GBS+ Need advice on how to modify birth plan

insertclevername · December 2013

My original birth plan included having no hep lock, no iv and no medications. However, plans have changed because I am GBS+. I discussed antibiotic injection or oral antibiotics. My OB informed me that she follows CDC recommendations as well as the research on the most effective preventative measures. Therefore she uses the IV penicillin during labor.

I have done my research and am going to add a second probiotic to my supplements as well as up the amount of coconut oil I take and add apple cider vinegar as well. Although the chances are very slim of my child contracting GBS even without the antibiotics, I have made the decision to go through with the IV penicillin instead of refusing it.

My question is for any of you who were GBS+. What did you do to minimize interventions? At this point, I plan to request a hep lock so that I can be detached after each course of antibiotics. I also plan to refuse internal monitoring and cervical checks as these can increase risk of infection. Any other suggestions or tips?

ncbelle · December 2013

I was GBS+ both times and don't feel it interfered at all with my birth plans. I had a heplock and got the antibiotics - which took about 15 minutes? I was still able to move as I pleased even on the IV. I was never even offered internal monitoring - which I would have declined. Long story short - it's not something I would worry about interfering with your plans or leading to other interventions.

utlawgirl · December 2013

Your plan is basically my plan -- I'm in the same boat. I'm also upping probiotics (I have had to take a low dose of antibiotics throughout this pregnancy due to recurring UTIs, ugh) and requesting a saline lock so I can be untethered in between doeses.

I am GBS+ this pregnancy, but I wasn't my last pregnancy, so it took me by surprise. After the initial shock wore off, I was able to have a rational conversation with my MW, and I found out the the hospital I'm delivering in requires a hep lock for everyone, anyway. I might not have found that out until labor otherwise!

I went through allllllll the options when I first found out -- hibclens during labor, antibiotics orally or injection rather than IV, potentially declining -- and came back around to deciding that IV antibiotics really wasn't that big of a deal and is the best course of action for us to take, balancing risks vs. potentially screwing up my birth plan.

The only real way in which it impacts my birth plan is that I'll have to try to get to the hospital a little earlier than I had originally planned, since they want to try for an IV course at least 4 hours prior to birth. My plan is to go when I'm sure I'm in active labor, once my mom is able to get to the house to care for my daughter. Active labor was around 5 hours for me last time, so hopefully it works out okay. If I'm not able to get the course in the full 4 hours before the birth, my practice is actually pretty laid back about it. With a quick delivery (especially if you have a short-ish pushing stage and your water isn't broken for too long), the risks of baby contracting GBS are very minimal. Their precaution, if birth happens less than 4 hours after the antibiotics are administered, is to keep use in the hospital for 48 hours, rather than the normal 36. Not a huge deal for us.

insertclevername · December 2013

utlawgirl said:

Your plan is basically my plan -- I'm in the same boat. I'm also upping probiotics (I have had to take a low dose of antibiotics throughout this pregnancy due to recurring UTIs, ugh) and requesting a saline lock so I can be untethered in between doeses.

I am GBS+ this pregnancy, but I wasn't my last pregnancy, so it took me by surprise. After the initial shock wore off, I was able to have a rational conversation with my MW, and I found out the the hospital I'm delivering in requires a hep lock for everyone, anyway. I might not have found that out until labor otherwise!

I went through allllllll the options when I first found out -- hibclens during labor, antibiotics orally or injection rather than IV, potentially declining -- and came back around to deciding that IV antibiotics really wasn't that big of a deal and is the best course of action for us to take, balancing risks vs. potentially screwing up my birth plan.

The only real way in which it impacts my birth plan is that I'll have to try to get to the hospital a little earlier than I had originally planned, since they want to try for an IV course at least 4 hours prior to birth. My plan is to go when I'm sure I'm in active labor, once my mom is able to get to the house to care for my daughter. Active labor was around 5 hours for me last time, so hopefully it works out okay. If I'm not able to get the course in the full 4 hours before the birth, my practice is actually pretty laid back about it. With a quick delivery (especially if you have a short-ish pushing stage and your water isn't broken for too long), the risks of baby contracting GBS are very minimal. Their precaution, if birth happens less than 4 hours after the antibiotics are administered, is to keep use in the hospital for 48 hours, rather than the normal 36. Not a huge deal for us.

I had a precipitous labor with DS1 and my entire labor was only 3 hours. I was only at the hospital for 40-45 minutes before having DS1. Because of this my OB has asked me to call as soon as I am in active labor and explain that I am a special case. So like you I will have to go to the hospital earlier than is ideal. My practice is the same as yours in that if I do not get a full course of IV antibiotics we will be required to stay in the hospital for a full 48 hours. Not ideal with a 3 year old at home but we will survive.

Buckeye608 · December 2013

The instructor for our birth class (an RN/doula) suggested the possibility of the IV being placed in the forearm rather than hand. The reasoning being that it's possibly not as restrictive in moving around during labor. With the IV in your hand your wrist movement especially is affected.

insertclevername · December 2013

@joules235 were the complications your DD experienced due to the antibiotics administered for GBS?

pdilly2b · December 2013

ncbelle said:

I was GBS+ both times and don't feel it interfered at all with my birth plans. I had a heplock and got the antibiotics - which took about 15 minutes? I was still able to move as I pleased even on the IV. I was never even offered internal monitoring - which I would have declined. Long story short - it's not something I would worry about interfering with your plans or leading to other interventions.

This describes me for my son's birth. I would prefer no hep lock with this birth but suspect I'll be GBS again and get the hep lock again for the antibiotics. For DS, I was even able to get into the jacuzzi tub with it and they did doppler monitoring in there (when I wasn't in the tub, they did intermittent between me walking the halls and I sat on a ball while hooked up and the cords were plenty long to move around). Not nearly as big a deal as I stressed myself out about. This time, I will pay attention to which arm I get my hep lock though. Last time it was the arm that was on the inside of the tub, which was fine but a little bit of a pain trying to prop it up on the wall to not completely submerge (though it ended up somewhat submerged anyway).

HannahsHope · December 2013

I was GBS pos. My plan was to labor at home as long as possible. However, when my water broke before labor started, I had to go in for the abx treatment. It didn't change anything otherswise. The entire infusion only takes about 1/2hr. My IV/hep lock (they are the same thing), was inserted in my forearm. I even had my infusion running while I was in the shower during labor. They just cover the lock or running infusion with a bag. No biggie. You'll be just fine. I would rather have a 1/2hr infusion than risk the health of my baby (no matter how small that risk is).

CLLDLL · December 2013

I was GBS+ with DS2. My entire labor from first contraction to holding him was less than 4 hours. I was only at the hospital for around 2 hours before he was born. When I first got there, they hooked up a hep lock & ran IV antibiotics. They had to run them fast because of how fast I was progressing. It burned, but they just put ice on the area. That took maybe 15 minutes. Then they allowed me to unhook and labor as I needed to. They would have done a second course of antibiotics, but it was time to push!

My OB would have let us leave the hospital after 12 hours, but we wanted DS2 to be circumcised which couldn't happen till the 24 hour mark. We ended up staying until 30 hours once we got his circ done & stayed long enough that they were comfortable that he was fine.

My pedi wanted to see him at day 4 to be sure the GBS wasn't causing any issues. Other than that, our labor/NB days were the same as they would have been if I were GBS negative.

heatherneeny76 · December 2013

@jules235 would you mind sharing what you are doing to try and stay GBS negative? My first DD was born brain dead due to GBS crossing placenta and infecting her before delivery (extremely rare event). I am 7 weeks pregnant and have been limiting sugar and taking probiotics, but would love to know if there is more i can do. Thanks!

heatherneeny76 · December 2013

Thank you! Yes, what happened was extremely rare-about 0.04 of a percent chance of occurrence. I've seen several specialists, but since it so rarely happens no one really knows what to tell me to do. So, I figured I would be proactive and try to keep myself as healthy as possible. Thanks so much for the info!

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