Group B Strep (GBS) is a common bacteria, with about 20-40% of women carrying it. It is usually harmless but it can carry a risk to a baby during birth.
Routine testing for Group B Strep doesn’t take place in the UK for a number of reasons:
- Screening tests aren’t accurate. According to Tommy’s, 17-25% of women with a positive swab at 35-37 weeks of pregnancy would be negative by the time of giving birth. And 5-7% of women who are negative at 35-37 weeks would be positive at delivery.
- Premature babies are affected more by GBS, which is before the screening would take place.
- There is a concern about giving antibiotics unnecessarily to a higher number of women and babies.
If you are worried about Group B Strep
I speak to lots of women who are worried about the lack of routine testing for GBS. Testing isn’t routinely offered on the NHS but you may be tested if you had GBS in a previous pregnancy.
Talk to your midwife about your concerns and find out what your maternity unit offers.
You can arrange for a private test with an accredited laboratory.
What is the risk to your baby?
According to the Royal College of Obstetricians & Gynaecologists (RCOG):
1 in every 1750 newborn babies in the UK are diagnosed with GBS within the first week of life. Of these babies, 7.4% will have a long-term disability and 5% will die.
Every month 43 newborn babies will develop an infection
38 of these babies will make a full recovery
3 babies will have a long-term physical or mental disability
2 babies will die from their infection
What puts a baby at higher risk?
- your baby is born prematurely – the earlier a baby is born, the risk increases
- you have previously had a baby with a GBS infection
- you experience high temperature or infection during labour
- you have a positive swab during pregnancy
- your waters have been broken for more than 24 hours
What reduces the risk to a baby?
- A positive urine infection caused by GBS should be treated by antibiotics during pregnancy and with antibiotics through a drip during labour.
- If you have had a baby that was infected with GBS you should be offered a drip throughout labour
- If your waters break after 37 weeks and you have had a positive swab for GBS you will be offered an induction with antibiotics throughout.
- If you develop any signs of infection during labour, you will be offered antibiotic through a drip.
- If your labour starts before 37 weeks it may be recommended that you have antibiotics through a drip.
- Antibiotics may be offered if your waters have been broken for more than 24 hours.
- Antibiotics will be needed throughout labour if you have a positive GBS swab.
If you receive a positive swab…
You won’t receive any treatment until labour starts unless GBS is found in a urine test when you will be given antibiotics to treat the urinary tract infection. You will then be offered antibiotics by drip when you are in labour.
Antibiotics in labour
According to RCOG, if this is needed to prevent GBS infection, it should be started as soon as possible after labour begins or after your waters have broken – as this can happen without being in labour.
Having antibiotics by drip should not affect how mobile you are in labour and using a birthing pool should still be an option.
The antibiotic often used is penicillin, an alternative will be given if you are allergic.
what does this mean for your baby?
If you have had antibiotics in labour for atleast 4 hours before your baby is born, your baby will not require close observation. Otherwise your baby will be closely monitored for atleast 12 hours for signs of infection.
If your baby shows any signs of GBS infection , he needs to be seen urgently as tests may be needed to check for GBS. Sign include:
- grunting with noisy breathing
- seems to be struggling with breathing
- not feeding
- high/low temperature
- heart rate/breathing rate seems too fast or too slow
- low blood pressure
- low blood sugar
Understanding the guidance around group b strep can be complicated – please do talk to your midwife/doctor about your worries. Here’s the main points…
1.Testing by the NHS isn’t done routinely unless there is a medical need.
2.The main concerns around testing at around 36 weeks in pregnancy are:
- some of the women who test positive at this stage may be negative by the time labour starts and will have unnecessary antibiotics.
- some of the women who test negative could be positive by the time labour starts, so a test could give a false sense of security.
- most of the newborn babies infected with GBS are premature.
3.Treatment with antibiotics is offered in labour when there is a medical need such as:
- going into labour prematurely
- you have a temperature in labour
- your waters break for over 24 hours before labour
- you have previously had a baby with a GBS infection
- a positive GBS result
4.Your baby will only need to be closely monitored if antibiotics weren’t able to given at least 4 hours before birth in response to the medical reasons above.
5.If a baby has a GBS infection, it is usually identified in the first 12-24 hours. Tests to diagnose GBS and antibiotic treatment on confirmation will be needed immediately.
Group B Strep Support
The GBS3 trial is looking at whether testing pregnant women for Group B Streptococcus reduces the risk of infection in newborn babies compared to the current strategy in place in the UK.
If you are feeling anxious about this, you can book a session to talk it through and work out how you can manage it.
Copyright: Janine Smith