In the most recent posting the following appeared:

"....Third, the use of routine vaginal exams, AROM, and
internal fetal monitors has increased the rate of transmission to the
infant.  There is speculation that transmission is not very likely in the
actual passage through the vaginal canal, but that all of these
interventions allow a much greater time of exposure and in conditions where
the baby may still be "breathing/swallowing" amniotic fluid, opening
his/her eyes, etc....."

Apart from speculation I am not aware of any evidence that internal fetal
monitoring, ARM or routine vaginal exams increase the risk of early onset
neonatal group B streptococcal sepsis.  If I discover anything on this I
will post it.  I do agree that prolonged labor and/or ROM are risk factors.
Elective C-section is protective but I would not recommend it for every
pregnancy!  It is impossible to know how or when infants acquire the
infection except that it is probably during the process of labour and
vaginal delivery in the majority of cases.

"....Last, YES all of this IV antibiotic DOES lead to
greater problems with Candida/yeast...has anyone out there implemented a
counter prophylatic Nystatin protocol?..."  Please let me know the
references for this if anyone knows ;because I talk to mothers and give
advice on this issue and don't know whether to tell them that 2 or 3 doses
of iv ampicillin increase the risk of Candida in this situation.

From a breastfeeding perspective it is really important that the
obstetrician gives preventative treatment to the right mothers.  Failing to
do so means that more infants require avoidable intravenous treatment and
their feeding patterns are interrupted on day 1 and 2 (aside from the
obvious risk of septicaemia and menigitis).

Khalid

Khalid Aziz
Memorial University of Newfoundland