Sometimes I get discouraged.
This blog rests on the premise that anyone is capable of learning the basics of science, medicine and logic and using that knowledge to see through the quacktivist claims of the purveyors of pseudoscience. But then I read about the pure idiocy spewed forth on a topic like Group B Strep and I wonder if that is an over-optimistic sentiment.
How could anyone be stupid enough to believe that washing your vagina out with soap will prevent neonatal meningitis or pneumonia? (Feminist Breeder, I’m thinking of you, among others.)
Let’s step back for a moment and consider what you ought to know before you can make an informed decision to decline antibiotics for Group B Strep (GBS) and to substitute washing the vagina with Hibiclens (chlorhexidine) instead.
1. How does GBS hurt babies?
2. What are the chances of a baby contracting GBS?
3. What is the neonatal death rate of GBS?
4. How does IV antibiotics change the risk of a baby contracting and dying of GBS?
5. Has Hibiclens been shown to be as effective as IV antibiotics?
The latest information on Group B Strep can be found in the Prevention of Early Onset Group B Streptococcal Disease in Newborns published in the April edition of the journal Obstetrics and Gynecology.
1. How does GBS hurt babies?
Group B streptococci … emerged as an important cause of perinatal morbidity and mortality in the 1970s. Between 10% and 30% of pregnant women are colonized with GBS in the vagina or rectum… Invasive group B streptococcal disease in the newborn is characterized primarily by sepsis and pneumonia, or, less frequently, meningitis.
2. What are the chances of a baby contracting GBS?
For the past 30 years, GBS has been the most common cause of neonatal sepsis. The actual incidence is 1.7/1000 live births (approximately 7200 cases per year).
3. What is the neonatal death rate of GBS?
More than 15% of affected infants will die (approximately 1080 deaths).
4. How does IV antibiotics change the risk of a baby contracting and dying of GBS?
Since the early 1990s, national guidelines have resulted in an 80% decrease in the incidence of early-onset group B streptococcal sepsis, from 1.7 cases to less than 0.4 cases per 1,000 live births.
5. Has any other treatment been shown in large clinical trials to be as effective as IV antibiotics?
No, absolutely not.
In fact, large scale studies done the use of Hibiclens in low resources settings where IV antibiotics are unavailable show that it is in INEFFECTIVE in preventing neonatal group B strep sepsis. For example:
… We performed a placebo-controlled, randomized trial of chlorhexidine vaginal and neonatal wipes to reduce neonatal sepsis and mortality in three hospitals in Pakistan….
RESULTS: From 2005 to 2008, 5,008 laboring women and their neonates were randomly assigned to receive either chlorhexidine wipes (n=2,505) or wipes with a saline placebo (n=2,503). The primary outcome was similar in the chlorhexidine and control groups (3.1% compared with 3.4%; relative risk 0.91, 95% confidence interval 0.67–1.24) as was the composite rate of neonatal sepsis or 28-day perinatal mortality (3.8% compared with 3.9%, relative risk 0.96, 95% confidence interval 0.73–1.27)…
CONCLUSION: Using maternal chlorhexidine vaginal wipes during labor and neonatal chlorhexidine wipes does not reduce maternal and perinatal mortality or neonatal sepsis…
What is Hibiclens anyway?
The active ingredient in Hibiclens is chlorhexidine gluconate also known as (1,1′-hexamethylene bis [5-(p-chlorophenyl) biguanide]di-D-gluconate). According to the FDA:
… adequate and well-controlled studies in pregnant women have not been done. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.
And:
It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised …
Why are homebirth and natural childbirth advocates washing the vagina out with Hibiclens instead of using IV antibiotics?
It certainly can’t be because it works, since large scale studies show that it doesn’t.
It certainly can’t be because it doesn’t matter since GBS is the leading infectious cause of newborn death.
It certainly can’t be because IV antibiotics don’t work since they have reduced neonatal GBS deaths by 80%.
It certainly can’t be because Hibiclens [chlorhexidine gluconate also known as (1,1′-hexamethylene bis [5-(p-chlorophenyl) biguanide]di-D-gluconate)] is “natural.”
So why do women like The Feminist Reader wash their vaginas out with soap to prevent their babies from dying of Group B strep pneumonia or meningitis?
Because it fulfills the MOST important criteria for an NCB “treatment”; it is a form of ignorant, immature, self absorbed defiance of authority. And if that isn’t a good enough reason for NCB advocates to risk killing their babies, what is?
Doctors who think they know everything do more harm than good. Retire and stop positing yourself as an expert since it appears you no longer practice or should stop practicing immediately.
And who are you exactly? Not brave enough to actually interact on a recent post, eh?
“Retire […] it appears you no longer practice or should stop practicing immediately.”
Well, we can see right away that your “research” skills are sorely lacking – right at the top right of the page: “She left the practice of medicine to raise her four children.”
Of course, that doesn’t mean she isn’t an expert or has forgotten everything she learned or no longer has the ability to evaluate new studies and data.
Oh, don’t denigrate her “research” skills, Poogles! After all, she’s linking us to a 2003 article from Mothering Magazine.
She’s got mad research skillz.
Could you be more of a total know it all snatch about it? “Ignorant, immature self absorbed defiance of authority.” really? I realize you spent a good amount of time in med school, but it doesn’t make you the end all authority on what women do with their own bodies. Making informed, educated decisions for ourselves is our right. I can see that you are bitter about something in your life, but don’t take that out on those of us looking for an alternative to crap doctors hand out like candy. Crotchety old hag
So you come to this site, dig up a three year old post, and then proceed to slam a Doctor for what, trying to clear up the misconceptions of the NCB community? Look I understand what Dr. Tueter is doing here, apparently you don’t, because from what I remember you’re not really supposed to use soap on your vagina just water and a wash cloth, so in the same vein as your comment and because I haven’t slept in a couple of days, stop being a twit and read around, you might just learn something.
Stop being a twat and defending doctors who think they know everything. This woman’s ilk is the reason for antibiotic resistant GBS.
Always nice to have someone come onto a site run by a woman and frequently mostly by women and toss around words like “twat”.
Take your misogyny elsewhere, please.
“This woman’s ilk is the reason for antibiotic resistant GBS.”
What the hell are talking about? Bacteria become resistant to antibiotics because they evolve to be over time. Are you trying to claim that we shouldn’t treat GBS positive women with antibiotics? We should just let neonates contract infections and die, instead?
Wow, you’re a real breath of fresh air around here.
Don’t let the door hit you…
I’m wondering if the OB/hospital that delivered my daughter was trying to cover its’ own negligence in administering IV antibiotics to me by putting my daughter in the NICU for 9 days. I was insistent on being under midwife care when I tested GBS positive while pregnant with my daughter. When I thought my water broke I went into the hospital, the midwife found that I only had a high leak, & that my bag was still in tact below. An OB came in and got in my face and said “You want a home birth? go home!” then insisted that my water be broken & when I refused, she did it against my will. (the amniotic fluid was clear)
Isn’t this endangering my child? You can guess what came next…demands that I have pitocin, I didn’t want to have. So I tried to endure the contractions for 4 hours, until I passed out and they gave me an epidural. I never ran a fever & supposedly they pumped me full of antibiotics until they woke me up to push, then told me to stop until the doctor arrived because I was pushing “too efficiently.” When my daughter came out she passed meconium, but they verified that she had not swallowed any of it.
Then they said that I she had to have antibiotics administered in the NICU for 3 days despite testing negative for any complications and having no fever or any other symptoms. When I asked why she needed antibiotics if I’d already had them the neonatologist got in my face and poked my chest “you want to endanger your child by ignoring medical advice, don’t blame us if she dies.” Then, in her last 3 hours before release, they somehow found an apneic “type” pause in breathing for 4 seconds (apnea must be a full 15 seconds with a decrease in oxygen.” When we discovered her breathing/oxygen monitor was incorrectly attached they called social workers and CPS on us for trying to take her home. They asked us why we couldn’t just go home and relax. Please trust them to care for my daughter. Is this how they expect mothers to feel? Give birth and then be grateful someone else can care for her child?
So I’m trying hibiclens this time before the GBS test and up through labor, because after that experience I’m tempted to just have this next baby at home and avoid OB’s & hospitals altogether. I’ve never been mistreated so much in my entire life.
Having a high leak is like saying you’re a little bit pregnant. You’re either ruptured or you’re not. A high leak will still lead to chorioamnionitis if you have a prolonged labor. You do know that chorioamnionitis is one cause of cerebral palsy don’t you? Infection, hypoxemia, hypoglycemia, among other things are related to CP. sounds like your providers were trying to help deliver you in a timely fashion to help prevent this from happening. I guess if you didn’t get antibiotics and an augmentation of labor (since your body didn’t know how to go into labor), and your baby developed chorio and subsequently CP, you would be here complaining how the providers ignored you and allowed your baby to get CP.
About Hibiclens
I know third world countries and midwives use Hibiclens in the vagina. but when penicillin is available it should be used. It has the wrong vagina pH and is against manufacturers recommendations.
HIBICLENS® is an antiseptic antimicrobial skin cleanser possessing bactericidal properties. HIBICLENS contains 4% w/v chlorhexidine gluconate, a chemically unique cationic bisbiguanide with inactive ingredients: Fragrance, isopropyl alcohol 4%, purified water, Red 40, and other ingredients, in a mild, sudsing base adjusted to pH 5.0-6.5 for optimal activity and stability as well as compatibility with the normal pH of the skin. (pH of the vagina is 3-4, hibiclens could induce bacterial vaginosis to develop which in turn could cause preterm labor).
Manufacturers recommendations: Avoid getting this medication in your eyes, ears, nose, mouth, rectum, or vagina. Chlorhexidine topical is for use only on the skin.
FDA pregnancy category C. It is not known whether chlorhexidine topical will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.
It is not known whether chlorhexidine topical passes into breast milk or if it could harm a nursing baby. Do not breast-feed if you are using this medicine to treat a skin condition in the breast area.
Be very careful when using chlorhexidine topical on a child younger than 2 months old. This medication may cause severe irritation or chemical burns on a very young child.
Read more at http://www.drugs.com/mtm/hibiclens.html#iIV3vSXrKQkUR0c4.99
my current midwife said that a high leak means that the location of the leak was at the top near my fundus, which would mean that it was incredibly ill advised for that OB to rupture my bag from below, knowing I was GBS+, & 3 other OB’s confirmed this.
Your Megan Fox analogy does not work. A “high leak” may be at the top of the fundus or it may be 1 cm from the edge of the cervix. How would you prove it was all the way up at the fundus. Theoretically, infection, thrombus, trauma or other factors are more likely to create a leak near the cervix purely because of proximitry. It may not be over the cervical opening, but is more likely to be near the cervix than at the fundus. If your membranes are ruptured they are ruptured and further risk of GBS tracking up from the vagina via the flow of the leak and risks the baby. Get on PCN and augment labor with pitocin and when appropriate further break the forebag to deliver the baby before fever, chorio, or CP develops.
If you have unbearable contractions and pass out at home from pain 4hrs after a SROM, do you have a plan?
It was not after a SROM. I went 4 more hours with no contractions which is why they insisted on pitocin. I discussed it with numerous OB’s (4 officially consulted and several others by correspondence) & my midwife. I plan to go to a hospital once my contractions are 7 minutes apart or less and what caused me to pass out last time was that the pitocin caused the contractions to be on top of one another with no breaks at all. Since I will not be giving myself pitocin at home and my plan is not to have any pitocin under any circumstances in the hospital, (unless it is a small dose and then turned off immediately after being stalled for more than 6 hours at the same dilation) passing out at home is not really possible. All 4 OB’s I consulted confirm pitocin made my contractions at minimum, 5-10 times as painful as natural contractions, & without a doubt much closer together and longer. If my natural contractions cause me the same amount of pain, it’s highly likely to only be during transition, which since this is my 2nd pregnancy, highly likely to be shorter (last time it was 40 minutes). But if, by some bizarre, statistically inexplicable chance, my natural contractions are as painful as pitocin induced contractions, & I pass out again, they will give me an epidural again.
You won’t pass out at home? Google Caroline Lovell or Michelle “Dat Body” Phillips.
You sure are “special”. Every concern of yours gets 4-6 doctors opinions or correspondence opinions to back up your explanations. Most women just need one doctor to provide them care. I don’t believe you. I suspect you are playing the “I got so many doctors telling me I’m right, so na na na na na”.
I suspect you are a concern troll
I suspect you are not clear on the meaning of that term.
You know, my mother’s first labor (me) was augmented with pitocin after her water broke very early in labor. I was born 12 hours later. Her next labor was entirely unmedicated. It was a bit shorter, normal for a second baby, but it apparently wasn’t much different pain-wise. Pitocin isn’t actually a torture device, just a tool.
If you have never had pitocin without pain meds and a natural birth, please do not ever comment on the comparison. There is an enormous difference in the way natural and chemical contractions feel. Hypersystole is much more likely to happen with any induction method. Pitocin or other methods of induction may sometimes be necessary. No need to pretend they are as good as birth working the way it is meant to work.
Perhaps the greatest area of concern to medical researchers, as it should be to us all, is the alarming increase in antibiotic-resistant strains of bacteria. Antibiotic-resistant bacteria can cause infections in newborns that are very difficult to treat. Many large research studies have found not only resistant strains of GBS, but also antibiotic-resistant strains of E. coli and other bacteria caused by the use of antibiotics in laboring women.12-21 Some strains of GBS have been found to be resistant to treatment by all currently used forms of antibiotics.22
While many studies have found that giving antibiotics during labor to women who test positive for GBS decreases the rate of GBS infection among newborns, research is beginning to show that this benefit is being outweighed by increases in other forms of infection. One study, which looked at the rates of blood infection among newborns over a period of six years, found that the use of antibiotics during labor reduced the instance of GBS infection in newborns but increased the incidence of other forms of blood infection.23 The overall effect was that the incidence of newborn blood infection remained unchanged.
Oooh, you can copy and paste from an article on a non-scientific, biased website! How about you actually cite some studies and tell us how they prove your point. (BTW, the “one study” that found the overall incidence to be unchanged is from 17 years ago…no longer really applicable to this discussion all on it’s own).
You have no clue what I’m talking about do you.
The overall incidence of what. I don’t think you have any clue what I’m talking about.
“The overall incidence of what.”
From what you copied and pasted directly above from an article that originally appeared in Mothering Magazine (known for promoting psuedoscience and dangerous practices):
“One study, […] found that the use of antibiotics during labor reduced the instance of GBS infection in newborns but increased the incidence of other forms of blood infection.23 The overall effect was that the incidence of newborn blood infection remained unchanged”
“I don’t think you have any clue what I’m talking about.”
Do you?
You copy and pasted part of an article that is attempting to discount the science-based practice of administering antibiotics for GBS by claiming all the lives saved and illness avoided is “cancelled out” by increasing antibiotic resistance; the part you “quoted” is using a single study done 17 years ago to make that argument.
That’s the first article I found but there is more and more evidence that antibiotic resistance is contributing to the shockingly high infant mortality rate in the US.
I’m not supplying you with more links. Do your own research and put soap in YOUR vagina if you wanna Honey
You’re misusing the word incidence so this discussion is over/was over before it started.
How so? I used it in the same context your copy-and-pasted article did.
Incidence of infant mortality??? Honey you’re out of your league
“Incidence of infant mortality??? Honey you’re out of your league”
I think you’ve become confused…the part above that says “The overall incidence of what” is a question YOU asked ME. I answered by again quoting your copy-and-paste back to you. At no point did I bring up infant mortality, because we were talking about the incidence of newborn blood infections, not infant mortality.
https://www.healthychild.com/treating-group-b-strep-are-antibiotics-necessary/
Hibiclens causes chlorhexidine burns on some nurses that use it to scrub, and they are scrubbing hands/arms. I didn’t realize Hibiclens was approved for use internally and for mucous membranes. I can’t imagine having chemical burns in my vagina and trying to give birth.
Hope no hibiclens gets into the baby’s eyes! Fluids disperse easily and tract through surfaces easily and may get past the baby’s head and into the baby’s eyes. Ever get shampoo in your eyes when your washing your hair? Try putting hibiclens into your own eyes.
I don’t know why I never thought of that before! OW
You did not state that GBS is the leading cause of infectious death among neonates in fact. You did say that GBS is the leading cause of sepsis. Sepsis can be caused by a variety of bacteria. So, before you make the claim that GBS is responsible as the leading cause, you would need to prove that the combined total of all other bacterial infections leading to sepsis do NOT exceed the total caused by GBS. Mrs. Smarty Pants! You must not realize that there are a lot of studies coming to light showing that antibiotics given to the mother at the time of delivery are actually creating antibiotic resistant GBS and other bacteria like E-Coli. Among infants that developed a condition related to GBS in mothers treated with antibiotics at delivery, somewhere around 80% or more of the bacteria were resistant to the antibiotics that were given to the mother at delivery. Among those who developed a GBS condition whose mothers did not receive antibiotics, the bacterial resistance was closer to 20 or 30%. Additionally, the chances of a woman having a fatal reaction to the antibiotics is 1 in 10,000, whereas the chances of a full-term infant dying of GBS when their mother does not receive antibiotics is 2 in 10,000. Studies show that antibiotics do not reduce infant mortality, just the number of infections and that these same antibiotics INCREASE other blood infections. Therefore, it is possible that no lives are spared due to use of antibiotics.
Thank you for sharing your ignorance and demonstrating why the surest sign that someone has no idea what they are talking about is that they think they are “educated” about childbirth.
“the surest sign that someone has no idea what they are talking about is that they think they are “educated” about childbirth.”
Do you still have a license? Because I’m going to do something about that.
Misogyny is a bad look for you
QED!
Reading on this site could easily answer that question for you.
What exactly would you do about it?
“Do you still have a license? Because I’m going to do something about that.”
LOLOLOL! What do you think you could possibly do, if Dr. Amy hadn’t decided to let her license lapse to raise her children?
I guess you have never seen an infant that died due to GBS. I have. She was beautiful. She didn’t have to die.
Use your dead baby story to support your opinion again.
Can you translate that into English please?
“dead baby story” Fucking seriously? It was an actual real life human baby, that died a totally preventable death, not a “story”.
So the argument is this:
IV antibiotics can cause fatal anaphylaxis.
IV antibiotics can lead to increased resistance.
So far I agree.
But then comes the massive logic fail, that antibiotics in GBS positive women is of no benefit.
IV antibiotics will decrease the rate of GBS infections. Neonates will still get sepsis from other organisms, but not from GBS.
The babies who would have died from GBS will now survive, the babies whose mothers wouldn’t have got antibiotics still won’t get them.
You assume that the same number of babies who would have died from GBS are now dying from highly resistant organisms instead. They aren’t.
Perhaps the greatest area of concern to medical researchers, as it should be to us all, is the alarming increase in antibiotic-resistant strains of bacteria. Antibiotic-resistant bacteria can cause infections in newborns that are very difficult to treat. Many large research studies have found not only resistant strains of GBS, but also antibiotic-resistant strains of E. coli and other bacteria caused by the use of antibiotics in laboring women.12-21 Some strains of GBS have been found to be resistant to treatment by all currently used forms of antibiotics.22
While many studies have found that giving antibiotics during labor to women who test positive for GBS decreases the rate of GBS infection among newborns, research is beginning to show that this benefit is being outweighed by increases in other forms of infection. One study, which looked at the rates of blood infection among newborns over a period of six years, found that the use of antibiotics during labor reduced the instance of GBS infection in newborns but increased the incidence of other forms of blood infection.23 The overall effect was that the incidence of newborn blood infection remained unchanged.
https://www.healthychild.com/treating-group-b-strep-are-antibiotics-necessary/