I’ve been asked about this subject quite a lot recently so I thought I’d write a post about it. Before I begin, as always, remember I am a doula, not a health professional or medical expert. So, if this subject effects you, do talk to your midwife/doctor as well as reading other resources so you can make informed decisions about your birth.
I will therefore write this post based on what I’ve found out along the way as I’ve supported clients.
So…Group B Strep, GBS, Strep B…what is it and what ramifications does it have for your pregnancy and birth?
GBS is a bacteria that can colonise the human body. It is very common and usually causes no problems. Around a third of women are said to be carrying the bacteria in their vaginas. Most of the time, even when we are pregnant, here in the UK we are not aware of the presence of GBS because we are not routinely tested for it here.
The vast majority of term, healthy babies born to GBS+ mothers are fine. However, sometimes, this infection can cross to the new baby and cause a variety of problems. Here is what the NHS Choices website says:
Early-onset GBS infection
If a baby develops GBS infection less than seven days after birth, it’s known as early-onset GBS infection. Most babies who become infected develop symptoms within 12 hours of birth.
It’s estimated that about one in 2,000 babies born in the UK and Ireland develops early-onset GBS infection. This means that every year in the UK (with 680,000 births a year) around 340 babies will develop early-onset GBS infection.
What complications can it cause?
Most babies who become infected can be treated successfully and will make a full recovery.
However, even with the best medical care, one in 10 babies diagnosed with early-onset GBS infection will die. The infection can cause life-threatening complications, such as:
- blood poisoning (septicaemia),
- infection of the lung (pneumonia), or
- infection of the lining of the brain (meningitis).
Another one-in-five babies who survive the infection will be affected permanently. Early-onset GBS infection can cause problems such as cerebral palsy, deafness, blindness and serious learning difficulties.
Rarely, GBS can cause infection in the mother. For example, an infection in the womb or urinary tract, or more seriously, an infection that spreads through the blood, causing symptoms to develop throughout the whole body (sepsis).
So, whilst it’s a very rare occurance to have a baby become infected, and even rarer for that infection to be serious or God Forbid, fatal, the fear of this possibility for both parents and health professionals shouldn’t be under-estimated.
So, if infection is so rare, why are not all mothers routinely tested in the UK?
My understanding is that routine, universal testing has not been shown to improve outcomes. That means that even if you know you are infected, it won’t necessarily change the outcome for you, or your baby.
Why? Well, for a start, testing is not necessarily 100% accurate. Secondly, treatment for the condition during labour is not guaranteed to prevent your baby becoming infected. Thirdly, treatment during labour can restrict your birth choices (such as place of birth) and your ability to move and change position during labour. Fourthly, there are varying levels of risk factors for fetal infection, so if you are in a low risk group, the chance of your baby being infected are incredibly small. Lastly, the vast majority of newborn (“early onset”) infection if caught early can easily be treated.
As so many of us are GBS+, universal testing would probably mean a huge number of us on IV antibiotics during labour, with all the consequences that entails, not least a contribution to the number of women and babies developing resistance to antibiotics.
As I mention above, most of us will never know our GBS status and have perfectly normal healthy pregnancies and babies. However, for a variety of reasons, some women will find out in pregnancy that they are positive for GBS. They may also have known in a previous pregnancy that they were positive, in which case, any subsequent pregnancy will be treated as if she is positive this time, too.
For many reasons, some women choose to be tested, either by the NHS or privately. My experience with both kinds of testing is varied and I’d love to hear your views. My experience is that the NHS test appears to give quite a few false positive or false negative results. (I’ve seen it quoted that it can miss up to 50% of positive carriers) Whilst the private test seems to have a better repution in this respect, I do find the ‘customer service’ to be severely wanting. I have had more than one client receive a text telling them the result, with no explanation, no counselling through her options and no signposting to sources of information and support. This can be cripplingly upsetting for an emotionally vulnerable pregnant woman. Likewise, I have heard numerous stories of GP receptionists ringing women to tell them the results and informing them that they must therefore now go to hospital to have their babies. Again, very upsetting and frankly none of the receptionist’s business unless she also happens to be a doctor or midwife!
So, if you know you are GBS+ in this pregnancy, what are your choices?
Well, I think the first thing to remember is just that – you have CHOICES. No-one is able to tell you that you are GBS+ and therefore you MUST…
Most woman will be encouraged to have a hospital birth. This is because the recommended treatment is IV antibiotics. Hospital policy seems to differ from place to place, so it may well be useful to find out what your hospital advises. Some give one dose only, at least 4 hours before the birth. Others seem to want to put up another bag of antibiotics every 4 hours during labour. It takes around 20mins for the dose to go through, during which time your mobility is restricted somewhat by the cannula in your arm and the drip pole you are attached to.
IV antibiotics in labour have been shown in research to decrease the likelihood of a baby being infected. A recent Cochrane review concluded however, that many studies are particularly biased, more research is needed in this area and that prophylactic (Just In Case) antibiotics in labour did not decrease the chances of babies dying. Furthermore, there are serious albeit rare) risks to antibiotics being given, including allergic reaction either in the mother or child or thrush colonisation in mother and/or baby after birth, which can be extremely painful when breastfeeding and result in the cessation of nursing, with all the subsequent risks of not breastfeeding for baby and mum. There is also some research to suggest that early exposure to antibiotics as a fetus or newborn can contribute to the risk or allergies or asthma developing later.
In theory, IM antibiotics (an injection) during labour would be a possible alternative. This makes homebirth possible for mothers who feel they want to be treated. A couple of my clients have opted for this, but it was only possible because this choice was made available to them in my city. I am unaware of it being offered elsewhere and the evidence for it’s effectiveness is not there – but only because we need more research!
Some mothers opt for doing nothing and becoming familiar with what to look out for in their babies during the first few days.
(Early Onset infection will happen before one week of age (usually before – around 90% of infected babies will show symptoms by 48 hours) – if infection happens after this, it is unlikely that it has come from the mother but from some other source).
So here are some of the signs to look for in a baby who may be infected, there may be others, like low blood pressure that most parents couldn’t check for themselves.
(Early Onset): grunting, poor feeding, lethargy, irritability, and/or abnormally high or low temperature, heart rates or breathing rates.
So how do parents choose?
Well, many women will want to take their personal risk factors into account when deciding where and how to give birth if they know they are GBS+
Here are the risk factors, if you tick some of these boxes, whether you choose to reassess, or to stick with the original plan, but you do need to know that each of these factors increases the likelihood of fetal infection (risk increases as you go down the list)
If you are in preterm labour. That means before 37 weeks
If your waters have broken before 37 weeks
Where your waters have broken before labour starts and this situation has been going on for more than 24 hours
If you have a temperature, either in labour or before labour starts with ruptured membranes (waters broken)
If you know you are GBS+
If you have been tested and found to have GBS in your urine at any point in your pregnancy. If you do have it in your urine, this is a more serious infection and you should be offered treatment then with oral antibiotics.
If you have had a baby before who developed a GBS infection.
So many of us want straight answers, but unfortunately, in this situation, I don’t think there are any! If this subject applies to you and I were your doula, I would suggest you read some of the resources below (and some of these links in this article go to research abstracts), look at your particular risk factors, listen to your care-givers (ie doctors/midwives) and then listen to your gut instinct. This is one area where we really do need more research as it appears to me that at the moment we are possibly basing routine treatment on studies that may be flawed.
I’d love to hear your experiences and thoughts – do feel free to comment below, especially if you think I’ve forgotten something or got something wrong!