Are You Positive? GBS Positive, That Is.
Group B Streptococcus (aka Group B Strep or GBS) is a particular type of bacteria- not the same bacteria that causes strep throat, by the way- that exists naturally in the intestinal tract, urinary tract, vagina, and/or rectum. Roughly 25% of women are carriers, although the bacteria may come and go, almost always without triggering any symptoms or health issues. In fact, most women will never even realize it's there. It is a bacterium, however, so there are risks associated with exposure to those who are vulnerable. Think: elderly people, those with chronic medical issues, and- you guessed it-newborn babies.
It's thought that a baby is most likely to be colonized with GBS bacteria when passing through the birth canal, although the majority of these babies- just like their mothers- will never develop any symptoms of health issues. A baby is most at risk of developing a GBS infection, however, after the amniotic sac ruptures, especially if there's a long delay (more than eighteen hours) between the ruptures of membranes and birth. In these cases, the infection is usually the result of bacteria migrating up from the vagina into the amniotic fluid, which baby may then swallow or aspirate.
And GBS infections? They're not good. Complications range from fever and respiratory issues to pneumonia, sepsis, and meningitis. In short, GBS infections have the potential to cause life-threatening illness, which is why all pregnant women in the US are tested- via vaginal and anal swab- prior to birth, usually sometimes between 35 and 37 weeks. Occasionally, GBS is detected even earlier, during a routine urine test, in which case mama will be categorized as a "heavy colonizer" and considered to be GBS positive for the remainder of her pregnancy.
Okay, I've tested positive for GBS: Now What?
GBS infections emerged (for reasons unknown) back in the early 1970s; and at the time, an infected baby's prognosis was dire- as many as 50% of them died. In the face of such grim statistics, the medical community got right to work. Clinical trials and observational studies commissioned throughout the 1980s demonstrated that treating "high-risk" women with antibiotics during labor could prevent infant infections. By the mid-1990s, the CDC had issued new guidelines, giving bsetricians and midwives one of two choices: either follow a risk- management approach (meaning administer antibiotics during labor only to women who exhibit certain risk factors) or perform a recto-vaginal culture and give antibiotics to any woman who tests positive.
In 2002, the CDC deemed universal screening superior to risk management and revised it's guidelines.
Which brings us to today. If you test positive for GBS at any point in your pregnancy, the majority of midwives and doctors will follow the recommendations of the CDC and suggest treatment via IV antibiotics during labor. This approach, it's important to point oit, seems to have worked: GBS infections have plummeted since the 1990s, dropping from 1.7 cases per 1000 births dodwn to .25.
Universal screening, however, is by no means a perfect solution, and what we don't tend to hear too much about are the risks associated with widespread antibiotic use.
Here's what you need to know about GBS:
- Infections are mercifully rare, even among babies born to women who receive no treatment. Roughly 50% of GBS positive mamas will pass along the bacteria, but only 1-2% of those babies will develop a serious infection. The current mortality rate for infected infants is between 1-2%, although it's significantly higher for premature infants born before 33 weeks.
- GBS screening is not foolproof. Because GBS bacteria can come and go, your colonization status may change even after you've had the screening.
- Antibiotics do not appear to lower the rate of infant mortality. Most of the information we have to support the use of antibiotics during labor comes from those clinical trials and observational studies performed back in the 1980s. A recent Cochrane review of those trials, however, determined that while the number of GBS infections dropped significantly with the administration of antibiotics, the number of infant deaths remained unchanged.
- Antibiotics come with their own set of side effects. Minor risks include an elevated occurrence of yeast infections in both mothers and babies, as well as the (admittedly rare) possibility of allergic reaction. The much bigger concern, however, is the potential for creating antibiotic-resistant strains of GBS and other bacteria dur to widespread antibiotic use.
- Antibiotics may affect the formation of a healthy microbiome. We know that babues who are born vaginally pick up protective bacteria with long term benefits. We also know that babies who are given antibiotics shortly after birth appear to have lower levels of these protective bacteria. However, we know very little, next to nothing infact, about the potential effect IV antibiotics administered during labor may have on the formation of baby's microbiome. This is still an emerging field of medical research.
Alternative Treatments for GBS?
- Hibiclens: One of the more popular alternative treatments among more holistic-minded midwives is something called chlorhexidine, which is a topical disinfectant, as well s the active ingredient in an antiseptic skin cleanser known as hibiclens. Simply put, it kills bacteria. And to treat GBS, many midwives recommend douching with a diluted Hibiclens solution. You'll want to get the okay from your provider first, of course, but the process is simple: Dilute 2 tsp of Hibiclens in 8 oz of water in a periwash bottle and use to rinse both the inside of the vagina as well as the exterior of the rectum, keeping in mind that these areas should always be washed separately- you don't want to cross-contaminate! The trouble with Hibiclens is that a vaginal douche can't possibly remove any GBS bacteria residing in the intestinal tract, so the vagina and rectum are likely to be recolonized. For this reason, the douche must be performed at the onset of labor and repeated every four to six hours until birth.
- Garlic: Well known for its antifungal and antibacterial properties, it has been used in a dvance of routine GBS screenings for years. Standard protocol is to insert one peeled clove directly into the vaina before bed, remove in the morning, and repeat for 5-7 consecutive nights in advance of your GBS test.
- Probiotics: High doses of probiotics are another remedy that's gaining popularity in the natural world. It's thought that by flooding the system with good bacteria, our bodies naturally balance out the bad. Several studies, in fact, do indicate that higher levels of probiotics may inhibit the growth of GBS, although there is virtually no research on probiotics and colonization recommend in any case, however as probiotics have loads of other great benefits.
- Additional Immune System Support: A strong immune system is thought to ward off unfriendly bacteria, which is why daily vitamin C supplementation (opt for food based forms like citrus fruit), a dose of raw apple cider vinegar, and several cloves of smashed garlic may boost the effectiveness of probiotics and other natural remedies.
It's important to understand about most alternative methods that the results (if any) are almost certainly temp
Howland, Genevieve. The mama natural week-by-Week guide to pregnancy & childbirth. New York, North Star Way, 2017.