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Thursday, 12 April 2018

Knocked up.....Now what? GBS testing (Group B Strep)

Towards the end of your pregnancy (normally between 35 and 37 weeks) your Doctor will want to put another line on your bill and expose you to the worry of yet another test result...GBS.



What is GBS?

Group B Streptococcus or Group B Strep or GBS is a bacteria that resides in peoples intestines. It can move down our bodies into our urinary tract, rectum and/or vagina.

Why do I need to know about GBS?

It is usually harmless in adults (although not always, for more information see www.mayoclinic.org) but can cause serious illness in newborn babies. It has been cited as a major cause of meningitis, pneumonia and sepsis.

GBS can pass to your baby during a vaginal delivery and this is the primary reason why healthcare professionals carry out the test before finalising your birth plan. GBS can also sometimes (although rarely) impact conditions such as endometritis after delivery and if exposed, can increase the risk of infections to a C Section wound.

How do they Test for GBS?

It's a very simple, painless, swab of your vagina and rectum. It is worth noting that you can test positive and negative at different times in your life so being negative for one pregnancy, does not mean you are necessarily low risk for another pregnancy. This is why it is also important to have the test close(r) to your due date.

What if I test Positive?

In Thailand you will probably be "encouraged" to have a C Section. This way they feel that they can control and prevent the potential spread of the bacteria.

BUT in many other countries you would instead be put on a course of antibiotics during your labour (important to note that this is during labour, taking them before giving birth is pointless as they are fast growing bacteria...tricky little buggers)

If you do decide to have a C Section then antibiotics aren't normally necessary, as long as the amniotic sac is intact at the start of C Section.

It is important to highlight here that you should have the choice. In general (with no other complications) a positive GBS test does not pose you with only one option. You Doctor should discuss this with you clearly, and provide you with information to make an informed choice.

If I plan upfront to have a C Section do I still need a GBS test?

Opinions differ on this. You could go into labour earlier than your planned C Section, and is this case you may wish to be prepared just in case you are GBS positive and didn't know about it. But some countries do not routinely check for GBS (UK for example) so you may feel confident to decline the test.

What are the chances that I have GBS and will pass it on to my newborn?

Extracts from the Evidenced Based Birth website can explain this much better than I ever could:

"All around the world, anywhere from 10-30% of pregnancy people are "colonised" with or carry GBS in their bodies"

"If someone who carries GBS is not treated with antibiotics during [vaginal] labor, the baby's risk of becoming colonised with GBS is approximately 50% and the risk of developing a serious, life-threatening GBS infection is 1 to 2%"

PLEASE REMEMBER that being colonised does not mean that there is an infection necessarily "most colonised babies stay healthy"

"On the other hand, if someone with GBS is treated with antibiotics during [vaginal] labor, the risk of their infant developing an early GBS infection drops by 80%. So for example, the risk could drop from 1% down to 0.2%"

How bad is it if my baby gets a GBS infection?

Extracts from the Evidenced Based Birth website can explain this much better than I ever could:

"estimated that the death rate from early GBS infection is 2 to 3% for full terms infants"

"Death rates...are much higher (20-30%) in infants who are born at less than 33 weeks gestation"

Ongoing intensive care and long-term health problems may also be a consideration assuming infant survival.

Considerations with antibiotic use

Extracts from the Evidenced Based Birth website can explain this much better than I ever could:

"Although rare, severe allergic reactions have been reported. The risk is estimated to be 1 in 10,000 for a severe reaction, and 1 in 100,000 for a fatal reaction."

"IV antibiotics have been shown to cause a short-term negative effect on the infant’s microbiome; however, most infants will experience a recovery of their microbiome, and this recovery is enhanced by breastfeeding."

"There is an increase in the risk of maternal and newborn yeast infections, which can harm the breastfeeding relationship. In one study, 15% of women who received antibiotics in labor had mother-baby yeast infections (maternal nipple and infant mouth infections), compared to 7% of mothers who did not have antibiotics"

"Other potential harms have to do with side effects related to the antibiotic that is used....but keep in mind that most of the serious risks are rare"

"The potential medicalization of labor and birth"


"If you use the antibiotics, you will have an IV placed, but it only takes 15-30 minutes for the antibiotics to run in.  The antibiotics are only given every 4 hours until birth, which for many people is only once or twice. When the IV is running, it should not limit positioning, walking, or even laboring in water. For the hours in between, parents can ask for the IV can be “hep-locked” or “saline-locked” and detached, so that you are free from the IV pole....For low-risk, healthy pregnant people, it is a very reasonable request to ask for the IV to be hep-locked or saline-locked in between antibiotic doses."

If you decide to not have the antibiotics (or cannot for some reason) then under normal circumstances babies are closely observed but not necessarily tested for GBS.

Are there alternatives to Antibiotics?

Yes, but I have not found any that are truly recommended by healthcare professionals.

Your main alternative is to opt for a planned C Section, but please note that this is not a light decision to make.

Conclusion

From the reading I have done, and the professionals I have spoken to, I get the distinct feeling that in this instance Antibiotics are in the majority recommended throughout the World.


If you feel like you are being pressured into a C Section, and true consideration has not been given to your questions about antibiotics use instead, then I would strongly recommend reconsidering your choice of Doctor. Any Doctor that is not willing to assist you, within the realms of possibility, best practice and mother and baby safety, is not the Doctor for you.

Remember,

GET INFORMED, GIVE TRUE CONSENT


References:
Occasional Science & Sensibility contributor Rebecca Dekker of Evidence Based Birth wrote an amazing blog article about Group B Strep from where I have gleaned most of my knowledge, all credit should go to her for the content of this blog post. To read Rebecca’s article in its entirety, click here.

In addition I have used information from the following sites: 

Thursday, 22 February 2018

The Club (A note about The Mummy Club Bangkok)



The Mummy Club Bangkok has become synonymous with being an expat mum in Thailand. 

It's boundless resources and quick fire responses cannot be matched on any other Facebook Group or Webpage in Thailand.

But it does have one fatal flaw....administrators sometimes rule with an iron fist and becoming a member in the first place can be fraught with emotional hurdles.

The Mummy Club admin team pride themselves, quite rightly, in running a closed group, a safe environment for mums to seek support, information and resources without worrying about judgement, trolling, cruising or solicitation. But in so doing they have a simple, seemingly innocuous, rule that can inadvertently cause much heartache....you have to be a mum before you can join.

They claim to be open to "mums-to-be" but in reality it can be hard to get accepted as a member unless your profile picture contains a bouncing baby or tumbling toddler.

I fell foul to this strict approach by admin and was upset to be initially refused membership, despite being 26 weeks pregnant (our fourth, final and successful pregnancy).

With hindsight I can see that the job of policing and protecting this 'haven for mums' is not an easy task, so here is my quick guide to getting yourself onto The Mummy Club before your bundle of joy arrives, and without any unnecessary tears or tantrums.


All approaches to join The Mummy Club should include:
  • Confirmation that you live in Thailand
  • Motherhood status - TTC, pregnant, mum to x children etc
  • If you know other people that belong to the group it is worth name dropping them
  • Details of other relevant groups in Bangkok that you belong to can also help, especially if you are TTC. For example IVF Bangkok Support and BAMBI. This is to show that your TTC status is real, and not a hoax to get onto the group

There are two ways to join:

(1) If you have a friend on The Mummy Club get them to add you, including all of the details as above

(2) If you do not have a friend on The Mummy Club then send them a detailed note on their FB messenger link, including all of the details as above

If all else fails and you still cannot obtain membership, feel free to message me and I will try to investigate further on your behalf. Whilst it should not be an excuse, the admin team are all busy mums themselves, and they often get overwhelmed with the amount of work that such a great support group can generate.

One last thing I will leave with you. It's an amazing resource, but think about when is the right time to join for you. Whilst you are TTC might not be the right time, after all it is full of questions about newborn babies, toddlers, schools, paediatricians etc. Later in your pregnancy, when you may wish to pull of the resources and experience of other mums is probably the most useful time.

Good luck mama-to-be, you will rock it no matter what!


Sunday, 19 November 2017

How to get the birthing experience you want (in Bangkok)

I haven't been able to find much time to start writing again, but then I realised that life simply isn't going to give me a few spare hours a day anymore, pa ha ha. So I've promised myself that I will focus on short (and hopefully sweet) posts for a little while. Hope you like them and find them useful...

Here are my top five tips on how to get the birthing experience you want. This is from my experience at Bumrungrad earlier this year.


Ensure you have discussed your wishes with your Doctor
Emergencies happen,
and its important to listen to the professionals when they do,
but at the very least your Doctor should know your basic wishes
before you get into the labour room


Use your partner to be your voice
(they listen to dads more)


Hire a Doula
She will empower you to have a voice when it matters most to you
Article: Doulas - a friend in an hour of need
Article: Doulas Do More


Attend an Antenatal Class



Politely insist on anything and everything you want
You will ultimately get it if you stick to your guns


We insisted on skin to skin, which admittedly was more of a long awkward cuddle but we got some ✅

We insisted that dad went with bubba to the nursery for her basic checks, and that it was as quick as possible ✅ (they had her back to me before I’d even left the labour room) 

We insisted that bubba came back to me for her eye drops and vitamin k injection ✅ (as above, this was done in the labour room) 

We insisted that she stayed with us ✅ (in fact she stayed with us so much that they almost forgot to do her hearing test and BCG) 

We insisted that I was with her for her hearing test and BCG ✅ (we threatened to not pay if they didn’t allow me to have physical contact with her for her BCG)

So, other than a very quick trip to the nursery with dad, I was with her for everything. We had to be politely forceful, but it’s your child, and no one should/can dictate to you.

You've got this mama!

GET INFORMED, GIVE TRUE CONSENT!