Good question Mary. Thanks for your comments. As far as Chlorhexidine cream goes, my memory is that it was an antibacterial lubricant for vaginal examinations and that it irritated too many women's mucosa and that is why we gave that up in favour of the clear gel. As for the creams we put on babies to 'debug' them in the old days - my memory is 'phisohex' and 'steriskin' and yes, they were considered to be toxic after many years of dousing untold thousands of babies with these substances. As I have thought about your question I realise that I have no idea what the active agent was in these cleansers.
In thinking further about the issue of the chlorhexidine douche and toxicity, my thinking is that the concentration of active substance in a watery medium is much lower that any preparation that is cream based and quickly 'washed out' by the active vaginal mucosa and if membranes are released, the liquor, so reducing any possiblity of toxic reaction. My other thought that as it is locally given, the absorption rate would be much less than that of antibiotics given intravenously and so provides a satisfactory option for women who chose to use some form of preventative chemical therapy and yet wish to avoid antibiotics. What is interesting for me is that women who are GBS negative, have to transfer if they have SROMS and are over 18 hours without having given birth, but if they are GBS positive and using chlorhexidine they don't transfer ... all very fascinating. What do you think about the douche and toxicity? Is my thinking plausible? warmly, Carolyn ----- Original Message ----- From: Mary Murphy To: ozmidwifery@acegraphics.com.au Sent: Saturday, November 18, 2006 1:50 PM Subject: RE: [ozmidwifery] Alternative GBS What about the risk of absorption of chlorhexidine? When the cream was used on newborn babies it was toxic. MM A Danish Obstetrician came to John Hunter Hospital (Newcastle NSW) and presented some time ago on the use of Chlorhexidine douche for women with GBS positive swabs. Very popular in Denmark apparently and is being heralded as the treatment for women in third world countries because it is cheap. The Cochrane review is equivocal in its endorsment, but the Danish Obs was very very convincing with her stats. When Belmont Birthing Service first opened, all the women with GBS positive swabs had to go to John Hunter to give birth because we were not credentialled to give IV antibiotics at Belmont. We are a stand alone midwifery service so do not have doctors onsite for assistance if someone had an anaphylaxis. Many of the women were very upset about not being able to have their babies at Belmont, whilst others were very unhappy about using antibiotics for all the good reasons already mentioned, so remembering the chlorhexidine douche presentation, we were able to provide that as an option for those women who were willing to use that as something that was not considered as effective as antibiotics. We have since done the nurse immunisers course and so are also able to give IV antibiotics at Belmont. Interestingly, most women still choose the douche. We can give the women the equipment to take home and they can douche themselves if they think they are going into labour, or if their membranes release. We give them two doses and they let us know what they are doing. The chlorhexidine is a lovely blue colour, so it is interesting to see women's vaginal discharge after the douche - looks different on the partograph :-) We have a GBS policy for us and an instruction sheet for the women. We also have an information sheet for women to read before they do the swab. If you would like a copy, please email me at work and I can send them to you. [EMAIL PROTECTED] warmly, Carolyn ----- Original Message ----- From: "Melanie Sommeling" <[EMAIL PROTECTED]> To: <ozmidwifery@acegraphics.com.au> Sent: Friday, November 17, 2006 10:15 PM Subject: [ozmidwifery] Alternative GBS > Hi wise women of the list, > > I am curious if anyone can enlighten me of any alternatives to Antibiotics > in labour to decrease GBS transfer from mother to baby. I recollect some > info about douching during labour, but the info was sketchy to say the > least. I understand the risks of transfer are low and the risk or negative > effects are even lower, but alternatively have witnessed a birth of a GBS > positive mother where AB's were administered and the baby still developed > respiratory distress with several hours of birth and question the validity > of using AB'a at all. Any advice on the matter would be greatly > appriciated. > > Melanie > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
