Group B Streptococcus and Pregnancy
This information sheet may be confusing, boring or frightening but you do need to read it and discuss it with me later.
Group B Streptococcus is a bacterium that is the leading cause of bacterial infections affecting the fetus, the newborn and the mother in the United States today. At the time I write this report, about 12,000 cases of newborn infections are reported annually. This bacterium is associated with several different complications in pregnancy and childbirth. Infection of the membranes or water bag which surrounds the baby can cause preterm rupture of the amniotic sack and preterm labor. It can cause serious infection to the baby and the mother before, during and after birth. These infections can cause death or life-long disabilities. Screening tests for GBS are routinely done by maternity care providers. It is important that you understand what this is about so you can make informed choices for you and your baby.
Medical science is finding new information about Group Beta Strep all the time and the recommendations regarding this bacteria and pregnant women changes regularly. Modern medicine has not been very successful when it comes to dealing with GBS but the goal is to minimize the risks to mothers and babies as much as possible. No one can promise that the current treatments will prevent illness, death or disability due to GBS. The purpose of this report is to help you understand why GBS is a hot topic and why you need to be thoughtful when you make decisions about testing or treatment.
GBS lives in about 5-40% of pregnant women's bodies. It is carried in the rectum, the vagina, the cervix and the urinary tract. When a woman carries these bacteria she is said to be "colonized." She may have no symptoms of illness because, most of the time, she is not "infected." Many potentially unfriendly bacteria live on our bodies all the time but our immune systems keep them under control most of the time. Knowing where a woman contracted GBS is not possible. It is like asking where a woman contracted yeast. It is here with us all the time and it sometimes overgrows.
We can calculate that about 15% of all babies will be born "colonized" with GBS. The "attack" rate or infection rate is low and it is reported to be from .6 to 4 per 1000 live births. Of these infected babies, the mortality rate can be as high as 50% and long-term health problems remain for many babies as well.
Which babies are the most vulnerable to infections is not clearly understood. We know that there are several risk factors associated with infection. Prematurity, low birth weight, maternal fever, and premature membrane rupture for longer than 12-18 hours are factors indicating a greater risk of neonatal infection. Any baby exposed to medical procedures which invade the body may have a greater risk of infection. A woman who is receiving multiple vaginal exams in labor may be at increased risk of becoming infected with GBS or transmitting GBS to her baby. Premature babies have a much higher death rate with GBS but 75% of GBS babies are full term. A full term baby with no risk factors is not immune to GBS.
There are two basic categories of GBS infections in a baby. "Early onset GBS" presents with symptoms within the first week following birth. The first 48 hours is the usual time to see symptoms which may show up as respiratory distress or septic shock. This infection can be mild to severe. It can become very serious very quickly so it is treated aggressively when it is suspected or confirmed.
"Late onset GBS" shows up after the first week of life. It often presents with symptoms of meningitis. The death rate is usually lower for late onset infection but up to 50% of babies who develop meningitis develop neurological problems that are ongoing. Late-onset GBS may also present as localized infections of the middle ears, sinuses, eyes, breasts, lungs, bones, joints, and skin. Late onset GBS may come from the mother but it is also contracted in the hospital environment transmitted by members of the staff. This is called "nosocomial" transmission.
GBS can also infect a woman during and after birth. She may show signs of a high fever within 12 hours of delivery. She may have tachycardia (fast heart rate), abdominal distention and inflammation of her uterus and pelvic area. A GBS urinary tract infection shows with fever, chills, uterine tenderness, pain with urination or bladder urgency.
Standard medical treatment for GBS in a mother or baby is Penicillin or Ampicillin. It is delivered by IV or an injection in the muscles to a woman in labor if she is colonized, if she is in a high risk category or if she shows symptoms of illness. It is given to a newborn by IV for about a week if symptoms are present or lab tests suggest risk. This means the baby will have to stay in the hospital in order to receive the antibiotics.
Medical professionals believe that revention of transmission of GBS is difficult to do before labor. When a woman is known to be colonized she could receive treatment and clear up the GBS but it could come back the next day. Doctors believe the best way to prevent GBS infection is with prophylactic antibiotics in labor for those women who are colonized with GBS or if a woman is in an extra risk category; for example, her membranes have been ruptured for many hours and labor is not progressing. Alternative health practitioners and medical professionals in other countries believe it is possible to eliminate or reduce the threat of GBS bu using simple dietary and vaginal rinsing measures. I will address those measures later in this report.
Routine screening of women for GBS is the medical model’s recommendation. It is done at the 36th week of pregnancy. A care provider takes a Q-tip swab of the vaginal/rectal area, places it in a culture tube and sends it to a lab where it is either positive or negative for GBS. Those women who are positive for GBS who are planning a hospital delivery will receive IV antibiotics as soon as labor begins and receive repeated doses every four hours.
A woman planning a home birth can also receive antibiotics during labor. Her midwife can administer them to her in labor at home. It can be given as a shot in the muscle or delivered IV for 30 minutes every 4-6 hours as needed.
Medical practitioners know that treating all GBS positive women with antibiotics seems inefficient and foolish, given what we know about the dangers of overusing antibiotics. They also know there are side effects such as allergic reactions that women and babies are subjected to "just in case." This treatment has not produced excellent results and some studies make it look like it may not be worth doing at all; but, for now, it seems that it is the best that medicine can offer.
Some home birth people are not convinced that the threat of GBS is real enough to automatically comply with the routine screening or the treatments. It is confusing to look at the statistics and FEAR for the life of one's baby after reading terrifying literature is difficult to mesh with intelligent decision making. It may take you some time and you may need to do your own research before you decide.
Alternative health care practitioners will suggest other ways to guard one’s self from potential bacterial threats. Keeping the immune system functioning strong and avoiding unnecessary procedures such as excessive vaginal exams are good goals to have. There is a discussion of these methods at the end of this report. The research on these methods is not happening in the medical setting in our country that I know of. Pharmaceuticals are the popular and accepted approach to the threat of disease. More is being studied in Great Britain. Anecdotal reports of success cannot be a reliable way to evaluate the effectiveness of a treatment for all. People interested in alternative health therapies will have to steer their course in a way that makes them most comfortable
Symptomatic UTIs and vaginal infections should be discovered in prenatal visits and it is important that you report any suspicions you may have. Men and women will pass GBS back and forth with sexual contact, so it is important that a woman know the sexual habits of her mate when she evaluates her risk factors. If a woman has had her water bag break early in other labors she may want to take the GBS factor more seriously during pregnancy when it comes to keeping her nutrition and lifestyle in great form.
As a midwife, I have seen people deal with this matter in different ways. Some women follow the protocol recommended by the doctors. They screen at 36 weeks and get antibiotics to use in labor if they are positive. Some women do not do the test at all and keep focused on maintaining good health and avoiding those things which will increase their risks. Some women treat themselves with natural remedies as though they have GBS whether or not they were tested. They may take prophylactic herbs and other therapeutic products daily in pregnancy and/or hourly in labor. Some women are so anxious about GBS they do the antibiotics and the alternative methods. Each woman and her family will need to choose a course which seems best for them.
Several of my clients (6-10) in the last 15 years gave birth to babies who were treated for "possible" infections. These babies may have had a symptom of respiratory distress or some other problem that we transferred to the hospital for and treatment was instituted before there was confirmed infection. All of these babies showed signs of colonization but not always with GBS. Antibiotics were always used, whether infection was the main problem or not. Nearly every baby that spends time in the hospital after a home birth will receive antibiotics prophylactically because the risk of getting an infection in the nurseries is great. As far as I know, none of my mothers or babies has had serious side-effect problems from the antibiotics. All the babies recovered from their problems except one. This baby died at 4 days of age. It was never determined in the laboratory or by autopsy that the baby died of infection but his presenting clinical picture appeared to be that of septic shock and collapse within hours of his birth. "Presumed sepsis" was the official opinion about this baby. The mother had been screened negative for GBS and did not fall into any other risk category. Her baby was full term and labor and delivery were uncomplicated by ruptured membranes or other risk factors. His death was a tragic puzzle for us all.
I have assisted other midwives clients and many of my own who did fall into risk categories (prolonged ruptured membranes, fever, etc.) but who did not suffer illness in themselves or with their babies.
Fear of Infection seems to create a lot of stress for us all but it doesn't happen very often to my home birth families. When it does happen to a family, though, it can be a matter of life and death. It is extremely important to them. I cannot and will not tell a family the best course to take. There are pros and cons to every option. Some treatments will be politically correct and you will not be criticized for taking advantage of them and some treatments will be considered "quackery" by the dominate culture. When we come up with a great answer for the GBS issue, I'll let you know and we'll celebrate. For now, let's make a plan that is right for you.
CDC updates on line: http;//www.cdc.gov/ncidod/diseases/bacter/strep-b.htm
Alternative Therapies for the Reducing the Threat of GBS Infection
GBS seems to originate in the intestines. Alternative health practitioners recommend that healthy bacteria be richly supplied to crowd out the hazardous bacteria. Acidophilus and other live cultures can be supplied to the body in yogurt or other cultured milk products. Capsules of mixed live cultures can be taken several times a day. These are referred to as “probiotics.” Garlic in all forms seems to kill strep bacteria and is delicious. It can also be taken in lager doses as a supplement. Grapefruit extract (such as “Nutribiotic”) can be used orally as well.
Vaginally, colonies of strep can be reduced by inserting a clove of garlic, rinsing with white vinegar and water, rinsing with betadine or hibiclense and water or using an herbal rinse with Echinacea. There is a vaginal suppository product made with herbs which is specifically targets GBS.
Rinsing the peri-anal area after bowel movements will reduce the amount of bacteria that can move up into the vagina. Antiseptics such as vinegar, betadine, hibiclense or herbs can be mixed with water and kept in a squirt bottle in your bathroom near your toilet. The antiseptics can also be poured over wipes and used after bowel movements.