38w OB visit/GBS+ and abx clarification

Hi folks,

Just back from my weekly OB visit/NST. The baby's doing fine,
I'm now measuring 40cm (39cm last week, so on track), bp
was 96/62, weight fine, urine fine. I guess they like to do
an internal at 38w, so I had one: long and fingertip dialated,
baby at -3. This contrasts (I guess) with long and closed at
36w, but doesn't mean much, I know.

I asked about the antibiotics, and why it was every 8 hours,
instead of every 4. My OB says it depends on the particular
antibiotic they use, and the one they use (didn't catch the
name) is every 8 hours. I asked also what the goal was in terms
of how long the abx have been in my system before birth. She
said if I had a fast labor and the abx had only been there a
couple of hours, she wasn't worried about it, since fast labors
generally mean less risk of infection for the baby. She did
say there was a study that's complicated things for them. In
the study (of first time mothers), the followed women who had
developed a fever and then were given antibiotics. Babies born
within the first four hours after that were more likely to have
an infection than those born after the four-hour mark, but she
thought it likely that the babies born sooner were more likely to
have been in distress (and therefore delivered via c-section
etc), and the distress may have been because they *already* had
an infection. So, she feels that none of that has much relevance
for multips who come in and have fast labors, but nonetheless,
there's some regulation/guidelines requiring longer hospital
stays (48 hours instead of 24) for babies born to GBS+ mothers
within 4 hours of the first dose of abx. She also made it sound
like some pediatricians were willing to go against those guidelines
when it was clear that everyone was okay.

On the upside, she said that sometimes she has GBS+ arrive
at the hospital in early labor, gives them the dose of abx and
then sends them on a walk (with the heplock in), rather than check
them in to a L&D room where they (i.e., the OB) might get
tempted to "do something" to speed things along.

Emily
--
DS 5/02
EDD Labor Day 9/5/05

Emily wrote:

I asked about the antibiotics, and why it was every 8 hours,
instead of every 4. My OB says it depends on the particular
antibiotic they use, and the one they use (didn't catch the
name) is every 8 hours.

That is true that some of the other antibiotics are only
given every 8 hours. Penicillin is supposed to be the primary
protocol, probably in an effort to limit the use of the "big
gun" antibiotics. So, one might question why they are
using the alternate drugs instead of the recommended first
line drug, but every 8 hours is likely appropriate for the
drug they're using.

Best wishes,
Ericka

Joybelle wrote:
All sounds good! I had my NST on Tuesday, and I had the friendliest nurse.
That really helped the time pass fast!

That's good. This time around I had to keep pressing on the
heart rate monitor, because of how the baby was situated. It
meant I didn't have a hand free (between that and the clicker
for movement) to hold a magazine to read. I didn't mind so
much (though my hand got tired), but I did spend some time thinking
that there's *no way* I'd bother to do that while in labor.
If the baby's in a similar position and the nurse wants a trace,
she'll damn well have to hold the thing herself!

On the upside, she said that sometimes she has GBS+ arrive
at the hospital in early labor, gives them the dose of abx and
then sends them on a walk (with the heplock in), rather than check
them in to a L&D room where they (i.e., the OB) might get
tempted to "do something" to speed things along.


Glad you got more info on the antibiotics. Are you pretty comfortable with
their way of doing it then? It sounds pretty good to me.

Yes. I really like my OB, and from what I've seen of the rest of
the practice, they're all pretty much of the same philosophy.

What a good update, Emily! You are so amazingly close! Are you still
feeling pretty comfortable? Is the weather treating you well? Are you
still all ready to go?

Yup. I still haven't packed my hospital bag, but everything else
is all set (car seat installed, co-sleeper assembled, DS knows
the drill, etc etc). I'm pretty tired these days, and less and
less inclined to do any actual work, but that's okay (I'm not paid
over the summer anyway, and people are sympathetic). Really, any
day now would suit me fine :-)

Actually, the timing considerations at present are that I'm supposed
to be a bridesmaid on 9/4. I'd like the baby to come sooner rather
than later so that I can have more time to recover before the wedding.
If the baby doesn't come by 9/1, probably 9/5 is better so I can
at least be there! The other thing is that there's a conference in
a near-by city 10/6-8 that I would really like to attend. I can get
there by train and public transit (read: no carseat needed, just
me, the baby in a carrier [mei tai, if it works for us], and a
suicase). I've never actually attended a conference in my current
subfield, since I switched subfields and started a family at about
the same time (haven't been able to travel so much). I haven't
submitted a paper to this conference (of course), but would really
like to go if I can. It seems pretty feasible to me with a 5-6 week
old baby, less so if we're talking more like 4 or even 3 weeks.

Fortunately, things have cooled off, so I haven't been too
uncomfortable weather-wise. My hands are swelling, which is annoying,
but not alarming since my bp has stayed low. My grandma's been
calling every day to see if I'm in labor yet, but most everyone
else isn't pestering too much.

Emily
--
DS 5/02
EDD Labor Day 9/5/05

Ericka Kammerer wrote:
That is true that some of the other antibiotics are only
given every 8 hours. Penicillin is supposed to be the primary
protocol, probably in an effort to limit the use of the "big
gun" antibiotics. So, one might question why they are
using the alternate drugs instead of the recommended first
line drug, but every 8 hours is likely appropriate for the
drug they're using.

Interesting point, Ericka. I'm usually pretty wary about
super bugs (refuse to use antibacterial soap or dish soap
in our hosue, for example, even though it's hard to find
liquid soap that isn't these days!), but I wonder if in this
case this practice goes for the "big guns" because it's not
a situation where you can wait and see if the first one worked
and then try the next one if it didn't?

Emily

Ericka Kammerer wrote:
Emily wrote:

Ericka Kammerer wrote:

That is true that some of the other antibiotics are only
given every 8 hours. Penicillin is supposed to be the primary
protocol, probably in an effort to limit the use of the "big
gun" antibiotics. So, one might question why they are
using the alternate drugs instead of the recommended first
line drug, but every 8 hours is likely appropriate for the
drug they're using.



Interesting point, Ericka. I'm usually pretty wary about
super bugs (refuse to use antibacterial soap or dish soap
in our hosue, for example, even though it's hard to find
liquid soap that isn't these days!), but I wonder if in this
case this practice goes for the "big guns" because it's not
a situation where you can wait and see if the first one worked
and then try the next one if it didn't?


Well, the CDC recommended protocol is to use penicillin or
ampicillin unless the patient is allergic. I don't know all the
reasons they advocate for that position, but most of the studies
have been done with this protocol with pretty successful results,
so I'd be surprised if there was much evidence to worry that
penicillin wouldn't be effective enough.
You might consider asking the reason. It could be for
something quite valid (e.g., they've found a lot of penicillin-
resistant GBS in your area, or when they cultured your sample
they found it to be penicillin resistant). Or, it could be cheaper
for the hospital because they only have to run the antibiotics
half as often and the labor costs offset any cost savings from
the drugs themselves. Or, maybe their perception is that
customers like it better getting stuck less, or that there's
greater compliance with the 8 hour protocol.

All reasonable possibilities. I'll ask, if I get a chance (and
I bet my OB will wonder why I've suddenly gotten so curious about
this one thing ;-). But, this group has a history of fairly agressive
treatment for GBS (doing the test and treat all GBS+ protocol even
when the CDC/ACOG/whoever also allowed the other protocol), so
I wouldn't be surprised if it was them deliberately using the big
guns. It'll be interesting to find out.

Emily

Emily wrote:
Ericka Kammerer wrote:

That is true that some of the other antibiotics are only
given every 8 hours. Penicillin is supposed to be the primary
protocol, probably in an effort to limit the use of the "big
gun" antibiotics. So, one might question why they are
using the alternate drugs instead of the recommended first
line drug, but every 8 hours is likely appropriate for the
drug they're using.


Interesting point, Ericka. I'm usually pretty wary about
super bugs (refuse to use antibacterial soap or dish soap
in our hosue, for example, even though it's hard to find
liquid soap that isn't these days!), but I wonder if in this
case this practice goes for the "big guns" because it's not
a situation where you can wait and see if the first one worked
and then try the next one if it didn't?

Well, the CDC recommended protocol is to use penicillin or
ampicillin unless the patient is allergic. I don't know all the
reasons they advocate for that position, but most of the studies
have been done with this protocol with pretty successful results,
so I'd be surprised if there was much evidence to worry that
penicillin wouldn't be effective enough.
You might consider asking the reason. It could be for
something quite valid (e.g., they've found a lot of penicillin-
resistant GBS in your area, or when they cultured your sample
they found it to be penicillin resistant). Or, it could be cheaper
for the hospital because they only have to run the antibiotics
half as often and the labor costs offset any cost savings from
the drugs themselves. Or, maybe their perception is that
customers like it better getting stuck less, or that there's
greater compliance with the 8 hour protocol.

Best wishes,
Ericka

"Emily" wrote in message
news
Hi folks,

Just back from my weekly OB visit/NST. The baby's doing fine,
I'm now measuring 40cm (39cm last week, so on track), bp
was 96/62, weight fine, urine fine. I guess they like to do
an internal at 38w, so I had one: long and fingertip dialated,
baby at -3. This contrasts (I guess) with long and closed at
36w, but doesn't mean much, I know.

All sounds good! I had my NST on Tuesday, and I had the friendliest nurse.
That really helped the time pass fast!


On the upside, she said that sometimes she has GBS+ arrive
at the hospital in early labor, gives them the dose of abx and
then sends them on a walk (with the heplock in), rather than check
them in to a L&D room where they (i.e., the OB) might get
tempted to "do something" to speed things along.

Glad you got more info on the antibiotics. Are you pretty comfortable with
their way of doing it then? It sounds pretty good to me.

What a good update, Emily! You are so amazingly close! Are you still
feeling pretty comfortable? Is the weather treating you well? Are you
still all ready to go?

--
Joy

Rose 1-99
Iris 2-01
Spencer 3-03
# 4 Sept 2005