Group B Streptococcus has many names: Group B Strep, GBS, Strep B. It is part of the normal bacteria found in the intestinal and/or reproductive tracts of about 20% of healthy people in Vancouver. Under normal circumstances it is part of the balanced system of gut flora that does not cause disease. It is not associated with bad hygiene, nor is it sexually transmitted. GBS may come and go in people’s bodies, so having had it previously does not mean you have it now.
If you have GBS in your vagina when you give birth, your baby obviously will be exposed to it. Most of the time this is of no consequence. In fact, of those babies who are exposed only 50% will become carriers of GBS – i.e. they will have GBS on their skin or in their system.
But about 1 in 200 babies who are exposed to GBS will develop a systemic infection. Symptoms can include fever, irritability, trouble breathing or lethargy. These babies will need hospitalization and IV antibiotics. Further, of those who do get sick, for 1 in 20 this infection will be fatal. Babies that survive, particularly those who have meningitis, may have long-term problems such as hearing or vision loss, or learning disabilities.
Most GBS infection will be obvious at birth or within the first 24 hours, but can develop anytime within the first week. (This is called early onset GBS infection. There is also a late onset GBS disease that begins after the first week, but this is caused by transmission after birth.)
In summary, out of 4000 babies exposed to GBS:
2000 will become carriers …….. 2000 will not become carriers
20 will become sick …………….. 3980 will not get sick
1 will die ……………………………. 3999 will survive
The following risk factors multiply by 10 the chance of your baby getting sick:
Currently, the community standard is to test women at 35-37 weeks (which is a cotton-swab or “Q-tip” sample from your vagina and anus that you can do yourself). This swab is sent to the lab to be cultured and usually takes a 2-3 days to get results.
The test is done at the end of pregnancy because GBS bacteria can be present in your body temporarily. Testing within 5 weeks of your due date has been shown to be the most accurate way to determine your status at the time of birth.
Having an IV inserted can be uncomfortable or painful, and the plastic IV catheter in your arm can be somewhat annoying in labor.
Long term effects on baby of early antibiotic exposure are not fully researched.
There are no other treatment alternatives that have enough data for us to know whether they are effective.
Some parents may wish to avoid antibiotics, and will request an alternative approach to treatment with antibiotics where 1) they are found to be a GBS carrier, and 2) they develop any of the risk factors mentioned above which make it ten times more likely that the baby will get sick. This approach was based on a previous standard of care before universal testing and treatment for positive status was adopted.
The short answer is yes! We can easily administer antibiotics at home once you are active labor.
In the general population, there is about a 1 in 10,000 chance of having a severe allergic reaction requiring emergency treatment to these antibiotics, which is considered extremely rare. If you have a strong history of antibiotic allergies (i.e. a higher chance of having an anaphylactic reaction), your midwife may discuss the option of doing at least the first dose in the hospital.
The best strategy is to boost your own immune system by being as healthy as you can manage. Daily exercise and nutrient-dense food is always a good idea! Additionally:
