This is an example of what you’ll find in my program Baby Making and Beyond and the kind of discussions we have together in our Virtual Midwifery Appointments

Group B Strep (Streptococcus agalactiae) is a bacteria that is part of our normal vaginal flora and fauna, which means it exists in all of our healthy bodies. At any given time about 30{4dd43735419885e2296c717ac798d5bb3483a708b4c1340b99a8b965668bd4df} of women will have it present in their vagina. If it is present at the time of birth it can cause some babies, read more about that below, to become sick. So what’s the big deal? In North America, it’s standard obstetrical practice to swab all women at around 36 weeks gestation to check and see if it’s present.

Studies have shown that 90{4dd43735419885e2296c717ac798d5bb3483a708b4c1340b99a8b965668bd4df} of women who swab positive at 36 weeks will still be positive at the time of birth if that timeframe occurs within 5 weeks of swabbing. If 5 weeks has lapsed between your swab and your labour, you should consider being re-swabbed. (AOM 2010) If you swab positive you’ll likely be offered antibiotics given to you intravenously aka IV, at the time of labour. Antibiotics given in labour are currently considered the ‘gold standard’ and most mainstream option for treatment. The antibiotic (usually Penicillin, unless you’re allergic) easily crosses from your bloodstream into the placenta and into your baby’s blood stream. This offers your little one some protection in the event that they become colonized by the bacteria. GBS infection is the leading cause of newborn sepsis (serious blood infection) in North America. That’s a big deal!

What are the stats

References

• Risk of testing positive for GBS 3/10

• Risk of colonization (aka spread to baby) of GBS to baby from a women who’s tested positive 5/10

• Risk of infection in a baby who’s had GBS colonized to them 1-2/100 (5-10{4dd43735419885e2296c717ac798d5bb3483a708b4c1340b99a8b965668bd4df} of these will be fatal)

• This means that in a group of 1000 untreated women, approximately 195 will be GBS positive, 98 infants will become colonized, and 1-2 will develop GBS illness

• Reduction of risk with antibiotic prophylaxis reduces risk however true reduction of risk is unknown. Studies on GBS in pregnancy have shown a significant reduction of risk but many of these studies were poorly executed and highly criticized which has left us without properly conducted research to base solid discussion. Because we know that GBS causes harm, we can’t really do any further research because it would be unethical so, we’re stuck navigating our choices based on the information we currently have.

Out of the colonized babies (the babies who got the GBS from their mom), 1-2{4dd43735419885e2296c717ac798d5bb3483a708b4c1340b99a8b965668bd4df} of infants actually became sick. Other studies demonstrated that 1 in 200 babies who didn’t receive antibiotics and 1 in 4000 who did receive antibiotics will become sick. However you look at it, there is a low probability that your baby will get sick. However, if this is your unlucky baby stats don’t mean matter in the least. A sick baby is a sick baby…..that baby will be receiving her own IV antibiotics for 10-14 days in hospital and will be fighting off a major infection right from birth, that’s a big deal. That being said, we don’t want to sugar coat the risk at all. GBS is a horrible illness that can cause an otherwise healthy baby to die, plain and simple.

Before reading this, I am NOT suggesting that you decline antibiotics here, BUT, these are two strategies that women have used when making their own informed choice about taking antibiotics in labour or even if they will swab to find out if they have GBS. As always, talk to your provider about your choices.

Different approaches to GBS swabing

and antibiotic use:

1. Universal screening approach:

   This approach means that you swab for GBS within 5 weeks of birth and treat with antibiotics if positive at the time of labour

   This tends to be the most popular and best researched option for prevention of GBS infection in your baby. It’s been shown to reduce the risk of developing GBS to babies by 65-86{4dd43735419885e2296c717ac798d5bb3483a708b4c1340b99a8b965668bd4df}

2. Risk based screening approach:

• In this approach, women don’t swab for GBS and ONLY give antibiotics if you develop a risk factor that increases the chance of a baby developing a GBS infection.

• This approach has been shown to reduce risk to about 60{4dd43735419885e2296c717ac798d5bb3483a708b4c1340b99a8b965668bd4df} of babies.

• This could be a good option for you if you have a history of FAST births under 6 hrs. In order for the baby to be protected with antibiotics, he/she needs to have two doses given 4hrs apart. If your labour isn’g going to be that long anyway, it may be worth considering this approach.

• Risk factors include:

• Having a fever in labour

• Having MORE than 6 vaginal exams in labour

• Having ruptured membranes (aka your bag of water has been broken) for longer than >12hrs – 18 hrs (the research is mixed in regards to time of membrane rupture).

• Preterm birth (before 36-37 weeks)

• Having a bladder infection caused by GBS at anytime during your pregnancy

• Having a previous baby who became sick with GBS

3. Combined method of Risk based screening PLUS swabbing for GBS:

• This approach combines the two options by swabbing for GBS and only treating with antibiotics if the swab is positive based on risk factors (listed above).

• Additional considerations should be made for African American https://www.nature.com/articles/s41372-018-0308-3.pdf?origin=ppub women. This one may seem odd but non hispanic black women are more likely to convert from GBS negative to GBS positive between doing the swab and giving birth so it would be reasonable for these women to always consider antibotics based on the presence of any risk factor in labour.

• This approach has shown to reduce risk to babies by 51-75{4dd43735419885e2296c717ac798d5bb3483a708b4c1340b99a8b965668bd4df}.

What you can do BEFORE birth to reduce the risk of being GBS positive:

How to theoretically prevent GBS from being present:

1. Nourish your microbiome. In vivo, probiotics have been shown to inhibit growth and adhesion of streptococci bacteria. Current studies are focusing their attention on two particular strains of probiotic, Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 (Lactobacillus fermentum RC-14). Lactobacilli are part of normal gut and vaginal flora and have been widely used as probiotics to treat various conditions. In particular, these two strains have shown to be beneficial in the treatment of urinary tract infections and bacterial vaginosis. Therefore, they may have a role in preventing vaginal colonization by GBS. The addition of a yeast based probiotics such as Saccharomyces boulardii can also help by feeding the good bacteria and starving out the bad.

   Probiotics are considered safe for use in pregnancy and are one of those things that will very likely ‘do no harm’. It’s estimated that 1 in 1-5 million women will develop an infection from probiotics making them a very acceptable risk. While there are anecdotal reports of the use of probiotics, as well as garlic suppositories and homeopathy for GBS prevention, currently there is no large-scale published research available to either support or reject the use of alternative remedies to reduce the incidence of GBS colonization in pregnant women at term. Meg recommends starting probiotics at the start of pregnancy and doubling the dose after 32 wks choosing a brand that contains the two strains mentioned (Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 (Lactobacillus fermentum RC-14) https://americanpregnancy.org/pregnancy-health/probiotics-during-pregnancy/

2. Avoid dairy products. In one Korean study, drinking milk (no meniton of other dairy products) 6+ times per week significantly increased GBS colonization rates in women

3. Intercourse AND more especially oral sex has been shown to increase the risk of swabbing positive. We don’t really know how long you should abstain, but given GBS has a 6 week lifespan, I believe it would be about 6wks before you swab (from 30 wks-36wks) for it to be worth doing. I know!?!

   If you swab positive, in addition to taking probiotics consider:

   • Talking to your provider about reducing unnecessary vaginal exams. This could, in theory push the bacteria upward towards your baby once your water has broken. If you’re delivering at a teaching hospital and are GBS positive, remind the staff that you’d like to limit all exams to ones that are only 100{4dd43735419885e2296c717ac798d5bb3483a708b4c1340b99a8b965668bd4df} necessary (aka no student then attending exams). It’s quite normal to expect 1 vaginal exam about every 4-hrs once you’re in active labour.

   • Talking to your provider about having your waters artificially broken, unless medically necessary. This reduces the time your baby is exposed to ANY pathogen.

   • An Apple Cider Vinegar Bath– 2-3 times a week take a bath with ⅓ a cup of ACV. Some midwives also recommend drinking it 1tbs/daily as a tonic towards the end of pregnancy.

   • Garlic suppository: Take a clove of garlic and score it with a knife. Wrap it in sterile gauze and insert nightly into your vagina for 7-10 nights. Make sure you take it out EVERY morning and replace it each night with new garlic and sterile gauze. Although scientifically, this has shown to have no evidence for efficacy, it can’t hurt and many women swear by it. Garlic is a natural antibacterial.

   • Pleo not (Notakehl) : this homeopathic remedy made from the fungus Penicillium chrysogenum can be a bit hard to track down but is used to treat staph and strep infections. Meg has seen a number of clients ‘treat’ gbs and re-swab 2-3 weeks later only to find that they have become GBS negative.

   KEY POINT

   Being GBS positive is not the end of the world!

   You can still have a home birth (if your midwife can prescribe and give antibiotics), you can still have a water birth. If your water breaks before you’re at the hospital or place of birth, call your provider to talk about a good time to make your way in to get your antibiotics. It’s not an emergency, just something to consider in the grand scheme of your labour

If you did receive antibiotics during birth, learn how to prevent thrush and nourish your babies microbiome in our upcoming BIRTH module…….but also consider this…

In a recent 2018 study (Combellick et al 2018) , the microbiome of babies was studied. What they found was SHOCKING! There were no major differences between the microbiomes of babies who were exposed to antibiotics in labour and those who were not. The biggest factor that altered the gut bacteria was PLACE of birth. Babies who were born in hospitals were much more likely to have an altered gut flora vs babies born at home. This study was small but it does give us a bit of food for thought and may help give you some peace of mind if you do require antibiotics in labour. If you’re both healthy, it may be in your best interest to head home as soon as you’re cleared to do so. In Canada, with midwives, that’s usually about 4hrs after delivery.

Have more questions about GBS? Leave your comments below

UPDATE: I followed all my advice and swabbed negative for GBS. Perhaps just coincidence but also, perhaps not!

SOURCE: Meg the Midwife – Read entire story here.