Collective Responses from
Midwifery Today-Online
Question of the Week Responses
Q: A friend was just diagnosed, by urinalysis, with Group B strep. She is planning to have her baby at home (this will be her third successful homebirth). She has been told she will need IV antibiotic intrapartum. Is it safe to have a homebirth and if so what precautionary measures should be taken? She is due March 20.
-Colleen
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A: I have had several moms with strep B. I encourage the moms to avoid refined sugars and junk food. I also suggest they eat lots of leafy green vegetables and fresh fruit. Having a more alkaline diet will discourage the strep B. Liquid oxygen helps to alkaline the system as
well. This can be purchased in most health food stores. The medical profession has really terrified mothers. I have had no problems with moms who tested positive. They all had a fine birth.
All of us have strep B -- some have it more under control. Cleaning up the diet really helps. Most moms who have upgraded the diet will then test negative for strep B. The doctors will tell them they will still have the antibiotics regardless, since they had tested positive for it
at a previous time. That is very discouraging.
-Anon.
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A: In our country (The Netherlands) women with group B strep can deliver at home but with a few restrictions and depending if the obstetrician in charge is in favour of homebirth or not. I have had a case like this only two times. I asked for a second opinion from an obstetrician who I knew is not afraid of home delivery, and we agreed on the following:
Have the woman get another checkup (at 36 weeks gestation) and see if the bacteria are still present. If so, she can get antibiotics and be tested after the antibiotic treatment. If she is still infected she needs intrapartum IV antibiotics -- if she delivers after 4 hours. If she's a "flying multipara," as we say, and delivers within 4 hours, the IV antibiotics are too slow to work and then I think a shot of 50.000 units of penicillin for the baby postpartum will do (in the hospital I work with, this therapy is done, and after a day of observation mother and baby mostly go home without problems).
If there are no strep B left after the antibiotic treatment in pregnancy, the woman can deliver at home, but stay aware of the fact that nobody knows how long after the treatment with antibiotics in pregnancy the strep will! be eliminated. So close observation of mother
and child is still needed, and the baby must be transferred to hospital to get treated when only the slightest sign of infection occurs.
In my opinion this shot of preventive antibiotics also can be given at home to the baby (we are allowed to give the first vaccination against hepatitis B within two hours of birth to the baby at home as well, so why not antibiotics?).
Thorough observations of signs of illness of mother and child also can be done at home, but I never got a GP to give me the antibiotics for the baby because it is not "regular protocol." Still I think it could be an option (maybe that's my opinion about delivering in the most
natural environment; I think you need a hospital only if there's nothing you can do anymore at home). Remember that this woman already had two babies at home without complications and that close and thorough observations for signs of
-Mieke
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A: I have attended a homebirth where the mother needed GBS prophylaxis. If the labor is progressing rapidly, start an IV site and administer penicillin-G 500 million units or 2 grams of ampicillin if allergic to penicillin. Then give Clindamycin 900 mg or Erythromycin 500 mg. If the labor is going to take a while, start a saline lock instead, tape it nicely, and give her additional doses every 4 hours of Pen-G 2.5 million units or 1 gram ampicillin, or half doses of the other -mycins. I did not consult the ACNM Homebirth Handbook, but that is what I have seen and it worked out well. Now that the mother has had the screening and is known GBS positive, the CDC guidelines suggest she receive intrapartum prophylaxis. If a midwife is not familiar with doing it, she may be able to fi! nd a supportive RN in her community. The mother should still have a homebirth if she wants it, but we should remember that a baby with GBS sepsis often will die and we all should carefully do what we can to prevent that.
-Carla Cleary, RN SNM
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A: During my research into homebirth, I came across several articles that support giving antibiotics IM during the last 4 weeks of pregnancy as an alternative to intrapartum antibiotics. Recommended dosage is (1) 1.2 ml shot of penicillin G benzathine per week for 4
weeks.
-Erika O.
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A: I recently had a woman test positive with GBS from a yoni/rectum culture sent into a lab for testing at about 36 1/2 weeks. After getting the results, the mother was informed of her choices: the protocols of a hospital birth with a GBS+ test and what we would do at
home with a GBS+ homebirth. She decided that she would like to stay at home and try to work on the GBS using herbs, positive thinking, and a chance to retest after a few days of herbal treatment. It seems to me that GBS can come and go on a daily basis. My own feeling is that GBS
has to do with pH balance and allowing it to grow if this balance is out of whack. We had a remedy: First, we used a light herbal douche made of comfrey, calendula, a bit of goldenseal, 3 drops of Nutri-biotic diluted in warm water. She was advised to administer the douche just at the vaginal opening and not to push the herbal water too high or with force. She did this 2-3 times a day. Also, she drank 3 glasses of water infused with Nutri-biotic daily and ate lots of
veggies, fruit, and simple grains. After 5 days of this remedy, we retested. Her test came back GBS negative. She was ecstatic! I truly believe the herbs worked and the retesting was crucial. Her homebirth was wonderful!
-Anon.
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A: A UK support group for Group B Strep offers loads of evidence-based
-Zana, CBE
National Childbirth Trust, UK
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A: Group B Strep is carried as normal flora by approximately 20% of women. Having said that, the consequence of neonatal/perinatal infection can be fatal. Here in Austalia the normal hospital practice is IV antibiotics in established labour, usually 2 g ampicillin
initially, followed by 1 g fourth hourly till delivery. If your midwife is able to canulate I see no reason why you should not have a homebirth, with an interval of no less than 4 hours from the first dose till delivery. This may seem interventionist but is actually evidence-based care.
-Jaz
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Disclaimer: This information is not intended to be your sole source of information on the subject. Please use it just as a jumping off point for further research on your own and to begin dialogue with your chosen careprovider.