Strep B also known as GBS
This week I have been in contact with the hospital system and had extensive discussions about GBS. Group B Strep is a bacteria that can live in your vagina. It is transient – it comes and goes – 15 to 30% of us have it at one time. This is only a potential problem if you happen to be pregnant.
There is a lot of scare mongering about GBS and it’s implications, so what is the real deal?
Well first of all should you get the test? In the UK where screening isn’t part of the antenatal testing circus this is what they have to say:
Estimated effects of bacteriological screening. Approximately 25% of mothers in the UK are likely to be GBS carriers. This estimate is based on a single study performed in the 1980s and it is possible that this study does not reflect the current picture. With the addition of women who present with other clinical risk factors for GBS disease, such as preterm labour, around 30% of all pregnant women would receive intrapartum antibiotic prophylaxis if a bacteriological screening programme were to be introduced in the UK (this is approximately 204,000 women per annum).
In Australia GBS testing is routine at about 36 weeks. If this is positive, you are assumed to be positive at the time of birth. The standard hospital treatment for this is antibiotics when in labour. Just because you have gbs in your vagina doesn’t mean you have an infection it means you have the risk of an infection. Just because you had gbs at 36 weeks doesn’t mean you have it at term as it grows in cycles.
Antibiotics - When in doubt give them out
Antibiotics are promoted as a preventative measure, which isn’t true. Antibiotics are not there to prevent infection but to cure it. As shown in the studies here, most people with gbs will give birth and their baby will either not be colonised by gbs or the baby will be colonised but suffer no ill effects. Antibiotics are inconsequential to those people, but there is a minute part of the population who’s baby will be colonised and become extremely ill from gbs. The Medical fraternity feel that antibiotics will cure any disease and have insignificant effects to those who have taken it unnecessarily.
The cochrane data base also says that although antibiotics reduces the rate of infection it hasn’t been shown to alter the the rate of death.
This is how most of the medical interventions occur, better to do something rather than just wait.
Taking unncessary antibiotics also carries a risk.
- 1 in 10 chance of an allergic reaction.
- 1 in 10,000 chance of a severe allergic reaction like anaphylaxis.
- 1 in 100,000 chance of death from taking antibiotics.
There is also a chance that the antibiotics affect the baby by restricting growth of natural flora which affects immune development.
Remember , this may all be worth it if you have an infection but having a positive swab doesn’t mean you have the infection but the risk of infection as listed below.
So what is the risk of GBS incidence? The biggest results are from the UK. It is difficult to be totally country specific. The only thing they really know is the incidence in the UK is much smaller than the incidence in America.
The current incidence of early-onset GBS disease in the UK and the Republic of Ireland is 0.50/1,000 births,which is equivalent to approximately 340 babies per annum. If we estimate that intrapartum antibiotic prophylaxis is 80% effective at preventing early-onset GBS disease, then this will decrease the number of affected babies to 68. Therefore each year in the UK 204,000 women will be treated to prevent 272 babies developing early-onset GBS disease. For every 1,000 women treated with antibiotic prophylaxis, 1.4 cases of disease may be pevented. However,the numbers of women treated to prevent one case may be higher, as this estimate assumes that antenatal swabs identify all GBS carriers, which is not the case. Also, when applied in practice, 65 to 70% may be a more reasonable approximation of the effectiveness of intrapartum antibiotic prophylaxis. Both of these factors will increase the numbers of women who are treated to prevent one neonatal infection. It is also true that the rate varies within the UK (0.21/1000 births in Scotland, 0.73/1000 births in Northern Ireland). Where local figures are known, the number needed to treat (NNT) should be adjusted appropriately. The mortality from early-onset GBS disease in the UK is 6% in term infants and 18% in preterm infants.
Intrapartum antibiotic prophylaxis will not prevent all deaths. Even when treated appropriately some infants will still die of early-onset disease, particularly when the disease is well established prior to birth. If one makes the assumption that the effect of antibiotic prophylaxis on neonatal death from GBS is equivalent to its effect on GBS disease, then to prevent one neonatal death from GBS would require at least 7000 colonised women to be given intrapartum antibiotic prophylaxis, which would require at least 24,000 women to be screened.
Estimated effects of risk based Screening
Information about the UK prevalence of the antenatal risk factors for early-onset GBS disease and data from the cases of early-onset disease in the UK surveillance study can be used to estimate the risk of the disease developing in the presence of each antenatal risk factor with and without antibiotic prophylaxis. The combined risk factor approach recommended by CDC may also be analysed in the same day.
Approximately 15% of all UK pregnancies have one or more of the following risk factors: intrapartum fever, prolonged rupture of membranes (PROM) greater than 18 hours, prematurity less than 37 weeks, previous infant with GBS. Approximately 60% of UK early-onset GBS cases have such risk factors. Thus, two cases of disease and 0.21 deaths from GBS disease occur for every 1,000 pregnancies with one or more of these factors. Approximately 625 women with one or more of these risk factors need to be treated to prevent one case of disease and 5,882 women need to be treated to prevent one death. This can be compared with prophylactic corticosteroids given prior to preterm birth when the number of women needed to treat to prevent one neonatal death is 23.
It seems that getting tested and treated isn’t as straight forward as it seems.
This article by Sara Wickham is another look at the figures.
What happens at home?
Unless requested, my clients do not have the test for GBS. We use a watch and wait policy which is advocated by RCOG and any clinical signs are immediately referred for the appropriate collaboration.
If a client has SRM there is no VE as this can aid ascending infection, extra vit C, B6 and garlic taken and there are lots of other natural remedies that can work including acidophilus and grape seed extract.
If you have had a positive swab I would recommend the natural course of action and retesting weekly to see if the GBS has gone and keep up the treatment until birth.
You can always choose the medical model of treatment at any time you feel uncomfortable and have weighed up all the pros and cons.
There has also some evidence that garlic pessaries can be useful.
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An excellent, well written and informative post Lisa. If I may, I have a question in regards to your clients not having a test for GBS unless requested. Is this an informed decision on their part when they either request it or not, or do you not mention the possiblity of GBS infection at all?
I ask because I recently discovered your amazing blog and found it such a wonderful resource of inspirational information, that I have bookmarked it and visit often to learn all I can.
Go Lisa!!
Hi there,
I do of course inform my clients about GBS swabbing as part of what is routinely available. All the information here is passed to them so they can make a decision on what they need for themselves. If they request a swab they go to their gp or if they have a hospital back up they take up an appointment there as I do not offer the screening myself. At a homebirth there are no IV antibiotics there is only a watch and wait philosophy and natural resourses so clients have to think very carefully how they would feel about a positive result before undertaking the test.
Sigh. GBS is my particular bugbear as it was what caused my undoing at hospital (GBS+ plus PROM = baby going to die, apparently). One other side effect you didn’t mention in your post is the high likelihood of developing nipple thrush which can really disrupt breastfeeding as I had the misfortune to find out a few weeks after DD was born.
Thanks Lisa. I always come here when I get disheartened about birthing in this country. Your writings always makes me feel so much better!! I have real hopes that this blog will help to bring about real positive change.
Have a great weekend.
Lisa,
What do you think about the use of chlorhexidine as an external periwash during labor for those mamas who are GBS+ and opt for it? Or a dilute tea tree oil solution as a periwash? Thank you for this very informative post.
Love
Brenda
Midwife of the plains, 20 years ago when I started it was standard practice to used chlorhexidine to wash a perineum and also hibitane to wash the baby. It was stopped because soapy water was found to be as effective. I find it amusing that a full circle has happened. Looking at the stats it suggests that doing nothing is as effective as anything else as the mortality rate hasn’t really altered. I am always open to looking at my practice over and over so if you have anything that shows it to be successful I’d love to check it out. Garlic probably has the best results over all.
Great info. I am embarking on the garlic regime. I am 32 weeks pg, in the UK. I am going to do the garlic for 2.5 weeks and pay for an ECM, GBS test. I have everything crossed it comes back negative. In addition to the garlic pessary I am eating a raw clove a day in a tspn manuka honey, taking 250mg vit c 4x a day and echinacea once daily. as well as a daily yakult probiotic drink.
I have also read about colliadal silver, but I am not convinced of it’s safety. Do you have any experience with CS in pregnancy?
I have only had experience with CS postnatally. I’m not really sure of it’s safety in pregnancy, maybe you could talk to a Homeopathic practitioner they would be able to tell you more.
Please let me know the result of your swab. Good luck.
Lisa
I accidently deleted this comment
"I used to visit sites like yours all the time and feel very empowered. It's only in recent months that I can talk about what happened to me in 2008. I'm pregnant again and feel like if nothing else, my loss will teach other women that NOTHING is worth putting your baby at risk.
Let's start by saying I was NAIVE, really really really naive. I wanted a homebirth, I wanted to take control and I wanted a spiritual, natural delivery. My baby girl died from and infection that could have been treated if I'd been in a hospital. GBS.
My life will never be the same again. OBs aren't out to rob you of your power as a woman, they are there to protect you and your unborn baby.
I wish someone had wrote this for me years ago."
I am very sorry for your loss. Individual circumstances are hard. However some babies die from GBS at the hospital. I often wonder if they feel they will have a homebirth next time.
Seeing as the autopsy revealed swift antibiotics would have resolved the infection, it's more than just "unfortunate".
I wonder if you've ever considered what it's like to have to get an autopsy on your much awaited and loved baby. To hold a cold lifeless body. As someone that this actually HAPPENED to, that lived through unspeakable grief (rather than just digging up and posting articles to support your opinion) I find your flippant response lacking human feeling and logic.
Homebirth is NOT safe in this country. The women who google GBS and homebirth need to get balanced reading, not just rhetoric.
Dear,
as it happens you nothing about my obstetric history which has been long and complicated. I did not dig up articles to support my opinion. The opinion came from the research. The research doesn't say a baby will never die. I don't think an autopsy can actually say that swift antibiotics can resolve an infection, that is actually an opinion post mortem deals with facts. Once again I am very sorry for your loss. I do know what it is like to have unspeakable grief. My response was not flippant but very serious. Babies DO die from infection at the hospital, way more often than they do at home. Hospital is not a guarantee of a live baby. Homebirth IS safe in this country the perinatal mortality in SA at home is 7.9% and at the hospital 8.2% the latest study figures say just this. LESS babies died at home than at the hospital.
Hi – thanks for the great post. I’ve found it hard to find info on pros/cons of GBS treatment so really appreciate your research and thoughts on the subject. I’ve been GBS+ with both my pregnancies; took the penicillin IV in labour with my first and luckily didn’t develop thrush or any other problems from it, had a healthy baby. This pregnancy, I’m really considering not taking anything and just going with “wait and see” and treat if necessary.
HI,
I am planning a homebirth for my second chlid. I recently was informed about GBS and the various options by my midwife. During my first pregnancy I never heard of GBS!! (hospital midwives, Obstetrician – no-one even mentioned it!). After the birth I developed a Group B Strep infection (stitches) and was quite unwell, thnakfully my baby was unaffected.
This time I have decided not to utilise the offer of prophalaytic antibiotics or have a test, but try prevention using naturopathic/homeopathic remedies. I have no scientific evidence that this work, but the anecdotal evidence from other independent midwives that use this is positive to date. The treatment is safe for pregnant women and it recommended that it be started 4-6 weeks prior to EDD; acidopholus – 4 billion cells per dose, echinacea 2 x 350mg capsules, garlic 2 x 580mg capsules, vitamin c 500mg with 200mg bioflavinoids, grapefruit seed extract 15 drops. This formula is to be taken twice per day. I’m going to try this and take the “wait and see” approach.
I will let you know the outcome, post birth!
Look forward to hearing all about it. Jmasher
I had my first two babies under the care of my GP, birthed in hospital. I did not learn about GBS until after I had my second baby. When I asked my Dr about it he explained he doesn’t have his patients do the test because GBS is transient and he believed it was better to take the wait and see approach.
My third baby was with a midwife planned hospital birth. She offered the test. We discussed my previous experience and the options. I decided to do the test just to see what it would say, It came back that I was positive. I decided to refuse antibiotics unless indicated. She supported this.
Fourth baby with a different midwife. I wanted to refuse the test. She didn’t think this was advisable. I said that even if I did the test and it came back positive I was still refusing antibiotic unless indicated because I wouldn’t have my baby relieve a large dose of antibiotics just in case. She was very adamant that is wasn’t just in case, that a GBS exposed baby could die very quickly. I found her reaction really interesting considering her stance on everything else. She is the most respected midwife in town(we only have three). She suggested I do the test, if it was positive and I refused antibiotics, at least we would have a heads up if the baby became sick. I agreed I would do the test and I knew I would still refuse antibiotics unless indicated. I knew I would be having a locum for the delivery as my midwife would be out of country the month I was due, might not even matter anyway. I was negative so it didn’t matter in the end. I can’t remember the time line exactly, but the pregnancy did start out as a planned hospital birth and later we switched to a planned homebirth, so maybe when we had the discussion she was thinking about the hospital.
Fifth baby now due in 18 weeks. I have only seen locums as my midwife is on holidays, she has cut back her practice getting ready to retire. My second appt was with the woman who help deliver our my last, we did discuss any testing still to come that I might do. She knew I was refusing glucose screening and wondered about GBS. I am unsure at this time and she said doesn’t matter, no decision to be made now as it is still weeks away. There was certainly not the push to have the test that I had last time.
Very different reaction between my GP and different midwifes I have seen. I am curious to see what her stance will be this time. She will be back by my next appt and will be here at my delivery time. I can only imagine her strong reaction was due to a bad experience or a lot of pressure from the hospital. I mentioned the conversation to a couple of friends who had her care as well, they have a like minded opinion regarding antibiotics and also found her reaction interesting as it is polar opposite of her general care.
Anyways long story regarding my GBS experiences.
Since the routine screening and use of antibiotics to reduce the GBS load on a woman, (and hence the chance of passing to her baby), the rate of serious GBS infections in babies of our hospital dramatically reduced. Whilst it is not common with or without antibiotics for a baby to die from an infection afterwards, it make so much common sense to try and prevent to the best of our ability the chance of this bug causing problems for any baby.
Most women when counselled, thankfully are happy to be treated with antibiotics, which is entirely sensible. Yes there are reactions to antibiotics, and yes, we should not be using them needlessly, but potentially saving a babies life or reducing the chance of them having a serious infection, I reckon that is a sensible use of antibiotics.
By all means use your natural therapies (although unproven) to assist with natural immunity and getting rid of GBS, but there is no substite for appropriate antibiotics to reduce the GBS load during labour.
AP , even the cochrane collaboration do not recommend antibiotics so what information are you counselling them with?
“This review finds that giving antibiotics is not supported by conclusive evidence. The review identified four trials involving 852 GBS positive women. Three trials, which were around 20 years old, compared ampicillin or penicillin to no treatment and found no clear differences in newborn deaths although the occurrence of early GBS infection in the newborn was reduced with antibiotics. The antibiotics ampicillin and penicillin were no different from each other in one trial with 352 GBS positive women. All cases of perinatal GBS infections are unlikely to be prevented even if an effective vaccine is developed.”
You are not potentially saving the life of a baby because antibiotics are a cure and not a prevention. You do potentially affect their immune system and their gut on a 0.1% chance that you cure gbs by default. The detriment to the population does not justify the treatment.
Sensible use of antibiotics is to treat a baby who has an infection.
There is great research on the use of garlic for gbs actually.