The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
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. |
This is from the informed consent I give my clients:
How common is GBS disease? GBS is the most common cause of sepsis (blood infection) and meningitis (infection of the fluid and lining surrounding the brain) in newborns. GBS is a frequent cause of newborn pneumonia and is more common than other, better known, newborn problems such as rubella, congenital syphilis, and spina bifida. Approximately 8,000 babies in the United States get GBS disease each year; 5%-15% of these babies die. Babies that survive, particularly those who have meningitis, may have long-term problems, such as hearing or vision loss or learning disabilities. In pregnant women, GBS can cause urinary tract infections, uterine infections (amnionitis, endometritis), and stillbirth. Among men and among women who are not pregnant, the most common diseases caused by GBS are blood infections, skin or soft tissue infections, and pneumonia. Approximately 20% of men and nonpregnant women with GBS disease die of the disease.
Does everyone who has GBS get sick? Many people carry GBS in
their bodies but do not become ill. These people are considered to be "colonized."
Adults can be colonized in the bowel, genital tract, urinary tract, throat,
or respiratory tract. Fifteen percent to 40% of pregnant women are colonized
with GBS in the rectum or vagina. A fetus may become colonized with GBS
on the skin if the mother is colonized with GBS in the rectum or vagina;
colonization occurs before or during birth.
How does GBS disease affect newborns? Approximately 1%-2% of babies
who are colonized with GBS develop signs and symptoms of GBS disease. Three-fourths
of the cases of GBS disease among newborns occur in the first week of life
("early-onset disease"), and most of these cases are apparent a few hours
after birth. Sepsis, pneumonia, and meningitis are the most common problems.
Premature babies are more susceptible to GBS infection than full-term babies,
but most (75%) babies who get GBS disease are full term. GBS disease may
also develop in infants 1 week to several months after birth ("late-onset
disease"). Meningitis is more common with late-onset GBS disease. Only
about half of late-onset GBS disease among newborns comes from a mother
who is colonized with GBS; the source of infection for others with late-onset
GBS disease is unknown.
How is GBS disease diagnosed and treated? GBS disease is diagnosed when the bacterium is grown from usually sterile body fluids, such as blood or spinal fluid. Cultures take a few days to complete. GBS infections in both newborns and adults are usually treated with antibiotics (e.g., penicillin or ampicillin) given through a vein.
Can GBS disease among newborns be prevented? Most GBS disease in newborns can be prevented by giving certain pregnant women antibiotics through the vein during labor. Any pregnant woman who previously had a baby with GBS disease or who has a urinary tract infection caused by GBS should receive antibiotics during labor. Pregnant women colonized with GBS should be offered antibiotics at the time of labor or membrane rupture. Colonized women at highest risk are those with any of the following conditions: fever during labor; rupture of membranes 18 hours or more before delivery; labor or rupture of membranes before 37 weeks ("preterm").
Because women who are colonized with GBS but do not develop any of the above complications have a relatively low risk of delivering an infant with GBS disease, the decision to take antibiotics during labor should balance risks and benefits. Penicillin is very effective at preventing GBS disease in the newborn and is generally safe. A colonized woman with none of the conditions above has the following risks: a 1 in 200 chance of delivering a baby with GBS disease if no antibiotics are given a 1 in 10 chance, or lower, of experiencing a mild allergic reaction to penicillin (such as rash) a 1 in 10,000 chance of developing a severe allergic reaction to penicillin, called anaphylactic shock or anaphylaxis.
Anaphylaxis requires emergency treatment and can be life threatening.
If a prenatal culture for GBS was not done or the results are not available, physicians may give antibiotics to women with one or more of the risk conditions listed above. (Increasingly, antibiotics are being given for all risk factors, even if a GBS culture was negative.)
Who is at higher risk for GBS disease? Pregnant women with
the following conditions are at higher risk of having a baby with GBS disease:
previous baby with GBS disease
urinary tract infection due to GBS
GBS colonization late in pregnancy
fever during labor
rupture of membranes 18 hours or more before delivery
labor or rupture of membranes before 37 weeks ("preterm")
The above information is extracted from materials provided by the Centers for Disease Control and Prevention. For more information, contact Childhood and Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases Centers for Disease Control and Prevention, MS C-09,1600 Clifton Rd NE, Atlanta, GA 30333
Much more information is available online from my Web pages:
Little information is available about the effects of antibiotic treatment
during labor and birth on the newborn's establishment of normal bacteria
on the skin and in the digestive tract. Typically, a baby is born
sterile and relies on immediate, intimate contact with the mother to introduce
the bacteria that will colonize the baby's skin and digestive tract.
Nature has provided a wonderful system whereby these first germs will "rule
the kingdom". These germs from the mother are the germs for which
the baby has been receiving antibodies through the placenta and will continue
to receive antibodies through the colostrum and breastmilk from the mother,
and a healthy colonization from these germs will protect the baby from
other, foreign germs. Antibiotic treatment certainly disrupts this
process and leaves the baby vulnerable to colonization from foreign germs
to which it has no antibodies, many of which may be untreatable by antibiotics.
Another disadvantage of relying on antibiotics is that they need to
be in the mother’s system for a few hours before they are effective.
This is problematic for second or subsequent babies who come quickly.
The alternative approaches such as hydrogen peroxide and chlorhexidine
vaginal washes are effective on contact and so are much more practical
for second or subsequent babies.
Commentary
Unfortunately, there is no ideal, guaranteed approach to the issue of
GBS. Cultures don't yield consistent results; women without risk
factors can still pass on GBS to their babies; women who receive antibiotics
can still pass on GBS; antibiotics can cause severe, even fatal side effects;
even the most aggressive treatments cannot reliably prevent death and disease
in newborns; and antibiotic treatment may actually increase the severity
of infection from antibiotic-resistant organisms.
It is important to understand the danger of establishment of any antibiotic-resistant
strain. Bacteria have a very interesting and very dangerous ability
to share resistance across species of bacteria. This means that any
antibiotic-resistant bacteria that comes in contact with the staph and
strep germs that are all around us in the environment may pass along the
antibiotic-resistance to those germs, resulting in a raging, untreatable
infection in a vulnerable newborn.
Standard of Care regarding Group B Streptococcal Carriers
I believe that parents have the right and obligation to decide the treatments
that they and their baby receive around the time of birth. I believe
that women who have had positive Group B Streptococcal cultures have the
right to choose or decline antibiotic prophylaxis during labor. A
woman may reasonably decline antibiotic prophylaxis because she has bad
reactions to antibiotics which would interfere with her labor and might
require other, more dangerous interventions; she wants to avoid the risks
associated with antibiotics; she wants to avoid the risks to the baby of
receiving antibiotics, particularly the risk of infections from antibiotic-resistant
GBS or antibiotic-resistant E. coli.
For clients who have positive test results, I can work with them to
reduce colonization levels through alternative methods and to provide education
as desired in order for you to make informed choices. It is your
choice whether to transfer care to a hospital-based practitioner or choose
other options:
[Note that it can be difficult to find a doctor who will co-operate
in any non-standard antibiotic treatment plan for GBS.]
________ I have chosen NOT to labor and birth in the hospital, where
prophylactic antibiotics can be administered during labor. I have
chosen an alternative approach for Group B Streptococcal Carriers.
[Please select the individual forms of treatment you choose.]
________ I have chosen to give birth in my home, where the risk of infection
from antibiotic-resistant infections and other "super bugs" is less than
in the hospital.
If the amniotic membranes rupture early in labor, I understand that
the risk of infection to the baby starts to increase after 18 hours, although
this may be reduced by avoiding cervical exams or other procedures which
introduce bacteria into the cervix.
___________________________________________________
________________________
___________________________________________________
________________________
http:
Non-Standard Observations on Risks and Benefits
Risks from Antibiotic Treatment - - The risks of intrapartum penicillin
include mild allergic reaction (about one case per 10 instances of penicillin
administration), anaphylaxis (about one case per 10,000 doses) and fatal
anaphylaxis (about one case per 100,000 doses). In addition, as the
administration of intrapartum penicillin becomes more common, GBS is becoming
more resistant to penicillin; in about 4% of cases, the GBS is not affected
by the penicillin as expected, so "preventive" treatment doesn't prevent
the disease. In this case, a baby showing mild signs of illness may
not be properly evaluated because it is assumed that the GBS has already
been adequately treated. Lastly, the administration of intrapartum
antibiotics increases the risk to the baby of all antibiotic-resistant
bacteria - in particular, antibiotic-resistant E. coli infections, which
is relatively common. The incidence of E. coli infection of newborns
has doubled in the last ten years, and most deaths from these infections
are from ampicillin-resistant organisms, typically associated with intrapartum
administration of ampicillin.
Recent Research
Several recent studies have focused on the increase of newborn infections
from resistant strains of bacteria following administration of antibiotics
to the mother during labor. "The increased administration of antenatal
ampicillin to pregnant women may be responsible for the increased incidence
of early-onset neonatal sepsis with non-group B streptococcal organisms
that are resistant to ampicillin."
Current recommendations from the CDC consensus protocols are:
Obtain cultures from all women (rectally and vaginally) at 35-37 weeks.
If the woman's rectal or vaginal cultures are positive for GBS, she should
be offered intrapartum antibiotic prophylaxis.
Treatment. Oral antibiotics are ineffective. The following regimens
may be used:
Penicillin G 5 million units IV and then 2.5 million units every 4
hours until delivery. Penicillin G is the preferred antibiotic because
of its narrow spectrum, thereby making it less likely to select for antibiotic-resistant
bacteria.
Ampicillin 2 g IV followed by 1 g every 4 hours until delivery.
If the patient has a penicillin allergy, either clindamycin 900mg IV
every 8 hours or erythromycin 500 mg IV every 6 hours may be given until
delivery.
The Issue of Group B Streptococcal Infections in my Practice
You may arrange to have another healthcare professional come to your
home to administer IV antibiotics during labor. (I can offer a referral
for a midwife in Burlingame who sometimes does this.)
You may obtain a prophylactic injection of penicillin in your last
month of pregnancy from your physician or your baby's pediatrician or a
prescription for oral antibiotics.
You may obtain a prescription from your baby's pediatrician for a postpartum
injection of penicillin for your baby.
You may choose to pursue only alternative approaches to reducing colonization
and preventing and treating infection. However, you must be fully
aware that these methods are not proven to be as effective as antibiotics
during labor.
Statement of Choice for Group B Streptococcal Carriers
Please have both parents initial these first three statements, and then
check off your all choices for treatment options.
I understand that a rectovaginal culture shows that my body carries
Group B Strep, and that there is a risk that my baby may be exposed to
this bacteria during the birth process, and that this may cause an infection
which could cause brain damage and death.
________ ________ (Both parents – please
initial here)
I understand that the standard of care in the medical community is
to administer IV antibiotics during labor in order to prevent infection
in the baby; I also understand that this approach is not 100% effective
and carries risks of its own, e.g. "The increased administration of antenatal
ampicillin to pregnant women may be responsible for the increased incidence
of early-onset neonatal sepsis with non-group B streptococcal organisms
that are resistant to ampicillin." (Towers et al., 1998).
________ ________ (Both parents
– please initial here)
I understand that there are no studies comparing homebirth without
antibiotic prophylaxis to hospital birth with antibiotic prophylaxis.
In particular, there are no studies that weigh the overall increased risk
of infection in the hospital against the increased risk of declining antibiotic
prophylaxis at a homebirth. ________ ________
(Both parents – please initial here)
Please check all the choices that apply:
________ I have chosen to labor and birth in the hospital, where prophylactic
antibiotics can be administered during labor, at least four hours prior
to the birth.
________ I have chosen to take herbal formulas to strengthen my immune
system. It is my understanding that this will help reduce the level
of colonization that the baby may be exposed to, and it will help increase
the level of antibodies that will be passed to the baby through the placenta
and protect the baby. (Wood, 1981; Baker, 1976)
________ I have chosen to take homeopathic formulas to strengthen my
immune system
________ I have chosen to take nutritional formulas to strengthen my
immune system
________ I have chosen to give birth in water, which will dilute any
vaginal bacteria and further reduce the risk that the baby will become
infected with Group B Strep. (Zanetti-Dällenbach, 2007)
________ I have chosen vaginal lavage with chlorhexidine at the onset
of labor and at 6 hour intervals. (Stray-Pedersen et al., 1999)
________ I have chosen to go to the hospital for prophylactic antibiotics
when membranes have been ruptured for 12 hours, if it seems that the baby
will not be born within 6 hours.
________ I have chosen NOT to go to the hospital for prophylactic antibiotics,
even if amniotic membranes are ruptured for greater than 18 hours.
Other Details:
I understand that my midwife, Ronnie Falcao, LM, will strongly encourage
me to go to the hospital for prophylactic antibiotics if I have a fever
during labor, i.e. temperature over 100.4 degrees Fahrenheit, regardless
of membrane status. ________ ________
Mother/Client’s Signature
Date
Father’s Signature
Date
This Web page is referenced from another page containing related information
about Group B Strep (GBS)
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