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hits since 22 Mar 2002

Advice for moms who have had a previously infected baby by Lisa Porter

Remember, I'm not a doctor or a lawyer...ask your birth professional for more information and educate yourself about the issues. Decide for yourself if this information is reasonable for your situation.

When you've had a sick or preterm GBS baby or had a loss attributed to GBS infection, you are in a unique category. You're no longer one of the women for whom the national CDC protocols were written and you wonder how you can prevent problems in subsequent pregnancies. The fact that losses from GBS are very rare doesn't help -- when your baby has been effected, you "risk" feels like 100%, not "1 in 200." No medical organization has written protocols for moms who've had preterm complications, because the majority of GBS+ women have no complications. The CDC writes recommendations for the majority, not the few. So moms who're educated about GBS prevention have made an effort to come up with tips for those who need a more specific protocol. These ideas are gathered from anecdotal information -- talking to moms who had complications and figuring out what worked for them. Talk with your provider and use the parts that work for your situation.

The CDC recommendations still apply to you in many ways (treating u.t.i.s as they happen, treating with IV antibiotics during labor, no c-section needed just for GBS prevention,) but in some cases, it's necessary to be more proactive once you know GBS is more than a just a "theoretical risk" for you and baby.

 

 

 

If you're one of the small minority of GBS+ women who have had a loss or a sick baby before 37 weeks, here are some suggestions for handling GBS in the next pregnancy.


Educate Yourself

The most important step in preventing GBS is educating yourself. Read all you can about GBS disease, and be prepared to help your provider update his education. Most providers won't know as much about GBS as you will, and that's okay. It's *personal* for you, and it's usually not personal to the doctor. Help him get educated about GBS so he'll work with you on your level.Top

Find the best Provider
Find a provider who will work with you medically AND emotionally. Believe it or not, the BEST provider for a mom with a "GBS history" isn't necessarily a high risk doctor. The *best* provider is one who will work with you to create an individualized care plan based on GBS prevention, your circumstances and your *mental* health. Top
Proactive Urine Cultures
Once you're pregnant, get a urine culture for GBS every month. This is not just the "dipstick" test they do every time. You need a bacterial culture of the urine looking for GBS every month. GBS in the urine is a warning -- a sign that you carry lots of GBS (which is a risk factor for having complications.) Testing every month gives you a chance to get rid of it as soon as possible. If you test the urine monthly, you can have some peace of mind that GBS hasn't been allowed to grow "unchecked," because it's never more than a few weeks since you "looked" for GBS.

Treat GBS with oral antibotics every time it is found in the urine, and reculture the urine to be sure it stays gone. Be sure to ask to have the culture tested to see which antibiotics kill it, and use those antibiotics. This is especially important if you have GBS in the urine more than once or twice, or if you're allergic to penicillin-type antibiotics. Top

Are Oral antibiotics appropriate?
Being pregnant again after a loss or a preemie is scary. If your MENTAL health and peace of mind would benefit from being treated with antibiotics a few weeks before the problems last time, work this out with your provider. There's no protocol for this, and generally it's not recommended to treat GBS colonization before labor, but if it will make you feel calmer and more in control, it's a reasonable thing to discuss with the doctor.

If you've had a complication from GBS in the past, it seems prudent to stay "ahead" of GBS if your culture shows "heavy colonization" or GBS is found in the urine (which is another sign of heavy vaginal colonization.)

Some women go on oral antibiotics for weeks or months in an effort to "suppress" GBS. This isn't a great idea b/c of the risks of long-term antibiotics and the stress it puts on your body, but again, you're in a different category than the average GBS+ woman. Discuss your options with your doctor, and decide what works for you. Top

Is screening necessary?
In addition to urine cultures, decide if you'd like to have the vagina/rectum cultured a few times during pg to make sure you're not "heavily colonized." Having GBS in the urine or being "heavily colonized" in the vagina/rectum mean the same thing --- *possible* increased risk of GBS crossing the membranes or causing preterm labor. Be mentally prepared that you'll still carry GBS -- you should expect that it's still there, and be surprised it if isn't.

It's disheartening to some women to keep finding GBS in the vagina/rectum, so decide if this information will HELP you emotionally or if it will make you more nervous. Top

Incompetant Cervix and GBS??
If you've been told you have an "incompetent cervix," get antibiotics in your system before, during and after the cerclage placement and before, during and after removal. Any manipulation of the cervix allows GBS to be introduced to the cervix and potentially get closer to baby, so it's important to get rid of GBS before the procedures. Also, you must weigh the benefits of cerclage against GBS infection risk.

In my opinion (I'm not a doctor), cerclage is too often recommended for GBS+ moms with a history of preterm labor or preterm rupture. "IC" is a common diagnosis to explain the early labor or rupture. However, since GBS sometimes causes preterm labor or rupture (especially in moms with heavy colonization or untreated u.t.i.), it might *look* like you have an incompetent cervix when you don't. By this, I mean that your cervix opens in response to the infection, not b/c it's "incompetent." Your doctor assumes that your cervix is "incompetent" b/c you have dilation before term, but he might not be looking at it from the viewpoint that uterine or amnion infection can sometimes lead to dilation. This is worth discussing with your doctor.

So, if you are sure you need a cerclage placed, get antibiotics before, during and after the procedure (and removal) to be safe. But if you are unsure, educate yourself and talk with your provider. Top

Is it better to have the baby born ASAP via induction/c-section?
Weigh EVERY intervention for its benefits and risks in light of GBS. Doctors sometimes suggest induction or c-section or other interventions in an attempt to reduce your anxiety about the baby. They assume that you'd rather see baby and hold him in your arms than wait for labor to start on its own. While that's certainly true -- who wouldn't want to hold her baby sooner if she could? -- it's important not to take baby before he's ready. As scary as it is to wait for baby to come, inductions and c-sections add risks of infection.

While it seems logical to "get the baby out before anything can happen," you cannot be sure that you're doing the safest thing for baby if you intervene in birth just to get baby out "soon." As hard as it is, it's important to keep your fears and stresses from impacting the decisions you make for baby. At the end of your pregnancy, the fears and pressures to see your baby are strong. Try to balance your needs (fears for baby's health and a need to see and hold him) with baby's needs so you can advocate for the healthiest birth process possible. Top

Find Support
Get lots of support -- ask for pep talks and hugs when you need them. Check in to this board often, we're here for you. Top
Think Positive!
Think positively. GBS causes fewer problems in moms who are educated about the bacteria, b/c we know what to ask for, and we're proactive. If you're checking your urine monthly and working with your provider to develop a practical prevention plan for your situation, the odds of a term, healthy baby are excellent. Happy endings DO happen to GBS+ moms. Top
More Information
Read the 20 page document from Group B Strep Support in the UK for Parents with a baby infected with GBS (pdf) Top