Posted by My OB said WHAT?!?.
Sep
9
Posted by My OB said WHAT?!?.
Thoughtful Thursday! “You Have The Right To Refuse Any Testing You Want.”
“You have the right to refuse any testing you want.” -OB to mother who expressed concerns about possible interventions that a positive GBS test might lead to.
There are 28 comments to this post.
Is there a “but…” after this? Usually this is followed by “but if you do refuse testing, then the hospital policy is to assume you are GBS+ and treat you with antibiotics accordingly.”
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Kathryn T. Reply:
September 9th, 2010 at 11:09 am (Quote)
No “but.” She did say “they’ll try to get you to take antibiotics in the hospital if we don’t have a negative result, but you can refuse those too.”
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Or…but if you refuse testing, your insurance may refuse payment.
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Heather P Reply:
September 9th, 2010 at 8:26 am (Quote)
This is a scare tactic. They can’t do that.
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brige Reply:
September 9th, 2010 at 11:18 am (Quote)
See… I’m not too sure on that… please inform me… they told me (if I wanted my child released AMA (against medical advice) which we were hoping to leave the hospital around 8 hours post birth if everything was okay….) that insurance companies have the right to refuse payment if something was done against AMA, now I called my insurance company and they said that was not the case, but IDK… do you have anymore info?
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Angela Reply:
September 9th, 2010 at 11:28 am (Quote)
I have contacted several different insurance companies (Aetna, BCBS, HealthNet, Kaiser, etc.) about this very issue. Every single one of them said the same thing. NO…they will NOT refuse to pay for the birth or newborn care if you leave AMA. HOWEVER…if you leave AMA and return to the hospital for a problem that would have been caught had you remained in the hospital, they MAY (at their discretion) refuse to pay for treatment for the condition you returned for. For example, if you leave 8 hrs after birth, and the baby has a seizure 3 hours later, when you “should” have still been in the hospital, the insurance company MAY refuse to pay for that subsequent visit and treatment for the seizure.
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I’m kind of saddened that an OB stating the mother’s rights is considered exceptionally thoughtful. Maybe it was the context? Maybe this mom had been railroaded by the nurse, the NP, three midwives, the director of the hospital and two partners at the OB practice…?
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I don’t like this. Simply because while Mom is being told that she can refuse it, she’s not being told the consequences of refusal. I’m not talking about the dead baby card either, just the things she may have to experience even if she refuses. Like others said, insurance might hassle her, she may still have to get antibiotics, the baby may still have to be watched and get antibiotics, if she doesn’t get the same doc for labor/delivery then the one who does deliver may give her crap.
Its good that she’s being given the knowledge that she can refuse, I just hope she also got the rest of the info. Or even better, I hope there were no strings attached to her refusal for gbs testing.
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Kathryn T. Reply:
September 9th, 2010 at 11:12 am (Quote)
See above — she did line out the consequences of having no test results on record, but also was very firm that I could refuse any and all testing and intervention if I wanted. She made the same point about the newborn interventions, and when I said I wanted the vitamin K shot but not the eye goop or the hep B vaccination, she quirked an eyebrow but wrote it down in my chart without a qualm.
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I *do* like this simply because its so rare to actually hear an OB say that you have the right to refuse anything. I didn’t know better with my son. I remember at one appointment I was sent up the road to get my blood drawn for a RhoGam injection. I didn’t know what RhoGam was or why I needed it. And *he* wasn’t even the one who told me I needed to go. The order for blood draw was given to me along with my prescription when I checked out.
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This will probably sound massively uneducated, but: What is the GBS test and what is it testing for? In fact, if any of you have links for the number of tests for pregnant mothers and newborns I’d appreciate it. My girlfriends is pregnant, and she keeps putting off the OB appointment because she doesn’t know what they’ll do.
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Kat Reply:
September 9th, 2010 at 3:44 pm (Quote)
“GBS” testing is testing the mother to see if she has an active Group B Strep colony. This is a very common bacteria, and many women are colonized but never have any symptoms of it. It is not a STD, and in most healthy individuals it doesn’t cause problems at all.
Group B Strep bacteria can cause severe illness in the newborn if he becomes infected with it.
The problem with it is: Testing at 36 weeks (standard time for the test) only indicates the mother’s status at that exact moment. She could test negative, but develop a group b strep infection prior to labor. She could be positive, and her immune system could do its job and fight the bacteria off before labor.
Once a woman is labeled “Group B Strep positive” she is generally expected to submit to IV antibiotics every 4 hours during labor. If she does not receive two doses of the antibiotics, the hospital may make a fuss about closely observing the baby for 48 hours to monitor for any signs of infection.
There are some natural methods to reduce the risk of an active GBS colony while giving birth:
Good nutrition and boosting the immune system through a healthy diet.
Eating yogurt and taking probiotics to maintain a balance of healthy bacteria, crowding out harmful strains.
Gentle antibacterial rinses of the area can also help (google GBS and hibiclens).
Not doing vaginal exams during labor also reduces risk of infection in both mother and baby. Allowing the membranes to rupture on their own also maintains the natural protection of the amniotic sac around the baby as long as possible.
I was diagnosed GBS positive during my second pregnancy, and my labor was a total of 5 hours, maybe 45 minutes of that at the hospital, so no IV antibiotics. My water broke as I was pushing, and I only had 2 vaginal exams, one on admission (5cm) and one after transition (GET THE DOCTOR IN HERE NOW). She was under observation for 48 hours but never showed any sign of infection.
After doing my research, I did consent to GBS testing during my last pregnancy, but I did everything I could think of to reduce risk factors, and I did test negative. I felt that was a good balance of taking GBS seriously (which it should be!) and protecting myself from unnecessary levels of intervention.
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JulietsButterfly Reply:
September 10th, 2010 at 4:27 am (Quote)
It also helps not to allow any internal monitoring if you do test GBS+. When my MIL was in labor with DH, she had tested GBS+ was treated (I think) with abx, but her labor was very slow, like over 26 hours or something and her water had broken and they had insisted on an internal fetal monitor which she described as “a direct pathway for the germs from me to the baby.”
I was GBS+ with DD and being young and not knowing any better, they did the abx but my labor was super fast, like I checked in just after midnight and had DD by 3am. I found out later that with such a speedy delivery and my water intact until the dr broke it at 10 when it was time to push (again, didn’t know better) that DD’s chances of infection were much lower than someone who has their water break at 4cm and takes several hours to get to 10 and push.
I personally feel that the GBS test is one of the lesser interventions they can do and it can avoid a larger intervention (abx that you might not have time for). With my second pg, my OB was kind enough to retest me at the usual time, so I took a strong regiment of probiotics for about a month before the test so I could “pass” it. Many OBs won’t even retest you and if you’re GBS+ for your first birth, they’ll treat you as GBS+ for all subsequent births.
Again though, a lot of it depends on where you have your baby and your dr. MIL was in Chicago in ’79. I was in GA in 2004 and ’08.
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Cmat Reply:
September 9th, 2010 at 4:25 pm (Quote)
GBS is group b strep testing. For I think its like 15-20% of women its present but you won’t know unless you’re tested for it. It can be passed to the baby during birth (though I think I’ve read its rare to have it actually happen) so they like to test for it and if its present, give you antibiotics to help prevent passage to the newborn.
If your friend is in early pregnancy, all they’re going to do is routine stuff. If she goes to an OB the first appointment is usually a pelvic exam (usually not painful at all), some blood work, urine sample and getting an RX for prenatals. After that its usually weight/blood pressure check (every appointment), check for baby’s hearbeat with a doppler and get information from mom as well as give her info. The prenatal appointments really aren’t that bad. Tell her that if she is at all nervous or unsure to ask every question she can think of until she understands what’s being done and why. A good doctor will always be willing to answer questions. I’m not sure about what a midwife would do because I’ve never seen one but the care is excellent from what I’ve heard.
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Beth Reply:
September 9th, 2010 at 5:15 pm (Quote)
If a woman is colonized when she gives birth the chances of passing the infection to the baby are 1 in 200 without the antibiotic protocol. With 2 doses of antibiotics on board before birth, the chances of passing the infection drop to 1 in 4,000.
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Lovely Labor RN had this to say,
Sep 9, 2010 @ 10:48 pm (Quote)
No sure why this is a Thoughtful Thursday. Yeah sure you can refuse, that is indeed your right. However, GBS can cause serious harm to babies. We had one die at 10 hours post delivery of GBS septicemia. Had the mom received PCN for GBS prophylaxis during labor (she also *refused* the GBS swab) that baby probably would not have died. It is not a scare tactic, it is real and serious. Granted, only about 2% of babies who are born to untreated GBS positive moms have problems, but would YOU want to be the 2% statistic?
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Lovely Labor RN Reply:
September 9th, 2010 at 10:49 pm (Quote)
Also, Hibiclens should not be used in the genital area, says so right on the bottle…
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StaudtCJ Reply:
September 10th, 2010 at 4:51 am (Quote)
I wish I could *like* posts. I’m all for least intervention, best birth for baby and mom, but Our lovely nurse is absolutely correct. GBS is no joke, and it’s common enough that testing and antibiotics if necessary is not something I’d do without. Part of being informed and giving consent is knowing when routine intervention is probably a *good* thing. I’d say that GBS+ is one of those times.
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Angela Reply:
September 10th, 2010 at 6:12 am (Quote)
I don’t completely disagree with you. I am, however, curious what your thoughts are about the fact that a woman can be colonized one day, but not the next, and then be colonized again a few days later. So a woman can test negative at her 37 weeks GBS test, but then in fact be positive a few weeks later when she gives birth.
We do have rapid GBS testing available. However, in my experience as a doula, hospital staff is very reluctant to do this. I’m not entirely sure why though. It would seem to me that this would be a far more accurate way of determining which women/babies may benefit from antibiotics. Still some women may choose to decline those antibiotics, but that is her choice to make. In order for women to make informed choices, they need to have accurate/CURRENT information. And rapid GBS testing instead of routine testing at a pre-determined schedule just seems like a much smarter way to do this.
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Dreamy Reply:
September 10th, 2010 at 9:05 am (Quote)
This is my feeling and question as well.
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StaudtCJ Reply:
September 10th, 2010 at 2:52 pm (Quote)
I must have had an amazing midwife, because she checks for GBS when you arrive in labor. I didn’t know they still checked so far ahead unless they know you’re prone to it! So yes, I absolutely agree with you. Such decisions should be made with the most current info possible.
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Kat Reply:
September 10th, 2010 at 11:12 am (Quote)
I agree that GBS is something to be taken seriously, BUT as such it is still the parents’ right to make an informed choice, taking into consideration ALL factors:
Any allergies to antibiotics in the mother/family history.
How prone the mother is to experiencing yeast problems after use of antibiotics (thrush can greatly complicate establishment of breastfeeding).
How the antibiotics being administered will affect freedom of movement during labor.
Whether oral antibiotics are an option.
Etc.
One size *does not* fit all, even in issues where routine testing and intervention DO have benefit.
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Kind of off topic, but…
When a doc told one of my clients that she couldn’t refuse pitocin after the birth (there was a tiny amount of bleeding) I stage whispered to her, “Yes, you can.”
He was angry but he knew he had just lied to her and that she knew it, so he stopped talking and dropped the subject.
Mothers need to know then can refuse anything, and should simply ask for papers to sign documenting their refusal. When they ask for those papers, ‘caregivers’ realize they’re educated, and (mostly) stop pushing it.
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Kathryn T. had this to say,
Sep 20, 2010 @ 9:47 pm (Quote)
To give this a little more depth, I was basically telling her that I really didn’t want my GBS swab to come back positive, because I didn’t want to have to deal with antibiotics during labor. She looked at me and said “Well, we don’t have to do the test. You can refuse this or anything else; your consent is required for anything we do.”
I said “Oh?” and she said “Oh yeah. This isn’t a disease; this is a normal process. The testing guidelines are set up by the clinical practice, but you don’t have to abide by them if you’re uncomfortable with them.”
“Well,” I said, “but I want to know if I’m GBS+. Because if I am, I know I need the antibiotics. I just don’t want to be GBS+, is all.”
“I don’t want you to be either,” she said. “And I’m glad you’re getting the test; I think it’s a really good idea. If you don’t have the test done, a lot of times they’ll want to hang the antibiotics just to be on the safe side, anyway. But you can refuse that too, if you want. It’s your pregnancy, your baby, your birth, and you are the one in control. You run this show, not me.”
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This is what they *should* be telling us from the start. From reading stuff, if you don’t get GBS tested, they might give you antibiotics during labour just in case, or to baby after and watch him every some # of hours after birth.
So, unless OB also said something about having the right to refuse treatment, I don’t see this as ‘thoughtful’.
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