Issue link: http://cp.revolio.com/i/855118
Page 60 | Abby's Magazine - www.AbbysMag.com An alterna ve treatment to IV an bio cs that has been inves gated in Europe and developing countries, but is not employed in the United States other than by homebirth midwives, is the use of chlorhexidine, a topical an sep c solu on that kills GBS. While some studies have shown that chlorhexidine does reduce neonatal coloniza on and infec on compared with conven onal an bio c treatment, other studies have shown only a reduc on in coloniza on but not in the rates of early onset GBS infec on. More inves ga on of this cost effec ve, easy to use op on is needed to determine whether this is a consistently effec ve alterna ve to rou ne IV prophylaxis for neonatal GBS infec on. It is also unlikely to help in the preven on of infec on when there is prolonged rupture of membranes, as it can't keep bacteria from ascending. Hibiclens, which contains chlorhexidine, is the form that is typically used by midwives in the US. Keep in mind that Hibiclens and chlorhexidine will also wipe out healthy vaginal flora, likely for many hours a er each applica on, and not just selec vely eliminate the GBS, so while you might avoid the an bio c, you may be defea ng the purpose of avoiding it without a be er outcome, which is keeping the vaginal flora healthy so baby gets op mally colonized with mom's flora at birth. What if I Test Positive but a Later Test Comes Back Negative? When it comes to GBS infec on in pregnancy, once you test posi ve, even if you later test nega ve in the same pregnancy, you are s ll considered to be posi ve, and an bio c treatment is recommended by the CDC, (note if you are nega ve in this pregnancy, but were posi ve in a previous pregnancy, you do not require an bio cs, unless your previous baby developed GBS infec on, in which case an bio cs are considered appropriate). So, while you might use natural approaches to try to reduce your coloniza on, if you are having your baby in a hospital or birthing center, the standard protocol would s ll be to administer an bio cs. Can I Decline Antibiotics & What are the Risks of Doing So? You do have the right to decline an bio c prophylaxis in labor. If you decline, while there is an overall very low likelihood (2-3% chance) that your baby will develop early onset GBS infec on; the risk is about double than if you did accept the an bio c. I have also seen a few situa ons get legally complicated, including social work being called to assess for negligence and child abuse when parents declined an bio c prophylaxis in labor, and one case where the parents were forced to let the baby be given the an bio c a er birth, since mom had declined to receive the an bio c in labor, even though the baby had no signs of infec on. While hopefully you'd not be met by that vitriolic a response by your care provider or hospital risk management team, having the discussion with your obstetrician, family doctor, or midwife at the me of the posi ve test result, rather than during labor, is strongly advised so you don't face any surprises. It's important to be fully aware of the risks of GBS before choosing to pass on the an bio c prophylaxis. There is also no natural subs tute for an bio cs in women who are GBS posi ve, with signs of infec on and prolonged rupture of membranes (>24 hours rupture), and all newborns exhibi ng signs of GBS infec on must receive immediate and aggressive an bio c therapy. Keep in mind that if you decline in labor, and are GBS posi ve, you may be pressured to give your baby an bio cs a er birth. Can a Healthy Microbiome Protect Against GBS? A healthy vaginal flora and healthy gut microbiome can reduce the likelihood of GBS coloniza on, and as a result, reduce the likelihood of infec on transmission to baby. Lactobacillus has been shown to inhibit the a achment of GBS and other harmful bacteria to the vaginal lining. Lactobacillus reuteri and Lactobacillus rhamnosis are species known to be especially helpful for suppor ng normal vaginal flora. I recommend 1-2 capsules of a probio c daily during pregnancy, and especially in the 3rd trimester, not just to help prevent GBS, but also because it has been shown to reduce the risk of atopic condi ons in kids (allergies, eczema, asthma) when taken by mom in the last third of the pregnancy. When there is GBS coloniza on (a posi ve test), a history of GBS in a previous pregnancy, or a history of frequent urinary tract, yeast, or other vaginal infec ons, I also recommend use of a vaginal probio c – simply insert a capsule of probio c containing the above species, or work with a func onal medicine doctor or naturopathic doctor who can help you to get a compounded vaginal gel with these species. Live ac ve culture yogurt can also be inserted vaginally, using your clean fingers, daily. I recommend my pa ents do this at the start of a shower several mes each week star ng the third trimester, then simply rinse it off at the end of the shower and put on a panty liner (organic is best!) to catch what drips out. Interes ngly, one study found that pads soaked with probio c helped to reduce vaginal GBS.