The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
An interactive resource for moms on easy steps they can take to reduce exposure to chemical toxins during pregnancy.
Other excellent resources about avoiding toxins during pregnancy
These are easy to read and understand and are beautifully presented.
I was planning a homebirth, but the GBS culture came back positive, with low colonization. The midwives are now recommending that we birth at the birth center so we can get antibiotics during labor.
We wanted our baby to have a gentle birth with the best start possible
and no drugs, including antibiotics. We are heartbroken, of course.
Why can't they administer the antibiotics by IV in your home?
I encourage you to ask for complete information about this issue, including:
What are the increased infection risks of birthing at the birth center? (If your birth center is attached to a hospital, infection risks are significantly higher than in your home.) Are these increased risks greater than the risk of infection from GBS?
What are the specific complications associated with administration of antibiotics during labor?
What are the effects on the baby of being born with antibiotics in the system?
How do these antibiotics affect the colonization of the baby's normal skin and gut bacteria?
Nobody will be able to answer these last two questions because there's no research on the subject.
All that's really known is that administration of antibiotics during labor makes the baby very susceptible to any antibiotic-resistant infections, since there are no normal bacteria to crowd them out.
Getting a positive result from a GBS culture doesn't necessarily mean
that giving birth in a birth center or a hospital will be safer.
Ideally, you could use alternative treatments to reduce the colonization,
which is the safest approach to the GBS problem.
I was glad to learn that midwives do administer IV meds at home prn.
It would seem a shame to have to bring a low risk mom to a hospital for
IV antibiotics, especially when the increased risk of infection in the
hospital could offset any benefits.
In our area, the moms can get a prescription for IV antibiotics, and
then we call in ICare (home health nurses who do only IVs) to do the IVs.
According to the ACNM. A strategy for expectant management of a mom with ROM > 18 hours and no labor yet...and no other risk factors...is PO Amoxicillin 500mg TID at 18 hours of ROM. Apparently Amoxicillin is better absorbed than PO PCN VK or Ampicillin. When real labor begins they recommend a switch to IV Penicillin G because PO absorption from the stomach is not assured in laboring women.
ACOG, AAP, and CDC in their recent consensus report do not recommend
the use of PO antibiotics to prevent GBS disease.
We know a doctor who has his Group B strep patients start taking oral antibiotics at the onset of labor. That was they can avoid the IV entirely if they so desire. This would work well for staying at home, if your client can talk her OB into it.
If not, she can probably still stay home until ROM - but then she would
need either IV or IM antibiotics, regardless of echinacea or culture. I
had one client (a VBAC) who really didn't want an IV, but she was Group
B strep positive. Her doctor ordered shots every 4 hours postrupture (which
was, unfortunately, about 18 hours before her baby was born by CBAC).
There are many ways to skin a cat. no one has said +GBS requires iv
antibiotics in hospital. If you do the risk-based management, you would
only need antibiotics if >18 hours ROM. this might buy you some time.
We give all clients the option to culture @ 36 weeks, some do &
some don't. And we Rx in labor all positives & all who ROM <18 hours
or who have other risk factors. We give antibiotics IM, unless there is
some other reason why we might want an IV later. We also have had two clients
in the last year who tested positive who declined antibiotics and their
babies were fine.
I have a small home birth practice and my protocol is as follows: I
culture everyone at 35 weeks. If +, I provide information and informed
consent for antibiotic refusal. If the client is interested in antibiotic
prophylaxis, I will do PO amp at 38 weeks 500 Mg qid X 10 days, then offer
IV amp in labour. I do this for both home and birth center births
-- no need to go to the hospital for the IV meds. I just put in a
heploc and run them in q 4-6 hrs. My backup MD is also comfortable
with the woman doubling up on the PO meds during labour if she doesn't
want the IV stuff.
If you follow the history of the big Beta Strep deal, you will see that
the medico legal system made protocols re: beta strep following many articles
in women's mags. As you are probably aware, the big protocols have
gone through many evolutions. Many protocols forced on women didn't
work. The current protocol is not working well either. It would
take maybe 2 hours to educate each client re beta strep and the possibilities
protocols etc. I think it's antithetical to the midwifery model.
Not to mention the risks of antibiotic over-administration and the development
of super-strains of diseases, as well as the risk to any woman on any day
of allergic reaction to antibiotics. To encourage all clients to
get tested, knowing that 30 % of women will test pos, so they can worry
about yet another medical model thing, is bad midwifery to me.
So I am following the protocol of: if a woman ROMs before 38 wks,
or premature labor, or a previous strep baby, or develops a temp during
labor, or the baby's fhts become tachy, or ROMs >24 hours, THEN we will
offer IV antibiotics. I really want to get IV antibiotics to administer
at home in order to feel more confident about informed consent. (if
I can't offer it, it means she has to go to the hospital to get the IV,
so the decision changes to should I go to the hospital, not should I have
the IV antibiotics.)
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