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Thursday, 12 April 2018
Knocked up.....Now what? GBS testing (Group B Strep)
Towards the end of your pregnancy (normally between 35 and 37 weeks) your Doctor will want to put another line on your bill and expose you to the worry of yet another test result...GBS.
What is GBS?
Group B Streptococcus or Group B Strep or GBS is a bacteria that resides in peoples intestines. It can move down our bodies into our urinary tract, rectum and/or vagina.
Why do I need to know about GBS?
It is usually harmless in adults (although not always, for more information see www.mayoclinic.org) but can cause serious illness in newborn babies. It has been cited as a major cause of meningitis, pneumonia and sepsis.
GBS can pass to your baby during a vaginal delivery and this is the primary reason why healthcare professionals carry out the test before finalising your birth plan. GBS can also sometimes (although rarely) impact conditions such as endometritis after delivery and if exposed, can increase the risk of infections to a C Section wound.
How do they Test for GBS?
It's a very simple, painless, swab of your vagina and rectum. It is worth noting that you can test positive and negative at different times in your life so being negative for one pregnancy, does not mean you are necessarily low risk for another pregnancy. This is why it is also important to have the test close(r) to your due date.
What if I test Positive?
In Thailand you will probably be "encouraged" to have a C Section. This way they feel that they can control and prevent the potential spread of the bacteria.
BUT in many other countries you would instead be put on a course of antibiotics during your labour (important to note that this is during labour, taking them before giving birth is pointless as they are fast growing bacteria...tricky little buggers)
If you do decide to have a C Section then antibiotics aren't normally necessary, as long as the amniotic sac is intact at the start of C Section.
It is important to highlight here that you should have the choice. In general (with no other complications) a positive GBS test does not pose you with only one option. You Doctor should discuss this with you clearly, and provide you with information to make an informed choice.
If I plan upfront to have a C Section do I still need a GBS test?
Opinions differ on this. You could go into labour earlier than your planned C Section, and is this case you may wish to be prepared just in case you are GBS positive and didn't know about it. But some countries do not routinely check for GBS (UK for example) so you may feel confident to decline the test.
What are the chances that I have GBS and will pass it on to my newborn?
"All around the world, anywhere from 10-30% of pregnancy people are "colonised" with or carry GBS in their bodies"
"If someone who carries GBS is not treated with antibiotics during [vaginal] labor, the baby's risk of becoming colonised with GBS is approximately 50% and the risk of developing a serious, life-threatening GBS infection is 1 to 2%"
PLEASE REMEMBER that being colonised does not mean that there is an infection necessarily "most colonised babies stay healthy"
"On the other hand, if someone with GBS is treated with antibiotics during [vaginal] labor, the risk of their infant developing an early GBS infection drops by 80%. So for example, the risk could drop from 1% down to 0.2%"
How bad is it if my baby gets a GBS infection?
"estimated that the death rate from early GBS infection is 2 to 3% for full terms infants"
"Death rates...are much higher (20-30%) in infants who are born at less than 33 weeks gestation"
Ongoing intensive care and long-term health problems may also be a consideration assuming infant survival.
Considerations with antibiotic use
"Although rare, severe allergic reactions have been reported. The risk is estimated to be 1 in 10,000 for a severe reaction, and 1 in 100,000 for a fatal reaction."
"IV antibiotics have been shown to cause a short-term negative effect on the infant’s microbiome; however, most infants will experience a recovery of their microbiome, and this recovery is enhanced by breastfeeding."
"There is an increase in the risk of maternal and newborn yeast infections, which can harm the breastfeeding relationship. In one study, 15% of women who received antibiotics in labor had mother-baby yeast infections (maternal nipple and infant mouth infections), compared to 7% of mothers who did not have antibiotics"
"Other potential harms have to do with side effects related to the antibiotic that is used....but keep in mind that most of the serious risks are rare"
"The potential medicalization of labor and birth"
"If you use the antibiotics, you will have an IV placed, but it only takes 15-30 minutes for the antibiotics to run in. The antibiotics are only given every 4 hours until birth, which for many people is only once or twice. When the IV is running, it should not limit positioning, walking, or even laboring in water. For the hours in between, parents can ask for the IV can be “hep-locked” or “saline-locked” and detached, so that you are free from the IV pole....For low-risk, healthy pregnant people, it is a very reasonable request to ask for the IV to be hep-locked or saline-locked in between antibiotic doses."
If you decide to not have the antibiotics (or cannot for some reason) then under normal circumstances babies are closely observed but not necessarily tested for GBS.
Are there alternatives to Antibiotics?
Yes, but I have not found any that are truly recommended by healthcare professionals.
Your main alternative is to opt for a planned C Section, but please note that this is not a light decision to make.
From the reading I have done, and the professionals I have spoken to, I get the distinct feeling that in this instance Antibiotics are in the majority recommended throughout the World.
If you feel like you are being pressured into a C Section, and true consideration has not been given to your questions about antibiotics use instead, then I would strongly recommend reconsidering your choice of Doctor. Any Doctor that is not willing to assist you, within the realms of possibility, best practice and mother and baby safety, is not the Doctor for you.
GET INFORMED, GIVE TRUE CONSENT
Occasional Science & Sensibility contributor Rebecca Dekker of Evidence Based Birth wrote an amazing blog article about Group B Strep from where I have gleaned most of my knowledge, all credit should go to her for the content of this blog post. To read Rebecca’s article in its entirety, click here.