Group b strep during pregnancy? What the heck is this? Most of us do not have a clue about this until we are pregnant and most likely, well into our third trimester.
So what is GBS?
Group B Streptococcus a bacteria that normally inhabit the intestine, vagina, and rectum.
How did you get Group B strep during pregnancy?
1 in 4 pregnant women are carriers or are colonized with GBS (Group B Strep). These mamas are not dirty or do not have bad hygiene. It is not an STD or a lack of cleanliness. (That being said it can be transmitted during sex from a partner who is colonized at the time.)
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Here’s How it can affect a Baby at Birth?
GBS during pregnancy can be passed from a GBS positive mama to her baby during rare. According to the stats, it happend to 1-2 babies out of 100 when the mama doesn’t get antibiotics during labor. Treatment lowers the chances of your baby getting a GBS infection during birth.
Babies who get infected by GBS fall into one or two groups.
This baby will shows signs of infection or get sick within 12-48 after birth up until 7 days.
- Fast, slow, or difficulty breathing
- a floppy baby who is lethargic
- difficult to arouse
Early onset disease can be very critical and cause the baby infections such as:
The signs of GBS infection are scary and include fever and difficulty breathing. The baby may also be more drowsy but this one is difficult to spot.
These babies need immediate treatment and can become very sick.
Late-onset disease occurs when your baby gets sick after 7 days and up to a few months after birth. (Keep in mind the baby, in this case, may not have been affected by her mama who had GBS during pregnancy)
The problem with a pregnancy which is positive for group b strep during pregnancy, but infection could be from another source.
Late onset is also scary and critical because it can also cause meningitis.
Symptoms of Late-Onset:
- Decreased or no energy
- Difficult to feed or poor feeding quality
- High fever
(Always go with your gut)
Testing For GBS during Pregnancy
It is now a part of routine pregnancy testing to test a mama for group b strep during pregnancy. This type of test is called a culture test and is done between 36 until 38 weeks of pregnancy.
It is not painful mama, so don’t sweat it too much. Your provider or a nurse will use a sterile swab to take a sample from your vagina and rectum. We take the swab and swipe from your vagina to your rectum. It is then sent to the lab to test for GBS.
This is done in the office unless you are admitted to the hospital during those weeks of pregnancy.
Update: Many providers are testing through a urine culture done at the first prenatal appointment. If it is positive for GBS, your provider will consider you colonized and GBS positive for your pregnancy.
What if I am positive for GBS during pregnancy?
If you test positive for GBS during your pregnancy, then your provider will recommend antibiotics during labor. You will receive them through an IV once labor begins and until delivery. This treatment protects your baby from being infected by GBS.
Most often the treatment of choice is Penicillin unless you are allergic in which case an alternative antibiotic will be given.
CDC recommends that you receive antibiotics during labor at least 4 hours before delivery. By doing so, the chance of the baby getting infected is about 1 in 4000. (Remember, a baby whose mama did not get treated has a 1 in 200 chance)
There are studies being done on alternative treatments for group b strep during pregnancy, such as vaginal chlorhexidine wipes. So far it does not seem to be a good alternative.
Vaginal chlorhexidine was not associated with reductions in any of the primary outcomes of early-onset GBS disease (sepsis and/or meningitis) or GBS pneumonia. Vaginal chlorhexidine may reduce GBS colonization of neonates. The intervention was associated with an increased risk of maternal mild adverse effects. The review currently does not support the use of vaginal disinfection with chlorhexidine in labour for preventing early-onset disease.Cochrane
Coping with a Positive Result for group b strep during pregnancy
Mamas contact me often on LNM and ask what now?
I want to encourage you that your birth plan is not out the window when you find out you have group b strep during pregnancy. You can still have a beautiful and relatively intervention free birth. Just with a little accommodation.
Here are my tips:
(remember this is not medical advice, you need to make an informed decision with your provider)
What if I didn’t want an IV during labor?
If you plan to refuse the antibiotics (which I do not recommend but support your choices) then yes you can still have no IV. However, I recommend you ask for a saline lock. This means they start the IV but no IV fluids. However, every 4 hours they will hang the antibiotics and then disconnect.
What if I wanted to labor at home?
You can still labor at home even with group b strep during pregnancy. I recommend doubling the “go to hospital rule”. I teach my students in both my birth courses (Labor Academy and VBAC LAB) the following: FTM go to hospital when contractions are less than 4 minutes apart, each one lasting for 1 minute, and this occurs for 2 hours straight. Second or more baby, then I want you to wait until less than 5 minutes apart, lasting for 1 minute for one hour. If you are GBS + then double the less than rule.
What if my water breaks?
If you water breaks and you are GBS, let’s consider a few things.
Are you contracting? If not then you can stay at home for a while. If you are contracting then you may want to start timing and if they are getting regular and less that 10-15 min apart, head to the hospital.
Again, this is my opinion not the golden rule or medical advice.
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