Did you know you needed to have a swab of your vagina to your anus when you hit 36-37 weeks pregnant? Not everyone knows about this test and what it is for!
Let’s break down what GBS even is, and how you care may change if you turn out to be positive for GBS!
What is GBS? Why do we test for it?
Group Beta Strep is a normal bacteria that can be found in all our bodies, it lives in our gut and genital and comes and goes. It usually does not cause any issues for us, but if it invades our body it can cause some severe infection.
During pregnancy it can over grow and possibly cause severe issues for baby if they are born and contract the bacteria.
When and how is GBS tested?
GBS is tested at the 37 week appointment routinely in most US clinics, if this comes back detecting GBS on the swab you will be considered GBS+.
Sometimes they will find GBS in urine cultures done earlier in pregnancy and will consider you GBS + for delivery. They consider you GBS + if its found it in your body at any point during pregnancy to include the GBS test. This is because researchers have found that those who have GBS in their urine earlier in pregnancy are much more likely to still be GBS + at 37 weeks.
The test can be self collected or provider collected (which ever you prefer) It is a sterile swab of the vagina down the perineum and slightly into the anus. This is then sent for testing and takes 48 hours to return.
Learn more about your birth options and common prenatal tests in our childbirth education courses!
How and when do they treat GBS?
When you are GBS + the typical treatment is IV antibiotics during labor. The goal is to receive the first dose of antibiotics greater than 4 hours prior to delivery.
Why during labor? It was found that although GBS levels decreased when antibiotics are given, it quickly regrows and increases before labor begins.
The preferred antibiotic is Penicillin, if you are allergic to penicillin there are other options available to include clindamycin, vancomycin, or even ampicillin. The best practice when someone is allergic to Penicillin is to get a sensitivity culture done so they are treating the GBS with an antibiotic that will actually work against it!
Types of GBS Infection in Newborns
The types of GBS Infection differ from how they are acquired and when the symptoms appear. BUT their prevalence is the same. According to the CDC in the US in 2018, Out of 481,632 births (in the reported area not the entire US), 930 babies were diagnosed with Early Onset Infection and 1050 babies were diagnosed with Late Onset Infection.
Early Onset Infection
- Occurs within the first 7 days after birth, showing symptoms as early as 1 hour after birth. Most symptoms will appear by 1-2 days after birth
- Caused usually by direct transfer from birthing person to baby when they were GBS+, suspected that the infection occurs while baby is still in the womb
Late Onset Infection
- Occurs after 7 days of life
- Most of the time not due to GBS status of birthing person, but acquired after birth (This is why hand washing and limited who visits and touches baby is important!!)
Risk factors for Early GBS Infection in Baby
Now there is no way to know for sure what babies will develop GBS infection if you are GBS+, but there are risk factors that seem to increase the likelihood. If these are present, there is a higher likelihood of GBS infection.
- Preterm birth (before 37 weeks)
- Prolonged Rupture of Membrane
- Pre-labor Rupture of Membrane (PROM)
- Chorioamnionitis
- Fever during labor
- First time birth
- GBS in urine previously
- Internal Monitoring (Intrauterine Pressure Catheter or Fetal Spiral Electrode).
Even if these are not present though, there is a chance baby could still develop GBS infection.
Can you decline Antibiotics? Risks and Benefits
You can ALWAYS decline anything!
If you are not wanting to get antibiotics during labor for GBS + that is your choice, and you have every right to make that choice!
Discussing how your care may change based on your declining the antibiotic could be helpful in your decision.
Some hospitals will want you to stay longer to be observed if you do not get the antibiotics (similar to those who do not arrive in time to get the antibiotic before birth).
Here are some risks and benefits of both choices:
Getting Antibiotics Risks:
- Short-term effects on baby’s microbiome in their guts, most resolved by 1-year-old, if not sooner (the effect was lessened when baby was breastfed)
- Increased risk of developing a yeast infection (both birthing person and baby)
- Allergic Reaction to the Antibiotic (rare)
- Needing to have an IV and being connected to the IV Pole for the duration of the administration (freedom of movement may be limited)
Getting Antibiotics Benefits:
- Baby’s risk of developing a serious life-threatening infection is 80% less so only a 0.2-0.4% chance
Not getting Antibiotics Risks:
- Baby has a 1-2% risk of developing a serious life-threatening infection
Not getting Antibiotics Benefits:
- No effect on baby’s microbiome
- Less likely to develop a yeast infection
- Potentially more freedom of movement due to no need to be attached to an IV Pole
- Birth is less medicalized
Risks if baby get’s infected:
- Long NICU stay
- Long-term health and development issues (developmental delays, hearing loss, or paralysis to name a few)
- 4-6% chance of death
Alternatives Options??
Getting Antibiotics Risks:
- Short-term effects on baby’s microbiome in their guts, most resolved by 1-year-old, if not sooner (the effect was lessened when baby was breastfed)
- Increased risk of developing a yeast infection (both birthing person and baby)
- Allergic Reaction to the Antibiotic (rare)
- Needing to have an IV and being connected to the IV Pole for the duration of the administration (freedom of movement may be limited)
- Retesting after using probiotics
- One randomized control trial showed that you could potentially treat GBS by using probiotics for 3 weeks, specifically lactobacilli. It was 100% effective, but it’s an option to try!
- Chlorohexadine (hibiclens) during labor instead of antibiotics
- This is a topical disinfectant that kills bacteria on contact, Hibiclens has an anti-GBS effect of 3-6 hours when used vaginally.
- Research does not support the use of this for GBS treatment because it has not been proven to prevent GBS infections in the newborn in the few studies done, more research is needed.
- If antibiotics are not available, then this could be a suitable option if baby is also wiped down with it at birth per one study.
- This does not prevent the transfer of GBS to baby when the water has been broken
- There is the risk of irritation and pain at the vagina because the hibiclens is hard on the skin, similar to soap.
Can You Prevent Being GBS +?
More research is needed but based on a few studies it seems promising that taking a Probiotic, specifically lactobacilli, during pregnancy may decrease your likelihood of being GBS+ at delivery.
GBS was one of the things i worried about during my first pregnancy until I got my negative result. It seemed like a silly thing to worry about because the risk is really soooo low of it affecting baby either way.
My midwife and my mom both told me to eat lots of fermented food like kimchi or yogurt to prevent GBS infection, so i did eat a lot of kimchi and yogurt and I was GBS negative with my first…but i think it might have been coincidental.
With my second pregnancy I was afraid of GBS because I was delivering at a birth center this time and if baby displayed symptoms of GBS we were not in the place to treat it quickly! I took Needed‘s Pre-Probiotic throughout my whole pregnancy in hopes I would be GBS -, and I was…but again could have been just a coincidence!
Learn more about pregnancy and childbirth in our Childbirth Education Offerings here
