What is GBS??
What is GBS? GBS stands for Group Beta Strep, a bacteria many of us have in our gut, as a part of our microbiome. The microbiome is a HUGE part of our immune system and its response to pathogens.
Is GBS an issue for YOU?
Most of the time, We have this symbiotic relationship with the GBS–it does not affect us; it doesn’t make us sick. If you do have any symptoms of GBS, such as if it did overgrow outside of pregnancy, you might have UTIs. But usually, you do not have any issues if you are GBS positive.
Those of us who have GBS outside of pregnancy with no issues. Still, during pregnancy, this bacteria can overgrow and travel down to the vagina and anus, which is concerning because your baby comes out of your vagina for most of us.
When is GBS a concern?
GBS can be a concern if we have a decrease in our immune system response. When babies are born, they do not have a fully developed immune response. If you are GBS+ toward the end of your pregnancy, it can potentially transfer to your baby at birth. This could potentially lead to a GBS infection in baby and require a NICU stay for baby.
What is the ACTUAL risk of your baby contracting GBS disease at birth?
It’s not 100% that your baby will contract GBS if you are GBS +!
If you are untreated (you don’t get antibiotics) , there is a 1 to 2 percent chance that your baby could develop what is called early-onset GBS disease.
The babies that do develop early-onset GBS, could progress to death or they could have long-term neurological deficits or developmental issues, and a long NICU stay. Not every baby that develops early-onset GBS will progress to this point, though!
But this is one to two percent of the untreated population.
If you did get antibiotics, the risk of developing early-onset GBS disease drops by 80 percent.
If you do receive antibiotics during labor, there is around a 0.2 to 0.4 percent chance that your baby could develop early-onset GBS disease.
People are usually on one-side of the spectrum.
You may be wondering, why are we going to give all these people antibiotics if there is a 98-99% chance that these babies are NOT going to develop this disease? Antibiotics are not without side effects.
But, on the other spectrum, why wouldn’t you get antibiotics if you could decrease your risk of your baby getting this disease with the severe outcomes that could happen? Why wouldn’t you take the antibiotics? So, there are different views on the treatment of GBS during labor!
It is important to note that the choice that YOU make during your pregnancy and birth can be different than someone else when presented with the same risks.
Let’s explore more reasons why you may or may not want to be treated if you are GBS +!
Did you know that we offer an online childbirth education course? In our online course, we discuss your options and why/why not you may opt for specific birth options. Our goal is to help you make the best decisions for YOU without judgment and bias. What you decide for yourself and your family may be different than what we or anyone else may choose in the same situation, AND THAT IS OKAY!
If you want to feel empowered making decisions in your birth, check out our online course!
Universal Screening in the United States: Why??
In the 1970s, around one and a half to two babies were developing this disease, and they were trying to figure out how to decrease this number because it was like one and a half out of 1, 000 births. This may seem small, but it’s a pretty substantial number of babies that were getting this illness. And remember, early-onset GBS disease can progress to some long-term complications, potentially losing the baby.
There are two screening methods for GBS during pregnancy, depending on your country.
- Risk-based approach
- Universal approach
Each country may do a different approach, but in the United States, we do the universal screening.
In the universal approach, you are tested for GBS around 36-38 weeks of pregnancy. GBS goes through roughly a five-week cycle. It may fluctuate if you are or are not GBS positive, so testing this close to your due date can more accurately determine if you will be GBS + at birth.
With the universal approach, you know who is and isn’t positive for GBS generally at birth, which allows you to decide for your birth on whether or not you should be treated.
In other countries, they may do a risk-based approach where if you have risk factors, they will test you for GBS.
Some risk factors could include:
- Prior GBS + urine culture throughout pregnancy
- History of GBS disease in a baby
- If your baby is preterm (before 37 weeks)
- Prolonged rupture of membranes (your water has been broken for more than 18 hours)
- Developing a fever during labor
In comparison, countries that do the universal approach (the United States) have lower rates of early onset GBS in babies (.2-.4%) while countries that do the risk-based approach have a higher occurrence (.5%).
What are you treatment options if you are GBS +?
If you are GBS +, the common recommendation is to be treated with penicillin at least four hours prior to birth. Research has supported that penicillin during pregnancy does not prevent the regrowth of GBS, so the treatment is exclusive to labor.
During labor, if you opt for antibiotics, you will receive a dose every 4 hours until birth.
The first dose is usually the largest dose–which may mean it’s usually the most uncomfortable. The first dose normally takes the longest (about an hour) while subsequent doses will take closer to 30 minutes.
My doula clients usually report that when they are receiving antibiotics it burns at the site of their IV. Some things that may help with this is applying a warm compress to the site, having the nurse dilute the antibiotics with more IV fluids, or they can slow down the rate of the antibiotic. These can all help with the comfort of the infusion.
Another option to is adjust the type of antibiotics you are receiving, but typically this is only done if you are allergic or have a sensitivity to penicillin.
One concern with receiving antibiotics is feeling tethered to the IV pole and concern that it will impact your freedom of movement. This is especially relevant if you want a low intervention or unmedicated birth! The good news is, you do NOT need to maintain a teether to the IV pole when you are NOT receiving any antibiotics. You can ask to be detached so you can freely move.
Secondly, the IV pole can move! You can unplug it and it should maintain a charge for some time so you can move around freely with this pole in tow.
How can you mitigate the side-effects of antibiotics?
There are things that you could do to offset the side effects of antibiotics!
Breastfeeding can help to further develop your baby’s microbiome back to normal. Additionally, taking probiotics could potentially help, but it still takes some time for that to rebuild after getting antibiotics.
What are reasons people decline antibiotics?
Antibiotics come with side effects. Penicillin is what we would call a broad-spectrum antibiotic. It doesn’t differentiate the different types of bacteria, such as the “good” bacteria and the “bad” bacteria.
Within our bodies, we have both good bacteria and bad bacteria. The good bacteria are within our guts–it makes up our microbiome, which is a big factor in the immune response. Penicillin can decrease the amount of good bacteria, that’s in our body and could increase our likelihood of developing other sorts of infections due to the microbiome being disrupted.
A very common thing that people will get after getting antibiotics is a fungal infection, such as thrush or a yeast infection. Which can also apply to your baby! Your baby’s microbiome can be impacted by your intake of antibiotics, which could increase their risk of developing thrush and could impact their gut microbiome for up to a year postpartum.
Additionally, the overuse of antibiotics within the healthcare system is a concern because this increases the likelihood of having antibiotic-resistant bacteria. Eventually, a lot of bacteria will be resistant to the medicines that we have, which could lead to people getting sick and potentially dying from preventable or curable diseases that we used to be able to cure with antibiotics.
If we’re giving all of these people antibiotics when the likelihood of developing GBS in their babies is pretty low, is this an overuse of antibiotics? And for some people, it is viewed as an overuse of antibiotics.
The biggest reasons some may decline antibiotics?
The impacts on the gut microbiome for both you and baby, and the overuse of antibiotics.
What other options do you have with GBS treatment?
Some alternative treatment options can include:
- Hibiclens
- Garlic
Hibiclens
Hibiclens has been shown to be effective at decreasing the amount of GBS for three to six hours.
However, Hibiclens can sting when applied and dry out the skin in the perineum which may increase your risk of tearing. Hibiclens formerly was used routinely during pushing, but they found that there was also an increase in perineal tears at birth.
Garlic
Garlic was shown to decrease the amount of GBS in a petri dish. Not been tested on humans, so don’t come for me if you try garlic because it has not been tested to be effective against GBS in actual human bodies!
Garlic is supposed to be good for your microbiome, so maybe that’ll just decrease your risk of GBS, altogether.
Questions to ask your provider about GBS!
One source of anxiety with being GBS+ is trying to figure out WHEN to go to your birth location so you can receive antibiotics with enough time before birth. This is especially hard for someone who wants to labor at home for as long as possible. And can be challenging for someone who’s water breaks before they feel ready to head to their birth location.
Some good questions to ask your provider can include:
- What is the common treatment for GBS in my birth location?
- What are my options if I decline antibiotics? Some hospitals may recommend staying an additional 24 hours postpartum to monitor you and baby if you decline antibiotics, for example.
- If I am GBS+ and my water breaks, when do you recommend I come to the hospital? What is the risk of laboring at home after my water has broken?
- If I am GBS+, and my water is not broken, when do you recommend I come to the hospital?
- What happens if my baby is born within the 4 hour window of receiving antibiotics? How will our care change after birth?
- Can I receive a dose of antibiotics, then leave to go labor at home until I feel ready to come labor at the hospital?
The common recommendation is to head to your birth location if your water has broken and you are GBS+ because this could increase the likelihood of your baby developing early-onset GBS disease. The amniotic fluid sac acts as a barrier between the outside world and your baby. But, when this barrier has broken, there is a risk of ascending transmission, where GBS travels into the uterus and potentially affecting the baby. Remember, one of the risk factors of GBS disease is your water being broken for a prolonged period of time (typically defined as 18+ hours).
If your water breaks and shortly after your baby is born, this could decrease the likelihood of your baby contracting early-onset GBS disease.
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