GBS Information

Here’s what I’ve sort of come up with as sort of the “crucial” GBS info parents-to-be should know. Download as Word Doc (3 pages, 90K)

Group B Streptococcus (GBS) and Pregnancy

In summary:
Every mother is tested for GBS bacteria around 35-37 weeks [ 1 ] (unless GBS was already detected in a urine test, in which case further testing is unnecessary). [ 2 ] 30% of pregnant women are GBS-positive (there are typically no symptoms). [ 3 ]
2.5% of pregnant women are heavily colonized (GBS shows up in urine test). [ 4 ]

When a GBS-positive mother is given an antibiotic IV at least four hours before delivery, only 1 in 4000 babies get infected.
Without an IV, 1 in 200 babies get infected. (20 times worse) [ 5 ] For heavily-colonized mothers without an IV, 1 in 8 get infected. (500 times worse) If your GBS status is unknown when you go into labor, get an antibiotic IV.

After birth, monitor your baby for infection for 48 hours so they may be treated (they will usually seem 100% healthy and have no symptoms for the first several hours). Without treatment, GBS is nearly 100% fatal. With treatment, only 2-30% of GBS-infected newborns die. [ 6 ] 20-30% of survivors are left with speech, hearing, vision or mental problems. [ 7 ]

What is group B strep?
Group B strep (streptococcus) is a type of bacteria that can cause serious illness and death in newborns. Until recent prevention efforts, hundreds of babies died from group B strep every year. This type of bacteria can also cause illness in adults, especially the elderly, but it is most common in newborns.

How does someone get group B strep?
Anyone can be a “carrier” for group B strep. The bacteria are found in the gastrointestinal tract (guts) and may move into the vagina and/or rectum. It is not a sexually transmitted disease (STD). About 1 in 3 women carry these bacteria. Most women would never have symptoms or know that they had these bacteria without a test during pregnancy.

Why do I need to get tested for group B strep during each pregnancy?
Group B strep bacteria can be passed from a mom who is a carrier for the bacteria (tests positive) to her baby during labor. Since the bacteria can come and go in your body, you need to be tested for group B strep every time you are pregnant, whether you tested negative or positive during the last pregnancy. Toward the end of pregnancy (35-37 weeks), the doctor will swab your vagina and rectum to test for GBS.

What happens to babies born with the group B strep bacteria?
Group B strep is the most common cause of sepsis (blood infection) and meningitis (infection of the fluid and lining around the brain) in newborns. Group B strep is a frequent cause of newborn pneumonia and is more common than other, more well-known, newborn problems such as rubella, congenital syphilis, and spina bifida. Group B strep infection is fatal in up to 20% of infected newborns. Another 20% of those who survive are left with speech, hearing, or vision problems, or mental retardation.

How can group B strep disease in babies be prevented?
Most early onset group B strep disease in newborns can be prevented by giving antibiotics (medicine) through the vein (IV) during labor to women who tested positive during their pregnancy. Because the bacteria can grow quickly, giving antibiotics before labor has started does not prevent the problem. Any woman who has a positive test for group B strep during this pregnancy should get antibiotics. Also, any pregnant woman who has had a baby in the past with group B strep disease, or who now has a bladder (urinary tract) infection caused by group B strep should get antibiotics during labor. The IV will decrease your baby’s chances of getting infected 20-fold (to just 1 in 4000).

What if GBS is detected in my urine?
This means you are heavily colonized with GBS. Only about 5% of pregnant women are heavily colonized with GBS (as opposed to 30% having GBS at all). If GBS is ever detected in your urine during pregnancy, there is no need to be tested at 35-37 weeks; you definitely need to get an antibiotic IV as soon as you go into labor. Heavily colonized women have a 2,500% greater chance of passing GBS to their baby (1 in 8 chance) than a typical GBS positive woman (1 in 200). Fortunately, by getting the IV as soon as you go into labor (at least four hours before delivery), you reduce the chances that your baby becomes infected by 99.8% (to just a 1 in 4000 chance of infection).

What if I’m allergic to some antibiotics?
Women who are allergic to some antibiotics, such as penicillin, can still get other types of antibiotics. If you think you are allergic to penicillin, talk with your doctor.

Are there reasons not to get an antibiotic IV?
There is no need to get an IV if a mother is tested to be GBS-negative. However, numerous studies have determined that because of the high likelihood and terrible consequences of infection, all GBS-positive (or unknown GBS status) mothers should receive an antibiotic IV at least four hours prior to delivery.

If I know that I’m a group B strep carrier, why can’t I just take some antibiotics now?
For women who are group B strep carriers, antibiotics before labor are not a good way to get rid of group B strep. Because they naturally live in the gastrointestinal tract (guts), the bacteria often come back after antibiotic treatment. Antibiotics during labor are effective at protecting your baby because they greatly reduce the amount of bacteria the baby is exposed to during labor. Even if you had IV antibiotics for your last baby, you may not need them for this pregnancy if you are not a carrier now. Get tested every pregnancy.

What do I need to do during pregnancy or labor if I’m group B strep positive?
Talk with your doctor and create a labor plan that includes getting antibiotics for group B strep prevention in your newborn. When your water breaks, or when you go into labor, make sure to get to the hospital at least four hours before delivery to make sure there is enough time for the antibiotics to work. When you get to the hospital, remind the staff that you are group B strep positive.

What makes it more likely for my baby to catch GBS from me during labor?
* Labor before 37 weeks of pregnancy (even just one day before).
* Fever (>100.4F) during labor.
* Rupture of membranes (broken bag of water) for more than 18 hours before birth.

What should I do after my baby is born?
If you were GBS positive or had an unknown GBS status, even if you got an IV, your baby should be closely monitored for at least 48 hours for any signs of infection (they will usually seem 100% healthy and show no symptoms for several hours after birth):

* Breathing problems or grunting sounds (it may seem like a constant soft crying or “whimpering”/”wheezing”).
* Difficulty feeding, or even suckling a finger, especially if they fed earlier.
* Fever, or problems with temperature regulation.
* Seizures, stiffness, or extreme limpness.
* Unusual change in behavior.

If any of these occur, immediately go to the emergency room. Your baby can be given an antibiotic IV to significantly improve their chances of survival. With no treatment, nearly 100% of GBS-infected babies die.

Little Lion Man

I’ve recently been hearing this song by Mumford and Sons on the radio and I like it. I found out what it was called and realized I liked it because it reminds me of Wren (but in a sad way). Wren’s Chinese name is (Gao Xiao Hu), which means “Little Tiger”. And the chorus to the song is:

But it was not your fault, but mine.
And it was your heart on the line.
I really fucked it up this time.
Didn’t I, my dear?

It was GBS

We got the autopsy back for Wren (I’ve scanned it as a pdf here) and it turns out he died of pneumonia due to Group B Strep.

Everything else about him was perfect.

Chinese Wren and Cherry Blossom Painting

We received this beautiful Chinese painting of a wren on a cherry blossom branch from May, Brian, and Mason Goldstein. May asked her father, who seems to be quite practiced in the art of Chinese brush painting, to paint it for us. When Josh opened the box and we saw the painting for the first time, we were completely floored. The tears just came. I love that we have this perfect quiet representation of our son. I will always associate spring flowers with Wren. I’m not sure where we should hang it, but I’d like it to be where we pass by and view it everyday.

Grief Processing by Reading

I can’t believe it’s already 6 weeks postpartum.  Yet it also feels like time has slowed down.
I think we’re doing okay.  Some days are a lot worse than others.  We spent a nice week in NYC last week – saw some old friends and ate at some of our favorite restaurants.  Did a lot of walking and some retail therapy.  And eating desserts therapy too!

Josh’s cousin Kari recommended the book, An Exact Replica of a Figment of My Imagination by Elizabeth McCracken. It is a memoir and tribute detailing Elizabeth McCracken’s own experience when her first pregnancy resulted in the stillbirth of her son, nicknamed Pudding. Zoo-ee-mama! It was a very good read. Beautifully written, and it felt like I was conversing with someone who knew what I was feeling and had moved forward through the pain and heartache. Available from the local library.
Recommended by our midwife, I also found this book helpful: Empty Cradle, Broken Heart: Surviving the Death of Your Baby by Deborah L. Davis. It’s sort of like the bible for people who have experienced miscarriage, stillbirth, or infant death. Available from the SMPL.
There are quite a few books out there! I’ve also been reading Pregnancy After a Loss: A Guide to Pregnancy After a Miscarriage, Stillbirth, or Infant Death by Carol Cirulli Lanham. This book overlaps with Empty Cradle Broken Heart a little, but also acts as a practical guide for parents who are considering or ready to conceive another child – known as the subsequent pregnancy. I checked this book out from the library, but also own a copy via Paperback Swap so I can refer back to it in the future. An example of the kindness of strangers: the woman who sent the book wrote me a nice note telling me how sorry she was and recommended Elizabeth McCracken’s memoir because it was so helpful to her.
I liked reading Finding Hope When a Child Dies by Sukie Miller, but it is a little more out there. It was interesting reading about how various primitive cultures talk about and explain the death of children and try to answer the question of “why did my child die?” While it is difficult to prescribe to the same beliefs and faith adhered to by the cultures presented, it can be comforting to think about child death from an alternative perspective. Also available from the good ol’ S-M-P-L.
There you have it! Therapy by library card.

Salt Jones in Videos

And now, a collection of all videos we have with Salt in them! Leading off with the certifiable world-wide youtube hit, “Hungry Like the Wolf”…

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Salt Jones in Pictures

Just to remember old Salty Bear, here’s every picture I could find with him in it. (There’s about 600.)
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Wren’s Viewing and Cemetary

Thanks mostly to our four year-old niece Alyssa, we have some pictures of Wren’s viewing, and Woodlawn cemetary too… and then afterwards a little bit when we went to the Richmond’s in Riverside and the Santa Monica Pier.






Celebration of Life Videos

Thanks again Uncle Robert




How the Wren Became King

Image by Emma Sancartier

Adapted from a Manx Folk Tale

A long while ago when there were not so many people on the earth as there are now, and the birds and animals had things about their own way, a Cuckoo gave a tea party.

She invited all the birds there were, from the great Eagle, through the Larks, Swallows, Finches, and Crows, down to the little brown bird that sings alone in the hedges and had no name then. She seated them all around her table, although it was a task to find places for them all; and she gave each bird whatever it liked best of all to eat.

Every one wondered why the Cuckoo took such trouble as this, and certain people say to this day, “as silly as a Cuckoo,” because of it; but when all the birds had eaten their fill, the Cuckoo hopped upon the table and addressed the assembled company.

“It seems to me,” said the Cuckoo, “that things have been going very badly with us for some time, and that all would be remedied if we had a king to settle our affairs and rule over us. I would suggest that we choose a king today.”

Oh, how the birds chirped, and chattered, and peeped at that. The Cuckoo had imagined that she would have the say as to which bird should be king, and she had in mind one of her own sons, but, no indeed! Each bird at the tea party was sure that he had royal blood in his veins, and they all began to argue and quarrel about it.

About that time a Rooster and a Hen passed by, taking their daily airing. They had not been invited to the tea party and so they were greatly excited at hearing the commotion; grandfathers, and fathers, and cousins, and sons among the birds were all talking and arguing at once.

“Wat? Wat?” clucked the Hen.

“I will go and see, my dear,” said the Rooster, and so he rushed into the midst of the tea party to see what all the hubbub was about. When he found out, he had a plan to offer. He was often called upon to settle disputes among the Hens, so he was always quite willing to help in any such matters.

“Have a test! Have a test!” said the Rooster. “You will never decide anything by arguing in this way; but it shall be decided that the bird who is able to fly the highest shall be your king.”

This seemed a fair way of settling the matter. All the birds agreed to it except the Plover, who went off into the woods and has lived there, wild, ever since.

Then the birds lighted in a row, and spread their wings, and flew with all their strength, and as high as they could, up, up into the air. One by one, though, they dropped back for they did not all have the same strength of wing. The Lark flew higher, indeed, than most of them, but finally he, too, was outstripped by the Eagle, who soared and soared until he was only a speck in the sky.

“The Eagle is our king! The Eagle is king of the birds!” sang all the others; but, no! Way, way above the Eagle flew another bird, so tiny that he looked like nothing but a mote, floating in the sunlight. It was the little brown bird that sings alone in the hedges, and had no name then. He had hidden himself in the Eagle’s feathers and had been carried up with him until he wanted to fly on by himself.

“I am the king of the birds!” he twittered as he flew down among the others again.

But the other birds did not wish this. They did not like to think of so tiny and humble a bird being exalted to be their king. They were about to fall upon the little brown bird and drive him out of their midst when the Rooster spoke to them again. Since the plan had been his, he wanted to make a success of it, so he said,

“The mistake was mine, all mine. This is how we will arrange it. The bird that is able to fall deepest into the earth shall be your king.”
The Rooster had a plan of his own in mind when he said this. As all the birds began to look about for places to jump into deeper places, and the Duck tried to see how long he could hold his head under water, the Rooster called to the Hen. He instructed the Hen to scratch, and when she had made a deep hole, he hid himself in it.

“I am king of the birds! I am your king!” the Rooster crowed, poking his head up out of the hole.

But the little brown bird that sings in the hedges, and had no name then, had again got the best of them all. What had he done but creep into a mouse hole, and there he was, deeper down in the earth than any of them.

“I am your king!” he twittered up to them.

Then all the birds were very much put out, for they saw that the little brown bird was truly the king. They decided, though, that they would not recognize him, and they appointed the Owl to sit, night and day, at the opening of the mouse hole and not allow the little brown bird to come out. Then all the birds went home from the Cuckoo’s tea party, and to bed, for they were quite worn out with all the excitement.

All went well that night with the Owl. He watched the mouse hole and did not allow the little brown bird to so much as put his bill out. When it came to be day, though, the Owl was tired, and he closed, first, one eye, and then the other eye. There he was, fast asleep, and out hopped the little brown bird who had a name now, because he was the little Hedge King.

It was a great disappointment to the other birds to be obliged to recognize so humble a little brown bird as their king, and they blamed the Owl for it. That is why he still sleeps in the daytime now, and looks about only at night. And that is why, also, he is such an enemy of the mice, continually hunting them in their holes.

But the little brown bird who sings alone in the hedges really made himself king of the birds. He has two names now, Hedge King, and Wren.