Not a catchy title, huh? It's a test that all pregnant women are offered around 36 weeks. I'm not going to lie to you, it's not my favorite topic, mostly because I don't like how it's handled, regardless of where you are giving birth. I've been doing a lot of research on GBS lately. Allow me to share my findings.
What is Group B Strep, or GBS?
Group B Strep, or GBS, is a bacteria that lives in the intestines, urinary, and genital tracts of many healthy people. It is generally not serious in adults, but can be life-threatening to a newborn. Most adults do not have symptoms, but occasionally will develop an infection, such as a bladder infection or urinary tract infection.
Testing:
The Center for Disease Control (CDC) and the American Congress of Obstetricians and Gynecologists (ACOG) recommend that all pregnant women be screened between 35-37 weeks of their pregnancies to determine if they are carriers of GBS. The pregnant woman's vaginal and rectal areas are swabbed during the screening. According to The March of Dimes and the CDC, approximately 25% of pregnant women are found to be colonized with GBS.
Treatment:
If found positive, antibiotics are administered through an IV during labor. Ideally, antibiotics are given at least 4 hours before the birth. Oral antibiotics given before labor begins has been found to be ineffective, as the bacteria reproduces very rapidly. To date, the only proven strategy to protect a baby from early-onset GBS is IV antibiotics.
Two types of Group B Strep:
1. Early-onset GBS: Can cause pneumonia, sepsis, or meningitis. Symptoms include fever, trouble breathing, and drowsiness. Symptoms often begin on the first day. About half of all GBS infections are early-onset. Babies who develop early-onset GBS are more easily treated than late-onset GBS.
2. Late-onset GBS: Usually begins between 7 days and 3 months of age. Symptoms include fever, coughing, congestion, trouble eating, drowsiness, or seizures. Treatment of antibiotics during labor does not prevent late-onset GBS. After birth, baby can get GBS from other people who have the infection. Babies who develop late-onset GBS are not easily treated and are more likely to die. At this time, there is no prevention for late-onset GBS.
If left untreated, the chances of a baby developing a GBS infection (born to a GBS-positive mother) is 1 in 200. If the mother does receive antibiotics in labor, however, the odds are 1 in 4000 of the baby developing GBS.
There are three significant risk factors that place a GBS-positive woman at risk for her baby developing Group B Strep:
1. Fever during labor
2. Prolonged rupture of membranes (PROM) - water is broken 18 hours or more prior to delivery
3. Pre-term labor (PTL) - labor begins prior to 37 weeks
If a woman tests positive (or does not know if she is positive or not) and does not receive antibiotics during labor, her baby will receive antibiotics after he/she is born.
Written by Donna Ryan, Birth Boot Camp. Adapted from:
GBS Prevention in Newborns, Centers for Disease Control and Prevention, http://www.cdc.gov/groupbstrep/about/prevention.html, May 7, 2012.
Group B Strep Infection, March of Dimes, http://www.marchofdimes.com/pregnancy/prenatalcare_groupbstrep.html, March 2010.
What I Think:
Now that the facts are out of the way.... I've seen this handled so many different ways, and to be honest, they all make me feel kinda yucky. The CDC is working on a vaccine for GBS, so more options will likely one day be available to pregnant women.
If a woman is having her baby in the hospital, this is pretty cut and dry. If she tests positive, she'll have antibiotics in labor. If she has her baby before she has time to have a full round of antibiotics, they'll treat the baby with antibiotics.
But what about the woman birthing outside the hospital? I've seen several women told to follow a certain regimen so she will test negative at 36 weeks -- tricking the test, in my opinion. Like mentioned above, if GBS is present, it will grown very rapidly. I've also seen a number of women prescribed a "vaginal wash" which does not necessarily kill the Group B Strep but does reportedly kill the beneficial bacteria in the vagina. One of the benefits to a baby being born vaginally is being exposed to that beneficial bacteria.
You should be able to have antibiotics, however, regardless of where you are having your baby. Check with your care provider on her protocol.
I've written about my personal feelings about antibiotics here before. I'm not a fan unless truly required. The GBS symptoms in a baby with early-onset GBS are pretty clear, pretty quick. The antibiotics given in labor will not prevent a baby from developing late-onset GBS. With that being said, you still cannot ignore the numbers. The use of antibiotics during labor in a woman who tested positive for Group B Strep significantly decreases the chances of her baby developing Group B Strep.
Personally, I was never tested for Group B Strep with any of my pregnancies. Knowing what I know now, maybe I would have been. If I would have tested positive, I can't say what my choice would have been. And I'm not about to tell you what your choice should be. The numbers quoted by the CDC and March of Dimes are lower than what I've read elsewhere. Some areas of the country report as high as 40% of women test positive for GBS.
Talk to your care provider and to your partner. As with everything else, do your research. Make an informed decision. If you are planning an unmedicated birth, this is but a blip on the radar. Not a big deal, just something to be aware of and plan accordingly.
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