Monday, March 01, 2010

Inquisition Monday: GBS

Natalie asked, "What would you do if your labour began with a premature rupture of membranes and the labour took longer than the usual advised 24hrs? - after which they say that there is a greater risk of infection of the baby with GBS (if present in the birth canal). These were conditions from my first labour and I am wondering what I could have done differently to have a homebirth. They do not routinely check for GBS in a swab sample prior to labour locally, they treat everyone as if they potentially have a GBS infection - and hence I laboured under pressure of the deadline and was given pit to speed up labour - Not a happy time."

Good question. Group B Strep, or GBS, can be dangerous for babies. It's present, often without symptoms, in 10-30% of pregnant women. It dangerous if 1) it's present in the birth canal/anus at the time of birth, 2) the baby's first few breaths takes the bacteria into its lungs, and 3) the baby isn't monitored closely for signs of the infection for the first few hours after birth. According to ACOG in the link above, "GBS infections cause death in about 5% of infected babies." That means the great majority don't die from it even if they are infected.

But still, enough babies die each year from it that they test everyone at around 36 weeks. As you know, the amounts of the GBS bacteria varies over time. They test around 36 weeks thinking it'll be close enough to birth to get an idea of the birthing conditions. Of course, with babies like Margaret who are born at 43 weeks, that gives almost 2 months for conditions in the vagina and anus to change!

We didn't worry about GBS with Margaret because she was born in water, meaning her first breaths were far enough away from my vagina that even if I was GBS positive, the likelihood of her breathing in the bacteria was infinitesimal. Also, there is some evidence that water "washes out" the vagina and reduces GBS infections that way. Plus, she was born in the caul which also meant her first breath wasn't right next to my vagina.

Your situation is obviously different. If you're hoping for a homebirth next time, you might be able to find a midwife who is comfortable with skipping the GBS test all together. If I were seeing an OB or CNM and planning a hospital birth, this is what I would do:
  • About 2 weeks before the GBS test at 36 weeks, I would start a regimen to limit the growth of bacteria in my body. There are herbal rinses/douches specifically for reducing GBS positives. I would increase my intake of garlic and other natural antibiotics. I actually might go to the effort of putting garlic in my vagina to kill off bacteria- but remember to tie the garlic clove to a string like a tampon or else it might get lost. Haha! As an anecdote, a friend of mine said that putting garlic in her vagina made the back of her throat taste like garlic. Our bodies are weird.
  • If I tested positive at 36 weeks, I would continue with an antibacterial regimen. When I was pregnant with Margaret, Rixa posted at link to a regimen that includes lots of stuff I have around the house: garlic, echinacea, grapefruit seed extract, etc. Even if you have to go out to a health food store and pay to get all that stuff, I'm guessing it would cost less than the hospital bill of antibiotics in your IV.
  • If I tested positive, I would ask again for a test at 39 weeks or closer to the birth. Results come in 24-48 hours, so there's a chance to find out you're negative before labor starts. It may mean that particular visit costs more, but again, it would likely be cheaper than receiving antibiotics in labor.
  • For broken water: there are varying degrees of broken water. If it's just a trickle, it could be just a small leak, which can even close on their own. I'd increase the amount of water I drink by a lot- maybe even half gallon to a gallon an hour (make sure you get some electrolytes, too). Your amniotic fluid will replenish itself as long as you are giving it water to use for that purpose.
  • You would probably be offered antibiotics through an IV if you've tested positive for GBS. Natalie, you didn't mention whether or not you were receiving antibiotics through an IV during your labor. If you were, I wonder why the emphasis on a time limit. If you weren't, I wonder why they didn't offer it to you. For your reading pleasure, here's a article on treating GBS with antibiotics.
  • If we feel like we need a hospital birth in the future I would first stay home as long as possible. Second, I would bring a doula who is familiar with my birth plan. Then when the nurse/doctor says, "We need to do X," I will be able to say, "Can you give us 10 minutes to discuss that?" A good doula would be able to say, "Well, I know you wanted to try Y before doing X. How about we try that?" or "I know some women who have done Z before X and it helped," and even, "You know, I think we have exhausted our options and X might be the best thing to do right now." Having that extra opinion is a good idea. In fact, you can always ask for a second opinion from a different OB, especially if the suggestion is major surgery.
  • Remember you can always ask for a new nurse. If you feel like the nurse is giving off a "hurry up and birth that baby" vibe or whatever vibe you're not comfortable with, ask for another. It can make a big difference. Don't worry about offending the nurse- it's likely that s/he can feel the strain in your relationship and would probably welcome a change.
  • I wouldn't wear a hospital gown. You could bring your own or even nothing at all. I've seen lots of custom hospital maternity gowns on etsy. As I've mentioned in my birth nudity post, being naked helps me feel less restrained. For me, a hospital gown would symbolically represent me giving up my body and autonomy and I would feel more powerful and in control without it. That might be something to help you get into a "I'm in charge" mindset: forgo the hospital's gown and bring your own or just go nude. Birth is very involved mentally so if you can feel more powerful, a time limit will have less impact on your birth.
  • Speaking of time, I'm not sure if L&D rooms have lots of clocks in them, but I would hide/cover them and not watch TV. We even hid all the clocks in our house for our homebirth. In the line of feeling powerful- I would probably close the door in the room to give myself an area that is specifically and physically "mine" where nurses and doctors can't just enter my space without warning.
So in all: I would start by trying to prevent a positive GBS test with herbs, but if that's not possible, I would try to make my environment conducive to me feeling like I'm in control of the birth. If you are comfortable in birth, your contractions will be more effective and those time limits won't matter.

I hope that helps. Anyone else have suggestions? Have you been GBS positive in the hospital with a time limit?


  1. Hi Heather, Thank you so much for your insight! I fully intend to try and home birth next time and have a Doula present to support us! I did have antibiotics in the IV around 1 hr before my son was born. I am in the UK so luckily the cost of the antibiotic wasn't my concern (NHS), my main concern was the fact I was birthing under so much pressure and think it may have impaired my ability to birth naturally. Hopefully trying some of your suggestions will improve my chances of having a labour that will be better for myself and the baby. Thank you once again.

  2. I've opted not to get tested for GBS with both my births. The risk didn't seem high enough for me to add another thing to worry about to my list. My home birth midwife was really supportive of not testing-- even though if I had been positive she could have given my the heplcok with the antibiotics in it. And actually with my first birth the back up OB i saw said she would rather I didn't get tested for it if I wasn't planning on being treated for it because she didn't want the liability. Everyone has to do what they are comfortable with, but I've never gotten tested and haven't ever had any problems.

  3. re: garlic getting 'lost' -- That is so weird. Can some women not reach the top/end of their vaginal canal? I guess they can't, because I've heard some people say they can't even reach their cervix. Apparently there's a huge range of lengths!

  4. As far as IV antibiotics go for GBS+, there is a time limit because you have to have a full dose, then another if you haven't delivered within 4 hours. I had two doses in my IV during my labor.

  5. Thank you for posting this! I was GBS positive when they tested me. I knew the chances of my son dying from it were very small, but they didn't really give me a choice in the hospital. I'm susceptible to yeast infections as it is, and I am sure the antibiotic treatments only made things worse--I ended up with thrush which caused further problems in our already difficult breastfeeding relationship. ARGH!

    Next time I will try to reduce the likelihood of infection.


Please review my blog comment policy here before commenting. You may not use the name "Anonymous." You must use a Google Account, OpenID, or type in a name in the OpenID option. You can make one up if you need to. Even if your comment is productive and adding to the conversation, I will not publish it if it is anonymous.