Log onto Squarespace
Archives
« Those Darned Shoelaces | Main | Chlorhexidine/Hibiclens Vaginal Wash Info »
Thursday
Jun172010

My GBS Consent Form

Barbara E. Herrera, LM, CPM has informed me of an herbal treatment that is done during pregnancy that has been shown to be effective in eliminating GBS. The protocol is a standard of care in the midwifery community, but I understand it is not in the medical community. After completing the herbal treatment, testing can confirm or deny if there is GBS in the vagina or rectum. If I am negative, I have the option of continuing the treatment through until birth or I can stop the herbal treatments, accepting that I am GBS Negative. I understand that the medical community considers me GBS Positive after a positive result whether or not I subsequently test negative. 

Barbara E. Herrera, LM, CPM has informed me of the standard MEDICAL protocol for a GBS Positive woman. The CDC protocol requires a woman to receive IV antibiotics in labor, one dose every four hours after the initial loading dose. I understand that at least two doses must be given in order for it to be effective. I also understand that accepting the antibiotics does not guarantee my baby will not get GBS and that additional antibiotics would need to be given to the baby if s/he is GBS Positive. 

Barbara E. Herrera, LM, CPM has also informed me of an alternative to the routine antibiotics in labor: a Hibiclens wash… 4% Hibiclens to 10% water, put in a PeriBottle to gently wash the lower vagina and vaginal area. She has sent me information showing the effectiveness of the wash and I have also researched the information myself. I understand this protocol is an (alternative) standard of care in the midwifery community. 

In light of the information provided and after researching on my own, I choose: 

_____ Antibiotics in labor 

_____ Using the herbal treatments 

_____ Doing the chlorhexidine wash in labor 

_____ Do none of the above but will have Barb monitor me for infection during labor and will transfer to the hospital if necessary. 

_____ Prefer to do nothing, but watch for GBS infection in the baby postpartum

 

Signed ____________________________________________       Date ____________

  

Midwife ___________________________________________      Date ____________

Reader Comments (13)

Is your herbal treatment the Oregon grape root extract?

June 17, 2010 | Unregistered CommenterAshley F.

I should publish it, eh?

June 17, 2010 | Registered CommenterNavelgazing Midwife

So ... I recently tested positive, and my midwife said it's possible they'll only get one dose of antibiotics in me because it's my second baby (though, based on family history, I wouldn't be surprised if they get two in). She also said, though, that that's adequate. I checked out the CDC protocol you linked in the other post, and I didn't see (though maybe simply missed) anything about needing two doses at a minimum. I'm just curious what the source is on that or whether it's something there's disagreement about.

June 18, 2010 | Unregistered Commenterchingona

http://cl-cathiemac-ivil.tripod.com/gbs/GBSPos.htm#Inducing

"Plan ahead if you have short labors or live far from the hospital. The intravenous (IV) antibiotics you should receive in labor generally take 4 hours to be effective." (The doses are given in 4 hour intervals, so this means two doses.)

http://www.perinatology.com/protocols/GBS.htm

Scroll down to: "Recommended regimens for intrapartum antimicrobial
prophylaxis for perinatal GBS disease prevention"

http://groupbstrep-ivil.tripod.com/id22.html

So, *technically*, it isn't getting in 2 doses. Technically, it is making sure the first dose is 4 hours old. Since the doses of PCN are given every 4 hours, that is what gives the common guideline of having 2 doses on board. It doesn't mean 8 hours, but that the 2nd bag was able to be hung.

Good question!

June 18, 2010 | Registered CommenterNavelgazing Midwife

Just to piggy back on Barbara- I gave birth in a large suburban hospital
last week with a GBS positive status. I delivered two hours after the IV antibiotics were administered. The pediatricians were much more concerned that they hadn't been in for the four hours than that I hadn't received the second dose. Our baby ended up staying an extra day at the hospital because some of her blood work indicated inflammation and we had to wait for full GBS cultures to grow. Fortunately, she was fine, but it gave us a good scare. I lost my first pregnancy at 20 weeks to GBS chorioamnionitis and was beside myself
when I thought I might have endangered my baby.

June 19, 2010 | Unregistered CommenterGlennis

I am very glad to see this and hope it becomes very well publicized, like all information about GBS! My grandson died 12 hours after his home birth with "probable GBS" pneumonia. What an unnecessary tragedy...well, I assume unnecessary in this day and age. Take GBS seriously, newborns are delicate little humans! Love to you, Wren...
See wrenjones.com
love always, Grandmama

June 19, 2010 | Unregistered CommenterJoan W. Jones, RN

Who is watching for GBS postpartum and how do they know what to look for? The problem with doing "normal" all the time is you don't know what abnormal looks like.

Watching is the most natural thing of all to do. But it is the most time consuming and requires the most clinical skills. That's why the antibiotic gets done -- because it is the only thing that gets done reliably with minimal time and expertise from nursing staff.

June 21, 2010 | Unregistered Commenteranon

*We* are watching for GBS in the newborn. I'd venture to say the parents and I are quite adept at attending to the baby, in many ways, better than a nursing staff... overworked, bored and not always learned in new mamas and babies.

And sorry, but if I see normal all the time, I bloody well DO know what abnormal is.

When I balked at going on to become a CNM wayyyyy back in 1987, I whined about having to work with geriatric patients in school.... that I didn't want to be on the cardiac floor. And my sweet CNM-friend said to me, "When you listen to hundreds of normal hearts, you immediately recognize the abnormal ones."

While I am not a CNM, I *have* listened to *thousands* of hearts and do -and have- recognized abnormalities.

Sure, I am not the All-Knowing Midwife, but I do know how to watch for GBS and how to teach the parents to. I don't just wave buh-bye to them 3 hours after the birth and leave everyone on their own. There is a great deal of follow-up, including at least 2 visits in the first 72 hours.

June 23, 2010 | Registered CommenterNavelgazing Midwife

Can you clarify what "4% Hibiclens to 10% water" means?

I use the rule of thumb that an hour after IV administration of antibiotics, they have begun to take effect. I take this from the CDC information on GBS. So, if I suspect there will not be an hour before the birth occurs, I will not start antibiotics. I tell my clients, 1 hour for some effect, 4 hours for full effect.

June 30, 2010 | Unregistered CommenterJane

4 parts Hibiclens: 10 parts Water

June 30, 2010 | Registered CommenterNavelgazing Midwife

Sorry for the question on an old post but my midwife's info says that for a penicillin allergy cefazolin or clindamycin will be used every 8 hours. Does this mean it needs a full 8 hours to be effective?

September 25, 2010 | Unregistered CommenterEmily Weaver Brown

I don't know... great questions. Let me ask the CNMs and get back to you.

September 25, 2010 | Registered CommenterNavelgazing Midwife

This is what I've got so far:

"That is what they say. Don't understand though. Clinda reaches a peak serum level within the hour (oral doses). It is absorbed very fast, and 90% of the dose too. You can give Q6 too. I was given Ancef (can have cross allergy though). You can... reach adequate antibiotic levels (serum and tissue) within the first hour after the first dose."

I (Barb) was also taught q6, not q8, so interesting to see the different dosing requirements.

September 25, 2010 | Registered CommenterNavelgazing Midwife

PostPost a New Comment

Enter your information below to add a new comment.

My response is on my own website »
Author Email (optional):
Author URL (optional):
Post:
 
Some HTML allowed: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <code> <em> <i> <strike> <strong>