What is GBS?
Group B streptococcus (GBS) is a bacteria that is often
present in the rectum, vagina, or urinary tract of adults. It usually causes no symptoms in young,
healthy adults. It is of concern when a
pregnant woman has it in her vagina because it can infect her baby, both during
pregnancy and birth. It can also
infect a baby several weeks after birth.
Once GBS has infected the baby, serious complications can arise within
hours. GBS infection can cause pneumonia, meningitis, and death. Treatment does necessitate NICU admission,
antibiotics, repeated blood draws, lumbar punctures, and separation from the
mother. Women are usually tested for colonization with GBS at 35-37 weeks of
gestation. The current medical standard
of care is to give IV antibiotics to GBS-positive women during labor in the
hopes that enough antibiotics will reach the baby and kill the GBS bacteria
before they infect the baby. IV
antibiotics do not prevent all cases of GBS infection. The likelihood of neonatal infection is as
follows:
• If a GBS-positive mother receives antibiotics: 1 in 4000
• If a GBS-positive mother does not receive antibiotics: 1
in 200
• About 1,700 out of 2.1 million babies per year get GBS
disease at birth
• Another 1,500 get GBS disease in the weeks after birth
Risk factors
associated with GBS and its treatment
Some women are at higher risk of having a baby that becomes
infected with GBS. They have the
following conditions:
• Urinary tract infection from GBS during pregnancy
• Previous baby with GBS disease
• Fever during labor
• Rupture of membranes 18 hours or more before birth
• Labor or rupture of membranes before 37 weeks gestation
The risk of GBS infection is increased when routine
obstetrical interventions, including vaginal exams, stripping membranes and
artificial rupturing of membranes, are used during labor and birth. In our
midwifery practice, we reduce the number of obstetrical interventions to a
minimum in order to reduce the likelihood of GBS infection. It is important to note that stillbirth can
be caused by a prenatal infection, but the likelihood of GBS being the cause of
infection and stillbirth is unknown. The
pregnant woman should be aware of her baby’s movements every day and
immediately contact her care provider if she notices a decrease in fetal
movements, especially if she feels any flu-like symptoms at the same time. There are significant risks associated with
the antibiotic treatment, particularly antibiotic resistance in GBS and other
bacteria, such as E. coli and MRSA.
While the incidence of babies being infected by resistant organisms is
low, each dose of antibiotics increases the overall chances of resistance
developing. Antibiotics given to
newborns also disrupt their normal colonization with their mother's beneficial
bacteria, thus increasing his risk of gastrointestinal distress and disease,
allergies and asthma among other long-term health effects. It also allows other types of infectious
bacteria to multiply, potentially creating the very risk for which you are
being treated.
GBS research
The incidence of GBS in newborns is based solely upon
research done in hospitals, most of them large, tertiary care centers. Personalized and non-interventive care is not
the norm in this setting. As of yet, there are no published rates derived from
out-of-hospital births attended by midwives.
This is significant because homebirths are associated with fewer vaginal
interventions during labor, fewer maternal fevers, and less time between
rupture of membranes and birth. The
standard of care emphasizing antibiotics for all GBS-positive women does not
address topics that are particularly pertinent to understanding why GBS infects
certain babies and how therapies can be targeted more effectively. For
example, it is not known if antibodies to GBS are produced in breastmilk. It is not known whether mothers produce
antibodies to GBS that pass through the placenta. It is not known whether certain strains of
GBS are more infectious than others.
Significantly, it is not known whether maternal colonization by GBS
GBS that occurs for the first time during pregnancy has an
impact on newborn infection rates, as it does for certain other infections
during pregnancy.
Our GBS
recommendations and protocols
Evidence supports a non-invasive style of practice as a way
to reduce the incidence of GBS disease.
This is our first-line of defense against neonatal infections. GBS colonization in the vagina comes and
goes throughout pregnancy as the GI flora fluctuates. For this reason, we recommend probiotics and
a healthy diet to our clients throughout pregnancy so that the beneficial
bacteria naturally out-compete the GBS.
We recommend that our clients all be tested for GBS at 35-37
weeks of pregnancy. If you test negative,
there is nothing else we need to do. If
you test positive for GBS, we recommend a two-week natural regimen followed by a
retest. This new protocol is in an
attempt to use natural methods to achieve a negative test result before your
delivery. Of course, you always have the
choice of receiving or refusing antibiotics during labor and birth. We are concerned about the rise of antibiotic
resistant organisms and the possible health consequences of antibiotic use. We feel that the current standard of care
that recommends antibiotics to all GBS-positive women (approximately 1.2
million each year) does not address the impact of obstetrical interventions on
GBS infections but does increase antibiotic resistance and health problems in
individuals who receive antibiotics. We
support the targeted use of antibiotics in the reduction of GBS infection. If a
transport to the hospital is needed, your GBS status is important to know and
we do recommend
GBS testing. If you
are GBS-positive or unknown, you will likely receive antibiotics upon arrival
if you have not yet birthed.
Additionally, your baby will likely be taken to the NICU for observation
and/or a full sepsis workup. If you are
GBS-negative, the hospital will likely recognize that you have followed CDC recommendations
during your labor and delivery and do not need any antibiotics or
sepsis workups. Your postpartum time in
the hospital will thus be shortened and expense spared.
Group B Strep Natural Treatment
- Naturally Fermented Foods: Incorporate goods such as kefir, miso,
natural yogurt, and kombucha. These
fermented foods help to promote a healthy bacterial balance throughout the
body.
- Grapefruit Seed Extract: Take Nutribiotic Grapefruit Seed extract
10 drops two to three times daily until birth along with HMF Probiotic
capsules which can be obtained at www.rockwellnutrition.net. The HMF Probiotic should be taken in
capsule form, one to two, twice per day.
One capsule of the HMF Probiotic can be inserted into the vagina at
night.
- Hibiclens: The mother should have
a bottle of Hibiclens on hand for the birth. During her labor, the midwife will wash
her vagina with this to promote killing any bacteria that could be present
and transmitted to the baby.
- Build the Immune System: Echinacea, vitamin C, and honey all
boost the immune system. Take
Echinacea and vitamin C according to package directions.
- Minimize Vaginal Exams during Labor: It is essential to keep vaginal exams to
a minimum during labor to prevent contamination and the spread of
infection to the baby during the labor process, especially if the water is
broken.
- Avoid Refined Foods: It is essential that refined foods, especially
those high in sugar, be avoided. Sugar breeds the growth of more bacteria. Avoid fruit juices and soda as
well.
Please note that all information in this article is information only and is not intended as medical advice or to replace the advice of your physician or midwife.
