Strep B Saga continued…

Since my first post on my strep B positive result (if you need a catch up, click here), I had another midwife appointment, and I’m feeling a little better about things. I think I’ll backtrack a bit though to continue the story.

In my last post I wrote that I tested positive for GBS, and I explained why this result might change how things go for labor and delivery. Here’s the rest of the story:

Alternative treatment to antibiotics

At my 35-week appointment (when I tested for strep B) the midwife was telling me that in Europe practitioners have been studying a type of wash they feel can reduce mother to newborn transmission of the bacteria. Instead of giving a mother penicillin or some other antibiotic, they use a wash in the time leading up to a vaginal delivery to reduce the possibility of the bacteria being picked up by the newborn.

She said they’ve seen very good results with this alternative, but unfortunately, the studies have yet to be replicated in the U.S.

Fast forward to the following week when I had my appointment to discuss my strep B result. I left that appointment somewhat discouraged, knowing I would have to have antibiotics with the birth and all of that. I headed to Cradle, a baby store in Northampton that has tons of resources and offers workshops and classes during pregnancy and for the postpartum period. They also sell cloth diapering items, baby carriers, etc. I was headed to purchase some final things on my registry, and I mentioned to one of the women behind the counter that I had tested positive for GBS. She immediately went to a file and handed me some information on an alternative treatment, then encouraged me to ask about being retested at my next appointment.

Turns out, the info she gave me was from one of the European studies I’d been told about. The method uses Chlorhexidine (sold under the name Hibiclens) and water. It can be applied in one of two ways, and according to the study, researchers found washing or “flushing” with this mixture to have the same efficacy as using an antibiotic.

I wasn’t sure if you could buy Hibiclens around here, and I first wanted to run the study by my midwives. At my appointment on Friday I asked about being retested and mentioned the information I was given. The midwife I saw attended a conference last year on this very treatment, and she also said there are herbs you can take that some find to help rid a person of the bacteria. Unfortunately, I’m a little too close to my due date to try these alternatives, and even if I were to retest and have a negative result, the first positive on my chart will stay with me. Apparently, once I’m at the hospital, the pediatricians there would see the first positive and still insist I have the antibiotic, regardless of a second negative test. If I opted out, they would run tons of tests on the baby following birth and keep it under close watch for at least 48 hours. So basically, at this point, I may as well accept the positive and proceed.

For the next pregnancy, though, the midwife suggested I try the treatment a few weeks before I would be tested, get a negative and then be done with it. I’m definitely going to hold onto it for that reason. She also said their office gave thought to running their own study for the moms who test positive and choose to opt out of antibiotics. They were going to offer the wash and herbs and track the results; however, they decided it probably wouldn’t be well accepted at this time by the medical field. As she put it, the U.S. isn’t “edgy” enough for this type of research!

She did encourage me that it is still entirely possible for me to deliver without pain medication, and that even if I have to be induced with Pitocin, it is entirely possible for me to get through the birth without an epidural. I said something about being afraid the contractions would come so fast I couldn’t stay on top of them, and it would be more painful since Pitocin doesn’t offer the release the natural hormone it imitates does. She replied, “Well, we won’t make them come so fast.” (I figured out this meant they won’t turn the dial up so much!) So I left more encouraged that I could still deliver naturally, even with a GBS positive result.

A word on the mental/spiritual effect of the result

 I mentioned the result upset me a lot initially. I’ve figured out why, and I thought I may as well share that, too. I’m well aware that birth is an unpredictable event. You can write the best birth plan, prep for months and months and still end up having an emergency c-section. Things happen. Birth is just one of those things that cannot be controlled.

But I like control. It’s something that has consistently hindered my relationship with God—I could probably find something I have trouble giving up control of daily. At least weekly. I knew before this GBS test that if things were to end in a c-section, I would have a real possibility of being depressed and feeling like I failed. Knowing that, Andrew and I (and friends who know) have been praying that I’ll remember who is in control of this birth and trust that regardless of how it turns out, things went the way the Lord had planned.

That’s why the positive result hit me the way it did. It was one more roadblock to remind me that I’m not in control. “Doing this my way” is prideful and sinful, and I need to not only continue to confess that but keep praying that my faith and trust will be bigger than the outcome of this birth. AND that if I do end up having a natural birth, the glory doesn’t go to me—it goes to God because he’s the one with the plan and the one who got me through it.

Strep B Disappointment

Easter Sunday was a great day other than the fact I was dealt a bit of an emotional blow to my pregnancy hopes. My new midwifery office has an online portal that sends email reminders for appointments, and it also loads your test results there for you to check if you need to. I got an email that the results for my strep B test were in. Obviously by my saying I was dealt a blow, one can assume the results were positive, which they were, but I’ll stop here and give you some background on what the heck strep B is, how it affects a pregnancy and why my positive result may cause some problems for me in labor.

Between 35-37 weeks of pregnancy, moms are tested for something called Group B Streptococcus, or GBS. This is not strep throat. That is apparently a bacteria called strep A. Strep B is a bacteria that approximately 30% of women carry—I apologize for suddenly throwing these terms out, but it’s all medical—in their vagina or rectum. Apparently it can also be in your lower intestine, but since your baby doesn’t come in contact with that area, the test is performed by swabbing the other two areas mentioned.

I felt like this wordy post needed a picture. This is what I got when I Googled strep B. This and screaming baby pictures. (From I-am-pregnant.com)

(I believe, from the quick Google searches I’ve done, that men can also carry this bacteria, but since they don’t give birth, I haven’t really looked into how it affects them. Sorry if you're a dude and hoping for that information.)

The reason women aren’t tested until 35-37 weeks is because this bacteria can come and go. The carrier may never know she has it unless she becomes pregnant and is tested for it. Even then, she could’ve carried it at one point but not be carrying it at the time of the test, resulting in a negative result. Basically—I tested positive this time, but with my next pregnancy, or even if I were tested again in two months, I might not have it.

So how does this affect pregnancy?

When a baby is born and passes through the birth canal, there is the possibility it can pick up the strep B bacteria if the mother is a carrier. There is no way of knowing which babies will contract it and which ones won’t. The most common illnesses/diseases the bacteria causes in newborns are sepsis, pneumonia and meningitis—all very bad things for a newborn to have. There is some commentary on the bacteria also affecting the mother, but from the majority of what I’ve read and been told by medical professionals, the concern is for the baby, not the mother.

In order to prevent the baby from catching the bacteria, mothers are given penicillin intravenously every 4-6 hours during labor. Administering the antibiotic significantly reduces the chance a baby will get strep B. The most common stats I’ve read say 1 in 200 babies will pick up the bacteria if no antibiotics are given whereas 1 in 4000 pick it up with the antibiotic. So it’s a really good thing to let them give you antibiotics, though some women opt out. At that point, pediatricians watch the baby very closely for signs of illness.

[I should probably also mention that this bacteria hasn’t always been tested for—I’m fairly certain my mother wasn’t.]

Now, why did me finding out I tested positive make me so upset? It’s just a little IV, and I don’t even have to be attached to the pole. I can get the drug, have it plugged and continue to labor as I please—even giving birth in the birthing tub if I so choose.

Well, it just complicates some other hopes a bit more. Two main things will change. Number one: if my water breaks before labor starts (happens in fewer than 10% of women) I will have to get to the hospital for the antibiotic. If this happened and I had tested negative, I might be given up to 24 hours for labor to begin on its own (totally dependent upon practitioner). Because I tested positive, I’ll only have maybe 12 hours before they’ll want to induce.

Number two: I won’t be able to labor at home as long as I wanted. Because pediatricians like to see the dose given at least four hours before the baby is delivered (like you can technically plan these things), I will need to head to the hospital and arrive hopefully at 5-6 cm dilated as opposed to maybe showing up at 8-9. My midwife told me today that most docs like to get two doses in, but since some women progress quickly, that isn’t always possible. If for some reason I were to get there and give birth in less than four hours or even so quickly the meds can’t be given, they will just watch the baby very closely. But ultimately, they’re going to want me there sooner than if I had tested negative.

I’ve decided I’m going to end my post here and tell you the rest of the story with my next post. I was presented with some research of alternate ways to deal with a GBS positive result that I want to share, and I also think it’s important to talk about why I finally determined this upset me so much. All that to come…stay tuned!