The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

GBS Treatment for Homebirth

I was planning a homebirth, but the GBS culture came back positive, with low colonization. The midwives are now recommending that we birth at the birth center so we can get antibiotics during labor.

We wanted our baby to have a gentle birth with the best start possible and no drugs, including antibiotics. We are heartbroken, of course.

Why can't they administer the antibiotics by IV in your home?

I encourage you to ask for complete information about this issue, including:

What are the increased infection risks of birthing at the birth center? (If your birth center is attached to a hospital, infection risks are significantly higher than in your home.)  Are these increased risks greater than the risk of infection from GBS?

What are the specific complications associated with administration of antibiotics during labor?

What are the effects on the baby of being born with antibiotics in the system?

How do these antibiotics affect the colonization of the baby's normal skin and gut bacteria?

Nobody will be able to answer these last two questions because there's no research on the subject.

All that's really known is that administration of antibiotics during labor makes the baby very susceptible to any antibiotic-resistant infections, since there are no normal bacteria to crowd them out.

Getting a positive result from a GBS culture doesn't necessarily mean that giving birth in a birth center or a hospital will be safer.  Ideally, you could use alternative treatments to reduce the colonization, which is the safest approach to the GBS problem.

I was glad to learn that midwives do administer IV meds at home prn. It would seem a shame to have to bring a low risk mom to a hospital for IV antibiotics, especially when the increased risk of infection in the hospital could offset any benefits.

In our area, the moms can get a prescription for IV antibiotics, and then we call in ICare (home health nurses who do only IVs) to do the IVs.

According to the ACNM. A strategy for expectant management of a mom with ROM > 18 hours and no labor yet...and no other risk factors...is PO Amoxicillin 500mg TID at 18 hours of ROM. Apparently Amoxicillin is better absorbed than PO PCN VK or Ampicillin. When real labor begins they recommend a switch to IV Penicillin G because PO absorption from the stomach is not assured in laboring women.

ACOG, AAP, and CDC in their recent consensus report do not recommend the use of PO antibiotics to prevent GBS disease.

We know a doctor who has his Group B strep patients start taking oral antibiotics at the onset of labor. That was they can avoid the IV entirely if they so desire. This would work well for staying at home, if your client can talk her OB into it.

If not, she can probably still stay home until ROM - but then she would need either IV or IM antibiotics, regardless of echinacea or culture. I had one client (a VBAC) who really didn't want an IV, but she was Group B strep positive. Her doctor ordered shots every 4 hours postrupture (which was, unfortunately, about 18 hours before her baby was born by CBAC).

There are many ways to skin a cat. no one has said +GBS requires iv antibiotics in hospital. If you do the risk-based management, you would only need antibiotics if >18 hours ROM. this might buy you some time.

We give all clients the option to culture @ 36 weeks, some do & some don't. And we Rx in labor all positives & all who ROM <18 hours or who have other risk factors. We give antibiotics IM, unless there is some other reason why we might want an IV later. We also have had two clients in the last year who tested positive who declined antibiotics and their babies were fine.

I have a small home birth practice and my protocol is as follows: I culture everyone at 35 weeks.  If +, I provide information and informed consent for antibiotic refusal.  If the client is interested in antibiotic prophylaxis, I will do PO amp at 38 weeks 500 Mg qid X 10 days, then offer IV amp in labour.  I do this for both home and birth center births -- no need to go to the hospital for the IV meds.  I just put in a heploc and run them in q 4-6 hrs.  My backup MD is also comfortable with the woman doubling up on the PO meds during labour if she doesn't want the IV stuff.

If you follow the history of the big Beta Strep deal, you will see that the medico legal system made protocols re: beta strep following many articles in women's mags.  As you are probably aware, the big protocols have gone through many evolutions.  Many protocols forced on women didn't work.  The current protocol is not working well either.  It would take maybe 2 hours to educate each client re beta strep and the possibilities protocols etc.  I think it's antithetical to the midwifery model.  Not to mention the risks of antibiotic over-administration and the development of super-strains of diseases, as well as the risk to any woman on any day of allergic reaction to antibiotics.  To encourage all clients to get tested, knowing that 30 % of women will test pos, so they can worry about yet another medical model thing, is bad midwifery to me.   So I am following the protocol of:  if a woman ROMs before 38 wks, or premature labor, or a previous strep baby, or develops a temp during labor, or the baby's fhts become tachy, or ROMs >24 hours, THEN we will offer IV antibiotics.  I really want to get IV antibiotics to administer at home in order to feel more confident about informed consent.  (if I can't offer it, it means she has to go to the hospital to get the IV, so the decision changes to should I go to the hospital, not should I have the IV antibiotics.)