so i got my test results back and for some reason i knew that it was going to come back positive. how? i dont know, i just figured worst case scenario type bullshit that my cynical mind likes to wrap itself up in and get cozy with. that and the fact that this pregnancy has been good and kind of uneventful in comparison to others ive heard about.

positive for what?? Group B Streptococcus or GBS. It is a bacteria which many women carry in the vagina and or rectum with no symptoms at all, while for others it can cause infections in the uterus or the urinary tract. The bacteria that causes group B strep normally lives in the intestine, vagina, or rectal areas. Group B strep colonization is not a sexually transmitted disease. Approximately 15-40% of all healthy women carry group B strep bacteria.

A proportion of babies pick up GBS from the birth canal during labor, and again, for the vast majority of these, it will not cause any problems at all. However, a small minority of babies go on to develop Group B Strep Disease, more technically termed Early Neonatal Group B Streptococcal Septicaemia (ENGBSS), which is where the GBS infection causes blood poisoning. This can lead to meningitis and disability or death.

Some women are at far higher risk of having a baby affected by GBS disease than others. Babies who fall into certain groups have a higher risk of developing the disease:

• Preterm babies (especially before 35 weeks, but also before 37 weeks.
  
• Mother having a fever during labor
• Prolonged rupture of membranes - over 18 hours
• GBS found in the mother's urine, not just the vagina
• Mother having had a previous child with GBS disease
• Rupture of membranes before 37 weeks

Obviously I do not fall in these higher risk categories. well, i hope not to anyway.

Arrghh, mention POSITIVE for some bacteria that can cause DEATH will automatically send a pregnant woman careening off the edge, no? so my next thought or rather question is am i still going to be able to do a home birth?

now actually looking back at my kaiser appointment with the ob, as she was setting up her little test taking station she mentioned that this was nothing and its standard procedure to test and that my midwives would be able to administer antibiotics. and actually i dont ever remember her saying if you are positive for strep b its nothing to worry about. she just said or what i remember her saying was - administer antibiotics.

apparently in the UK women are not normally screened for GBS in pregnancy, the vast majority of women who carry GBS during pregnancy and birth will never know about it, their labors will not be managed any differently, and they and their babies will be none the wiser. Women in the UK are not routinely screened primarily because colonization is extremely variable and there is a tendency for recolonization after treatment.

GBS disease is very rare - in the UK, if the mother is known to carry GBS when she is in labour, there is a 35-50% chance that her baby will pick up GBS, but only 0.2-0.5% of these babies will become ill as a result. Putting these figures together, if a woman who is carrying GBS in labour has a 50% chance that her baby will pick up the bacteria, the chance of the baby developing GBS disease is between 1 in 400 and 1 in 1,000.

The source for these statistics is a good introduction to GBS from the Women's Health website, which is owned by a UK obstetrician, Danny Tucker. Note that rates for GBS disease in newborns are higher in the USA than in the UK, which is why you may read of higher infection rates in other articles online. (i wonder why that is??)

These figures are for the average risk faced by all women carrying GBS in labor. They do not tell the whole story, because some women are at a higher risk of having a baby affected by GBS disease than others.

and so after much research (which i wish i had done sooner) like this from empowering birth blog:

From Anne Frye, a few reasons to avoid the GBS test if no risk factors are present:

• Some babies will become ill with GBS without any evidence of colonization from their moms.
• There are risks of fatal or severe side effects due to drug reactions.
• In many cases mom will transfer antibodies to fetus which will protect fetus from GBS infection (see http://www.ncbi.nlm.nih.gov/pubmed/768760?dopt=Abstract or http://www.jci.org/cgi/content/full/98/10/2308 for example). Instead of routine testing, why not a GBS vaccine?
• Antibiotic treatment may cause bacteria to develop mutations that will make them resistant to antimicrobial treatments.

10-30% of all women have already been colonized by GBS bacteria and studies have shown that many colonized women pass on the antibodies that protect against GBS infection to their infants. If almost a third of the female population is colonized by GBS, women probably had to come up with a mechanism of protecting their young (thus the transfer of antibodies) or natural selection would have weeded out moms colonized by GBS, right? So what will happen if we continue to routinely test for Group B strep and administer antibiotics to all GBS positive moms, regardless of risk factors (a relatively new practice)? Will our immune systems be compromised? Will bacterial mutations render the antibodies that protect our infants from GBS ineffective? Hospitals have loads of bacteria and procedures such as more then 12 hours of continual monitoring and more then six vaginal exams have already shown to increase the risk of active infection. Will babies be at an even increased risk of infection, having lost some of the natural immunity passed from their moms?

and from Henci Goer on infection rates for GBS Strep:

"By the way, we do not know what GBS infection rates would be if clinicians kept their fingers out of the vaginas and monitoring devices out of the uteruses of GBS positive women with ruptured membranes because we have no studies of which I am aware, where vaginal exams and internal monitoring were avoided. The GBS organism comes from the rectum and is usually limited to the lower part of the vagina in colonized women where it is harmless to babies. It is possible that avoiding giving the bacteria a free ride on the examiner's finger or through internal EFM or contraction monitoring would be equally effective without the downside of antibiotic treatment. We'll never know because IV antibiotics do work, which leads to the question: If doctors had had antibiotics in Semmelweis' time, would they be washing their hands today?"

BUT apparently - a home birth is still an option after a positive GBS result. You can have a home birth with, or without, intravenous antibiotics. And I remember our midwives talking about it. its strange, usually im so concentrated on the tests and diseases that our midwives tell us about and i dive myself into research but seriously the appointment we had when we discussed GBS, i think i was just not all there since i was still quite raw from my mother's suicide that i couldnt dive into anything. at least i think it was around that time. as i have heard from many suicide survivors time is fuzzy and can only be distinguished by before and after.

anyway, so our next midwife appointment is on Friday the 21st. and obviously i have a few questions:
1. Am I still a candidate for a home birth? (here is a home birth story from a women who was positive)
2. If so, is a water birth out of the question?
3. Are the antibiotics given intravenously or is it in the form of a pill? (I have heard of both oh wait, i think my midwife said/wrote something about how ineffective oral antibiotics were)
4. Now, about placentas, what are your thoughts on placenta tinctures and encapsulation?

hahaha, yes i said it. placenta tinctures and encapsulation...what the what? im gonna get pretty gross up on here (if i havent done so already)...wait, maybe i'll save this for another post..

30 more days to go. THIRTY MORE DAYS TO GO..HOLY SHIT!