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.
• 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
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.