GBS

38 weeks, 4 days
(prepare for longest blog post, ever)

Perhaps my last post about GBS was a little vague - here let's get statistical!   I will say it was a good test of blogging from my phone, should I need to send out any brief birth announcements in the upcoming days!  :)

What is GBS?  It stands for Group B Strep.  It is a normal bacteria in our bodies, but sometimes causes death in newborns.  Pretty serious stuff.  Let's look at what "sometimes" means:

So if you have GBS (which I did, at least two weeks ago - well, they say the test is 87% accurate), 50% of babies will be colonized by it, and 1-2% will get sick.  So that's 0.5-1% of babies will become sick (serious consequences including death/life long disability).  To quote the midwives, of 17 500-50 000 pregnant women, 1-4.5 babies will die due to GBS.

Who are these babies?  There are some risk factors that make it much more likely it will be babies of a certain set rather than others:

• Preterm [thankfully, Appleseed is not!]
• Baby weighs less than 5 lb 8 oz [the last u/s put Appleseed at 6 lb 8 oz, which makes me SUPER happy, but I know that is not the most accurate of measurements, so am not banking on it]
• Previous baby with GBS disease  [thankfully, no]
• Water broken for more than 18 hrs
• Fever during labour

So what is to be done?  Two common choices:

1. Take IV antibiotics during labour if you test +ve for GBS
2. Take IV antibiotics during labour if you test +ve for GBS and have another risk factor.

Life is further complicated by the fact that I'm probably allergic to penicillin, and so have to take clindamycin.    This means two courses of IV antibiotics during labour (6-8 hours apart) vs only one course with penicillin.  And these aren't getting little nudges of antibiotics, they really whack you with them.  And if my labour is less than 6-8 hours long?   It will be like I didn't do it (in the view of medical professionals, anyway).

Ok, CS, just take the antibiotics, what's the big deal?

Again, looking at the stats is very interesting.  With choice #1, 30% of preggos receive IV antibiotic.  This leads to GBS (/other) antibiotic resistance.  The lamest stat of all is that 21% of GBS strains were resistant to clindamycin, while none were resistant to penicillin (yet?).  But nothing to be done about that.  Sorry Appleseed!  Blame Grandma for calling "allergic" without proper testing!  Can't test now - pregnant!

With choice #2, 3.4% of preggos receive IV antibiotics.  Quite a dramatic decline.  One would argue that's almost everyone that needs it.

We can say it like this.  With #1, about a 1000 infants receive antibiotics during birth to prevent one GBS death.  With #2, about 6 infants receive antibiotics during birth to prevent one GBS death.  That's pretty striking.

Why say almost?  Success rates of methods 1 and 2:

1. 65-86%
2. 51-75%

So even if I do opt for antibiotics with no other risk factor, it isn't 100% successful in preventing GBS disease.  That's sort of surprising, right?  Here is what they don't tell you - those 14-35% of babies that STILL get GBS - do they belong to a particular group of babies?  Like, are they all preterm?  They don't say.  Interestingly, the majority of those 14-35% are of mothers that screen GBS negative - that should give you the willies!  (sorry)

Still seems like slightly improved chances if I just take the antibiotics no matter what.  BUT - what about the downside of antibiotics?

• Yeast infections - not life threatening, but a bummer, and can cause breast feeding drama
• Potential for baby to be allergic to the antibiotics (rare, not too worried about this - 1 in 10 000)
• Death from Antibiotics (very rare, 1 in 100 000)
• Public Health concerns about growing strain resistance
• Potential for increased allergies or asthma for Appleseed.  

There is where I struggle -  potential for increased allergies or asthma for Appleseed.  By maybe overreacting, I am maybe increasing her risk of allergies and/or asthma.  We have TONS of allergies in the family.  I really struggle with starting her off on that path.  The data totally isn't clear on this point. 

And that's where I stand today.  I'm leaning towards only taking the antibiotics if I have a second risk factor.  Even though the official risk bar is set at 18 hrs for membranes ruptured before baby comes, some studies indicate risk begins to slowly climb after 6 hrs.  I will ask about that - can I change my mind after 6/8/12 hours of ruptured membranes?

I'm planning on talking to a friend of mine who I think was GBS positive, and also to my doctor friend, for their opinions.  And this does not preclude a home birth - midwife can give IV antibiotics while I'm at home, no worries.  So at least that is uncomplicated!

If interested, the real (LONG TECHNICAL) details are here.

A very interesting quote about garlic (and for the LIFE OF ME I tried to find this full document online - our public library should give us access, but no dice).  There is no research to back it up....but maybe it can't hurt....?