If you have been told that you are Group B Strep, you may be upset, you may think that your baby is in danger. You may have been told that you have become ‘higher risk’ and may be concerned that your hypnobirth is out of the window. This isn’t the case, Group B Strep only rarely causes complications, it’s not routinely tested for in the UK and many thousands of women probably go into labour completely unaware that they have it. In fact, just because you are positive 4 weeks before labour starts does not mean you will have it during labour, likewise a woman who tests negative 4 weeks before labour may have it when she goes into labour. GBS can come and go.
Understanding the research on GBS, can help you make an informed decision. 10-20% of women are colonised with GBS, colonised is not the same as having an infection. A large majority of women do not go on to have an infection, although the presence of GBS may in some cases trigger pre-term birth or infection in the baby. If you have GBS there is a 50% chance your baby will be colonised, but only 1-2% of developing infection. If you took a sample of the population and tested them for Strep A in their throats, many people would have it, but without any infection.
If you’ve been diagnosed with GBS you will be advised to come to the hospital to have IV antibiotics 4 hours before your baby is born. First of all this is difficult to judge, as a doula, I wouldn’t be able to judge when to get a women into hospital 4 hours before her baby was born, and would err on the side of caution by getting her in earlier, if her choice was to have IV antibiotics. This means that most women end up in hospital far to early, which puts them at risk of further interventions. If you are planning a home birth it may be even more devastating to be told that you can’t have a home birth. Some hospitals also say that you can’t have a water birth.
But wait! You do have options. While some hospitals don’t ‘allow’ water births others do. In fact, research has shown that birthing in water may actually decrease the risk of transmission by up to 300% and in a study of 4,432 water births, not one baby showed early onset GBS and only 1 showed infection. Remember you can birth at your hospital of choice, so if this is something you want then find a hospital that will support this or talk to your supervisor of midwives. If you want a home birth this can still be an option, you can go into hospital and have the antibiotics then return home. Some home birth teams may be happy to administer antibiotics at home although this is unusual and you will have to have discussed this with your Supervisor of Midwives (SOM). Or, you can choose not to have IV antibiotics during labour and instead choose what is known as ‘expectant management’. This means that they will watch baby very closely for the first 24 hours for signs of any infection. You can also choose to birth at home and be transferred in afterwards if you would like the midwives to monitor your baby more closely.
If you have GBS your baby is higher risk if any of the following apply
- Preterm babies (especially before 35 weeks, but also before 37 weeks)
- Mother having a fever during labour (by far the riskiest category)
- Prolonged rupture of membranes – over 18 hours
- GBS found in the mother’s urine, not just the vagina
- Mother having had a previous child with GBS disease
- Rupture of membranes before 37 weeks
Another factor to consider is the research contraindicating the use of antibiotics in newborns. While many studies have found that giving antibiotics during labor to women who test positive for GBS decreases the rate of GBS infection among newborns, research is beginning to show that this benefit is being outweighed by increases in other forms of infection. A study, which examined the rates of blood infection among newborns over of six years, found that the use of antibiotics during labor reduced the instance of GBS infection in newborns but increased the incidence of other forms of blood infection. A study of 43 newborns with blood infections caused by GBS and other bacteria found that, when the mothers of the ill newborns had been given antibiotics during labor, 88 to 91 percent of the infants’ infections were resistant to antibiotics. It is unlikely to be a coincidence that the drugs to which the bacteria showed resistance were the same antibiotics that had been administered during labor.
Things you can do to reduce the risk of infection
- Stay at home as long as you can, if you go in and have the antibiotics then feel you are in too soon, ask to head home again.
- Minimise vaginal examinations or anything other interventions that can introduce infection higher in the vagina
- Explore the option of a water birth
- Resist having your waters broken, they protect baby and once they are broken the risk of infection increases
- Breastfeeding, skin to skin and baby on breast. Colostrum has excellent antibiotic properties you can give you baby
- Monitor your temperature
The Mindful Hypnobirthing Approach to Group B Strep
Talk to your supervisor of midwives about keeping as close to your original birth plan as possible
Recognise you do have choice and do your research, make a decision that feels right for you. Know the benefits and risks
Listen to you affirmations daily and stick with your hypnobirthing practice, it will help you whatever happens
If it means a hospital birth instead of a home birth learn how you can create an oxytocin rich environment unconsciously
Research and Further reading
Evidenced Based Birth have a well researched article.
Article written for Mothering Magazine
Association for Improvement in Maternity Services article on GBS