Group B Strep and Pregnancy
There is a lot of information about Group B Strep and pregnancy. "Lots of information" inevitably means that there is a lot
circulating...some true and some not.
If you are pregnant, Group B Strep should be of great interest to you. Toward the end of your pregnancy, you will
be asked to take a Strep B test (amongst others). Depending on
the results of that test, you may have to make some very important
decisions which would affect your baby.
We want to give you what you are asking for: the facts. Then you can make the best decision
for your family.
Pregnancy can be a stressful and fearful time because there are so many decisions to make. Some women just go with
the flow and trust their care provider to have all the answers. Other women do the research because they want to know the
facts and the truth for themselves. They want to be in charge and make the best decisions. They believe in team work and that
their care provider is not "all knowing" but rather a part of the team. They do not want to be told what to do...so if you are
one of these women...we want to help you.
So if all the talk about Group B Strep and pregnancy stresses you and you want some facts...then again we are here to help.
Group B Strep and Pregnancy: What is Group B strep?
Group B Strep also called Group B Streptococcus - or GBS and/or Strep B for short - is a bacterium that normally lives in
the intestinal tracts of many healthy people without consequences.
So if that is the case, then why is Group B Strep and pregnancy a big deal?
That is such a wonderful question!
Group B Strep COULD become a problem IF it is present in your genital area when you give birth. If this was to occur there could be
a SMALL risk that GBS would be passed on to your baby. GBS can be deadly to a baby.
Is GBS the same bacteria which causes strep throat?
No. Group B Strep and pregnancy are an issue because
this bacteria can cause bladder and uterine infection in the mom resulting in a stillbirth. GBS can also cause a blood infection (sepsis), pneumonia
and meningitis (an infection of the fluid and lining of the brain) in newborn babies which can be fatal. But before you become too alarmed let's give you
some statistics.
Before prevention and detection methods were used, it is estimated that about 8,000 babies contracted GBS per year and of these
babies about 5 percent
of them died...which is devastating and sad.
Group B Strep and Pregnancy: ACOG's Recommendations
For the reasons mentioned above, ACOG - the American Academy of Obstetricians and Gynecologists - and the CDC
- Center for Disease Control - recommend to test all pregnant women between 35 and 37 week of gestation.
The test involves a painless swab of the vaginal area and of the rectum.
The results of the test are available in a few days. It is reported that about 30% of pregnant women
will test positive in one of both areas. As you can see this represents almost 1/3 of all women tested.
Group B Strep and Pregnancy: If You Test Positive...Then What?
Again both the CDC and ACOG recommend that all women who test positive be given IV antibiotic during birth.
During childbirth, the antibiotic most commonly used as a prophylactic - preventative - for Group B
Streptococcus is penicillin. So if you are allergic to penicillin, another method must be used. That poses a problem.
The other drugs of choice - namely Ampicillin and Amoxicillin - are just about worthless for treating Group B Strep.
Why is that?
The overuse of antibiotics - for anything and everything which has gone on for decades - has created drug resistant "bugs."
If you think penicillin is immune to this phenomenon - think again! It is a fact that it takes more of the drug for a longer
period of time to eradicate bacteria.
It may not be common knowledge, but already research has found resistant strains of Group B Strep.
It is now a fact that 12 to 21 strains of Group B Streptococcus are resistant to all forms of antibiotics currently used.
So in light of this should 1/3 of pregnant women be given a drug which has the potential for more harm than good? Is treating
Group B Streptococcus this way proving to be worth it...namely saving the lives of babies?
To find the answer...please read on.
Group B Strep and Pregnancy: The Facts
No woman can make a truly informed decision until she is told all the facts. Simply being told "you test
positive and you must take antibiotics" is falling short of "being given all the facts."
To begin, if as mentioned before, many healthy people walk around with GBS in their intestinal tract can the term "infected" be an accurate one?
Why do some women carry the bacteria and never have a problem and others do?
For most people Group B Streptococcus is a non issue. It is only of concern when it shows up in your vaginal area
during birth and then again only in certain cases. Of the women who have GBS, only
.5% will have a baby who becomes ill with GBS when given no antibiotics during labor.
So testing of the genital and rectal area is a very poor predictor of which babies will - or might - become sick with GBS.
Group B Strep and Pregnancy: Is Antibiotic Therapy Effective?
Some studies do show that the use of antibiotics during labor has decreased the rate of GBS infection among newborn babies. So this
is great news.
The bad news is that the same research shows that while there is a decrease in the number of infections there
is no decrease in the rate of death. In short, the same number of babies die whether antibiotics were used or not.
It gets worse. Other research is showing that the benefit of less GBS infections is being outweighed by increases
in other forms of blood infection!
Remember 98-99% of babies born to colonized women will not become infected.
So here are the facts: The worst case scenario, is that 40% of women are colonized and that 2% of those babies will become
infected, if nothing was done
at all - so no antibiotics or anything else at all - .0225% or 1 in 4,444 babies would die of early onset Group B Strep. We agree that even one death
is tragic but even with antibiotics the morbidity - death - rate stays the same!
Group B Strep and Pregnancy: How do Babies Fair?
A study done in 2002 - and published in the American
Journal of Obstetric Gynecology - showed that of 43 ill newborns with blood infections caused by Group B Strep and other bacteria
and whose mothers had received antibiotics during labor,
88 to 91 percent of these infections were now resistant to antibiotics.
Do you think it was a coincidence that the drug the bacteria showed resistance to was the very antibiotic
used on the moms during labor?
Now, of the babies who had also developed a blood infection during labor but whose mother did not receive antibiotics only 18 to 20 percent
of their infections were resistant to antibiotics.
Again...coincidence?
Group B Strep and Pregnancy: Prematurity and GBS
One of the risk factors of GBS is prematurity. Nutrition is
known to reduce the rate of prematurity but also
to help you - and your baby - have a stronger immune system.
So if you go into premature labor, you are even more likely to be pressured to take the meds.
Keep in mind that a premature baby is even at greater risk to drug-resistant bacteria. This is no laughing matter when babies die.
At St. Joseph's Hospital in Denver Colorado, 4 moms whose water broke before 37 weeks were given medication. Infection of the amniotic fluid
occurred in all 4 cases. Sadly two of the babies died from drug-resistant bacterial blood infections. Another was stillborn.
So if you choose to take the test and are positive what are you to do?
Group B Strep and Pregnancy: Risk Factors
There are 3 main risk factors for GBS:
1) As mentioned above, prematurity is one (baby born before 37 weeks).
2) Developing a fever during labor - which is not due to an epidural.
3) Prolonged rupture of membranes (PROM) - Water broken for 18 hours. This is another reason why
you should avoid having your membranes ruptured AND receiving any vaginal exams.
Group B Strep and Pregnancy: Forms of Strep B Infection
There are two forms of Group B Strep infection:
1) Early-onset GBS: The baby becomes sick within seven days of his birth.
Of these babies about 6% will die from the infection. Full term otherwise healthy babies (good birth weight) fair better.
2) Late-onset GBS: In these cases, the baby will become sick between 7 days and up to three months of age.
Group B Strep and Pregnancy: Are There Alternatives Methods to Antibiotics?
Are there alternatives methods to antibiotics?
Well the answer is not clear cut. Yes, there are alternative methods (one was used by Alisha with success) and no
because none have been researched extensively at this point. However, for many moms natural methods make more sense and have proven quite
effective as evidenced by a negative re-test and a healthy newborn.
Group B Strep and Pregnancy: The first mode of treatment involves strengthening your immune system through various means - which in our opinion is just plain
common sense, GBS or not:
Garlic
Vitamin C: 3 gm per day.
Grapefruit Seed Extract: Has antibiotic, antifungal and antiviral properties.
Echinacea:
250 mg
Or drink a cup of Echinacea tea
Oregon Grape Root: Use the one for children in a glycerin base.
Note: Please choose either Echinacea or Oregon Grape Root.
Bee propolis
Glyconutrients
Eat live cultures:
Natural yogurt or kefir
Sourdough bread
Fermented foods
Aged natural cheeses
Lactobacillus:
Orally as above or in good quality capsule.
Internally in the form of a gelcap daily for 2 weeks (a gelatin capsule of high quality lactobacillus inserted
vaginally once or twice a day works well).
Group B Strep and Pregnancy: The second mode of treatment involves the ph and sometimes flora of your vaginal area:
Lactobacillus: as mentioned above a good quality capsule inserted internally once or twice a day for 2 weeks.
A tampon soaked in a 2% Tea Tree essential oil and 98% Olive oil inserted into the vagina and left for up to 4 hours each day
for 6 days.
Goldenseal tincture: Add 1/2 teaspoon of goldenseal tincture to 2 cups of warm clean water (spring water is best).
Use this mix in peri bottle and spray the area once a day for a week. Another method can be to use a sitz bath and soak your bottom into it. Some
recommended douching. However, we do not recommend douching while pregnant. Use this in addition to
lactobacillus
implant daily for 2 weeks.
Note: Goldenseal should not be used before 37 weeks as literature says it could induce labor.
Chlorhexidine: A double placebo blind study was performed to determine whether chlorhexidine (a .02% dilution) applied
with a squeeze bottle before the
birth, reduced mother-to-child transmission of Group B Streptococcus and other micro-organisms. The study involved 1,130 women. One group used
chlorhexidine and the other a sterile saline solution.
The vaginal douching with chlorhexidine significantly reduced the vertical transmission rate from 35% with
just the saline solution to 18% with chlorhexidine.
This study concluded that vaginal
douching with 0.2% chlorhexidine during labor significantly reduced both maternal
and early neonatal infectious morbidity. Moreover the squeeze bottle procedure was simple, quick, and well tolerated.
A few drops of lavender essential oil in warm water douche (squeeze bottle method).
Group B Strep and Pregnancy: Alisha's Story:
When I was pregnant with Johnathan, I tested
positive for GBS. I was terrified.
What was this disease I had contracted and what would happen with my baby?
The midwife at the birth center didn't give me a satisfactory explanation. I went home to do research on Group B Strep
and pregnancy - all the information I found
scared me more!
But then finding out that most - if not all - people carry it anyhow, I was relieved.
So what to do? I was told I would have to have antibiotics during labor. This did not make me happy. I asked if I
could re-test. They agreed.
A midwife (not at the birth center) told me to spray with a mixture of chlorhexidine. I did it every day for a week. Re-tested... NEGATIVE!
So I didn't have to take antibiotics, but I was kept at the birth center for observation for about 6 hours
to make sure Johnathan was okay. He was!
When I was pregnant with Kathleen, since I had already
tested positive with Johnathan, I was already at risk and would
require antibiotics again and possibly even be transferred to the hospital. Not gonna happen!!
Fortunately, my midwife trusted me, did not require the test, but recommended that I spray with the
chlorhexidine at term and before I knew I was going into labor. Kathleen was perfectly healthy.
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Group B Strep and Pregnancy: Resources
B. F. Anthony et al., "Epidemiology of Group B Streptococcus: Longitudinal Observations during Pregnancy," Journal
of Infectious Disease 137 (1978): 524-530.
J. A. Regan et al., "Vaginal Infections and Prematurity Study Group: The Epidemiology of Group B
Streptococcal Colonization in Pregnancy," Obstetric Gynecology 77 (1991): 604-610.
H. C. Dillon et al., "Anorectal and Vaginal
Carriage of Group B Streptococci during Pregnancy," Journal of Infectious Disease 145 (1982): 794-799.
Mothering Magazine
Midwifery Today
K. M. Boyer et al., "Selective Intrapartum Chemoprophylaxis of
Neonatal Group B Streptococcal Early-Onset Disease: II. Predictive Value of Prenatal Cultures," Journal of Infectious Disease 148 (1983): 802-809.
S. J. Schrag et al., "A Population-Based Comparison of Strategies
to Prevent Early-Onset Group B Streptococcal Disease in Neonates," New England Journal of Medicine 347 (2002): 233-239.
M. Dabrowska-Szponar and J. Galinski, "Drug Resistance of Group B Streptococci," Pol Merkuriusz Lek 10, no. 60 (2001)
C. V. Towers and G. G. Briggs, "Antepartum Use of Antibiotics and Early-Onset Neonatal Sepsis: The Next Four Years," American
Journal of Obstetric Gynecology 187, no. 2 (2002): 495-500.
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