What is GBS

“Infection” can be a scary word, especially in pregnancy. Group B Strep (Group B Streptococcus, or GBS) is a transient bacteria that can “come and go”. A person can test positive temporarily, or consistently and having colonization does not mean there is or will be an infection. Most of the time the bacteria is not harmful to us, but it can cause serious illness. We worry about GBS in pregnancy because if your baby is exposed to it during birth, they could develop a serious illness.

From Evidence Based Birth: “If a mother 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 I noted earlier, being colonized is not the same thing as having an early GBS infection– most colonized babies stay healthy.

On the other hand, if a woman with GBS is treated with antibiotics during labor, the risk of her infant developing an early GBS infection drops by 80%. So for example, her risk could drop from 1% down to to 0.2%. (Ohlsson 2013)”

How to Test for it 

The GBS test (a culture) is performed between 36-38 weeks of pregnancy and is done with a swab that resembles a long q-tip. Because GBS bacteria commonly live in our gastrointestinal and genital tracts, that is where the culture is taken. The swab is inserted into the vagina then rubbed along the perineal skin, and then quickly into the rectum. The whole test is pretty quick! You can ask your provider how they perform this test—some offer a self swab (so you can do it yourself), some only swab the vagina and perineum. If your provider performs the test themself, they may offer to do a vaginal exam to check your cervix. You can consent to this exam, or decline it. The choice is yours. 

Navigating the Results

If the test is negative, there’s nothing else to do. 

Sometimes, having a positive GBS result can be scary or worrisome. Just know that nothing you did or didn’t do caused a positive result and an infection in your newborn is rare. If the results come back positive, standard treatment is IV antibiotics in labor for at least 4 hours. If you are planning a cesarean birth, you may not need antibiotics even if you are positive as the baby won’t come in contact with the bacteria via the vagina. You may need IV antibiotics with a cesarean birth if your water broke prior to the cesarean. Once the amniotic sac ruptures, the GBS bacteria can travel to baby. 

Alternative Options

You also have some alternative options available to you. 

First, you can decline the test all together. If you decline the test, you may be strongly encouraged to accept IV antibiotics in labor since your GBS status will be unknown and there is a (quite) small chance your baby could become infected. 

If you decline the test, and the IV antibiotics, your baby’s pediatrician may perform “watchful waiting” of your baby. Watchful waiting may include closer monitoring of your baby for signs of infection, such as fever/temperature and/or rapid breathing. 

You can also treat preemptively with more natural methods. Talk to your provider about using garlic, and probiotics prenatally to help ward off GBS all together. Using an antibacterial rinse such as chlorhexidine (such as prior to your test) may also give a negative result. Keep in mind that using any antibiotic may kill off good bacteria as well.

Taking a probiotic, for you and baby, after birth can help restore good bacteria if any antibiotics are used. 

Antibiotics Without Being Tested

There are some situations where you may be given/offered IV antibiotics without having been tested for GBS. Those situations include (but may not be limited to):

  • Having a previous child diagnosed with GBS disease
  • GBS bacteria in your urine at any point in your pregnancy
  • If your GBS status is unknown when you go into labor (if labor begins before test results are back, or if you go to a birth location where they do not have access to your medical records).

You have choices in the care you and your baby receive. Weigh the risks and benefits and reach out to your doula if you need help navigating all your options!

Further Reading

https://pubmed.ncbi.nlm.nih.gov/15266490/

http://www.earlyadvantagebirth.com/RefFiles/GBSchpflagpw.pdf

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