Saturday, September 05, 2009

Chlorhexidine (Hibiclens) Protocol For Labor Among GBS Positive Women

By Danelle Frisbie © 2009



In pregnancy, as in labor and birth, you have options. It is your choice whether or not you will be tested for GBS during pregnancy. If you are attending a typical obstetrical practice in the United States, you will likely be told that you need to be tested for GBS (even though your results will change depending on the week, and may not be the same during labor as they are on the day you are tested). You will likely be told that if you decline the tests, you will receive IV antibiotics during labor in the hospital - just in case you are GBS positive. If you would like to ensure a negative result during your OB visit (so as not to receive antibiotics in the hospital during labor) you can use Hibiclens within 6 hours of your GBS test for negative results.

No matter where you plan to birth, (home, birthing center, hospital) if you elect to test for GBS and the results are positive, you also have options other than automatic antibiotics. The likelihood of a baby being harmed by a GBS positive birth is very unlikely. In fact, there is a greater chance of antibiotics having negative consequences on your little one than GBS. However, other alternatives exist as well, and the one backed by a fairly decent amount of research is the use of chlorhexadine (Hibiclens) during labor. Please see this article for more information and links to further research on this topic.

A recent homebirth midwife shared, "I use a Hibiclens (chlorhexadine) protocol for vaginal washes which is the European protocol for treating GBS. Basically 0.5 oz of Hibiclens in 7.5 oz of warm water, mixed in a peri-bottle gently squirted into the vagina every six hours in labor. There is loads of data to support its effectiveness equal to the IV antibiotics protocol in use in the USA, but this research is totally ignored here due to the widespread use of IV in labor in the United States. After all, it can't possibly be any good if it is from Europe!"

Your body. Your birth. Your baby. Your choice.



Chlorhexidine (Hibiclens) Protocol for Labor

Chlorhexidine vaginal wash at the onset of labor or at rupture of membranes, whichever comes first, repeated every six hours.

Method:

• 2 Tbsp Hibiclens (4% chlorhexidine solution) mixed with 20 oz sterile water.
• You may be most comfortable in a squatting or sitting position (even on the toilet) or laying down with your hips slightly elevated.
• Put 4oz of the mixture into a periwash bottle. Use the entire amount for each application.
• Slowly instill the solution into the vagina under very gentle pressure using a peribottle.
• Begin at onset of labor or ROM and repeat every six hours.
• A woman can self administer the vaginal flush, and her spouse/partner can assist as well if she wishes.


For more information, see:

GBS and Homebirth

Treating Strep B

Prenatal Screening for GBS




References

Helen references the 1992 Am. Journal of Obstetrics and Gynecology, 162(1):1171.

Vaginal disinfection with chlorhexidine during childbirth. Stray-Pedersen B, Bergan T, Hafstad A, Normann E, Grogaard J, Vangdal M. Int J Antimicrob Agents 1999 Aug;12(3):245-51

Lancet: Burman LG et al. Prevention of excess neonatal morbidity associated with group B streptococci by vaginal chlorhexidine disinfection during labour. Lancet 1992; 340: 65- 69.

Chlorhexidine versus sterile water vaginal wash during labor to prevent peripartum infection. Sweeten KM, Eriksen NL, Blanco JD. Am J Obstet Gynecol 1997 Feb;176(2):426-30

GBS/Vaginal Wash Alternative-long J Matern Fetal Med 2002 Feb;11(2):84-8 Chlorhexidine vaginal flushings versus systemic ampicillin in the prevention of vertical transmission of neonatal group B streptococcus, at term.

31 comments:

  1. Thank you! I'm a new CNM and had no idea this existed.

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  2. As a recent CNM grad, I felt stupid when asked about the Hibiclens protocol for GBS by a prospective client. I told her I had never heard of it. After she told me more about it I researched it and found I like the protocol much better than IVs. I worked in L&D in the time before GBS protocols started. In nearly 20 years, I had one baby whose MOTHER had GBS infection post delivery, baby grew negative blood clutures but had to have 2 weeks of therapy never the less.

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  3. Thanks for posting the protocol! Was looking for this. I plan to offer this as an alternative to antibiotics :)

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  4. Thank you! I have done a lot of research on GBS positive options and only recently heard of using chlorhexidine. However, I didn't realize that it was Hibclens... I have some in my cabinet right now.

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  5. I was GBS positive (tested at 37 weeks) but had such a quick labor that they only had time for 1 bag of antibiotics. As a "precautionary" they gave my child a round of antibiotics after birth. I was never offered a choice with this. Later, they told me that the antibiotic they gave him could have affected his hearing permanently. I was furious. It's nice to know there are other options to antibiotics during labor.

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  6. I am glad you brought this up. This test wasnt even around when I had my first child. When pregnant with my second child I was given this test, tested + and was advised that I would be on antibiotics during labor. I dont like medicine of any kind so I refused. I believe the doctor tried to put the fear of god in me by telling me the effects of GBS during & after labor. Does anyone know if it is still possible for a baby to contract GBS after birth? Say at home? Do we know how long is lives once exposed to air. He stated it could be transmitted during intercourse, can it live on the sheets & be picked up that way? The whole situation kind of freaked me out to say the least....

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    1. GBS is not sexually transmitted. It's not a disease, it's a bacteria that normally lives in many peoples intestinal/digestive tract. It's common. During pregnancy it tends to flourish and can travel down into the colon and end up getting transferred and colonizing in the vagina, where your baby has a CHANCE (very low) to pick up the bacteria when they travel through the birth canal during delivery. That is to say if you are even positive at the point of delivery since GBS colonization lives in cycles. So you can test positive one time and a few weeks later test negative. There is also many options to try to treat it and reduce the colonization of it in the vagina through natural remedies as to avoid antibiotics. This is what I am attempting now as I just tested GBS + for my 2nd pregnancy at 35 weeks 5 days.

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  7. My daughter was born GBS positive 13 years ago. At that time there were no routine tests to detect it, at least in my area. I'm not trying to scare anyone, just stating that the risk, while small, is a real one. We almost lost her multiple times. She required the use of ventilator the first 11 days of her life. I can't explain the sheer terror and helplessness of watching your baby slowly dying before your eyes.
    I am pregnant again and am electing to procede as if I were GBS positive. I have read a lot about Hibiclens and have decided on this route rather than antibiotics. The rate of effectivness is the same and it has none of the side-effects of the IV antobiotics.
    I guess the idea that the risk is so small that GBS could be passed on to baby that it's okay to ignore it just bothers me. Coming from a mom who almost lost her first-born to GBS, I would advise any mom, please, do something.

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  8. I am so sorry you and you child had to go through that experience, Melissa. I cannot imagine living with that fear. I'm glad you have found a plan that helps you feel comfortable for your upcoming birth.

    I declined the test with both of my children because it didn't fit the "logic" test for me. If I tested positive, I would be treated as though I had it when giving birth. But if I tested negative, nothing would be done. Despite the fact that I could become positive between the test and giving birth. If the risk to the baby isn't high enough to test women when they enter their birthing time, then I didn't see it as worth it to take the test at all, considering I could become positive in the time between the test and birth.

    I had never heard of this protocol before and I'm a birth worker! It is automatic antibiotics around here, no matter who you are birthing with.

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    1. The reason for relying on a negative result at 37 weeks of pregnancy as predictive of your GBS status at delivery is this study (Yancey MK, Schuchat A, Brown LK, Ventura VL, Markenson GR. The accuracy of late antenatal screening cultures in predicting genital group B streptococcal colonization at delivery. Obstet Gynecol 1996;88):811--5.) which demonstrated that a negative swab is 95-98% predictive of GBS status for up to 5 weeks.

      Hope that helps to clarify why it is done that way.

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  9. Hi Vanessa!

    I can totally see where you are coming from. I think the thing that tends to get me when this subject comes up is that a lot of mamas don't seem to realize the severity of GBS when it does infect the infant. I completely understand acceptable risk as I have declined most testing and all ultrasounds this pregnancy. My reasoning has been that if I were to have a child with special needs, knowing about it before hand wouldn't do much. I have one differently-abled child. A nine year son who has IFSHMD (a rare form of muscular dystrophy). We know from having been given such a wonderful child that no amount of preperation would have helped us. Heck, just getting pregnant was an acceptable risk for us. We could very well have another child with the same disability. Logic, for us, has said that going through this pregnancy with minimal intervention and faith that things will be as they will be is what is right for us.

    I just wanted to add the conversation a voice that had actually experienced the devastating effects of GBS on their child. I used to be so disturbed that there was no test to tell me that I had GBS. Knowing that a simple round of antibiotics could have saved my daughter from the pain and agony of her first few months of life, not to mention the trauma I experienced as a young mama, really bugged me for a long time.

    From what I understand the Hybiclens regimen and probiotics are widely used in Europe with excellent results. We lived in Germany for many years and this was where I first heard of it.

    Have a wonderful day!,
    Mellissa

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  10. Totally confused by the "required antibiotics and 48hr observation at hospital w/or w/o antibiotics". I already teste positive (wish i would have known sooner) but was advised very sharply to NEVER douche pregnan when I mentioned an option to retake test after usig this. What would be side effete of douching before labor. Would there be side effects during labor as well? Also, if I do develop a fever or have had ROM 18+hrs would this work the same as antibiotics? Basically, because I'm not sure what else the antibiotics are precautionary for?

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  11. Thank you so much for posting this! I see GBS testing come up a lot in the homebirth debate and this is precisely the kind of thing we should all know about.

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  12. I am still confused! My midwife has me doing sitz baths of vinegar & water daily. I also wash my vaginal area with hibiclens in the shower daily~ I take probiotics &used garlic in my vagina. I will retest today & hope that I am now negative- but I have read about GBS infections in newborns even with the test coming out negative ~ ugh.
    Too many ideas~ just be aware of the signs especially if you are a home birth momma like me:)

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  13. Let me say that; we do not vaccinate our children, we do not take unecessary medicines & that even though I am a nurse, I don't believe everything a doctor says;) I'm all about researching things for myself & deciding what is best for me & my family.

    I think this information is great about Hibiclens for GBS & hope to use it for myself. I do, however, want to share an alternative view of a baby lost to GBS. WARNING: Death is mentioned & this is a very sad situation. I only share it, to help those who do not believe that GBS is anything to worry about. Regardless of treatment decisions, ie IV abx, Hibiclens or others, GBS is very real & affects real people. I hope little Wren's story will open the mind of someone who is not believing in GBS. http://blog.dreamhost.com/2011/03/09/wren-jones/

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  14. @AikoArt - I appreciate the warning about the link/story you shared. So incredibly tragic. But this particular protocol is more for preventing GBS with a less invasive measure. It appears nothing was done in this baby's case? It doesn't entirely relate here because the use of Hibiclens (quite common where I am from) IS doing something proactive and preventative. Just not sure the rare scary stories fit? But as you said, it is always best to be well informed and read all aspects from all angles, so I appreciate your input.

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  15. Where/how can I get the Hibiclens wasH?

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    1. Hibiclens is available upon request at almost any pharmacy. They typically must order the pumpable/foaming type (pink with a pump). The other non-foaming type is often on the shelf.

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    2. The pink pumpable type is sold on the shelf at Walgreen's. I just got some.

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  16. do you have any updated info about GBS infection crossing the placenta? I have heard that it is now known this is typically the case for babies born with GBS infection.

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  17. I was just wondering what a woman should do if she uses the wash during labor, but then has a bowel movement. Should she use the wash again right after that?

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    1. The wash is being used in/around the vagina (not the rectum) so I wouldn't think this would make a difference.

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  18. I called Walgreens and CVS but both said I needed a prescription for Sterile Water? And I cannot find a periwash bottle and had to order online....I am just hoping it will be here before my doctors appointment/ birth of baby. Could Distilled Water or Nursery Water be used instead?

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    1. We used distilled water. Nursery water usually has fluoride added to it.

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  19. I don't believe that is true because my brother buys sterile water to rinse his eyes (severe allergies) straight off the shelf at local pharmacies. I purchased a periwash bottle online - there are many sellers of homebirth supplies or OB/GYN supplies like this. I think they can also be found at some pharmacies.

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  20. I am curious how safe this is to do, especially considering the warning on the bottle that states "Do not use in the genital area." I have seen tons of things about using it as a vaginal flush, but this warning straight on the label concerns me.

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    1. I believe this notice is placed on the bottle because it has never been tested for use in this part of the body, and it can cause abrasions if used for too long. I probably would not use it to wash my genitals just because it is a powerful soap. But I did dilute and used it for GBS testing with pregnancy #2 and with labor for pregnancy #1.

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    2. 2 TBSP in 20oz of water is *very* diluted -- not the same as using the straight product to wash your genitals... We used it to wash hands after our baby was born (the only thing I really trusted to rid everyone's hands of everything all winter long...) but even then I wouldn't use very much for washing.

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  21. Has anyone every used colloidal silver to eradicate the GBS? If so, I would love to hear your comments.

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    1. Your question has been shared with the FB PP community here: https://www.facebook.com/peacefulparenting/posts/10152485639562671

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    2. Thank you, thank you, thank you for this info! After flunking my first GBS test at my birthing center (by their regulation I'd have to go to the hospital if I was going to decline the antibiotics), I decided to "trick" the test right before retaking it by using a Chlorhexidine wash, yet I didn't know what kind to use or how to apply it. As the GBS test includes a swap of the vagina AND the rectum (at least in Indiana, USA), you probably want to add to your instructions to additionally flush a couple inches or so into the rectum.

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