With Eowyn, I was tested and was GBS- (I didn't have any Group B Strep bacteria colonizing me at the time), so it wasn't an issue. This time around, I had the option to not have a GBS test done, as well as having an interest as a doula in the issue. So... I set off researching. First off, I wanted to know the risks of having GBS and not being treated. Second, I wanted to know the risks of standard practice (IV antibiotics to all GBS moms). Thirdly, I wondered if there were more selective, less invasive means of treating GBS (if it needed to be treated), both before birth, and after birth. Lastly, I wondered what steps could be taken to help babies and moms treated in the standard way. Here's what I've found out!
First off, I wanted to know the risks of having GBS and not being treated.
About 10-30% of all women have GBS colonizations (and generally have no symptoms). I'll use 25% as a steady figure: 1 in 4 moms are GBS+. According to CDC estimates, without treatment only 1-2% born to moms with GBS will become infected (2% of 25% is 0.5%, or 1 out of 200 babies), and of those, 6% will die. So death is a risk of about 3 in 10,000 babies born to GBS+ moms with no treatment. Infections in newborns are never good things-- GBS infections affect the brain, spinal cord, or lungs. The risk of a baby getting a GBS infection goes up if the mom has a long labor (18+ hours with water broken), a fever above 100.4 in labor, or goes into labor before 37 weeks. For perspective, about 1 in 150 of all delivering moms in the US will have some form of placental abruption, and 1 in 300 will have a prolapsed umbilical cord.
Second, I wanted to know the risks of standard practice (IV antibiotics to all GBS moms).
|my belly at 35 weeks|
Another, more dramatic risk of the antibiotics, is the risk of anaphylactic (allergic) reaction-- this can happen even if a mom's never reacted to a drug allergically before, at about a 1 in 10,000 rate. These cases put both mom and baby at a very real risk of dying. I'll quote again from an overview of the topic in Mothering magazine:
"We can compare this to CDC estimates that 0.5 percent of babies born to GBS-positive mothers with no treatment will develop a GBS infection, and that 6 percent of those who develop a GBS infection will die. Six percent of 0.5 percent means that three out of every 10,000 babies born to GBS-positive mothers given no antibiotics during labor will die from GBS infection. If the mother develops anaphylaxis during labor (one in 10,000 will), and it is untreated, it is likely that the infant, too, will die. So, by CDC estimates, we save the lives of two in 10,000 babies-0.02 percent-by administering antibiotics during labor to one third of all laboring women. We should also keep in mind that this figure does not take into account the infants that will die as a result of bacteria made antibiotic-resistant by the use of antibiotics during labor-infants who would not otherwise have become ill. When you take that into account, there may not be any lives saved by using antibiotics during labor." (emphasis mine)** The linked-to article is very helpful, and is a GREAT starting point to thinking through this issue! Every GBS+ mom should read it and use it as a jumping-off point-- there are plenty of citations to journal articles and scientific studies that bear reading!**
A final risk of the routine IV treatment is non-GBS infections (often anti-biotic resistant), especially E. coli infections.
A study published in 1998 on the effects of the use of ampicillin before delivery concluded that:
"The increased administration of antenatal ampicillin to pregnant women may be responsible for the increased incidence of early-onset neonatal sepsis with non–group B streptococcal organisms that are resistant to ampicillin. At this time penicillin G, rather than ampicillin, is therefore recommended for prophylaxis against group B streptococci. In addition, future studies are needed to determine whether alternate approaches, such as immunotherapy or vaginal washing, could be of benefit. "
|E seems unimpressed with the idea of IV antibiotics for GBS|
"We should not take lightly the use of antibiotics for 200 women and their babies to prevent only a single blood infection-however serious that infection might be-especially in this age of increasing resistance to antibiotics. [Edit: remember the figure that 1 out of 200 babies get a GBS infection if their moms are untreated.] Concerns have arisen in several areas regarding the use of antibiotics for so many laboring women. One dilemma is that colonization of the vaginal area by GBS is, at best, a poor method of predicting whether a newborn will develop a GBS infection. As mentioned, even without any intervention during labor, fewer than 1 percent of infants born to carriers of GBS develop infections."
"A study of 43 newborns with blood infections caused by GBS and other bacteria found that, when the mothers of the ill newborns had been given antibiotics during labor, 88 to 91 percent of the infants' infections were resistant to antibiotics. It is unlikely to be a coincidence that the drugs to which the bacteria showed resistance were the same antibiotics that had been administered during labor. For the newborns who had developed blood infections without exposure to antibiotics during labor and delivery, only 18 to 20 percent of their infections were resistant to antibiotics."So, are there more selective, less invasive means of treating GBS (if it needed to be treated), either before birth, during labor and after birth?
YES!! The more I've read about IV-antibiotics, the more they seem like using an AK-47 to shoot a fly: waayyyyy overkill.
First line of defense: help the body regulate its own bacteria before birth. If a mom is re-tested before she goes into labor and is GBS-, this whole issue is removed from the table. This occurs without any intervention in some moms, and it can be helped along by non-invasive natural means, the biggest of which are: probiotics (in capsules and in fermented foods like saurkraut and yogurt), garlic, and echinacea. My own midwife puts any GBS+ moms on doses of garlic & echinacea, and retests in 3 weeks. Read here about using garlic & goldenseal. A fuller listing of suggestions is here. As far as probiotics go, L. rhamnosus GR-1 and L. reuteri RC-14 are really helpful in regulating vaginal flora, and S. cerevisiae boulardii, Lactobacillus rhamnosus GG, and Bacillus coagulans GBI-30 are good for regulating digestive flora, so probiotics containing those strains would probably be most helpful. (See a great article on using probiotics to fight various ailments here.)
Second line of defense, during labor: avoid cervical exams (and stripping of membranes), dilute the bacteria by giving birth in the water, or use a chlorhexadine vaginal wash (once every 6 hours) during labor once water has broken. Not only are these methods less invasive, they target the only area where the GBS is located, as opposed to flooding the entire body. To use the wash, a mom is handed a periwash squirt bottle and irrigates herself... no needles, no invasion of privacy, it's simple and done. This has the added benefit of reducing other, non GBS infections, such as E. coli, as well-- remember, IV antibiotics INCREASED the risk of those!
"In this carefully screened target population, intrapartum vaginal flushings with chlorhexidine in colonized mothers display the same efficacy as ampicillin in preventing vertical transmission of group B streptococcus. Moreover, the rate of neonatal E. coli colonization was reduced by chlorhexidine." (from “Chlorhexidine vaginal flushings versus systemic ampicillin in the prevention of vertical transmission of neonatal group B streptococcus, at term.” J Matern Fetal Med 2002 Feb;11(2):84-8.-- Read its abstract and other related articles here.)Third line of defense, after birth: as has been stated before, if a mom goes into labor without knowing her GBS status, or as an untreated GBS carrier, her baby can be tested for GBS infection and treated immediately if infected.
Lastly, I wondered what steps could be taken to help babies and moms treated in the standard way.
Probiotics!! Both mom & baby will desperately need to rebuild their bacterial ecology. One study found huge reduction in "colic" in infants who received the probiotic L. reuteri. It would make sense to proactively give antibiotic-exposed infants such probiotics (the specific brand in the study was BioGaia, and it's readily available online at Amazon or at drugstores such as Walgreens), and to have moms taking therapeutic doses of the above mentioned probiotics.
One final note I'll make is that there is no real need for an expectant mom to have to have a full pelvic exam to be tested for GBS. Many midwives simply hand their patients a swab and send them to the restroom to privately culture themselves. I must say I greatly prefer this method. :) As a dear friend put it yesterday, "they're called PRIVATE parts for a reason-- I'd like to keep it that way!"
[Personally, I feel the proactive measures of taking probiotics-- both in fermented foods and capsules (I'm taking first Renew Life Ultimate Flora Extra Care Probiotic- containing 10 probiotic strains including L. rhamnosus, L. acidophilus and several Bifidobacteria strains, then Nature's Way Primadophilus Reuteri, which contains L. reuteri, L. acidophilus & L. rhamnosus)-- as well as planning a water birth are the way to go. If I'd had the option, I would have cultured myself and been tested that way... next time! If I were GBS+ I'd first try the preventative measures of probiotics & garlic, etc, and if those weren't enough, I'd do the chlorhexadine wash. :)]