Good News/Bad News

The midwife today said she would be "very surprised" if I was still pregnant on my due date, Jan. 31. She said this after palpating my abdomen and feeling that the baby, while not low enough to be considered "dropped," had already moved into a pretty low position. It does seem like the rib-kicking has lightened up a little lately, replaced with new weird sensations like bladder-kicking and unidentified-internal-organ-kicking.

So that's the good news. The bad news is that I tested positive for Group B Strep bacteria. This means that there's a small chance (1 in 100 or 1 in 200 if untreated, 1 in 4,000 if treated) that the baby could pick up an infection during birth and get very sick. Six percent of these babies die (that's 3 in 10,000). There's even a chance of stillbirth if somehow the amniotic fluid gets infected before birth. I didn't see any statistic on stillbirth caused by Group B Strep, but considering the small numbers of babies that get infected at all, I'm guessing it's pretty microscopic.

On a practical level, the Group B Strep thing is not so much something to worry about in terms of having a sick baby, but it can have an impact on how your labor goes. The midwives -- and the pediatrician -- want to follow the CDC recommendation of giving the mother two doses of intravenous antibiotics during labor. That means having an IV during labor, something you generally try to avoid with natural childbirth, but that didn't upset me too much because I figured I might need an IV anyway to deal with dehydration, if I end up throwing up during this labor as much as I did last time. The annoying part is that the doses are supposed to be about 4 hours apart. The midwife who told me about my positive test last week said that if I were to come to the hospital, say, 5 cm dilated, being a second-timer, I might not have time for both doses. Our doula generally recommends her clients go to the hospital at 7 cm or more dilated, and I was hoping to follow that recommendation.

Actually, I still am. Both the midwives I spoke to said they wouldn't insist on me coming in earlier in labor -- and honestly, they can't come to your house and force you even if they wanted to. The pediatrician said that two doses are much better than one, but all three of them acknowledged that you just can't count on having time for two doses, especially when it's not a first-time labor. The consequence for having only one dose: 1) increased chance that the baby gets sick, although I could not find a comparison for what the odds are with one dose vs. two; 2) the doctor may take a blood culture from the baby and keep an eye on her. The midwife said some pediatricians will require a longer hospital stay (like a whole 48 hours) if the mother doesn't get both doses, but our doctor does not.

All this was mildly reassuring that I wouldn't be a horrible mother if I stick to my original labor plan despite my new status as a filthy whore*. Also reassuring is the fact that not all caregivers agree with the idea of dosing 200 women with antibiotics for every 1 potential sick baby. This is a bacteria that up to 40% of all pregnant women have, so this is a pretty widespread antibiotic application in the age of superbugs. Some caregivers wouldn't give me any antibiotics even if I showed up at the hospital in early labor -- unless I was running a fever, having a preemie, or had my water broken for 18 hours before delivery. I'm 37 weeks today, so a preemie is officially off the list of possibilities.

As if feeling guilty about possibly not getting both doses of antibiotics weren't enough, our doula gave us an article from Mothering magazine arguing that babies might actually be harmed by the mother taking antibiotics during labor because the babies could end up with an antibiotic-resistant strain of e. Coli or some other nasty. Fortunately for me, the article said this risk was mainly with antibiotics other than penicillin, which is what I'll be getting. By the way, this article estimates that 3 in 10,000 babies are saved by the antibiotic use, but 1 in 10,000 mothers dies of a severe allergic reaction from them, usually taking her fetus along with her. So then we're down to 2 babies.

But as our pediatrician said on the phone the other day, "If it's your baby, it's 100 percent."

* My mother, and all the literature, insist that testing positive for GBS doesn't mean you have bad hygiene. Nor is it an STD. But come on, when they tell you you're harboring bacteria down there that threaten the health of your child, don't be surprised if the Whore of Babylon uses a little Purell after shaking hands with you. Ya filthy whore.