Hi Henci, I really appreciate your book and credit it with my having such a successful natural birth with my first child. We were living in Italy at the time and I was fortunate to find a doctor and midwife who believed in a women's ability to give birth without intervention. I was inclined to do so anyway, but reading your book gave me the facts I needed to confirm that my instincts were right. I am GBS+ and trying to decide whether or not to have antibiotics in labor. Doing so would prohibit a home birth in the part of the UK where I now live. I did have them with my first baby, but since my water broke when the head came out, I doubt my daughter was ever at risk. My concern stems from the fact that my daughter has nut allergies (we have no family history) and though not proven, there is a theory that early exposure to antibiotics may be linked to allergies. (This was not her only exposure to abx as I had mastitis and she had strep throat and an ear infection in her first year.) I'd rather limit the exposure where I can. I have read on this site that how heavily colonized you are can help determine how great the risk is. So my question is, how does one find out how heavily colonized they are? It has not shown up in my urine.

Thanks, Leigh

The U.S. Centers for Disease Control GBS guidelines say this:

Heavy colonization, defined as culture of GBS from direct plating rather than only from select broth, is associated with higher risk for early onset disease. GBS identified in clean-catch urine specimens is considered a surrogate for heavy maternal colonization and also is associated with higher risk for early-onset GBS disease.

Unfortunately, this is not an area of my expertise but perhaps your midwife or doctor could interpret for you. If it is any help, the CDC guidelines also say that the attack rate for early onset GBS in the newborns of untreated GBS + women who do not have other risk factors (less than 37 wk pregnancy, membrane rupture longer than 12 hr, fever greater than 99.5 degrees) is 5 per 1000. The fatality rate for early onset disease in newborns is 4%, which would calculate to 2 per 10,000 in untreated GBS + women without the risk factors listed above. 

I should add that I am not aware of any study that looked at the effect of vaginal exams or invasive procedures such as stripping membranes or internal fetal heart monitoring or contraction monitoring on GBS infections, although I have studies showing that uterine infection in general can be linked to number of vaginal exams and length of time. I would be willing to bet that one could show an equally marked reduction as with prophylactic antibiotics in GBS infection rates just by keeping instruments and fingers out of the vagina with none of the downsides of antibiotics. Those studies will never be done, though, because whatever else can be said against them, prophylactic antibiotics are effective at preventing early onset GBS. My sound bite on that issue is: "If they had had antibiotics in Semmelweis' time, doctors still wouldn't be washing their hands."  

Thank you for your kind words about my book.

-- Henci

If I may add, hibiclens has been clinically proven to be just as effective in treating GBS as antibiotics.

I would suggest a treatment of that and retesting if you are worried.

http://www.medscape.com/vi

Wow! This is exciting news! Unfortunately, I couldn't access it via your link because it took me to a sign-in page. Is there more detailed info you can post such as what were the evidence sources for this strategy? Also, if there were any more details about exactly what to do, when to do it, and whether any side effects fwere seen. Vaginal thrush occurs to me as a possibility, although there may be a strategy to recolonize with harmless bacteria to prevent it.

-- Henci

Not sure why it brings you to a sign in page, but maybe it is because the link was broken. Here the correct link

http://www.medscape.com/viewarticle/542430_4

The proper dilution from the European studies is 0.2% and if you buy a 4% bottle of hibiclens typically available in the US you will need to dilute it 1-20 one part hibiclens and 20 parts water ( about 2 Tablespoons to 20 oz of water). Put it in a peribottle and use it as an external rinse and shallow douche.

The good thing about hibiclens is that it leaves lactobacillus in tact- but the other thing is that women who have GBS are low in lactobacillus particuarlly H2O2 producing lactobacillus so you would need to supplement with lactobacillus, and eat fermented foods to recolonize yourself - you could also directly instill active culture yogurt into your vagina-

In the case of hibiclens more is not better- you really need to dilute because full strength can cause some tissue breakdown. Chlorhexidine is another name for hibiclens.

Thanks for this!

-- Henci