Group B Strep

GBS (group b strep) is a scary sounding thing, not to be taken lightly, as it is potentially life threatening. However most people have it without   But, as with most things, deciding what to do about it is not clear cut. It is about the balance of probabilities. You will need to weigh up the pros and cons, to work out what is right for you. You may like to have several plans depending on what happens. Everything is your choice. It is your body, your baby, your birth, so you decide. Women make different decisions to each other, and some accept the standard care offered, and others opt for an individualised approach, taking into account their individual situation, and other factors.

 

The following information is for women/pregnant people who find themselves being offered treatment for GBS, either because it has been found that they are a carrier in this pregnancy or at a previous time. I am not a doctor or midwife. This information is what I have gleaned from reading the sources quoted and supporting clients who have had Group B Strep.

What is it?

About 30% of the adult population in the UK is a carrier of GBS at any one time, usually without symptoms. It is not a sexually transmitted disease. It is a bacteria carried in the gut, and can be present in the urethra and vagina. It can be passed to the baby during childbirth. It may be discovered before or during pregnancy, or during a previous pregnancy. It is not routinely tested for in the UK as so many people are carriers it would result in a lot of people receiving antibiotics when only a small proportion will have it at birth and will actually pass that infection on to their baby. There are negative effects of giving newborn babies antibiotics, which is one of the reasons for balancing the different factors. Read the Cochrane review.

Standard care

If you have been identified as having GBS in this or a previous pregnancy, or some other time the common policy is to consider that you do have it. Recommended care is to to give birth in hospital, go in early in labour, have intravenous antibiotics during labour, every four hours, and stay in hospital for 12-24 hours so your baby can be monitored.  It is worth asking your midwife for a copy of your unit's policy for GBS. Policies are a bit like birth plans, but written by somebody else. You need to know what is in the policy so you know can decide whether to accept or decline aspects of the offered care. Read on for different options.

National guidelines

This is the 'patient' leaflet about GBS from the Royal College of Obstetricians and Gynaecologists.

This is the guidelines for practitioners also from RCOG. This is useful because it will give you the quality of the evidence behind the recommendations. A for highest, down to E, which is just recommendations of the panel. There is a table at the end that tells you what it all means. 

 

You will see that having antibiotics in labour will only be effective if you get in two doses, four hours apart, so that means being in hospital in labour for at least five hours. If you are on baby number two or more then that might not happen. The advantage of antibiotics in labour is that it doesn't need to be given to the baby after the birth. 

You might like to read the GBStrep support website. Their FAQs are interesting.  If you read the site you will be aware that they are very pro antibiotics in labour, as you would expect from parents of babies who've been so affected. They do say that it could be there isn't time for two lots of antibiotics .

Individual situations

Standard care is a blanket approach that does not take into consideration individual situations. Some women will in a situation which increases the chance of their baby picking up GBS, and others will be in a situation where there is a lower chance of passing it on, and this will be a factor in your decision making.

Factors that increase the chance of baby picking up GBS if you have it

  • ​previous baby with GBS

  • waters breaking 24 hours or more before labour

  • premature birth (before 37 weeks)

  • induction (part of the process of induction is breaking your waters, and also having frequent vaginal examinations)​

  • vaginal examinations (the vagina is self cleaning downwards, vaginal examinations risk pushing bacteria up the vagina)

  • sweeps/stretch and sweep, same logic, especially if more than 3cm dilated, as more likely to break your waters accidentally

Factors that decrease the chance of baby picking up GBS if you have it

  • antibiotics in labour at least 4 hours before baby is born, preferably two doses 4 hours apart.

  • intact waters till late in labour (this gives a shorter time for baby to be in touch with any germs. 80% of waters break towards the end of labour.);

  • water birth 

  • skin to skin (skin to skin time after birth is known to decolonise the baby from bacteria. This study showed that skin to skin time with mum or dad reduced the amount of MRSA germs in babies in a neonatal unit.

Plan A, B and C

It could be that at the moment you don't have any of these higher risk factors, so you might have a plan A to give birth without having antibiotics in labour, but if any of the higher risk factors happen, then you can go to plan B, or plan C. 

Also if you are having a second or subsequent baby and waters don't go till pushing, as the average pushing stage for second plus babies is 20 mins or less, that means babies are exposed to the bacteria for a very limited amount of time.

Options

This is not a comprehensive list.

  • Here's an article listing other natural treatments by world renown Canadian midwife Gloria Lemay.

  • Home birth to reduce chance of infection, increase chance of water birth and skin to skin

  • There is the possibility of giving antibiotics to the baby after the birth. Many hospitals no longer gives antibiotics to the baby if woman is GBS positive, even if she didn't have the recommended antibiotics in labour. They just monitor babies and treat them if poorly, due to the downsides to giving babies antibiotics unnecessarily.

  • Monitor baby at home.

 

If you are planning a home birth.

You can have a plan A to give birth at home, if you are low risk of passing it on, and a plan B if that changes (such as waters breaking and no contractions). Having a home birth reduces the chance of having your waters broken, and increases the chance of having a water birth and having skin to skin.

Some areas do give antibiotics at home but not many.

 

Monitoring baby at home

You can choose to go into hospital after the birth for 12-24 hours for monitoring or opt for monitoring at home. This is a useful guide about monitoring your baby for neonatal infection. 

More information: 

Midwife, researcher and lecturer Sara Wickham has lots of useful information and has written a book

AIMS (Association for the Improvement of Maternity Services) also has a book on the topic. 

Disclaimer: I am not a medical professional. This is information I have gleaned from reading the sources provided. Please do your own reading. Nothing on here constitutes medical advice.