Welcome back to episode 17 of Your Birth Bestie podcast! Today we are talking about GBS or Group Beta Strep, what it is, why it’s often tested for, what is treatment like if you’re positive and if it’s actually necessary, and then a few other pieces of information to know about as you’re navigating your own pregnancy.
And I wanted to give you just a quick background of my own personal experience with being GBS positive with both of my pregnancies and having hospital births.
With my first daughter… I was tested at 36 weeks, was positive, knew they recommended IV antibiotics during labor which required an IV on admission and I just went with the flow. But if you’ve listened to this birth story in episode 2, you’ll remember I was convinced to get a cervical check my my midwife at my 39 week appointment and then because I was almost 7cm dilated without knowing, I was rushed to labor and delivery for an induction and that meant antibiotics were given right away. Because we’ll talk about the recommendation of getting two doses of antibiotics in before baby is born, so that was all done right away without me really consenting to anything, that was just standard and I accepted it. So I went with the flow for sure with my first birth.
With my youngest, I had a lot more information but I have even more now, because of course we’re always learning from new perspectives, but I felt at the time, I made an informed decision, and planned for antibiotic treatment in labor when I was found to be positive again at 36 weeks, despite my efforts of taking probiotics to help reduce the risk. The antibiotics were started when I was admitted into the hospital again, but I was aware of the plan this time and felt comfortable with my choice. I talk about this birth story in episode 4, and I had agreed to an elective induction because I was 7cm dilated without labor starting even though I had mild contractions for weeks. If this was me today, I would have waited for labor to start, but in the moment I was good with this plan. So when I was admitted IV penicillin was started right away for GBS and I agreed for my water to be broken once the first dose was in.
But… when my water broke, labor went 0 to 100 and I was holding my baby just 45 minutes later. So, no time for dose number 2 of the IV antibiotics. It was an uncomplicated pregnancy and delivery, we were both healthy, it was great. But because I didn’t get the recommended 2 doses of antibiotics, I was told I could not go home for 48 hours, or really my baby wouldn’t be discharged for 48 hours… I had the most amazing birth experience and literally like 2 hours after she was born was ready to go, it was just that amazing post-birth endorphin high. But anyways… the pediatricians were telling me I had to stay for my daughter to be monitored because she didn’t get the antibiotics in utero so was at an increased chance of an infection and more about that later… but I was so irritated!
I knew the risks, I wanted to monitor baby at home as I was comfortable doing that, and I am grateful for having prompt access to emergency care if needed. So… I signed AMA or against medical advice to leave the hospital at 24 hours postpartum because I didn’t get full treatment of the antibiotics, but I was comfortable leaving. It was such a struggle leaving, I had several pediatricians come in to inform me and I’m sure it was a “cover your butt” kinda thing… but really was a lot. And I’ll talk more later about why I was comfortable leaving in my situation and how you have the decision to treat or not to treat and just really know your options and be in control of your baby’s health.
And I wanted to share this because the decision of treating GBS, just like making any other decision in pregnancy or during childbirth is uniquely yours. You can listen to what I have to share in this episode too, to best make the choice that you feel most comfortable with. Yes, I’ll share statistics that show testing ALL women and treating those that are positive with GBS with IV antibiotics is the “best” method for reducing the rate of newborns who develop GBS disease, which can be fatal, BUT even though that sounds scary, it is very very rare. So just like with every choice you make, I want to be sure you are informed and confident with the potential interventions in labor and feel empowered to have an autonomous hospital birth experience.
So, let’s start with what is GBS?
And this stands for group-beta strep which is a bacteria naturally found in the digestive and reproductive tract of both men and women, and it’s completely normal. It’s not an STD or an infection, and usually doesn’t cause any symptoms in pregnancy. About 25% of women are what we called “colonized” or positive with GBS during pregnancy when it’s screened for at the end of pregnancy usually at your 36 or 37 week prenatal appointment.
GBS is easily tested for with a swab at the opening of the vagina and rectum. It just takes a few seconds for your provider to collect the swab or you can do it yourself in the office if that makes you more comfortable.
After the swab is collected, you will have your results in about 48 hours after they see if the culture grows. The results are predictive for 5 weeks so if you have a history of preterm labor, you may be tested earlier and then of course if you’re tested right at 36 weeks and are pregnant past 41 weeks, you may be retested because that’s past the 5 week mark.
So you get your results… and you might wonder why do we care if they are positive or negative?
About 25% of healthy women will test positive for group B strep in pregnancy. And even though it’s normal and not dangerous to healthy adults with strong immune systems… baby’s are different and have immature immune systems and if infected can cause sepsis (infection of the blood), meningitis, or pneumonia. Without antibiotics, about 1% of these babies will become infected with group B strep, and of those, the infection is fatal in about 20% of those babies. So, if nobody was treated for group B strep, out of every 1,000 women positive for GBS, one baby would die. If you are positive and decide to be treated with antibiotics during labor, the risks to baby drops from 1% down to 0.2%.
Of course this sounds very, very scary but it is rare and usually in developed countries with proper monitoring and quick diagnosis and treatment, it is usually treatable, even though a NICU stay with invasive tests and treatment would most likely be necessary.
And with those risks, you have to consider if you’re okay being tested and if you’d be okay with treatment?
Just like with anything else, nobody can make you do anything… so it’s important you consider the risks and benefits and come to your own decision. If you test positive, your doctor will probably recommend that you receive IV antibiotics every 4 hours during labor, each infusion takes about 30 minutes… and the gold standard is to get at least two doses in before baby is born…. but this is hard to time right, because we don’t know when baby is going to be born and sometimes labor goes fast and that just doesn't happen.
Usually antibiotics are started around when moms reach 6 cm dilation and that is the textbook definition of active labor, or if the bag of waters is broken they would be started. And if a provider is breaking the bag of water as part of an induction process, antibiotics would typically be given before this procedure is done.
So this is what treatment looks like in the hospital setting, but it’s also not required. Antibiotics are a medication that can be accepted or refused, it’s up to you. Which means you need to ask yourself, “Would I rather antibiotics enter my baby, in one of the most crucial stages of their life to build up their gut microbiome, or lower their chance of infection from 1% to 0.2%.” Because yes, the antibiotics given in labor will hopefully decrease the GBS bacteria, but it will also get rid of a lot of the good bacteria that is so important for baby also.
But, if you do feel more comfortable treated with the antibiotics to limit the risk of infection from GBS, know that breastfeeding after delivery in that first hour of life and until at least 3 months will really help baby’s microbiome develop and improve their immunity and overall health. Any amount of breastfeeding or even feeding of colostrum those first few days is so helpful to line the gut with a protective layer that helps protect baby against future infections and diseases and also helps good bacteria grow to contribute to baby’s overall well-being.
But, what if you don’t get treated with antibiotics during labor? That might be planned or unplanned because labor went too quickly…
And what usually happens is the pediatrician will want you to stay at least 48 hours after delivery to closely monitor your baby. It’s between 12 to 24 hours after delivery when an infection typically begins to show signs and that’s why a longer stay is recommended. But they’ll be assessing the baby for signs of infection like fever, irregular breathing, and high heart rate.
In my own experience, I mentioned I left against medical advice at the 24 hour mark after talking with many providers. In my situation, I had a normal pregnancy and delivery, my baby wasn’t showing any symptoms of infection, she was full-term so greater than 37 weeks, I didn’t have any kind of uterine infection, my water was not ruptured for over 18 hours, so basic monitoring was all that was necessary. They weren’t doing anything for me or baby in those 24 hours I was there anyways, besides lactation helping me with breastfeeding… but I was perfectly comfortable going home and following up with my pediatrician a few days later.
And the last thing I want to talk about is how to reduce your chances of testing positive for GBS?
The fact is that there really isn’t strong evidence to say we can get rid of GBS colonization or prevent it, but taking probiotics may lessen your chances of testing positive. Side note: I started my probiotic as soon as I found out I was pregnant and still tested positive, so it didn’t work for me.
What we do know is that a healthy gut is important, so prioritizing a healthy diet of fruits and vegetables, incorporating garlic, and a probiotic early in pregnancy can help with digestion.
And with that, remember you have the right to decline anything in pregnancy or labor, whether that’s the GBS test itself or the potential treatment if you are positive. This is an individual decision based on your beliefs and risk factors and if this episode was helpful for you as you navigate this choice, I’d love if you would leave me a review! It is seriously the best way of supporting this show and would definitely make my day, knowing I could help you out! Take a screenshot of your review and submit it to me at bethconnors.com/review and I’ll send you a little gift of appreciation! Thanks so much for tuning in this week, bye guys!