A Quick Word on GBS
What is GBS?
GBS stands for Group Beta Streptococcus, which is a species of bacteria carried by about 30% of the population. It normally lives in the digestive tract and does not cause any symptoms or issues. During pregnancy, it can sometimes travel to the vagina and colonize that area, which can present a problem. Outside of the end of pregnancy and birth, we don’t normally look for or treat GBS colonization as a problem.
Why do we care about GBS?
If GBS is present in the vagina at birth, it presents a slightly higher risk of respiratory infection, particularly for babies who are at risk due to other conditions. Babies who are small for their age (normally due to growth restriction), have a lung condition, or are preterm may have a harder time clearing mucus from their lungs, so the GBS bacteria is able to grow and cause infection more easily than in a term, healthy baby. Luckily, babies born out of hospital are normally full term and healthy since high risk or preterm clients are transferred to higher level care. However, the standard of care in the US is to offer testing for GBS to all pregnant people at 36 weeks, and to offer antibiotics to everyone who tests positive. Regardless of where you choose to birth, you will likely be presented with a GBS swab to either accept or decline.
What are my options?
In most midwifery practices, you will be presented with the option of whether or not to test for GBS before 36 weeks so you have time to decide. If you choose to test, you should know that a positive result on file may have certain consequences if you birth in the hospital. Although you can decline any treatment, most hospitals will have a requirement for you to stay longer in their care postpartum if they want to monitor your baby for signs of infection. They tend to take this approach with anyone who was GBS positive and did not receive antibiotics, or anyone who had an unknown status. The standard treatment offered is antibiotics every 4 hours in labor, which treats mother and baby together. If you birth outside the hospital, most midwives will offer the option for holistic treatment as an alternative to antibiotics if you wish to treat on a less invasive level. You also have access to antibiotics every 4 hours through your labor, if you wish to exercise the standard option at any time.
What does research say?
The latest research shows that antibiotic treatment does lessen the number of GBS infections for babies of positive mothers, but does not reduce the number of babies who dies from the infections they did get. Infection is also possible by other bacteria which are not GBS, which can also have serious consequences for babies. We also know of other risk factors outside of the baby’s age which increase the chance of them getting a GBS infection. One major risk factor is the baby’s exposure to pathogens in general after their membranes have ruptured- after the protective bubble is broken, many bacteria including GBS are then able to enter the uterus and potentially infect the baby. We can lessen the chance of bacteria entering the uterus by limiting vaginal infections and introducing either antibiotics or holistic immune support once the membranes have ruptured. We also know from research that antibiotic treatment must be given at least 2 times over 4 hours before the birth of the baby to be effective at lessening the chance of infection. So, for very quickly progressing labors, we may not have a chance to get 2 doses in time.
What’s the big deal?
For many people, testing negative for GBS puts the issue at rest and allows them peace of mind to move forward with their birth plan unchanged. For others, testing positive may create doubt or questions about how much medical intervention is necessary, whether any side effects are worth the treatment, and how to decide what is best. While antibiotics do lessen the chances of your baby getting a GBS infection, they also kill the beneficial vaginal and gut bacteria which help to colonize your baby as they are born and form their fragile microbiome. It may be helpful to know that the US is the only developed nation which tests for and treats GBS routinely. Who benefits from such a practice? Who may be at risk from such a practice? You must decide where the line lies between the risks and benefits of treating or not treating for GBS.
Whether you decide to test or not, to use antibiotics or immune boosters, or to simply trust your body and watch for signs of infection, your birth team should support your right to choose and your individual choice. Only you can decide what is best for you and your baby based on your personal risk factors, your intuition, and yours and your provider’s experience. I hope this quick discussion helps you to start thinking about GBS, and to take charge of the treatment plan that feels best for you!
Let me know what you think about GBS testing, treatment, or what we should talk about next!
