Group B Strep

 

Prevention–of Infection And Needless Treatments

Preface:  We consider Group B Strep because US medical maternity-care providers see it as a threat to birthing mothers and especially babies.  Women planning a hospital or birth center birth will most likely be tested during pregnancy for GBS; if testing positive, mother and baby are likely to face treatments for the prevention of GBS infection.  If you plan a homebirth, but transfer to the hospital, medical staff will apply customary GBS routines to your care.  Any family may have to deal with medical routines for GBS, so you need to know about the medical protocols surrounding it.  Here I’ll give parts of the ‘GBS story’ that families won’t hear from medical staff, to help you make informed decisions. 

 

Introduction: Group-B Streptococcus is a common bacterium, living in us, our homes and general environment.  GBS lives inside the bowel, bladder, and/or vagina of some women (estimates vary from 5-30%of women), though most have no symptoms and are essentially ‘GBS carriers’.  They are healthy enough that their systems are able to keep GBS  in check—low colony-numbers pose women no problems.  Some who carry GBS in the bladder have repeated Urinary Tract Infections (UTIs), though not always; various factors play a part in UTIs.  So, GBS is only seldom a problem for women, but some babies exposed to it during birth develop an infection.  More rarely, women get GBS infections during birth.  GBS infection is most often curable with antibiotic treatment; still, it is fatal for a very small number of babies. 

Some babies are more likely to get sick than others—and those with more than one of these risk-factors, are the most likely to get sick if exposed to GBS or other pathogens in their mothers, or the environment:

~ Babies born before 37weeks: premature babies are not always ready for life on the outside, and are more vulnerable to many issues including infections of all kinds.

~ Babies born after rupture of the amniotic waters for more than 18hrs, and doctors/nurses perform vaginal exams.  Risk of infection rises between 18-24hrs of first vaginal exam, especially if done before active labor has started; the more exams performed, the higher the risk for infection. 

~ Small babies at any gestational age: babies less than 5lbs are sometimes like premies, less ready for life on the outside, more vulnerable to problems including infections.

~ Babies born to mothers with infections of any type, especially infection of the amniotic sac or uterine lining: because then baby is directly exposed to mother’s pathogens.   Evidence of maternal infection is a fever of 100.4 (Fahrenheit) or greater; discoloration or foul odor of amniotic fluid can point to infection of uterus or chorioamnion (bag of waters); infection may be GBS or ‘other’. 

 

Testing and Treatment: Women who plan hospital births are tested around 36 weeks gestation by vaginal-rectal swab, cultured for GBS in their bowel or vagina.  Some doctors also culture women’s urine for GBS, but usually only in women who suffer UTIs (‘Culturing’ means intentionally growing organisms.  The provider inserts a swab into vagina and then rectum, or dips it into mother’s urine, and then swipes it across a special growing plate to transfer body fluids to the dish.  Lab techs place the plate in conditions that encourage the fast growth of organisms present; after 2 days, they examine it for GBS).  Any woman who has tested positive for GBS in pregnancy is treated as if she still carries GBS at birth, even though GBS is known to come and go in roughly 4-week cycles.  Nurses will give her IV antibiotics during labor as ‘standard precaution’, to kill the GBS before the baby encounters it while moving down toward birth.  Further, hospital staff is likely to perform precautionary tests and treatments on the baby, to make sure s/he is not infected.  They might draw baby’s blood to check for signs of infection, possibly give baby IV antibiotics in the NICU while awaiting lab results, and may give a spinal tap to look for GBS in baby’s cerebro-spinal fluid.  If a woman refuses GBS testing, she and her baby are usually treated ‘as if GBS positive’ in these ways.

 

Benefits, Risks & Sorting Available Information: Some babies get sick in spite of preventive antibiotics.  Also, maternal antibiotics during labor give no benefit to babies who get sick after they are born, from germs in the environment.  Without evidence of maternal infection during labor, it is difficult to pinpoint the source of newborn infections.   When GBS-positive mothers receive antibiotics during labor, fewer full term babies get sick–but if your baby gets infected, antibiotics can then be given and are most often are effective.  Of every 40,000 babies born, about 2,000 will get a GBS infection–with or without preventive antibiotics–and only 1 will die.  So, while antibiotic treatment of laboring mothers lowers the total number of GBS infections, it does not save more lives on the whole.  Further, preventive antibiotics may cause more deaths—because while there are fewer newborn GBS infections, there are more antibiotic-resistant e. coli and other infections for newborns and mothers alike: our antibiotic overuse causes mutation of ‘superbugs’ that are more deadly, as well as being harder to kill than the original forms of organisms.

The above statistics come from the US Center for Disease Control and Infection (CDC), which generates statistics from information on birth certificates.  No one controls the information placed on birth certificates and the CDC does not verify it.  So, a birth certificate may state that a newborn was ‘treated for infection’.  That baby may have been healthy—but ‘suspected infection’ was treated while hospital staff awaited test results.  Tests may eventually show no infection after all, but the birth certificate says ‘treated for infection’ so the CDC records it as a ‘GBS infection’.  Also: in some cases, true infections may have come from the hospital environment, not from the mother, but this is not noted.  Further, some infections come from other pathogens, not specifically determined by tests; hospitals may assume ‘GBS infection’, when it was another pathogen—perhaps one found mainly in hospitals, such as Group D strep.  Given this margin for error, and the assumptions made by medical staff as well as CDC technicians, we are most wisely skeptical of CDC findings about GBS.

There is no research available on GBS and homebirth. The CDC gathers information for statistics mainly from hospital births because in the US, only 1-2% of families give birth at home.  According to my informal survey of homebirth midwives in 2008, many homebirth midwives have never seen an infected newborn.  There are many possible reasons for this, but numerous studies show: far fewer mothers and babies suffer infections from planned homebirth, than in the hospital.

 

WomynWise Comments:  Our awareness of the potential for infections in mothers and babies at birth, and our use of infection-prevention methods, are helpful to preserve mother/baby safety (and there are many ways to naturally help prevent infections).  However, US medical understanding of GBS is illogical: GBS does ‘come and go’; there is no way to know if a woman is carrying it on her birthing day.  Thus, an unknown number of women are given needless antibiotics in labor—even though we know antibiotics have many possible adverse effects.  Also, after the rupture of amniotic sac, risk for infection increases greatly between 18 & 24 hrs after the first vaginal exam performed.  Vaginal exams can even cause the rupture of membranes.  GBS normally lives in the lower part of the vagina; the examining hand pushes GBS and other organisms up into the cervix/uterus.  With the membranes broken, these germs can easily find their way into the bag of waters when they might have stayed safely away from baby.  Yet medical staff performs vaginal exams repeatedly after membrane rupture.  Additionally, hospital born babies are usually taken to the nursery or NICU for ‘newborn routines’, testing or treatments, even if apparently healthy.  There, we expose babies to a huge number of germs living on surfaces and carried by staff or other babies–including GBS, Group D Strep and other dangerous pathogens found mainly in medical institutions.  Going to the nursery can elevate your baby’s risk of infection greatly.  With all this in mind, it is hard to see logic–or improved safety– in medical protocols for GBS.

In Great Britain, on the other hand, GBS testing is not done in pregnancy–nor do doctors routinely give antibiotics to laboring women.  They instead keep an eye on mother/baby signs of health or problems developing; they also consider the risk factors (on 1st page) in managing labor.  If a mother’s water is broken for many hours, then a mild solution of hibiclense is used as a rinse/low douche of her vagina during labor, to kill GBS if its present, before the baby descends (hibiclense is chlorhexidine, an ‘antiseptic’—used on human tissues to kill germs).  Repeating this rinse/douche every few hours until birth is a gentle way to prevent infection, that has few adverse affects for mothers and babies.  Antibiotics are only used when there are signs of infection, or if mother/baby present other risk factors.  This protocol seems to me safer and more sensible than US GBS protocols, and GBS statistics from the UK bears this out: they see no more GBS deaths than the US does. 

 

GBS-testing and Homebirth: I strongly recommend GBS testing during pregnancy for homebirth mothers.  With simple, due precaution, GBS will only rarely pose a surprise problem for otherwise healthy moms and babies–so testing is not recommended for ‘medical reasons’.  But GBS testing can help families avoid problems at the hospital if you transfer care during or after your birth.  Women and babies of ‘unknown (untested) GBS status’ are treated as if they are carrying GBS in the hospital, potentially in all the ways I’ve described.    However, if you enter the hospital with a record of a negative GBS test, you can avoid many tests and treatments for mom and baby, along with avoiding much separation-stress for the whole family.  GBS testing is a sort of ‘insurance policy’, giving families a better chance of care that is as natural and non-interventive as possible in your circumstances.  If you test and are GBS-positive, there are natural methods, along with over-the-counter treatments, to build your immune system and reduce or wipe-out GBS colonization (reducing GBS colonies, reduces chance of infection).   One way and another, it is possible to achieve a GBS-negative test or re-test.  There are also hygiene measures, and other health-promotion measures, for families and midwives to use during pregnancy, birth and the first postpartum weeks to lower risk of infection.  You can prepare yourself: understand GBS and make choices for a safer homebirth, or easier hospital transfer if needed.

http://www.gentlebirth.org/search.html  enter ‘group b strep’ to get to page of links–very thorough resources here

http://www.unassistedchildbirth.com/forum/viewtopic.php?f=2&t=233  register first, great forum and resource!

http://www.medscape.com/viewarticle/542430_4

http://www2.cochrane.org/reviews/en/ab007467.html

http://www.cochrane.org/reviews/en/ab000115.html

http://rixarixa.blogspot.com/2008/01/gr … ation.html

http://www.moondragon.org/mdbsguidelines/strepb.html

http://www.hpakids.org/holistic-health/ … up-B-Strep

http://www.mothering.com/treating-group … -necessary

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