Group B Strep

As we have learned more about GBS through the years, I have found that this page  from Evidence Based Birth is a fantastic and informative page to get up to date information on GBS testing and risks.  Please read this page as well as below for concise information.

 

FACTS ABOUT GROUP B STREP (GBS)

* Routine screening for GBS on all pregnant women became the standard in 2002.

* There are two types of GBS infection in the newborn – early onset (occurs before 7 days of life), and late onset (occurs after 7 days of life). The rate of each occurring is about 50/50.

* About 25% of women are estimated to be colonized with GBS at some point in their pregnancy according to the March of Dimes – the CDC estimates the figures to be 15-40%

* 99.5% of babies born to mothers who are GBS+ will not become sick from it..

~ Of those babies who DO get sick with EARLY onset of GBS infection…4.7% will die according to an Oxford study, 2-3% according to the CDC. Early onset GBS has a higher death rate than late onset GBS.
~ Of the babies who get sick with late-onset GBS, 2.8% will die. Of those infected with LATE onset of GBS…50% of those were not infected by their mothers, but by outside sources (according to the CDC)

Here are the risks of GBS if we take the highest risk estimates according to various estimations…
Let’s say that 40% of women have GBS (the highest rate I could find)…and those who have GBS have a 1 in 200 chance (according to the CDC) of having a baby infected with GBS.

If we DON’T screen a woman for GBS…the odds that her baby will be infected and become sick is .2%.
Of the babies that are infected (.2%), those infected with early onset (50% of them) brings the total percentage of babies in the general population who, if mom were not screened and no antibiotics were given, that would contract early onset GBS…we’re at .1% of babies who would contract early onset GBS at all.
Understanding that a baby sick with early onset GBS has up to a 4.7% chance of dying…that means that if we didn’t screen at all, didn’t give antibiotics, did nothing at all…the percentage of babies who would be born, contract early onset group B strep, and would die from this infection….we’re at the last figure of .0047% (or 1 in 21,276 babies in the general public without screening)

I’m going to repeat that figure for emphasis….
if we did not test you for GBS, and did not treat you for GBS, your baby has a 1 in 21,276 chance of getting sick and dying from GBS (.0047%).

Serious complications can result from GBS other than just death – those complications include pneumonia and meningitis which can have life-long effects on the baby.

What increases the risk?
There are certain conditions that we know increase the risk to a baby of a GBS+ mother – some of these do not apply to my client (like preterm babies), others are possible.  Those possible risk factors for those having a planned homebirth are…
1. Previous baby colonized with GBS
2. First time mother
3. Rupture of membranes during labor 18 hours or more before delivery
4. A fever during labor of >100.4
5. Having a UTI caused by GBS

6. Being African American

7. Infection in the uterus

Limitations of the test:
It is possible for your status to change between the time we check and the time that you birth your baby.  You can test negative and be positive when you birth, or test positive and be negative when you birth. There is a greater chance that your status will not change – but it is not unusual.

What is done if I test GBS+?

The current CDC recommendations are that all pregnant women should be routinely screened for GBS between 35-37 weeks of pregnancy, all women who test GBS+ should be given antibiotics during the course of their labor (at least 2 rounds – 4 hours apart), and all women whose GBS status is unknown should be treated with antibiotics only if they develop risk factors that I have listed above.

What are the down sides to antibiotics in labor if I am GBS+?
Antibiotics are not without risks to you or your baby – a good unbiased review of some of the risks can be found at Medscape. I could copy/paste the entire article, but that would be plagiarism and seems silly when you can just go there and read the article.

Even if the antibiotics were without notable risks, there is question over the effectiveness of them during labor for GBS.  A very recent study published in the Cochrane Review (2009) concluded, “Intrapartum antibiotic prophylaxis appeared to reduce EOGBSD, but this result may well be a result of bias as we found a high risk of bias for one or more key domains in the study methodology and execution. There is lack of evidence from well designed and conducted trials to recommend IAP to reduce neonatal EOGBSD.”
(EOGBSD= early onset group B strep disease IAP= intrapartum antibiotic prophylaxis)

Are there alternative options?
There are always options. You can…
~ Choose to screen at 35-37 weeks as is recommended by the CDC – or you can choose not to screen at all.

If you test positive, you may…
1. choose IV antibiotics while in labor if you test GBS+
2. choose to refuse antibiotics and accept the risks as they are
3. alternative treatments – see below

There are multiple ‘natural’ treatments you can find online – from hibiclens (Here is a good page on Medscape about the possible benefits of chlorohexadine in labor to prevent GBS infection in the newborn.) to garlic in the vagina.  However, none of these are proven effective/ineffective and therefore can not be considered an equal treatment or response to a GBS+ result.

FINAL THOUGHTS:
There are no guarantees. You can have a baby that dies from GBS even though you had antibiotics…or a mother that dies from an anaphylactic reaction to the antibiotics. Life is all about risk assessment and choice, and this is one only you can make. Please read the Evidence Based Birth page on GBS as well….and I will respect your decision during our next appointment together, regardless of what you decide.

16 Comments

  1. Nicole Z. Harrison wrote:

    Here is my problem in regards to my birthing my (so far 6 , cookin #7 right now) babies…I NEVER feel a thing till it’s too late & ‘time’ to push baby out. They ‘say’ I have a condition called painless dilation, I will drop, dilate & efface & never feel it; but here is another problem, my water never breaks on it’s own either & I tend to do this dropping, dilating & effacing usually early, like between 34-35+- weeks. I go for routine checks several times from 32-33 weeks on, sometimes 2-3 times a week & when it is discovered that I’m ‘there’ they admit me, tell me I have this ‘infection’ & MUST submit to Q4H antibiotics for 2 cycles b4 they break my water, & as history dictates, within 2-12 minutes, I have a baby! I never have liked the antibiotic thing, mainly bc I do NOT like needles, but now I have another reason NOT to like the antibiotic thing that has always been told I HAD to do!

    Saturday, May 1, 2010 at 11:17 am | Permalink
  2. Tatiana wrote:

    Genius! Sharing it wide and far!

    Saturday, May 1, 2010 at 1:04 pm | Permalink
  3. Kelli wrote:

    Thanks Stephanie. I’ve been meaning to research this and ask you about it, your posts always have such good timing. I’m so glad you started this blog!

    Saturday, May 1, 2010 at 1:28 pm | Permalink
  4. Lindy wrote:

    Ok- here’s my question. How is a GBS+ mother treated in a homebirth (AZ)? I know you don’t use IVs so if she was positive, would she be considered risked out and transferred to a hospital? Also since GBS is present in the vagina naturally and is only a problem if it’s out of balance, can douches/washes/creams be used to bring it back into equilibrium? What about herbal/ all natural treatments (probiotics, apple cider vinegar, etc.)?

    Saturday, May 1, 2010 at 4:09 pm | Permalink
  5. I didn’t know much about GBS, so thank you for this comprehensive post!

    Saturday, May 1, 2010 at 4:18 pm | Permalink
  6. elfanie wrote:

    Lindy:
    I do not believe that the risk posed by GBS+ is high enough to warrent a risk out of a homebirth….however, a mom may disagree with me and risk herself out so that she can go to the hospital and get IV antibiotics if that’s what she is wanting. My protocols for someone who stays home whose GBS status is either unknown or + is to not break her water, and if her water has been broken for >12 hours have her do a hibiclens rinse of the vagina (I carry Hibiclens with me). Yes, there are many natural remedies to reduce the colonization of GBS, and you can find those remedies online (grapefruit seed extract, garlic pessaries, etc) – but it’s not something that I focus on because the bacteria can grow back so quickly and it’s so easy to get the vagina out of balance in other ways once we start messing with it…

    Saturday, May 1, 2010 at 5:50 pm | Permalink
  7. Kelli wrote:

    Wow, how can “painless dilation” be classified a condition? Sounds like a blessing, I’m sure it could cause some issues like birthing in a movie theater, grocery store ect. , but on the bright side those pesky contractions must not be so pesky!

    Saturday, May 1, 2010 at 7:03 pm | Permalink
  8. I’ve had great luck (?) with the herbal regimen in GBS+ women. They continue the regimen through the rest of the pregnancy and every re-test (if they want it) shows negative.

    I had one mom with Systemic GBS, more than just in her urine, and did risk her out (in concert with her back-up doctor who is home-birth friendly); she had had 3 different courses of oral abx already, but still had the (apparently) very resistant case. In labor, she was given 2 different IV meds. The baby was born with pustules all over her body (I have pics somewhere); no one could explain them, but I *swear* they were from the massive amount of abx in utero. As expected, both had yeast issues for months.

    I’ve abandoned IV abx in labor for the Hibiclens wash. If women want the abx, I *can* do it, but, so far, no one has chosen that course.

    Sunday, May 2, 2010 at 11:00 am | Permalink
  9. Lindy wrote:

    THX for responding. It just seems so counter intuitive to place on mom on antibiotics for a naturally occurring, normally benign bacteria. Plus the risk of yeast infection… NavelGazingMW, maybe that’s what those pustules were…

    Monday, May 3, 2010 at 1:57 pm | Permalink
  10. Sheridan wrote:

    Thank you. This is a wonderful resource to send my students too!
    Sheridan

    Tuesday, May 4, 2010 at 11:02 pm | Permalink
  11. Thea wrote:

    Early onset GBS means the baby obtained the strep during delivery. Late onset usually occurs from someone handling the baby that is unaware they are GBS+ and aren’t as meticulous with their handwashing than if they knew. Years ago, we would treat for GBS+ if a patient came in with PTL. The current theory is that an infection causes the PTL and the biggest offender is strep. Some years ago we would also treat GBS+ if we found it in urine earlier in the pregnancy with oral antibiotics but we found that some of our women would recolonize after treatment, even several treatments. The CDC sent out recommendations for all women to be screened at 36-37 weeks. Yes, a small percentage that were negative at 36-37 weeks will come up positive in labor. I would really be interested in the studies on hibiclens and its effectiveness on GBS+. I love hibiclens, especially if used to bathe with prior to a scheduled C/S. What is the ratio of clens to water when used to clean the vagina? On a different note. The push is for no more than 6 exams on all women byt especially those that have prolonged rupture of membranes or any kind of infection down there… I know that statistically the passing of +GBS is slim if mom is not colonized much. I don’t know, even with these numbers, I’d want antibiotics because I’ve seen what strep can do. Until the CDC changes their guidelines, we will continue antibiotics. There are all kinds of studies being done and with this kind of info I’m sure we’ll see a change in the future. This is a wonderful source. I use to teach students about GBS but I didn’t have the fine print details. Thanks for sharing.
    Thea

    Thursday, May 6, 2010 at 1:37 am | Permalink
  12. elfanie wrote:

    Thea:
    The studies on Hibiclens and GBS are reference in my blog. As for late onset usually occurring from someone handling the baby, like I said….it’s about 50/50 (50% from mom, 50% from outside sources).
    For those reading Thea’s comment that don’t know…PTL means Preterm Labor.
    As for my hibiclens protocol…it’s 1/2 oz hibiclens to 7.5 oz water.

    As for no more than 6 exams on all women….that’s a LOT of internal exams, and LOTS of opportunity to push all sorts of infectious bacteria up towards that baby!! But everyone needs to make the decisions regarding GBS for themselves…

    Thursday, May 6, 2010 at 11:34 am | Permalink
  13. Anna wrote:

    I wouldn’t be so eager about using Hibiclens either, as it kills both good and bad bacteria in the vagina, and messes with the bacterial balance in the flora.

    In general, I seriously don’t buy the argument that the vagina is somehow “dirty”, and it may harm the baby unless we sterilize it in some way. In fact, think of all the beneficial bacteria that the baby is getting as well, as she is born! There’s a neat article about it here: http://blogs.discovermagazine.com/notrocketscience/2010/06/23/baby%E2%80%99s-first-bacteria-depend-on-route-of-delivery/

    Unless you have an infection or an inflammation in your vagina at the time of birth, the vaginal flora is in perfect balance. Do yourself a favour and don’t mess with a good thing — neither by using antibiotics, nor by douching with antiseptics.

    Oh. And make sure the people who handle your baby (and shake hands with you!) wash their hands after they go to the bathroom.

    Tuesday, July 6, 2010 at 10:31 am | Permalink
  14. QoB wrote:

    Also it’s worth noting that other developed countries do not routinely screen for GBS as it’s considered not cost-effective and more risky than worthwhile e.g.: the UK and Ireland.

    Sunday, July 25, 2010 at 6:05 am | Permalink
  15. Brittany C. wrote:

    This is great, Stephanie. Thanks!

    Friday, October 15, 2010 at 3:44 pm | Permalink
  16. Nicole Ahava wrote:

    Thank you. Just the info I needed!

    Blessings 🙂

    Monday, July 9, 2012 at 8:00 am | Permalink

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