GB Say What? Testing positive for group b strep and what that means for your labour
We had a midwife home visit at 37 weeks. We welcomed her and a midwife student into our home, gave them mugs of hot apple cider (seriously, I went all out), and they made themselves comfortable. Then, my primary midwife looked at me sternly, and quietly said, “...so you tested positive for GBS. DUN DUN DUN.”
Okay, so maybe the last part isn’t true, but the apple cider was definitely true. And I did test positive for GBS, she just didn’t seem to be bothered by it, she even told me it was super common, there are just a few decisions we have to make because I’m a carrier of this bacteria that I’ve never heard of. So I tried to hide the concern on my face until she left so I could grab all my pregnancy books and figure out what the hell Group B Strep was, why I had it, and why it felt like I was being punished.
So what is GBS and why was I tested for it and what happens now? All good questions. I googled the answers because I couldn’t possibly remember everything the midwife said.
What is GBS?
Group B Strep, Group B Streptococcus, or Streptococcus agalactiae, if you really want to show off, is a bacteria that is naturally found in the digestive and lower reproductive tracts of both men and women, and approximately 1 in 4 pregnant women are colonized with GBS according to Group B Strep International
So, anyone can carry it, it isn’t an STD (this had crossed my mind, naturally), and it isn’t an infection. The test is a swab that you insert vaginally and rectally to test for the presence of the bacteria. What I found super interesting reading on Kids Health is that the bacteria can come and go, so most people who carry the bacteria wouldn’t really know. I mean why would you know unless you were specifically tested? You wouldn’t really. Unless things got complicated.
Why do we get swabbed for GBS?
The US Centre for Disease Control and Prevention and the American College of Obstetricians and Gynaecologists recommend that all pregnant women get screened between weeks 35 and 37 of their pregnancy. Out of the 1 in 4 women who have are carriers, sometimes GBS can cause infection of the urinary tract, placenta, womb, and amniotic fluid - and that’s what you can pass onto baby during labour and delivery. Birthing persons who test positive for GBS bacteria aren’t sick, but they can pass the bacteria onto their babies who could become very ill.
If the birthing person isn’t treated during L&D they risk baby becoming colonized - which could mean sepsis, pneumonia, and meningitis in newborns.
So basically, we get swabbed because we need to know whether we carry group b strep bacteria so we can make informed decisions of how it affects our birth plan. GBS only presents itself as a problem when it’s present in the genital area during labour and delivery. Healthy Child tells us that .5% of women who forego antibiotics during labour and delivery will deliver babies who become ill from GBS.
So you’ve got the GBS. Now what?
There isn’t a straightforward answer, but the good news is you have options. The more informed you are, the easier it will be to add what you decide in your birth plan.
Option one: antibiotics administered prophylactically (also known as culture-based strategy)
GBS can grow quickly. One day you can test negative, the next you’re positive as hell. Because of how quickly the bacteria can return, the CDC says antibiotics can’t be prescribed before labour starts. Antibiotics get administered intravenously during labour and continue to be administered every 4 hours. Penicillin is the antibiotic of choice, but if you’re like me and allergic there are alternatives. Or, if you’re also like me and the strain you carry doesn’t respond to the penicillin alternatives, then the antibiotics you would need must me administered by a physician - which means if you were planning a home-birth or a birth at a birth centre separate from the hospital, this could throw a wrench in your plans. The AAFP also advises that newborns born to a GBS colonized birthing person be observed for 24 hours for signs of sepsis.
Option two: wait and see method (risk-based strategy)
This might depend on what country you’re giving birth, but your midwife or doctor can wait to administer the IV until certain factors are present that would increase the likelihood of transmission. Because the transmission rates are so low, some have argued that the introduction of antibiotics before it’s necessary contribute to antibiotic resistant super-bugs. Though, there isn’t significant research on the effects of antibiotics given during labour on the mother’s or baby’s microbiome.
The AAFP outlines some risk factors that would increase the likelihood of GBS transmission to a newborn, and if any were present would require immediate antibiotic intervention:
GBS in urine at any point during pregnancy (you would be considered a heavy colonizer)
Maternal temperature of 38.0°C or greater
Preterm labour or waters breaking before 37 weeks
Previous delivery of newborn with GBS sepsis
Broken waters for over 18 hours
So really, now what?
My midwife had previously told me that because of my allergy, I could be given an alternative antibiotic to penicillin that they would administer either at home or at the birth centre.
But, they lied.
Okay they didn’t lie. They just didn’t know that my strain of GBS was resistant to the other antibiotics they had on hand. I found out that if I decided to get the antibiotics administered prophylactically I would need a doctor to write the prescription and would need to deliver my baby at the hospital.
Birth plan, out the window. Or as our doula, The Birth Boss likes to say, birth vision board. Though we did plan for emergency situations, I really wanted to have a homebirth. We hadn’t even toured the hospital because we thought we wouldn’t end up there.
So, our plan is a bit different now. We’ll labour at home for as long as we can and then make our way to the hospital. I don’t feel comfortable making a decision in the heat of the moment or having there be so many variables to decide on the day of, so I feel strongest with just deciding we will have the baby at the hospital. We booked a tour, we’ve almost packed our hospital bag, and I think mentally I’ll feel a lot better once I see what the birthing unit looks like.
So I’ll be receiving an antibiotic every 4 hours during active labour (or when my water breaks) and will be eating all of the probiotics I can find to help keep the GBS at a minimum.
Did you test positive for Group B Strep? What did you end up deciding to do?