV as I had scheduled c-sections

> -If you had IV antibiotics during labor, how long did you have to be
> hooked up to them, and how well can you move around while hooked to an
> IV?

N/A for me, sorry.

> That's all!
>
> -kim

Sophie
#4 due July 7, 2004

[Ericka Kammerer]

Kim E. wrote:

> Hi all-
>
> I never knew how complicated pregnancy would be! I just found out at my
> last appt about Strep B screening. I found some literature so I know
> basically what Strep B is and the (rare) effects it can have on a
> newborn...so what I am looking for is people's opinions about the
> screening.
> -Did you have the screening or did you decline it?

I declined and went with risk based management.
I would have had IV antibiotics during labor if I showed
up with risk factors (preterm labor, PPROM, membranes
ruptured more than 18 hours, fever). There have been
studies showing that screening is more effective than
risk based management; however, if you look closely,
most of the improvement from screening comes from
increased compliance. In the risk based protocols,
many women who had risk factors did NOT have antibiotics
during labor. When they re-jiggered the numbers and
compared risk based management with good compliance,
the two methods had nearly the same risk. Furthermore,
GBS is not universally distributed across the population,
and I am in a group that tends to be lower risk. Also,
things like avoiding AROM and vaginal exams can also
help lower the risk. Put all that together, and I was
comfortable going with risk based management rather
than screening.

> -If you were positive once, did they screen again?

Rarely, because even if you screened negative next
time, there'd still be a risk you'd be positive at delivery.
(Astute readers will note that this also means that just because
you have a negative screen, it doesn't guarantee that you'll
be negative at delivery, but no one seems to talk about that ;-)

> -If you were positive, did you do oral antibiotics prior to labor or an
> IV during?

Current standard of care does not recommend antibiotics
prior to labor (unless you're treating something else, like a
UTI). They have not been shown to be as effective as IV
antibiotics during labor. On the other hand, it's not like
extensive studies have been done in this area.

> -If you had IV antibiotics during labor, how long did you have to be
> hooked up to them, and how well can you move around while hooked to an
> IV?

It only takes a few minutes to run the antibiotics
in there, so you can have a heplock most of the time and
only be hooked up to an actual drip for a few minutes
every few hours (four hours? my brain isn't working tonight...).

Best wishes,
Ericka

[Leslie]

Ericka said:

>It only takes a few minutes to run the antibiotics
>in there, so you can have a heplock most of the time and
>only be hooked up to an actual drip for a few minutes
>every few hours (four hours? my brain isn't working tonight...).


Why can't they just give you a shot of them and have done with it?

Anyway, I'm glad you posted this. I've been positive in the past, and I don't
want to give them any excuse to confine be to an IV and bed. I want so badly
to go natural this time.

Leslie

[Carol Ann]

> -Did you have the screening or did you decline it?

Had it. Just a swab.

> -If you were positive once, did they screen again?

Had it and no I didn't retest.

> -If you were positive, did you do oral antibiotics prior to labor or an
> IV during?

IV during induction, labour and after delivery.

> -If you had IV antibiotics during labor, how long did you have to be
> hooked up to them, and how well can you move around while hooked to an
> IV?

Had to be on an IV anyway. Lasted until the day after I delivered.

HTH

~Carol Ann
Mom to Morgan born 3.24.04
http://tinyurl.com/28zno <---Pictures!

[Ericka Kammerer]

Leslie wrote:

> Ericka said:
>
>
>>It only takes a few minutes to run the antibiotics
>>in there, so you can have a heplock most of the time and
>>only be hooked up to an actual drip for a few minutes
>>every few hours (four hours? my brain isn't working tonight...).
>
> Why can't they just give you a shot of them and have done with it?

Apparently they can't get enough to the right places
that way. Having said that, I'll reiterate that there's
precious little research on some of these more detailed
issues. Maybe shots would be good enough, even if they're
not as good as IV antibiotics. I don't think there's been
a study directly comparing the two approaches, and I don't
know enough to know if the notion of IM antibiotics in
this situation is laughable to begin with. I know that
some midwives have talked about the possibility (as they
have about all sorts of other possibilities), and probably
anything that reduces the bacteria helps at least somewhat.
The only thing that's been tested fairly extensively, though,
is IV antibiotics. Probably most people don't think it's an
issue because the vast majority of women already *have* an
IV while in labor.

Best wishes,
Ericka

[Jenrose]

"Ericka Kammerer" > wrote in message
...
> Kim E. wrote:
>
> > Hi all-
> >
> > I never knew how complicated pregnancy would be! I just found out at my
> > last appt about Strep B screening. I found some literature so I know
> > basically what Strep B is and the (rare) effects it can have on a
> > newborn...so what I am looking for is people's opinions about the
> > screening.
> > -Did you have the screening or did you decline it?
>
> I declined and went with risk based management.
> I would have had IV antibiotics during labor if I showed
> up with risk factors (preterm labor, PPROM, membranes
> ruptured more than 18 hours, fever).


My inclination is to skip it next time. It wasn't offered back in 1993, but
in our family, the risk of developing allergies is MUCH higher than the
risks associated with GBS, and antibiotic use in pregnancy can be a trigger.
So I go with the lowest chance of needing antibiotics.

I'm pretty low-risk anyway--I was on a series of really high-intensity
antibiotics a few years back, went on probiotics, and have just not been
very susceptible to bacterial infections since getting my allergies under
control. I used to get yeast infections all the time, but don't now, etc...

I might reconsider with PROM--but I'm better nourished now than I was with
DD and my membranes didn't rupture until 8 cm or so with her.

I *really* want to avoid antibiotics. I haven't needed them in years and
would really like to maximize next baby's chances of being allergy-free.

My feeling is keeping other people's hands out of my crotch will go a long
way towards reducing risks of all kinds of infections.

Jenrose

[Kim E.]

In article >, says...
> Kim E. wrote:

> > -Did you have the screening or did you decline it?
>
> I declined and went with risk based management.
> I would have had IV antibiotics during labor if I showed
> up with risk factors (preterm labor, PPROM, membranes
> ruptured more than 18 hours, fever). There have been
> studies showing that screening is more effective than
> risk based management; however, if you look closely,
> most of the improvement from screening comes from
> increased compliance. In the risk based protocols,
> many women who had risk factors did NOT have antibiotics
> during labor. When they re-jiggered the numbers and
> compared risk based management with good compliance,
> the two methods had nearly the same risk. Furthermore,
> GBS is not universally distributed across the population,
> and I am in a group that tends to be lower risk. Also,
> things like avoiding AROM and vaginal exams can also
> help lower the risk. Put all that together, and I was
> comfortable going with risk based management rather
> than screening.

That is interesting, I know the risk factors, but hadn't heard of risk-
based management for this. Thanks for sharing!!
>
> > -If you were positive once, did they screen again?
>
> Rarely, because even if you screened negative next
> time, there'd still be a risk you'd be positive at delivery.
> (Astute readers will note that this also means that just because
> you have a negative screen, it doesn't guarantee that you'll
> be negative at delivery, but no one seems to talk about that ;-)

Yeah, that's a good point.

> > -If you were positive, did you do oral antibiotics prior to labor or an
> > IV during?
>
> Current standard of care does not recommend antibiotics
> prior to labor (unless you're treating something else, like a
> UTI). They have not been shown to be as effective as IV
> antibiotics during labor. On the other hand, it's not like
> extensive studies have been done in this area.

Right, I had seen statements that oral antibiotics are useful, but not
nearly as much as the IV during labor, but I was wondering how they came
upon those stats.

> > -If you had IV antibiotics during labor, how long did you have to be
> > hooked up to them, and how well can you move around while hooked to an
> > IV?
>
> It only takes a few minutes to run the antibiotics
> in there, so you can have a heplock most of the time and
> only be hooked up to an actual drip for a few minutes
> every few hours (four hours? my brain isn't working tonight...).

I am having premature IV anxiety but I have not even gotten tested for
Strep B yet, but only being hooked up intermittently like that doesn't
seem too traumatic, as long as I can move around freely most of the
time.

-kim

[Kim E.]

In article >,
says...
> Ericka said:
>
> >It only takes a few minutes to run the antibiotics
> >in there, so you can have a heplock most of the time and
> >only be hooked up to an actual drip for a few minutes
> >every few hours (four hours? my brain isn't working tonight...).
>
>
> Why can't they just give you a shot of them and have done with it?
>
> Anyway, I'm glad you posted this. I've been positive in the past, and I don't
> want to give them any excuse to confine be to an IV and bed. I want so badly
> to go natural this time.

When you were positive in the past, how long did they drip the
antibiotics into you? Did they start right when you arrived in the
hospital?

-kim

[Kim E.]

In article <gC9yc.67220$3x.31782@attbi_s54>,
says...
> > -Did you have the screening or did you decline it?
>
> Had it. Just a swab.
>
> > -If you were positive once, did they screen again?
>
> Had it and no I didn't retest.
>
> > -If you were positive, did you do oral antibiotics prior to labor or an
> > IV during?
>
> IV during induction, labour and after delivery.
>
> > -If you had IV antibiotics during labor, how long did you have to be
> > hooked up to them, and how well can you move around while hooked to an
> > IV?
>
> Had to be on an IV anyway. Lasted until the day after I delivered.

I am assuming you were induced with Pitocin - how much were you able to
move around while you were hooked to the IV?

Did you have to be on the antibiotics the day after you delivered, or
was that an IV for other things? I thought Strep B only affected the
baby negatively during L&D.

-kim

[Kim E.]

In article >,
says...
>
> "Ericka Kammerer" > wrote:
> > Kim E. wrote:
> > > -Did you have the screening or did you decline it?
> >
> > I declined and went with risk based management.
> > I would have had IV antibiotics during labor if I showed
> > up with risk factors (preterm labor, PPROM, membranes
> > ruptured more than 18 hours, fever).
>
> My inclination is to skip it next time. It wasn't offered back in 1993, but
> in our family, the risk of developing allergies is MUCH higher than the
> risks associated with GBS, and antibiotic use in pregnancy can be a trigger.
> So I go with the lowest chance of needing antibiotics.
>
> I'm pretty low-risk anyway--I was on a series of really high-intensity
> antibiotics a few years back, went on probiotics, and have just not been
> very susceptible to bacterial infections since getting my allergies under
> control. I used to get yeast infections all the time, but don't now, etc...

Yeast is a fungus, not a bacteria tho.
>
> I might reconsider with PROM--but I'm better nourished now than I was with
> DD and my membranes didn't rupture until 8 cm or so with her.

I did not know that there was a connection between nutrition and PROM.
Can you elaborate?

> I *really* want to avoid antibiotics. I haven't needed them in years and
> would really like to maximize next baby's chances of being allergy-free.
>
> My feeling is keeping other people's hands out of my crotch will go a long
> way towards reducing risks of all kinds of infections.

:) I am trying really hard to be good and not make a comment about how
that sort of thing might have contributed to your getting pregnant in
the first place! :)

-kim

[Shena Delian O'Brien]

Kim E. wrote:

> -Did you have the screening or did you decline it?

I had it. I was positive.

> -If you were positive, did you do oral antibiotics prior to labor or an
> IV during?

No oral. My water broke first thing in the morning so when I went into
the maternity ward they started me on IV antibiotics as soon as they
actually believed me that my water had broke. I got a bag every 4 hours
while I was there, which ended up being a total of 7-8 bags of
penicillin. :P Ugh.

> -If you had IV antibiotics during labor, how long did you have to be
> hooked up to them, and how well can you move around while hooked to an
> IV?

I'd say between the IV where I was receiving antibiotics and pitocin,
and at some points glucose and saline drips, and the baby monitors, I
had definite restriction of movement. But whenever I wanted to do
something I could request they unhook me from the baby monitors and drag
my IV pole around with me.

[Circe]

Kim E. wrote:
> -Did you have the screening or did you decline it?
> -If you were positive once, did they screen again?
> -If you were positive, did you do oral antibiotics prior to labor
> or an IV during?
> -If you had IV antibiotics during labor, how long did you have to be
> hooked up to them, and how well can you move around while hooked to
> an IV?
>
I was screened during my first two pregnancies and was negative. During my
third pregnancy, for a number of reasons, I chose not to be rescreened and
went with risk-based management (as Ericka described). Although the CDC is
pushing screening over RBM pretty hard these days, I still feel RBM is a
reasonable choice, especially for mothers who hope to deliver without pain
relief medication and therefore want to avoid an IV.
--
Be well, Barbara
Mom to Sin (Vernon, 2), Misery (Aurora, 4), and the Rising Son (Julian, 6)

Aurora (in the bathroom with her dad)--"It looks like an elephant, Daddy."
Me (later)--"You should feel flattered."

All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman

[Welches]

Kim E. > wrote in message
a.net...
> Hi all-
>
> I never knew how complicated pregnancy would be! I just found out at my
> last appt about Strep B screening. I found some literature so I know
> basically what Strep B is and the (rare) effects it can have on a
> newborn...so what I am looking for is people's opinions about the
> screening.
> -Did you have the screening or did you decline it?
> -If you were positive once, did they screen again?
> -If you were positive, did you do oral antibiotics prior to labor or an
> IV during?
> -If you had IV antibiotics during labor, how long did you have to be
> hooked up to them, and how well can you move around while hooked to an
> IV?
>
> That's all!
>
Don't screen for it at all in UK unless you've been found +ve before. (and I
don't know how you'd know you were +ve before either)
Debbie

[Phoebe & Allyson]

Ericka Kammerer wrote:
> Maybe shots would be good enough, even if they're
> not as good as IV antibiotics. I don't think there's been
> a study directly comparing the two approaches, and I don't
> know enough to know if the notion of IM antibiotics in
> this situation is laughable to begin with.

FWIW, my midwife (who as a DEM couldn't legally run an IV) gave me 3 or
4 options that she'd feel comfortable with if I was GBS+. One of them
was IV antibiotics with the understanding that they'd cause trouble for
her in the event of transport, and the rest were IM. My impression was
that the best antibiotic for GBS was one that was only available as IV,
or worked best by IV, and the one she normally used IM was the 4th best
choice for GBS (but presumably the best one available IM).

I tested negative, so didn't need to make the decision.

Phoebe :)

[Dagny]

"Kim E." > wrote in message
a.net...
> Hi all-
>
> I never knew how complicated pregnancy would be! I just found out at my
> last appt about Strep B screening. I found some literature so I know
> basically what Strep B is and the (rare) effects it can have on a
> newborn...so what I am looking for is people's opinions about the
> screening.
> -Did you have the screening or did you decline it?

First pregnancy, I did the screen because my provider was completely
comfortable going 48 hours ruptured w/o transport if I was GBS-, all other
signs of health being there. Didn't want to have to hassle at the 18 hour
mark over this or else lie to them about when I ruptured. I was negative.

I won't test this pregnancy because I am not in a provider/client
relationship and it would be unlikely to affect my decisions; I'll only do
antibiotics of any kind if the baby and I have some kind of sign of
infection, and there will be no more vaginal exams, ever. If I rupture
without signs of labor, I'll probably take a lot of Vitamin C, echinacea,
garlic.

-- Dagny

[Leslie]

Ericka said:

Probably most people don't think it's an
>issue because the vast majority of women already *have* an
>IV while in labor.

Thanks, Ericka. I found last time that I cannot cope with labor lying down at
all, whereas I *know* I can if I am up and walking. I don't want any excuses
for reducing my mobility.

Leslie

[Ericka Kammerer]

Leslie wrote:

> Ericka said:
>
>>Probably most people don't think it's an
>>issue because the vast majority of women already *have* an
>>IV while in labor.
>
> Thanks, Ericka. I found last time that I cannot cope with labor lying down at
> all, whereas I *know* I can if I am up and walking. I don't want any excuses
> for reducing my mobility.

Oh, I hear you there. I hardly laid down at all
during any of my three labors. I couldn't stand it. It
made everything so much more painful. Frankly, I doubt
I would have done well with an IV either. I've never
had one, but given my relationship with needles, I
suspect it would have been a significant impediment.
I was willing to cope if there was a clear need, but
thank goodness there wasn't.

Best wishes,
Ericka

[Leslie]

Ericka said:

> Oh, I hear you there. I hardly laid down at all
>during any of my three labors. I couldn't stand it.

Yes! During my labors for #2 and #3, I walked all the time. I only lay down
to be checked (and intermittently monitored for #2, which was in the hospital).
For #2 I can honestly say I felt discomfort but not pain.

With #4, when pre-eclampsia and PROM mandated monitoring, IV, and lying on bed
on my left side from very early labor, I was in agony from almost the moment I
got to the hospital. I completely lost control of myself because I could do
none of the things I had practiced to cope. And the sad thing was that when I
had to get up to use the bathroom, and had contractions while standing, I could
feel how much easier that was. I can do it that way!

So I was ready and eager to have an epidural as soon as pit augmentation was
added to the mix. :-p And I know epidurals can stall labor but I had gotten
myself in such a state that I don't think I would ever have dilated without it.
On my own and all worked up, I did not dilate at all from 7 to 11 pm. With
the epidural, I dilated in my sleep all the way by 9 am.

Leslie

[[email protected]]

On Thu, 10 Jun 2004 21:23:14 -0400, Kim E. >
wrote:

>Hi all-

Hey Kim!

>-Did you have the screening or did you decline it?

I had it. Negative for both pregnancies.

>-If you had IV antibiotics during labor, how long did you have to be
>hooked up to them, and how well can you move around while hooked to an
>IV?

I had to have IV antibiotics during labor due to my water leaking for
24 hours. I was induced, so the pitocin was given through the IV.
The IV was removed as soon as Luc was delivered. My labour nurse
removed it as soon as my OB finished stitching up my tiny tear.

I definitely couldn't walk around! Certainly not out of the room. If
you're lucky like I was, you'll have a great nurse to help reposition
all the tubes and the bp cuff so you can get into different positions.

Nenette

[Carol Ann]

> I am assuming you were induced with Pitocin - how much were you able to
> move around while you were hooked to the IV?

Yes. Do you mean during inducement? None b/c I was also hooked up to
heartbeat and contraction monitors. Had to use a bed pan.

After the birth, however, I was able to move around all I wanted. I just
had to pull the IV with me.

> Did you have to be on the antibiotics the day after you delivered, or
> was that an IV for other things?

I think I had 3 or 4 bags of antibiotics. I don't know if it was just for
Strep B or if they just give it to you anyway b/c of the cesarean.

>I thought Strep B only affected the
> baby negatively during L&D.

No idea.

> -kim

--
~Carol Ann
Mom to Morgan born 3.24.04
http://tinyurl.com/28zno <---Pictures!

[Jenrose]

"Kim E." > wrote in message
a.net...
> In article >,
> says...
> >
> > "Ericka Kammerer" > wrote:
> > > Kim E. wrote:
> > > > -Did you have the screening or did you decline it?
> > >
> > > I declined and went with risk based management.
> > > I would have had IV antibiotics during labor if I showed
> > > up with risk factors (preterm labor, PPROM, membranes
> > > ruptured more than 18 hours, fever).
> >
> > My inclination is to skip it next time. It wasn't offered back in 1993,
but
> > in our family, the risk of developing allergies is MUCH higher than the
> > risks associated with GBS, and antibiotic use in pregnancy can be a
trigger.
> > So I go with the lowest chance of needing antibiotics.
> >
> > I'm pretty low-risk anyway--I was on a series of really high-intensity
> > antibiotics a few years back, went on probiotics, and have just not been
> > very susceptible to bacterial infections since getting my allergies
under
> > control. I used to get yeast infections all the time, but don't now,
etc...
>
> Yeast is a fungus, not a bacteria tho.
> >

I know, but the tendency to infection is the important factor. That is, I
used to flare up yeast infections really easily, alternating with bacterial
infections. Which tied closely to the fact that I got respiratory tract
infections "all the time". IOW, I used to be really suceptible to both
bacterial and fungal infections and I just don't get sick that way anyomore.


> > I might reconsider with PROM--but I'm better nourished now than I was
with
> > DD and my membranes didn't rupture until 8 cm or so with her.
>
> I did not know that there was a connection between nutrition and PROM.
> Can you elaborate?
>

Sure! If you do not eat a healthy diet, you will have a hard time growing a
nice, strong amniotic sac. Vitamin E certainly helps, but anything that make
s your tissues stronger will tend to help systemically. Nutrition has a huge
component in really healthy pregnancy and can make a real difference in how
well our bodies handle the stresses at term, but also how vulnerable we are
to infections of all sorts.

> > I *really* want to avoid antibiotics. I haven't needed them in years and
> > would really like to maximize next baby's chances of being allergy-free.
> >
> > My feeling is keeping other people's hands out of my crotch will go a
long
> > way towards reducing risks of all kinds of infections.
>
> :) I am trying really hard to be good and not make a comment about how
> that sort of thing might have contributed to your getting pregnant in
> the first place! :)

lol! Well, I'm mostly concerned about iatrogenic infections caused by doctor
hands and hands that don't normally spend time near my crotch.... And I'm
not pg right now, I miscarried a few weeks ago.

Jenrose

[Kim E.]

In article >,
says...
>
> "Kim E." > wrote:
> > I did not know that there was a connection between nutrition and PROM.
> > Can you elaborate?
>
> Sure! If you do not eat a healthy diet, you will have a hard time growing a
> nice, strong amniotic sac. Vitamin E certainly helps, but anything that make
> s your tissues stronger will tend to help systemically. Nutrition has a huge
> component in really healthy pregnancy and can make a real difference in how
> well our bodies handle the stresses at term, but also how vulnerable we are
> to infections of all sorts.

That makes sense! Well, I've been paying close attention to my nutrition
so I hope this helps my amniotic sac!! I knew of the connection between
poor nutrition/exercise and preeclampsia, but never thought about a
connection with PROM.

> > > My feeling is keeping other people's hands out of my crotch will go a
> long
> > > way towards reducing risks of all kinds of infections.
> >
> > :) I am trying really hard to be good and not make a comment about how
> > that sort of thing might have contributed to your getting pregnant in
> > the first place! :)
>
> lol! Well, I'm mostly concerned about iatrogenic infections caused by doctor
> hands and hands that don't normally spend time near my crotch.... And I'm
> not pg right now, I miscarried a few weeks ago.

I am very sorry to hear that. I don't always read the m/c posts so I am
sorry if I made an insensitive comment.

-kim