Informed Consent for Group B Streptococcus Positive Clients

Group B Streptococcus (GBS) is a type of bacteria that causes illness in newborn babies, pregnant women, the elderly, and adults with other illnesses such as diabetes or liver disease. GBS is the most common cause of life-threatening infections in newborns.

Your fetus may come in contact with GBS during birth. Approximately one of every 200 babies whose mother carries GBS will develop signs and symptoms of GBS disease.

Treatment during labor reduces the risk that a baby will get early-onset GBS disease by 70%, but even with treatment there is a 1 in 4000 risk of disease. There is a late-onset GBS disease (developing from 7 days of age to several months after birth) that is not prevented by antibiotics during labor and is much rarer.

___ I understand that I have tested positive for GBS that puts my baby at risk during birth for sepsis (blood infection), pneumonia, and meningitis after birth. One of every 20 babies with GBS disease dies. Babies that survive may have long-term problems such as hearing or vision loss or learning disabilities.

___ I have read and understand the information that I have been given about the GBS bacteria. I understand that the CDC recommends that I be treated during labor with IV antibiotics during labor to prevent my baby from being infected with GBS.

___ I understand that some symptoms in a mother increase the risk to the baby and I agree to antibiotic treatment if these signs present: go into labor or have membranes rupture before 37 weeks have a rupture of the membranes (bag of water surrounding baby) for longer then 12 hours

(inform the midwife as soon as your “bag of water” breaks) have a fever during labor have had a previous birth of a baby with GBS infection

___ I understand that most Pediatritions recommend that a baby stay in the hospital for observation for 48 hours after birth and that the Birth Center does not offer this service.

___ I understand that I can request to have my baby moved to the hospital for this observation period.

___ I understand that if I choose not to request this then I need to have myself or another adult monitor the baby for signs of infection. I understand that these signs can be mild and easily overlooked if the baby is not watched carefully.

___ I agree to have my baby seen by a provider at 2 days after birth.

___ I understand that the signs and symptoms of a newborn infection are listed on the back of this page and I agree to monitor my baby on the back of this form.

I, _________________________________________________ have been advised that I tested positive for Group Beta Strep at approximately 36 weeks of pregnancy. I am aware that the CDC recommends giving antibiotics during labor to pregnant women who carry GBS. I choose to decline prophylactic antibiotics and I agree to the plan of care as stated above unless I become high risk during labor.

_____________________________________ __________________Signature of Client Date

_____________________________________ __________________Signature of Witness Date

Signs and Symptoms of a newborn GBS infection: (Call the Midwife if any of these are present) Temperature > 100 degrees or < 98 eating less then 8 times in 24 hours excessive sleepiness or irritability poor muscle tone which means a baby that is loose and relaxed like a “rag doll” difficulty breathing (grunting or struggling to breathe) or breathing less than 60 breaths in 60 seconds

when your baby is calm

You will need to monitor your infant’s temperature at least every 4 hours, breathing at least every 4 hours, and eating patterns for the first 2 days.

Buy an infant thermometer and place the tip of the thermometer underneath your baby’s arm in the middle of the armpit. Hold the baby’s arm down over the thermometer until the temperature is complete (normal range is 97.9 to 99.5). If it is a little high you may need to take off your baby’s warm clothing or if it is a little low you may need to hold your baby “skin to skin”. Always retake the temperature again in 30 minutes if it is too high or too low. If it is still not in the range of normal call the Midwife.

Count the respiration (breathing) rate of your baby. Either place your hand on your baby’s on your baby’s chest and abdomen and feel for the rise and fall of breathing or watch your baby’s chest and abdomen rise and fall with each breath. You will need to count for a full 60 seconds since newborns have irregular breathing patterns and may breathe very fast for a few seconds and then not breathe at all for a few seconds. Call the Midwife if they are breathing faster then 60 breaths in a minute.

Record the start of each feeding session and the length of time that the baby was eating. Call the Midwife if the baby is eating well less then 8 times in a 24 hour period.

Time Temperature Respiration rate Breastfeeding Notes