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How to make informed decisions with Group B Strep in pregnancy

 

What is it?

 

• Group B Streptococcus is a normal bacterium which lives in the intestinal tract, throat and sometimes the vagina. It can come and go from the vagina with no symptoms throughout a woman’s life.

 

• It’s estimated around 25% of all women in the UK carry the infection in their vagina at any one time.

 

 

Why is it important now?

 

• Some babies pick up GBS and in a very small number the bacteria causes a type of septicaemia and can lead to death.

 

• The NHS has a general policy of treating every woman who has ever tested positive for GBS with IV antibiotics in labour and many healthy women and babies receive unnecessary treatment.

 

• IV antibiotics carry adverse effects for you and you baby – you will need to make a decision about the risk of GBS vs risk of antibiotics.

 

• This treatment is only offered and as with any intervention it may be refused.

 

• If you say nothing you will usually be given IV antibiotics in labour (following a positive test).

 

 

The Facts and Figures

 

• Around 40% of babies born to mums who are carrying GBS in the vagina (at the time of birth) pick up the infection on their skin as they travel through the vagina to be born. For the vast majority the bacterium is completely harmless.

 

• In 0.2-0.5% of these babies the infection develops into Early Onset Neonatal Group B Streptococcal Septicaemia (EOGBSS).

 

• EOGBSS carries a 10% mortality rate.

 

• Out of 764,000 births each year in the UK around 700 babies contract the disease and 115 sadly die or are left with problems.

 

 

Are these figures the same for everyone?

 

NO some groups are affected more often and more seriously:

 

  • Preterm babies before 37 weeks affected more often.
  • Mother having a fever during labour
  • Prolonged rupture of membranes - over 18 hours
  • GBS found in the mother's urine, not just the vagina
  • Mother having had a previous child with EOGBSS
  • Rupture of membranes before 37 weeks
  • Preterm babies before 36 weeks have a much higher mortality rate.

 

What are the signs of EOGBSS?

 

 

Most babies show symptoms within 12 hours of birth and 90% within the first 6 days Signs include:

 

  • grunting
  • lethargy
  •  irritability
  • poor feeding
  • very high or low heart rate
  • low blood pressure
  • low blood sugar
  • abnormal (high or low) temperature
  • abnormal (fast or slow) breathing rates with blueness of the skin due to lack of oxygen (cyanosis)

Treatment

 

If a baby actually contracts EOGBSS the treatment is IV antibiotics.

 

So do we need to prevent GBS in normal, healthy mothers & babies?

 

Much of modern treatment is focussed on preventing babies from picking up GBS at all by treating all mothers with a positive result with IV antibiotics in labour – the theory is to remove the GBS from the vagina at the time the baby passes through, therefore (hypothetically) removing the risk.

 

A stent will be placed in your hand (or you can ask for it to be placed elsewhere – wrist or arm where there is less bone is usually much more comfortable). This will be attached to a drip which will stay in place for the duration of your labour (at least 4 hours is recommended) This can usually only be done in hospital because of the risks, although some midwives are willing to do this at home during homebirths.

 

You can also ask for a bolus dose of antibiotics instead which only takes a few minutes and has the same effect – ask your midwife about this.

 

Will this treatment save my baby?

 

In short - no. Although this treatment has been shown to reduce the incidence of EOGBSS the same numbers of babies die from other bacterial infections and EOGBSS put together. This is thought to be

 

due to the adverse effects of mass antibiotic use creating virulent forms of antibiotic resistant bacteria.

 

What are the side effects?

 

  • Crosses placenta and enters baby’s bloodstream.
  • Babies born to mothers who’ve had the antibiotic treatment in labour and still get the disease have the antibiotic resistant form and are much more difficult to treat.
  • Increased risk of allergies.
  • Increased risk of cows milk allergy.
  • Killing the GBS seems to give other bacterium a head start. E-coli infections in newborns have doubled since the introduction of mass antibiotic use and 85% of these are antibiotic resistant.
  • Anaphylactic shock (mum or baby)– 1 in 10,000
  • Death from anaphylactic shock (mum or baby) 1 in 100,000
  • Labour becomes medicalised leading to possible higher rates of intervention and less satisfaction with birth experience.

 

 

Other Treatment’s

 

IV Antibiotics to baby straight after birth

 

This was once thought to be a good alternative if there wasn’t enough time for antibiotics during labour, however when ALL babies are treated with IV antibiotics (although incidence of EOGBSS is reduced) 40% more babies die. Therefore this should no longer be used.

 

If there was no treatment during labour your baby should be closely monitored for signs of illness and only treated if necessary.

 

Vaginal Douching

 

The vagina is washed with chlorhexadine, a disinfectant, during labour to remove the GBS and prevent transmission.

 

There is a small amount of data that shows this treatment does reduce the amount of bacteria passed to the baby but may not change the overall mortality rate. (very similar to the research outcomes for IV antibiotic treatment).

 

This treatment has fewer side effects and does not cross the placenta or cause antibiotic resistant bacteria.

 

 

Intramuscular injection of antibiotics at 35 weeks

 

There is not enough data to say how effective this is as a treatment, however if you are keen to have antibiotic treatment and do not have time during labour for the IV antibiotics this may be an alternative.

 

Side effects are the same as for IV antibiotics, it will cross the placenta and enter your baby’s bloodstream.

 

 

Herbal Treatments

 

Research studies are not carried out on herbal treatments so we don’t have data to say how effective it is.

 

You can use it alongside or instead of pharmaceutical treatments.

 

Herbal treatment works in two ways: Firstly by building up yours and therefore your baby’s immune systems from 32 weeks so your bodies are as robust as possible and able to either rid the GBS before the birth or allow your baby to be as strong as possible to fight any infection.

 

Secondly there are many natural antiseptic and antibacterial foods / remedies that can be taken or used in the vagina. These will help the body to rid the GBS and restore good bacteria to the vagina. See www.mothering.com for full herbal treatment instructions.

 

 

Probiotics

 

Are always good for you but especially good for during and after any antibiotic treatment as they replace the good bacteria that the antibiotics kill (antibiotics can’t tell the difference between good and bad – they kill everything). Steer clear of the sugary drink type and get some good ones on mail order look for 5 billion+ live bacteria.

 

 

Homeopathic Treatment

 

You can take a homeopathic nosode called ‘Haemolytic Group B Streptococcal’ which will remove the GBS from your vagina within 1 month. Again no clinical trials have been performed but there is excellent anecdotal evidence of the effectiveness. Homeopathy is completely toxin free and there are no adverse side effects. It can be taken alongside in combination with other treatments.

 

What Parents Say

 

‘I had to remain on the bed for most of the birth because of the IV and monitoring which was very much against my plan and the midwives were very aware of the time that I was birthing so I felt a bit like I was racing against their policies’

 

‘I think the biggest thing after birth was seeing such a tiny mite with a great big stent sticking out of tiny hand & being afraid of touching/catching/causing pain. The length of time I was separated from my newborn whilst they put the stent in (over an hour) was completely unexpected & unnerving. ‘

 

‘GBS is one of those things. I knew at the time that even with GBS, the chances of my son becoming ill from GBS exposure very very remote and also that labouring in water is still possible with GBS’

 

 

Further Support / Information

 

http://www.homebirth.org.uk/ - Even if you’re not planning a homebirth there is an excellent section on this topic and some birth stories involving GBS.

 

http://www.gbss.org.uk/index.php - GBS Support group – Mainly concerned with complete prevention via mass antibiotic use and uses resources to campaign for a mass screening program.

 

http://aims.org.uk/ - Association for Improvements in Midwifery Services – You will find good articles and information here.

 

http://www.rcog.org.uk – Royal College of Obstetricians and Gynaecologists – are responsible for setting guidelines for treatments.

 

http://www.homeopathy-soh.org/ - for more about homeopathy and where to find a practitioner.

 

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