Positive GBS culture but declined antibiotics

  1. Had an interesting couple in labor this weekend. Both intelligent, early 40's, in labor with first child. Mom tested positive for GBS yet declined antibiotic treatment. Dad stated that "the numbers needed to treat" were way to high for them to consider subjecting their child to an antibiotic that may not be necessary in the long run.
    This was a new one to me; most of the families who will decline antibiotics have NOT been tested for GBS and want to wait until the membranes have been ruptured for 18 hours (following the CDC protocol for unknown GBS).
    Membranes had been ruptured 17 1/2 hours at birth. Parents consented to a CBC and blood culture but of course declined prophylactic antibiotics for the baby. When I left baby was vigorous, nursing, seemingly doing well at the outset.
    Have others seen this situation before? The parents pediatrician was NOT very nice to these parents and I really felt bad for them.
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    About midwife2b

    Joined: May '05; Posts: 263; Likes: 11


  3. by   SmilingBluEyes
    Yes, we have, and all we can do is have them sign a specific AMA order (Against Medical Advice) stating they refuse tx and why. There is not much else you can do in situations like this. They do indeed have the right to refuse, once they have been truly informed as to the consequences of their decisions. All of this is spelled out word for word in their AMA form that they sign.
  4. by   NurseNora
    The couple I had who refused antibiotics despite being beta strep+ came armed with information they had gotten on the internet about the dangers of using antibiotics in all GBS+ babies. It said there is much higher incidence later in life of the child having a major infection with an antibiotic resistant bacteria. Also said that the incidence of infants getting GBS infections is very low and not worth the risk of the later major infections. You can find just about anything you want somewhere on the internet.
  5. by   Dayray
    I haven't had that one.

    Even though I often disagree with some patients decisions Ill go to my grave defending their right to make informed decisions. Still I would have a hard time with this one. Babies get SO SO SO sick from GBS. Sure most of them don't get sick. Still even the chance that a baby will have pneumonia, septicemia, meningitis, vent, brain damage, death is very worth the minimal risks of taking an antibiotic. It's not like we are treating with powerful antibiotics. Correct me if I'm wrong but amp and PCN are 1st or 2nd generation antibiotics. So even if the baby developed an antibiotic resistant infection later in life it would leave the "big gun" antibiotics to treat it.

    Even though I don't agree, I can see why parents might decline vit-K, erythromycin and immunization but this one goes way over the line. I wonder where the information against this is coming from. I would like to meet the person putting this stuff on the Internet and make them hold down a baby getting a spinal tap because their parents declined Amp or watch one get intibated and placed on a vent. There are too many anti medical people out there that get a self-important ego boost from vilifying doctors and medicine. Sure there are problems with medicine in the US but I wish they would stop looking for evil conspiracies and wrong doing behind every corner Grrrr.....
  6. by   elliebellie
    Why would you even bother getting tested if you are then going to refuse treatment??
  7. by   midwife2b
    Quote from elliebellie
    Why would you even bother getting tested if you are then going to refuse treatment??
    I guess the physician made a really hard sell to the parents.
    If anyone knows where the info against GBS treatment is posted, I'd really like to look at it...
  8. by   wannabeL&D73
    Quote from elliebellie
    Why would you even bother getting tested if you are then going to refuse treatment??

    She may have tested positive early in the pg., and then done research and made a decision regarding treatment. I was tested in the first trimester before I even knew what GBS was or why it was significant during pregnancy.

    I am with Dayray on this one--he summed it up pretty well IMO.

  9. by   FrumDoula
    I'm sure everyone here expects me to support the parents on this one, but this is a case where I cannot.

    My midwife, who is open to all sorts of traditional and nontraditional stuff, absolutely believes in testing her clients for GBS. If the culture is positive, then she approaches it first from an herbal standpoint, which has proven to be highly effective in her practice. (I can ask her what her protocol is if anyone is interested.) If that doesn't work, I think she next goes to antibiotics.

    Given that she is a homebirth midwife who is so alternative, it says a lot to me that she believes in prenatal GBS testing. So my husband and I opted for it.

    Now, perhaps this family treated herbally for it and didn't say anything? I think that some sort of treatment is appropriate, though statistically speaking, the odds remain very low that the child will become sick.

    I do not agree with a practitioner mistreating or threatening a patient/client because they don't agree with their choice. That is unethical. You present the pros and cons, make sure informed consent is had, then you treat them like an adult and let them make the choice. It isn't your child. I can certainly see the frustration in watching a client make a choice you wouldn't, but that's part of medicine and midwifery.

    Just my $0.02.

  10. by   FrumDoula
    While this might not be for all women, this might be an alternative for some, so I'm posting this information just so people can see the alternatives. I actually thought the garlic idea was sort of intriguing!


    You can all flame me and my alternative little ways later!

    Again, though, I'm really not anti-antibiotics if that's what's needed.

  11. by   midwife2b
    Thanks! I am interested in learning about alternatives, especially if my patients want to try something I haven't heard of.
    This couple went to a doctor for prenatal care. They did not have any alternative treatments proposed to them (I asked the doula). So far, 2 days out, everybody is fine.
  12. by   RNnL&D
    Okay, to play devil's advocate here, what do you all do for your GBS + moms that come in near complete and don't have time for a dose of antibiotics? We do not automatically treat baby if Mom is not treated. We monitor baby for 48 hours for symptoms.

    What would be the difference in Mom simply choosing to not have the Abs? Unless you automatically treat babies of untreated Moms with prophylactic Abs, it seems like the plan of care would be the same, kwim?