This page is also available in PDF – GBS Information Sheet from the Corpus Christi Birth Center
If you wish to read more detailed information about Group B Strep (GBS), we recommend you start with this link: http://evidencebasedbirth.com/groupbstrep/
This information is provided as a quick reference that includes the Corpus Christi Birth Center’s recommendations and protocols.
“Group B strep lives in the intestines and migrates down to the rectum, vagina, and urinary tract. All around the world, anywhere from 10-30% of pregnant women are “colonized” with or carry GBS in their bodies (Johri et al. 2006). Using a swab of the rectum and vagina, women can test positive for GBS temporarily, on-and-off, or persistently (CDC 2010).”
10-30% of all women are “colonized” with GBS. – The good news is that that means 70 – 90% of women are not colonized. And furthermore, most women who are colonized with GBS will never have any symptoms, will never have an infection and they will give birth to normal healthy babies. That’s the good news.
So why are we concerned about GBS?
We are concerned because even though the percentage is small, babies still die from GBS infections that they get from their colonized mothers during pregnancy or birth. There are two types of GBS infections: early and late onset. This document will focus only on early onset GBS infection of the newborn because it is early onset that comes through the colonized mother and because there are things we can do to help prevent this from occurring. Late onset is another topic and has more to do with transmission of GBS after birth. GBS colonization of newborn is not the same as GBS infection. But a GBS infection is life-threatening to a newborn, especially when it occurs prior to birth. Our aim is lower your baby’s risk of infection with as few interventions as possible by using a holistic approach.
How will you know if you are colonized and at risk?
At CCBC we screen for GBS two ways. We test your urine at the beginning of your pregnancy and at the end. We also do a swab culture of your vagina and perineum around 36-37 weeks gestation. If GBS is found in your urine it is because you already have a GBS infection and you will need to be seen by our consulting physician.
If GBS is found only in your vaginal area at 36-37 weeks, this tells us that you are colonized but it doesn’t necessarily mean you have an infection. If your urine was clear, your risk of becoming infected is much lower than if your urine is positive. However, because you are colonized, you and your baby are still at risk of infection.
Here are some Numbers for You to Consider
Out of the 10-30% of women who are colonized at the time of birth; up to 2% of them will have babies who develop a life-threatening GBS infection. That 2% can be lowered to as low as .2% with treatment. Of the women screened for GBS at 35-36 weeks, 17% who tested positive will actually be negative at the time of birth and 9% of the women who tested negative will actually be positive at the time of birth. We test between 36-37 weeks at CCBC.
How will you be treated if you are positive for GBS?
Our first line of defense against GBS at Corpus Christi Birth Center is a good offense which we will come back to that in a minute. But first let’s talk first about what we do when you happen to test positive for GBS.
If GBS is found in your urine, it is because you are already infected. So you will be referred to our consulting physician for antibiotic treatment during your pregnancy. Your baby will also be considered at a higher risk for getting a GBS infection and so we recommend IV antibiotics during your labor to lower his/her risk. The severity of this risk will be assessed by our consulting physician and this does not necessarily mean you will be risked out of our care. But it does mean we may have to obtain a prescription from him to use antibiotics during your labor.
If GBS is only found in your vaginal area at 36-37 weeks but your urine is clear, you will be given three options under our care. Each option has its own set of risks and benefits. We encourage you to weigh out all the known evidence and make a careful informed choice in the matter.
Option 1: Follow CCBC protocols for consideration of increased risk factors (see chart) and treat with Chlorhexadine (aka Hibiclens) vaginal washes every 4 hours during active labor, transporting for a hospital delivery if membranes are ruptured more than 12 hours and/or if maternal temperature ≥ 99.5. (See our handout on the research behind this protocol.)
Option 2: Follow CCBC protocols for consideration of increased risk factors (see chart) and treat with IV Antibiotics during labor (this will require a physician’s prescription), if membranes rupture after labor begins, you will be allowed to labor as long as you are making progress and as long as there are no signs of infection such as maternal temperature ≥ 99.5 or elevated maternal or fetal heart rate. If membranes rupture prior to the start of labor, you may be required to transport sooner if labor has not naturally begun within 12-18 hours.
Option 3: Follow CCBC protocols for consideration of increased risk factors (see chart) but refuse any treatments, transporting for a hospital delivery if membranes are ruptured more than 12 hours and/or if maternal temperature ≥ 99.5. This is NOT our recommendation. But we will respect your right to make this informed choice if this is your preference.
But Our FIRST Defense against GBS is a Good Offense!
We want to take a holistic approach: So how can you lower your chances of becoming colonized in the first place?
Unfortunately, there has not been as much research in this area as we would like. Most of the research so far, has focused on screening and how to lower the risk for the baby of the mother who is already colonized. But if there is a way to lower your risk of becoming colonized in the first place, why not start there?
To do that, we need to first look at where GBS begins. It starts in your intestines. So it is logical to assume that having a healthy gut would be very important if you want to prevent GBS colonization and infection. We know from research that both antibiotics and probiotics kill GBS. We also know that taking antibiotics kills healthy bacteria along with the GBS while taking probiotics only increases the healthy bacteria in your gut.
At CC Birth Center, we recognize that antibiotics are sometimes necessary and they can even mean the difference between life and death in certain situations. We also recognize that the current research on GBS supports the use of antibiotics to lower the risk of GBS infection; yet by comparison, there needs to be additional research on treating women with probiotics before we will know how well it does or does not work.
So our current approach is to use probiotics to help prevent colonization in the first place. We screen all women at 36-37 weeks and use the more aggressive treatments if the woman tests positive. We believe our approach offers a good balance and is still a more holistic way to care for our clients. We are not against the use of antibiotics. We just prefer to do what we can to avoid needing them in the first place.
So let’s consider this fact. A healthy gut has plenty of healthy bacteria. We know that healthy bacteria strongly inhibit the growth of GBS. There is research to back this up. We could write a whole paper on how to increase healthy bacteria in your gut. But keep in mind that a healthy diet is vital to a healthy gut: avoiding processed foods, especially sugar, is very important. But you can also help the process along by taking a good probiotic (lactobacilli) supplement. So we ask all our clients to take a probiotic supplement during pregnancy and to avoid processed foods, especially sugar.
Lower your Other Risk Factors: Statistically speaking, we already know that some women are more likely to become colonized with GBS than others. So if you could make any changes that would take you out of these risk categories, it would be worth knowing them and considering what you can do to change your risk where possible. We have listed all the risk factors for colonization mentioned in the article sited above for your consideration. Obviously, you won’t be able to change your race or your age. But we hope you will consider our comments and recommendations in the second column on the other risks because we believe they could lower your risk.
|Risk Factors for GBS Colonization||CCBC Comments/Recommendations|
||Obviously your race and age is nothing you can change. It is doubtful that genetics has much to do with this elevated risk. Whether or not cultural considerations have an influence on this statistic is not mentioned in the research but might be worth considering.|
|We recommend against the use of tampons by anyone. Tampons have been linked to Toxic Shock Syndrome, menstrual cramping and other symptoms, as well as this link to GBS.|
||Wash your hands frequently, especially after a bowel movement. Along the same line, it is best to always keep your underwear fresh, clean, and dry.|
|It is important to understand that men also can carry GBS in their urinary tract (without any symptoms of colonization). For this reason, GBS could be transmitted to the woman during intercourse. The more sexual partners you have, the higher your risk would be that you would have intercourse with a colonized male. So having only one partner lowers your risk.Because we know there are many benefits to healthy sexual relationships during pregnancy we don’t recommend abstinence unless you are at high risk for preterm labor. What we do recommend is for women to practice “clean” sex. So we recommend the practice of washing the penis prior to sexual intercourse to reduce the risk of spreading GBS from the male to the female. We know Chlorhexadine (aka Hibiclens) kills GBS. So using a solution of Chlorhexadine is even more likely to kill GBS.Because GBS is most likely to reside in the intestinal tract, we recommend avoiding anal sex during pregnancy, especially anal sex followed by vaginal sex.We recommend that women bathe daily and always wipe front to back after going to the toilet to avoid bringing GBS bacteria from your rectum up towards your vagina.We also recommend against the practice of male-to-female oral sex during pregnancy because of the related risk to the colonization of GBS.|