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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 ____________