# Washing with Hibiclens before group B strep test?



## mommy2madison03 (Jun 27, 2004)

I am seeing a cnm for this birth and will be delivering in a hospital. My midwife told me a couple of appt's ago that I should wash with hibiclens before I come in to have the swab done. She know's I want to labor in the water and I can't do that if the test is positive. Well, I was going to ask her at my 34 week appt exactly how to do it but she was out that day so I had to see an OB and I couldn't ask her. She told me in confidence that I wouldn't mention this with the OB's in the practice.

My appt is at 10:50 tommorrow. Will it still work if my shower is a few hours before the appt? How exactly do I wash with it. Do I just wash like I would with soap and then rinse it all off?


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## ZorroZ (Nov 3, 2003)

I recommend duluting (did I spell that right?) 1/2 w/ water. It can be irritating. It should be fine if you do it a few hours before the appointment.


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## mommy2madison03 (Jun 27, 2004)

So I should dilute it with water by half, wash, then rinse the area clean with more water right?

Thanks!


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## pamamidwife (May 7, 2003)

you only need a tsp of the hibiclens with about 8oz of water. just use a squirt bottle and sit on the toilet and do a low wash in and around your vagina.

truthfully, if you are GBS positive, is this something you'd like to know? are you hoping to just pass the screen and not worry if you could be GBS positive at the birth? or are you required to do the GBS test? if it matters to you about what you'd do to treat yourself if you are GBS positive, then using hibiclens will produce a negative result, but you still could be GBS positive at your birth. Does this make sense??


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## XanaduMama (May 19, 2006)

I was GBS+ and gave birth in a hospital--I had the antibiotics but could labor in the water as much as I wanted (my waters had also broken early, if that matters). So maybe double-check that, or get a 2nd opinion? Not sure what the reasoning is there.

I also agree with the PP--would you be ok "passing" the test but still being +ve during labor? I hate antibiotics, was devastated at the +ve test, but would probably still take the antibiotics next time if I was positive. GBS is a scary thing, though obviously we each have to weigh the risks and restrictions that we feel comfortable with...


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## maxmama (May 5, 2006)

Quote:


Originally Posted by *pamamidwife*
you only need a tsp of the hibiclens with about 8oz of water. just use a squirt bottle and sit on the toilet and do a low wash in and around your vagina.

truthfully, if you are GBS positive, is this something you'd like to know? are you hoping to just pass the screen and not worry if you could be GBS positive at the birth? or are you required to do the GBS test? if it matters to you about what you'd do to treat yourself if you are GBS positive, then using hibiclens will produce a negative result, but you still could be GBS positive at your birth. Does this make sense??

I agree. It's not about faking out the test; it's done to know if you actually are vaginally/rectally colonized. I don't see why GBS would preclude a water labor anyway, but true GBS status is, I think, an important thing to know.


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## ma_Donna (Jan 11, 2003)

Doesn't GBS status change & that's why it's done late in pregnancy?

Isn't the hibiclense a treatment, so that you're treating before the test - rather than testing, and if you have a positive result, then treating (although it may be too late for a repeat test - I was told if I tested positive, there would be no treatment and retest, just abx during labor)?

Thanks for helping me understand, too







I'll be having the GBS test in 3 weeks and would reeeaallly like to avoid the IV this time.


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## maxmama (May 5, 2006)

Treating GBS in advance doesn't keep you from being recolonized, and since GBS comes from the rectum (it's a GI bacterium), vaginal washes wouldn't really address the issue.


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## poetesss (Mar 2, 2006)

Quote:


Originally Posted by *maxmama*
Treating GBS in advance doesn't keep you from being recolonized, and since GBS comes from the rectum (it's a GI bacterium), vaginal washes wouldn't really address the issue.

so is there a susceptibility issue here--like someone who tends to have GBS in their GI tract will keep being recolonized vaginally? So would this then lend support to the "once a positive, always a positive" line of thinking?

What about internal treatments like grapefruit seed extract or homeopathic treatment to address the underlying issue of the GBS being there in the system in the first place. Would that resolve the issue?

I guess I'm trying to get a handle here on what it means to determine one's "true GBS status" and how to deal with that info once you have it.


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## pamamidwife (May 7, 2003)

you can have GBS in your rectum and never have it colonize (or at least in high amounts) in your vagina.

it's best to use treatment to support WHOLE body health - like probiotics or oral grapefruit seed extract rather than topical treatments, though there is some good evidence around Hibiclens washes during labor (used at the end of pregnancy and in labor) that shows it reduces colonization extremely well.


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## time4another (Mar 28, 2005)

So as far as probiotics to fight GBS "colonization" goes, what sort of treatment is suggested?

I was + with my first DD and - with my second DD. Abx in my frist labor not in my second and frankly, I'm really thinking of declining the GBS "screen" anyhow...(but I have _several_ weeks to think it over still)

Heather


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## maxmama (May 5, 2006)

When culturing for GBS, you don't distinguish between the vaginal and rectal swab (though obviously you do the vaginal one first!). they both get plated on the same plate, because the assumption is that it's possible for GBS to move from the rectum to the vagina at some point before or during labor. It doesn't matter for clinical purposes where the bug came from.

I should clarify: GBs lives in the lower GI tract, but generally nto as low as the rectum. When it's in the rectum or vagina, the risk of GBS sepsis is present. It colonizes the vagina via the rectum (bacteria get on perineum, get tracked to vagina, etc.).

Pretty much everyone carries GBS in their gut. The issue is how low it gets.


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## pamamidwife (May 7, 2003)

yeah, it's one reason why I and some other midwives separate out the swabs. I use one for rectal and one for vaginal and ask that they be cultured on different agar plates. I want to know where the high colonization is - it definitely helps when talking to clients about informed choice.

also, many MDs are doing urine cultures - evidently, GBS colonized in the urine tract often relates to a higher colonization in the vagina.


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## heidi_m (May 5, 2006)

i have heard that hibiclens is pretty irritating stuff. i found this on the gentlebirth.org website - you can do a search or contact me for more info, but i was GBS+ with dd#1, used this w/#2 and all came out fine (obv i don't know if i would have been + w/o it). here's a brief sample:

again, from gentlebirth.org: "As a midwife, I've become very enthusiastic about vaginal washes with hydrogen peroxide for yeast or anything pathogenic going on in the vagina, particularly because it's much safer even than the over-the-counter pharmaceuticals during pregnancy. The hydrogen peroxide (H2O2) is very safe, breaking down into water (H2O) very quickly; as it does so, an oxygen atom is liberated, which oxidizes organic matter it comes in contact with on the surface of the vaginal mucous lining. It literally washes out and kills pathogenic organisms, including yeast, group B strep, and a variety of other vaginal pathogens. Hydrogen peroxide is normally produced as a byproduct of acidophilus metabolism, which is why acidophilus is a "friendly" vaginal bacteria - it provides a continual bath of hydrogen peroxide to keep those yeasty beasties and other pathogens from developing an overgrowth."

she goes on to talk some more about it and indications for it, as well as instructions on how to do a vaginal wash.


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## maxmama (May 5, 2006)

Quote:


Originally Posted by *pamamidwife*
yeah, it's one reason why I and some other midwives separate out the swabs. I use one for rectal and one for vaginal and ask that they be cultured on different agar plates. I want to know where the high colonization is - it definitely helps when talking to clients about informed choice.

also, many MDs are doing urine cultures - evidently, GBS colonized in the urine tract often relates to a higher colonization in the vagina.

Yeah, with GBS bacteriuria at any point in pregnancy (it's often picked up in first-trimester UA) you don't even bother to swab because the colonization is so high.


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## pixiexto (Mar 6, 2003)

While it's true that a cleanse could show a "false negative", this is one of the problems with any testing for GBS, in my opinion. A + now doesn't necessarily mean that the mother is + at the time of birth, thus requiring antibiotic treatment that is certainly not without risk. A - now doesn't mean that the mother will be - at the birth, etc.

For myself, I opted not to test. I did a cleanse in the weeks leading up to my approximate due date (diluted 1/10 in water), and otherwise myself and my midwives were prepared to observe for signs of difficulties during labour, should they arise (i.e. prolonged labour, fever, etc).

I remember reading during my research on GBS that North America is the only place in the Western world where routine antibiotic treatment is prescribed for mothers who test + for GBS at 36 weeks. Apart from the US and Canada, the procedure is much more on the "watch and wait" approach.

I think, overall, that the potential risks of routine antibiotic use, both in the short and long term, are terribly minimized.


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## mommy2madison03 (Jun 27, 2004)

I'm sorry I haven't replied back to this thread. My midwife said it's a hospital rule that I wouldn't be able to labor in water if it came back positive. I just assumed this was a normal thing, I'll have to ask why. She also said that if I did decide to wash with the hibiclens before the swab that I need to bring it to the hospital so that she can wash me with it before delivery.

I need to talk to her about how she dilutes though. I definitely don't want any irritation down there after delivery.


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