GBS - Group B Strep
What: Group B Streptococcus- a common gastrointestinal bacteria found in the large intestine of approximately 10% to 30% of people.
The issue: When there is an imbalance of bacteria and the person becomes ‘colonized’, the GBS has migrated from the large intestine to other parts of the body: rectum, vagina, bladder, throat. Most people are unaware of being GBS colonized. In some people GBS colonization can cause bladder infections.
A person who is ‘colonized’ 50% of the time passes GBS to the newborn who then becomes a carrier. 1%-2% of these newborns develop a GBS infection and will need antibiotics and may have long term effects from the infection. Of the 1-2% of babies who become infected it will be fatal for 2-3% of them. We are looking at small numbers but they sure feel big if they happen to someone we know.
Being a carrier of GBS is common. GBS infection is a rare but serious complication.
Prevention: a healthy gut helps keep GBS in check. Eating fermented foods (to encourage the bacteria we want in our gut), reducing processed foods (to not feed the bacteria we don’t want in our gut) and / or taking a good probiotic can help with gut health.
Increasing chance baby will be colonized with GBS: (mom must be colonized first)
GBS positive in urine test in pregnancy
Delivery <37 weeks gestation
Amniotic membrane rupture >18 hours
Previous baby w/ GBS infection
Intrapartum temp >100.4f >38c
Chorioamnionitis - infection of the chorion
Mom with previous GBS infection
What GBS infection can look like in an infant: 90% occurs within first 24 hours after birth
Sometimes babies become infected while in utero - even before waters are open
Abnormal temp
Not interested in feeding
Lethargy
Irritability
Breathing problems
High pitched cry (meningitis causes skull pressure)
Pallor or cyanosis
Early onset vs Late onset of GBS
Early Onset - 90% occurs within the first 24 hours. Current research shows the majority of babies with a GBS infection will show symptoms of the illness within the first 1-2 hours after birth and the rest typically become sick within 48 hours and up to the first week of life.
Late Onset - 7 days to 3 months. Babies can come in contact with GBS in the hospital or from someone at home and develop an infection.
A GBS swab test is offered at 36 to 38 weeks of pregnancy. GBS colonization can ebb and flow, though it is believed that the results of a swab are likely to stay the same for the following five weeks. No guarantees.
Your GBS Testing Choices
No testing, then monitor the baby for signs of GBS infection.
Test with a vaginal/anal swab. If positive, choose from the below options.
People can swab themselves or I can help. The applicator looks like two long q-tips. The very end of these ‘q-tips’ is inserted into the vagina and are swirled, trying to get the edges of the vaginal. Then these swabs are dragged lightly down the perineal and then the very tip is inserted into the anus. These swabs are placed in the plastic vessel included and will be tested at the lab.
Positive GBS Test Choices - There is no wrong choice. Each family decides what is best for them.
Wait and Watch : no antibiotics, monitor baby for signs of infection
Risk Based Approach : Antibiotics with risk factors only
Antibiotics in labor : every 4 hours in active labor
In depth on each option when the test is positive
Wait & Watch: no antibiotics in labor and we monitor you and baby for fever or any signs of a GBS infection in the baby. 95% of the time symptoms of early onset GBS infection occur within the first 48 hours.
Signs: Abnormal temp, lethargy, breathing problems, persistent fast heart rate, high pitched cry, irritability, poor breastfeeding, pallor coloring.
Risk Based Approach: Antibiotics with risk factors only. If any of the following risk factors are present then antibiotics are administered every 4 hours. If there are signs of infection, including maternal fever, then transfer to the hospital is indicated (which is true, even without GBS). The risk based approach is thought to reduce GBS infection from 1-2% to 0.5%.
Risk factors: Birth before 37 weeks, amniotic membranes ruptured 18 hours or more, temp of 100.4F or higher. GBS positive in urine test. Previous baby with a GBS infection.
Antibiotics in labor: This can be usually done at home or at the hospital. Penicillin or ampicillin are typically used. If the client is allergic to these we will culture the swab to know which antibiotic would be most effective and not cause an allergic reaction.
An IV saline lock is placed and antibiotics are administered intravenously in active labor every 4 hours. For the best effect, antibiotics should be administered 4 hours before birth, with slightly less effectiveness between 2-4 hours before birth. Antibiotics are not 100% effective, however they do reduce GBS infection down from 1-2% to about 0.2%.
You are the best person to make this choice
I would like to reiterate that with all of these choices you’re offered, there is no wrong choice.
We’re all doing the best we can to make choices with the information we have while taking into account our lived experience, the beliefs we hold and our family’s needs. Every situation is unique. The choice you choose today may be different from what you chose in the past and may choose in the future. That’s okay.
My goal is to provide helpful information, choices and resources for further learning.
Resources for further study
Probiotics and Group B Strep: what do we know so far? by Dr Sara Wickham
Group B Strep in Pregnancy and birth. What’s a mom to do? by Aviva Romm
Evidence on Group B Strep by Evidence Based Birth
