Make a Donation
     Connect with UsFacebookTwitterYouTube
    Google Custom Search

    Questions? Ask Henci!


    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

    You must establish a username and password to participate in the Ask Henci forum, click here to submit your request.


    Aug 04
    2009

    REPOST: Group B strep & induction

    Henci Goer

    Dear Henci,

    Greetings!!  I am Group B strep positive and my midwife has recommended an induction of labor so that I may receive the 2 doses of antibiotics in the appropriate amount of time before the baby is born.  This is my 4th baby and with babies #2 & #3 my labor was between 80 and 90 minutes from first pain to birth.  If this labor is just as quick, there will not be time for the I.V. antibiotics.  I would like to weigh the risk of the baby contracting Group B Strep with the risks to the baby during an induced labor.  I have read information on both yet am having a hard time assimilating it all as it seems that very few people are objective.   My midwife recommends that I receive the 2 doses of antibiotics according to the recommended timing and then break my waters to induce labor.  The idea of induction does not sit well with me but neither does a potentially sick baby.  Please share you knowledge and opinion on this subject.  You may post this to your forum if you wish.  Thank You.  Jennie 

    (I cut & pasted Jennie's post because she could not post while the website was down. -- Henci)

    Henci Goer

    Jennie --

    I have reviewed the U.S. Centers for Disease Control guidelines for  women testing postive for group B strep. Nothing is said about induction in the recommendations. However, here is what theCDC guidelines say about women who give birth too quickly to receive the recommended antibiotic dose:

    In the event that intrapartum antibiotics are not given despite an indication (e.g., delivery occurred precipitously before antibiotics could be administered to a GBS-positive woman), sufficient data are not available on which to recommend a single management strategy for the newborn. Some centers provide intramuscular penicillin to asymptomatic infants within 1 hour of birth, based on results of observational studies showing declines in early-onset GBS disease coincident with a policy of universal administration of intramuscular penicillin to all newborns (121).

    Whereas they say infants of mothers who received the recommended dose do not need any special treatment unless they show signs of illness.

    Now that you have the link to the CDC guidelines, you can read through them and decide for yourself in collaboration with your midwife what you think the best course of action should be. You will want to consider not only the benefits of induction but the potential harms, whether having your baby have an injection of penicillin is acceptable to you, and what the risks would be in your individual case because risk of infection varies depending on how heavy the colonization, whether the baby is full-term, and how long the baby is exposed to possible infection during labor. Speaking of which, on general principles, I recommend avoiding any procedure that could carry the microbe up from the lower vagina, where it usually lives, onto the cervix or giving it access into the womb unless there is a compelling reason for doing it. This would include vaginal exams, stripping membranes, rupturing membranes, or internal electronic fetal monitoring (cardiotocography).

    -- Henci

     

    Archived User

    Dear Henci,

    I also spoke with the pediatrician and she did not feel strongly one way or the other.  She provided me information about the risk of the baby contracting Strep B (about one-half of one percent) and said that her experience has supported that statistic.  I stated that I was leaning toward allowing labor to start naturally so it is possible that I will not receive the antibiotics, she did not have any objections to that and said that the course of action would be to then watch the baby for sickness after birth.  By the way, I learned from a different source that Group B Strep may occur very quickly after birth (usually within 24 hours) or have a later onset.  The receipt of antibiotics during labor is preventative only towards the early onset.  Whether or not a woman receives antibiotics doesn't have any outcome on whether the Strep B occurs later in the baby.  Thank you for your quick response and for posting this.  Jennie   

    Henci Goer

    Oh, good. I'm glad you've come to a comfortable solution. And as I wrote in the earlier post, all women with group B strep colonization are not alike. Risk of infection varies with circumstances, so yours, while not zero, is much lower than the average. And the CDC guidelines also point out that antibiotics are only useful against early onset GBS infections, and, moreover, do not completely protect even against early onset.

    By the way, I suggest you think pro-actively with your midwife about how to minimize the likelihood of developing thrush as a side-effect of the antibiotic treatment. The antibiotics kill off the good bacteria as well as the bad. This allows thrush, a fungal infection, to develop in your nipples and the baby's mouth. It causes problems with breastfeeding because women feel like their nipples are sunburned and the baby feels like it has pizza mouth, as any adult who has had oral thrush can tell you. Some midwives recommend probiotics to prevent/restore the normal flora and fauna. Also, on general principles, one of the benefits of skin-to-skin contact after the birth is colonizing the baby's skin with the harmless bacteria that live on your skin, which prevents bad bacteria from taking hold.

    -- Henci


    All Times America/New_York

    Forum Disclaimer

    Please note that this Forum is intended to help women make informed decisions about their care. The content is not a substitute for medical advice.



    Copyright 2014 Lamaze International. All rights reserved. Privacy Statement | Terms of Use