Monday, June 4, 2012

Group B Strep

Not a catchy title, huh?  It's a test that all pregnant women are offered around 36 weeks.  I'm not going to lie to you, it's not my favorite topic, mostly because I don't like how it's handled, regardless of where you are giving birth. I've been doing a lot of research on GBS lately.  Allow me to share my findings.


What is Group B Strep, or GBS? 
Group B Strep, or GBS, is a bacteria that lives in the intestines, urinary, and genital tracts of many healthy people. It is generally not serious in adults, but can be life-threatening to a newborn. Most adults do not have symptoms, but occasionally will develop an infection, such as a bladder infection or urinary tract infection. 

Testing:
The Center for Disease Control (CDC) and the American Congress of Obstetricians and Gynecologists (ACOG) recommend that all pregnant women be screened between 35-37 weeks of their pregnancies to determine if they are carriers of GBS. The pregnant woman's vaginal and rectal areas are swabbed during the screening. According to The March of Dimes and the CDC, approximately 25% of pregnant women are found to be colonized with GBS. 

Treatment:
If found positive, antibiotics are administered through an IV during labor. Ideally, antibiotics are given at least 4 hours before the birth. Oral antibiotics given before labor begins has been found to be ineffective, as the bacteria reproduces very rapidly. To date, the only proven strategy to protect a baby from early-onset GBS is IV antibiotics.
 
Two types of Group B Strep: 
1.  Early-onset GBS:  Can cause pneumonia, sepsis, or meningitis.  Symptoms include fever, trouble breathing, and drowsiness.  Symptoms often begin on the first day.  About half of all GBS infections are early-onset. Babies who develop early-onset GBS are more easily treated than late-onset GBS.
2.  Late-onset GBS:  Usually begins between 7 days and 3 months of age.  Symptoms include fever, coughing, congestion, trouble eating, drowsiness, or seizures.   Treatment of antibiotics during labor does not prevent late-onset GBS.   After birth, baby can get GBS from other people who have the infection.  Babies who develop late-onset GBS are not easily treated and are more likely to die.  At this time, there is no prevention for late-onset GBS.

If left untreated, the chances of a baby developing a GBS infection (born to a GBS-positive mother) is 1 in 200. If the mother does receive antibiotics in labor, however, the odds are 1 in 4000 of the baby developing GBS.

There are three significant risk factors that place a GBS-positive woman at risk for her baby developing Group B Strep: 
1.  Fever during labor
2.  Prolonged rupture of membranes (PROM) - water is broken 18 hours or more prior to delivery
3.  Pre-term labor (PTL) - labor begins prior to 37 weeks

If a woman tests positive (or does not know if she is positive or not) and does not receive antibiotics during labor, her baby will receive antibiotics after he/she is born. 

Written by Donna Ryan, Birth Boot Camp.  Adapted from:
GBS Prevention in Newborns, Centers for Disease Control and Prevention, http://www.cdc.gov/groupbstrep/about/prevention.html, May 7, 2012.

Group B Strep Infection, March of Dimes, http://www.marchofdimes.com/pregnancy/prenatalcare_groupbstrep.html, March 2010.


What I Think:
Now that the facts are out of the way....  I've seen this handled so many different ways, and to be honest, they all make me feel kinda yucky.  The CDC is working on a vaccine for GBS, so more options will likely one day be available to pregnant women.  

If a woman is having her baby in the hospital, this is pretty cut and dry.  If she tests positive, she'll have antibiotics in labor.  If she has her baby before she has time to have a full round of antibiotics, they'll treat the baby with antibiotics.

But what about the woman birthing outside the hospital? I've seen several women told to follow a certain regimen so she will test negative at 36 weeks -- tricking the test, in my opinion.  Like mentioned above, if GBS is present, it will grown very rapidly.  I've also seen a number of women prescribed a "vaginal wash" which does not necessarily kill the Group B Strep but does reportedly kill the beneficial bacteria in the vagina.  One of the benefits to a baby being born vaginally is being exposed to that beneficial bacteria.

You should be able to have antibiotics, however, regardless of where you are having your baby.  Check with your care provider on her protocol.  

I've written about my personal feelings about antibiotics here before. I'm not a fan unless truly required.  The GBS symptoms in a baby with early-onset GBS are pretty clear, pretty quick.  The antibiotics given in labor will not prevent a baby from developing late-onset GBS.  With that being said, you still cannot ignore the numbers.   The use of antibiotics during labor in a woman who tested positive for Group B Strep significantly decreases the chances of her baby developing Group B Strep.

Personally, I was never tested for Group B Strep with any of my pregnancies.  Knowing what I know now, maybe I would have been.  If I would have tested positive, I can't say what my choice would have been.  And I'm not about to tell you what your choice should be.  The numbers quoted by the CDC and March of Dimes are lower than what I've read elsewhere.  Some areas of the country report as high as 40% of women test positive for GBS. 

Talk to your care provider and to your partner.  As with everything else, do your research.  Make an informed decision.  If you are planning an unmedicated birth, this is but a blip on the radar.  Not a big deal, just something to be aware of and plan accordingly.



15 comments:

Kate Rowan said...

I was positive for GBS, and I had a hospital birth. I chose to pass on the antibiotics, because I did not want to kill all of my beneficial flora in myself and my baby that soon after birth. We chose instead to stay in the hospital for 48 hrs for observation, in which time absolutely nothing happened. My son is 9 months old and has never been sick. I think we're doing ok!

Diana J. said...

I don't have any numbers, but I am far more worried about the after-effects of massive numbers of women being put on antibiotics than I am about GBS. There's antibiotic resistance, for one thing, and impaired gut health for the neonate (leading to all sorts of potential health probems down the road, a problem also present for c/s babies) and opening the door for opportunistic bacterial infections. I read somewhere about how GBS infections are decreasing but opportunistic E. coli infections are increasing at the same time, because antibiotics take away the colonization with beneficial gut flora that ought to be happening during the birth process and which give babies their best start with gut health. I definitely do everything I can to pass the test, because I would rather chance it with GBS than have my baby start life without the proper colonization from beneficial bacteria that s/he ought to have.

Sara said...

I think that this is a vicious circle. GBS will likely come back stronger after antibiotics, which means that more and more babies will be born to moms with compromised immune systems. So many babies are exposed to antibiotics within moments of birth, and/or hospital bacteria via c-section. This sets babies and children's immune systems up to be at a severe disadvantage, and probably leads to other immune system issues like asthma, excema, and food sensitivities, including intestinal disorders like celicas and UC. Add to that the multiple vaccines and environmental toxins that women and children are exposed to, and it's pretty clear why so many kids are sick and chronically ill these days.
I don't see any of that changing. In fact, it will probably get worse unless doctors start realizing that their treatment is actually making the current and future generation sicker.
Diet plays a huge role in whether a woman will have an imbalance of GBS, but again, no doctor will say that. A diet low in processed food and sugar and high in nutrients and probiotics will be protective against this kind of overgrowth, and will also help mom to have a better balance of bacteria to pass on to her baby.

Here's a question- I keep seeing that GBS infection is associated with preterm babies. I really think that this is because mothers who are GBS positive are more likely to have preterm babies, not necessarily that preterm babies are more likely to get the infection, does that make sense? I'm really starting to think that preterm birth is often because of immune issues that are rooted in a gut bacteria imbalance. (based partially on my own mother's experience with preterm births, mine included, and other moms that I've talked to). I think that a strategy for reducing preterm birth should include counseling mom on how to balance her gut system and heal her immune system so that it can better manage a pregnancy.

Mama Birth said...

Not to mention the very difficult time many women have breastfeeding when they and baby develop thrush because of unnecessary abx in labor. How will premature ending of nursing impact the lifelong health of mom and baby?!

Cathy said...

Your post is great but I'd like to clarify your comment about risk factors. Fever during labor is not a risk factor for GBS. It is a symptom of a maternal infection, most commonly GBS chorioamnionitis. It is an indicator that the baby may become infected. Also, premature labor can be caused by GBS. The premature infant, with its immature immune system, is much more susceptible to infection and less able to fight it. Prolonged rupture of membranes is indeed a risk factor.
Your description of the diseases related to GBS (pneumonia, sepsis, meningitis) do not match your symptoms( fever, trouble breathing, drowsiness). These babies are critically ill, on ventilators, with seizures, bleeding and hypotension. It is a terrible, deadly disease.
I agree that everyone can make their own decision about treatment. Typically, if a baby is asymptomatic, a blood culture is drawn and ampicillin is given until the culture has had a chance to grow for at least 48 hours. We are always striving to find new ways of confirming absence of sepsis in neonates. Until something is perfected, at least there is something that can be offered to protect the baby.
Thanks!

Anne Marie said...

I was GBS+ with my daughter. I gave birth at an out of hospital birth center. I am allergic to penicillin, so they gave me something else that only had to be administered every 8 hours. Early labor woke me up at 3am, we went into the birth center at noon, got a saline lock and antibiotics, were back home by 1:30pm, labored at home, went back to the birth center at 5:00pm, and had a baby at 6:47pm. It was great! I don't see why this couldn't have happened in a doctor's office and as hospital.

Knitted_in_the_Womb said...

Like Kate's experience, I've had clients who did not get antibiotics for GBS--generally because their labor was too fast--and their babies were not treated with antibiotics. I'd say the proper phrasing for that intervention would be "many pediatricians will want to treat the baby with antibiotics" rather than "the baby will be treated with antibiotics."

Raisin4Cookies said...

I live in the UK and have never even been tested for GBS, and I have had 4 babies here.

I wonder if it is more common in the States because of all the vaginal exams during pregnancy? More opportunities for introducing viruses?

Unknown said...

The thing with GBS is that even if women test positive at 37 weeks it does not mean it will necessarily be present at birth because it can come and go, depending on how colonized it is. The only way to know for sure that someone is a carrier would be to test during early labor which just isn't possible in most birth settings. My advice to anyone who is testing positive is to request that your provider re-test you every week up until birth. That alone might save someone from having to make the difficult decision about taking antibiotics or not.

Also from my experience I don't think GBS has anything to do with diet. You can be eating organic, grass fed, fermented foods, etc. and still test positive. That is just another way to put blame on the mother when it might not have anything to do with it.

Lastly, I have seen GBS go away by taking high doses of high quality garlic supplements. Garlic has antibacterial properties and is worth a shot.

Lisa Walters said...

tested postitive in 2010 and had antibiotic administered while give birth and my baby had to stay 5 days in NICU for more antibiotics.... this year im expecting again and was told that i am negative.... is this strange tp be positive one pregnacy and negative the next??

HaleeBurch said...

My question is, why bother taking/paying for a test you intend to cheat on? Seriously? Just don't take the test if you don't want the antibiotics. I just don't understand that mentality.

Christina Pond said...

Oh this is one of my issues in birth. With my first I was negative... but with my last pregnancy and my current one I have had GBS in my urine. I did not do the antibiotics in labor with my last, or at all in pregnancy. I did a Hibiclens wash during my labor and let me just say it hurt so bad, it burned the tissue of my vagina. I was raw and it was painful. With this current pregnancy I am 33 weeks, and taking a round of antibiotics now because I am symptomatic with the GBS right now, that is I was having extreme burning when I peed, and pain associated with it. So I decided to take a round of antibiotics in pregnancy because of the pain I have been having. I plan on after taking these antibiotics to take a 50 billion Renew Life Probiotic to surge good bacteria into the areas in hopes it will over power the bad bacteria. I would take Garlic, but I already have super low BP and don't want it lowered any more!!! But garlic works!!! This is always a source of stress for me, and I don't know exactly how to handle it every time I am faced with it. But I refuse to take the antibiotics in labor, or in pregnancy unless there is a serious issue (like BOW being broken for a long time, fever, etc.) because I don't see how they work at all.. The Hibiclens does kill the bacteria well, but like you said, also takes out the good stuff. It is a hard issue.

Christina Pond said...

I also encourage good nutrition in pregnancy high protein to keep the sac as strong as possible, as with my last who was almost born in the Caul. I ate 6 eggs every morning for breakfast... my BOW broke with my first (I was not good with my protein with her) at 2 cm!! But with my last it broke as she was coming out, which was also protection from the GBS in the birth canal!

I think some women do the fake out test in order to have their hospital birth free from drugs, and so they fake out their OB's to not have it be an issue, or they will pressure them on you in that setting.

Unknown said...

I talked to my doctor about skipping the test altogether. He understood and was supportive but told me the hospital would then insist on monitoring the baby for 48 hrs. I was/am not thrilled with that idea so went ahead and did the test. I have always tested neg. and assume I will this time as well. Ooooh I just wish I could give birth at home.

Joy

Doula! Liz Baer said...

The rinse you refer to is a surgical scrub and has been found to decrease the amount of group B strep bacteria. Antibiotics are not the only effective treatment for GBS and, as more strains become antibiotic-resistant, will work less and less often.