[runnybabbit]

I'm a little bit frustrated. I'm 34 weeks pregnant with my second baby, and since my first trimester I have been going to the local Birth Centre, linked to the local public hospital, as a public patient.

From my very first appointment I informed that that I swabbed positive for Group B Strep in my first pregnancy. With my first baby, it was about six hours after spontaneous ROM (no prior contractions) till we got to the hospital (37w2d, we were down south on our last romantic getaway). So there was no time for me to receive IV antibiotics, as was the plan. When my baby was born, he was swabbed and I think ear and nasopharyngeal swabs came back positive for Group B Strep. He had systemic antibiotics shortly after birth and then a course of oral antibiotics. So his swabs were positive but he never displayed clinical symptoms (obviously because of the prompt administration of antibiotics).

So this week, at 33++ weeks pregnant, my midwife informs me that she was talking to another midwife and that second midwife says that Group B Strep positive women are actually to be excluded from the Birth Centre as the hospital's policy is that the baby receives antibiotics within 30 minutes of birth. Previously the plan was that I would receive IV antibiotics in labour and as long as this was done within x hours of the birth then the baby wouldn't need antibiotics.

I'm just a little upset that the Birth Centre has known for over 20 weeks my full medical history (including the part about my son's swabs being positive etc) and now it seems my only option is to birth as a public patient at the maternity unit. Which isn't a bad option, and might have been the one that we'd gone with anyway if we'd been rejected from the Birth Centre from the start, but it just seems kind of slack.

I'll be talking to my midwife again this week and finding out more -- for example, if we found a private paed, would his/her presence at the Birth Centre then make it possible for me to birth there, since apparently the factor precluding it is needing the baby to be checked over and having ABs within 30 minutes of birth.

I'm not sure what I'm looking for here -- commiseration, I guess, experiences, suggestions would all be welcome.

[Melissam12]

Why can't they administer antibiotics to the baby in the birth centre?

[runnybabbit]

They don't have a paeds team there, it's midwives only.

But why can't they whiz me up after the baby's born? Surely if something bad happened and I needed a crash C-section, I'd be upstairs within minutes. I don't have to lounge around on the big double bed for ages after the baby's born, I'd be happy to go upstairs with the baby and have paeds do whatever they needed to do.

[surprisenofour]

Hmmm I tested positive and had iv anti b during labour, I would not want my newborn to be given anti b's as we have penicillin allergy running in the family. That was why I needed it via iv, my middle child has had a reaction and ended up quick sick in hospital, I would hate to see a newborn go through that. Thank you for posting though as I can ask about if my hospital has changed policies.

As for the birth centre, it is low risk I don't see them letting you labour or give birth in there. I had to be swapped from the birth centre to the labour ward after waters broke as it had mec in it. Yes I was disappointed but when it all went downhill quickly and the emergency button got hit it took less then 30secs for seven extra people to be in my room.

[*lightning]

I would wait and do another swab for strep b, you might not be positive this time. I was worried about not getting to hospital in time for ABs or getting the ABs and ending up with thrush but in the end I was negative for my last baby.

I was positive with my DS2 but negative with DS3, was never tested for my first two pregnancies. Our hospital just monitors babies temp and watches them for signs of infection, they don't administer ABs to the baby unless they show signs of infection. I never received ABs with DS2 because he was born 15 minutes after we arrived but they just wanted to monitor him and thankfully he never got sick.

[runnybabbit]

I would wait and do another swab for strep b, you might not be positive this time.

My understanding is that GBS is transient so once you have a +ve swab you're always considered +ve; am I wrong on this?

The baby will only need antibiotics if I don't get the IV antibiotics at least x hours before birth.

[RunawayPrincess]

This whole strep b business is just so rubbish. Did you know that in a few states (can't remember which new off the top of my head) they don't even do the strep b testing now?
I will absolutely refuse to be tested next time, and I will also be refusing the antibiotics during labour (because I will be treated as 'positive' because of my previous swabs). There would also be NO WAY I'd have antibiotics administered to my baby for no reason.

I am sorry, I can't help with the birth centre side of things, I wish I could. Strep B testing makes me so angry, especially the way they try to restrict where you can or can't birth (like in your case). It is so ridiculous.

[Chubbles]

This whole strep b business is just so rubbish. Did you know that in a few states (can't remember which new off the top of my head) they don't even do the strep b testing now?
I will absolutely refuse to be tested next time, and I will also be refusing the antibiotics during labour (because I will be treated as 'positive' because of my previous swabs). There would also be NO WAY I'd have antibiotics administered to my baby for no reason.

I am sorry, I can't help with the birth centre side of things, I wish I could. Strep B testing makes me so angry, especially the way they try to restrict where you can or can't birth (like in your case). It is so ridiculous.

I completely disagree. It's not rubbish at all. My baby got GBS from me and he became very ill, very quickly. He was born less than 5 minutes after my waters broke and my labour was incredibly quick. His chance of getting GBS was extremely low, almost non existent because there was no prolonged rupture of membranes.

We were very unlucky that he got sick but the fact is he did. They don't make this stuff up for fun babies can and do die from GBS.

[Strawberry Welli...]

I tested positive for GBS at 37 weeks but still had my baby in the birth centre (major Sydney maternity hospital). I got IV antibiotics shortly after established labour began and they recommended we stay in hospital for 48 hours after his birth to monitor him - every 4 hours they came in and checked pulse and breathing and temp I think.

Surely they can wait until your 37 week swab to make the decision about what you will need in labour? I too was told that GBS is transient so sometimes it is present and sometimes its not.

[runnybabbit]

Surely they can wait until your 37 week swab to make the decision about what you will need in labour? I too was told that GBS is transient so sometimes it is present and sometimes its not.

Because I've had a baby who has had GBS (even though not sick but he swabbed positive, which counts him as having had EOGBSD) it means the maternal risk factor is there. Regardless of GBS status in this pregnancy that risk factor is still there. I believe there are no plans for me to be swabbed at all in this pregnancy.

Chubbles I'm so sorry to hear that your baby got sick, makes me very very thankful that #1 got his antibiotics promptly. We did have to deal with thrush after that, but clinical EOGBSD sounds like a lot less fun than thrush.

Runaway Princess Yes and I believe QLD (where I am) is one of those states, they take a risk factor approach instead of a screening approach. Having had a previous baby with EOGBSD puts me in the risky category regardless of my GBS carriage status in this pregnancy.

I am fine with me and/or baby getting antibiotics if the medical indication is there. I just feel that surely if the baby needs a full blood count, blood cultures and antibiotics within 30 minutes of birth, DH and baby can go upstairs while the midwife stitches me up etc and I'll follow straight after. The plan was for me to be transferred to maternity ward upstairs anyway to stay for 24-48 hours. I just don't see that actually delivering in the birth centre will hold up the neonatal investigation and treatment significantly.

I will have another chat with my midwife.

ETA thank you everyone for your input so far.

This post has been edited by runnybabbit: 26/11/2012, 10:45 PM