Pregnancy may feel overwhelming at times: in addition to balancing work and rest, connecting with your baby and nesting vigorously, your prenatal care is full of routine tests and procedures set in place to ensure the wellbeing of the baby. When it comes to prenatal testing, in my doula practice I feel strongly about the birthing woman to always have options: these tests are merely a recommendation, an offer, not a necessity or a guarantee of a healthy pregnancy. This article explains one of the standard tests and help you explore alternative options when it comes to GBS testing and treatment.
What is Group B Streptococcus?
Group B Streptococcus (GBS, also known as Streptococcus agalactiae) is an organism commonly found in normal intestinal and vaginal microbiome. It is present in 20-40% of adult population, both male and female, during their lifetime. According to Group B Strep Support UK, carrying this bacteria is considered normal and healthy and is not associated with additional risks to the carrier. While GBS can be transmitted through skin contact or intercourse, it is neither a sexually transmitted disease nor a sign of poor personal hygiene.
What are the risks associated with being GBS+ in late pregnancy?
While GBS poses virtually no risks to a healthy adult, the concern is that during the birthing time the bacteria will be passed on to the baby who may get colonized with GBS. Out of those babies, a small percent of newborns could develop early onset GBS sepsis, pneumonia or meningitis.
According to Evidence Based Birth, “In 1993-1994, the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics recommended screening all pregnant women for GBS and treating GBS-positive women with intravenous (IV) antibiotics during labor. Since that time, we have seen a remarkable drop in early GBS infection rates in the U.S.—from 1.7 cases per 1,000 births in the early 1990’s, to 0.25 cases per 1,000 births today (CDC 2012).
If someone who carries GBS is not treated with antibiotics during labor, the baby’s risk of becoming colonized with GBS is approximately 50% and the risk of developing a serious, life-threatening GBS infection is 1 to 2% (Boyer & Gotoff 1985; CDC 2010; Feigin, Cherry et al. 2009). As noted earlier, being colonized is not the same thing as having an early GBS infection– most colonized babies stay healthy.”
What do Canadian guidelines recommend?
The Society of Obstetricians and Gynaecologists of Canada currently recommends the following steps for screening and treatment of GBS:
- Universal screening for all women between 35 and 37 weeks of gestation, including women planning a scheduled cesarean birth.
- Intravenous antibiotics to be recommended to birthers who tested positive for vaginal/rectal swab between 35 and 37 weeks of gestation; any birther with an infant who was previously infected with Group B Streptococcus; pregnant people diagnosed with streptococcus bacteriuria (GBS urinary tract infection) at any point of the current pregnancy.
- Additional guidelines recommend treatment for pregnant people under 37 weeks of gestation, people with suspected chorioamnionitis (infected uterus), as well as birthers whose GBS status is unknown.
Why is this problematic?
Originally, in 1996 the CDC has identified two ways to prevent early GBS infections: the universal approach (currently implemented in the US and Canada) and the risk-based approach that would mean foregoing universal screening and treat only those birthing people and newborns who develop certain risk factors. Universal screening is not currently recommended in the UK and Australia, while the numbers of early onset of GBS infection remain almost identical to those of North America.
There are, however, risks associated with administering antibiotics in labor:
- Anaphylactic reaction - “UK Obstetric Surveillance System study (2012 - 2015) identified 37 cases of maternal anaphylaxis over 3 years (1.6/100 000 maternities), around 50% of which were associated with the administration of antibiotics.
- The severe impact on the newborn’s microbiome - antibiotics have been linked to
- decreased amounts of lactobacilli or bifidobacterium in the newborn’s intestinal tract.
- Some studies have shown the link between the administration of antibiotics and long-term effect in baby’s life, such as decreased immunity and inflammatory responses as well instances of allergies, asthma, obesity, diabetes and serious bacterial infections.
- 6,600 women would need to be screened and treated for GBS to prevent one neonatal death.
What are your options?
You always have a choice in what feels right during your birth! Understanding the full spectrum of options, as well as risks, benefits and alternatives to every routine procedure in childbirth is essential to making empowered decisions. Depending on your unique situation you can:
- Decline GBS screening - as a pregnant person you have a right for informed refusal of any procedure or screening.
- Undergo GBS screening.
- In the event of a positive screening, you have a choice to accept antibiotic treatment in the birthing process.
- In the event of a positive screening, you can choose to decline intravenous antibiotic unless risk factors are present (some risk factors for an affected baby are preterm and low birth weight; prolonged labor; prolonged rupture of the membranes (more than 12 hours)).
- In the event of a positive screening, you can choose to use alternative methods to clear out the bacteria and ask to be retested before your birthing time begins or decline the antibiotic treatment in labor.
Holistic Treatment of GBS
While standard medicine often turns to tests and antibiotics, many midwives have successfully used these natural protocols to prevent or treat GBS. These natural remedies have been adopted from Emily Bartlett’s article that can be found here.
- Start taking a good quality probiotic as well as fermented foods (such as yogurt, water and milk kefir, kimchi, etc.) daily at 32 weeks of gestation if you haven’t been taking it throughout your pregnancy. This will encourage healthy vaginal and gut microbiome.
- Increase your daily intake of Vitamin C to boost your immune system and strengthen your amniotic sac. Fresh fruits and vegetables such as oranges and grapefruits are excellent sources of Vitamin C.
- Eliminate sugar from your diet, to help normalize vaginal pH and promote healthy gut flora.
- Reduce your stress throughout pregnancy -- make sure you are getting enough rest, sleep and relaxing activities. Some studies indicate that high stress impairs immunity, gut health, and the microbiome.
- Consume 1 cup of echinacea tea per day. To make the tea, 0.5 ounces of echinacea needs to be steeped in 4 cups of boiling water for 2 hours.
- Increase your consumption of garlic. Some people have successfully cleared out GBS infection with vaginal garlic protocols. Garlic is known to have antibacterial properties strong enough to inhibit growth of microorganisms such as E. coli and Salmonella, as well as yeast infections and GBS. Learn more about the garlic protocol in this article from Midwifery Today.
If you are looking for holistic doula support in the Lower Mainland or the Fraser Valley BC, check out my birth doula services, and schedule a free consultation with us to discuss your unique birthing preferences!
- Steps to a Healthy Microbiome: http://kellybroganmd.com/steps-healthy-microbiome/
- How to Treat a Vaginal Infection with a Clove of Garlic: https://midwiferytoday.com/mt-articles/garlic/
- Group B Strep: What you Need to know http://wisewomanwayofbirth.com/group-b-strep-what-you-need-to-know/
- GBS class with Gail Hart: https://www.indiebirth.com/gbswithgail/
- The Association of Ontario Midwives GBS Guidelines: http://www.ontariomidwives.ca/images/uploads/guidelines/No11CPG_GBS_May_2012FINAL.pdf --- excellent resource for informed decision-making
J Obstet Gynaecol Can 2013;35(10):e1–e10 SOGC: https://sogc.org/wp-content/uploads/2013/09/October2013-CPG298-ENG-Online_Final.pdf
Hughes RG, Brocklehurst P, Steer PJ, Heath P, Stenson BM on behalf of the Royal College of Obstetricians and Gynaecologists. Prevention of early-onset neonatal group B streptococcal disease. Green-top Guideline No. 36. BJOG 2017; 124:e280–e305
Group B Strep Support UK: http://gbss.org.uk/what-is-gbs/faqs/
Evidence Based Birth: https://evidencebasedbirth.com/groupbstrep/