Dear Doula,

Remind me again why none of my friends told me I was going to get my vagina and rectum swabbed at my 36 week appointment?!  You’d think they would have remembered to mention that one! I’m glad you gave me the heads up in our prenatal visit.  Anyway, I went back for my appointment this week and now they’re telling me I’m GBS positive.  You said that we’d talk more in depth if it came back positive, so here I am.  What does this even mean?  Do I have some sort of infection that is dangerous to me and my baby? My OB said something about antibiotics, and having to go to the hospital right away when I’m in labor.   Is my birth plan out the window now?  

Thanks!

Concerned in College Hill

 

Hey Concerned in College Hill,

Not to worry, you birth plan is not out the window!  This is one of those times (like we talked about when we met) where you have different information than you had before, and plans and preferences may need to change a little.  

Let’s start by going over the basics of GBS (Group B Streptococci):

Your OB did the GBS swab test to see if GBS bacteria was present on that day.  About 25% of birthing people are “colonized” with the bacteria and live a healthy life with no symptoms or infection.  It’s a variation of normal gut flora. The presence of the bacteria can increase and decrease over time, changing the likelihood of a positive or negative result. Having the GBS test between 35-37 weeks pregnant (within 5 week window of having your baby) is the best way to determine if you may have GBS present at birth (1), but it’s only 91% accurate.  That means 9% of people are getting a false negative result (2).  That’s enough of a variance for some people to talk with their OB or midwife about what declining the test may mean for them individually.

(And while I know you personally weren’t planning a homebirth, I do want to touch on it briefly for those who are.  People planning a homebirth often ask if it’s worth getting the GBS test in the first place.  They’re not going to the hospital and their midwife won’t be administering antibiotics.  Talk about your questions and options with your midwife.  If you’re choosing a home birth, you may still decide to be tested for GBS in case of hospital transfer)  

Anyway, here’s the concern with GBS bacteria:

Bacteria present in the vaginal canal, on the perineum and anus may be brought into contact with the baby during a vaginal exam, especially after the bag of waters has broken.  During birth the baby passes through the vaginal canal and across the perineum, coming into contact with the bacteria present in those areas.  Babies can become colonized with GBS bacteria during labor and birth if it is present at that time.

As I said, there are people who have GBS and have no symptoms, that’s why your OB did the test. Most babies who acquire GBS bacteria during or shortly after birth have no problems, but a few babies can become sick and develop serious health problems that could even lead to death.  

There are two types of GBS infection that a baby may experience.  Early Onset GBS infection occurs during the first week after birth.  Late Onset GBS infection in babies occurs between 1 week to 3 months old.  These babies were either exposed to bacteria during labor and birth, or from close contact someone who is a GBS carrier in the first few weeks post birth.  Cue my favorite phrase - Wash your hands. Wash your hands. Wash your hands.

When someone like yourself has tested positive during pregnancy, the standard protocol to help protect babies against early onset GBS infection is for the birthing person to receive IV antibiotics during labor, usually penicillin.  Other antibiotics may be an option for people who have a penicillin allergy.  

Antibiotics are also recommended during labor if:

  • A person had the presence of GBS in a urine culture during their current pregnancy
  • A person had a previous child who developed GBS disease
  • Labor starts earlier than 37 weeks, since GBS status is most likely unknown
  • There is fever during labor
  • There is prolonged rupture of membranes (bag of waters has been broken for 18 hours or more before birth) (3)

Take a deep breath.  Being GBS positive and taking IV antibiotics during labor doesn’t necessarily mean that your birth plan will need to change drastically.  

Just like your original plan, you’ll call your OB when you’re in labor to give them a heads up.  Depending on what’s going on at the time (how you’re feeling, if your water has broken, what your contractions are like, etc) they may have you go the hospital.  It’s hard to say what they’ll recommend in the moment because there are so many factors you don’t know yet - so not really different than what we discussed before.  

Once you get to the hospital most care providers prefer that you have a saline lock put in place to allow for medications and fluids to be given if they are necessary.  In this case, if you’re taking antibiotics they’ll be administered through the IV.  This doesn’t mean that you’ll be immobile, just that the IV pole will be close by.  If you’re up and moving around, we as doulas take the job of walking with IV pole so you don’t need to worry about it.   Once the antibiotics have run their course, your care team may be able to unhook the IV line if you want, leaving the saline lock in place for another dose of antibiotics later on if it is needed.

Most of the time you can still use hydrotherapy like the shower or getting into the tub.  Your nurse will just take the time to help us wrap your saline lock and IV to keep it dry.  (As a side note to our readers, you can even still have a waterbirth while being GBS positive.  As always, just talk about your birth preferences with your care provider to see if it is possible for you at your birth place).

Of course it’s normal to be concerned about yourself and your baby, and to be curious about the risks with GBS infection.  Approximately 1 in 200 babies whose mother did not take antibiotics during labor experience GBS infection, while approximately 1 in 4000 babies whose mother did take antibiotics during labor experience GBS infection (1).  

The important things to know are the signs and symptoms of infant infection.                            

Early Onset GBS Infection:                                      

  • Symptoms that start within several hours of birth
  • Breathing problems
  • Unstable heart tones and blood pressure
  • Gastrointestinal and Kidney problems
  • Complications following birth like Sepsis (blood infection), Pneumonia (lung infection), Meningitis (infection in fluid around the brain)

Your care team will monitor you and your baby during your postpartum recovery at the hospital just as planned.  Sometimes you may need to stay longer for monitoring if you didn’t have the suggested dosage of antibiotics during your labor and birth.  

Once you’re home, you’ll continue to be on the lookout for anything that seems out of the ordinary with your baby.  Let’s be honest.  This is every new parent anyway.  So you won’t be doing anything extra.  Just don’t forget that late onset GBS infection can occur even after you’re all settled in at home.  So keep an eye out for any signs and symptoms those first few months.  Meningitis is the most common symptom in this case (1).

Katie Brenner Cincinnati Doula

I know that was a TON of information, but I hope you’re feeling a bit better than you were before.  You’ve got some new things to think about.  Write down some of your thoughts and questions and take them with you when you see your OB next week so you can talk more about your specific care.  And of course, we’re here if you need anything.  

See you soon!

Answered By: Katie Brenner, MFA, ProDoula Certified Childbirth Educator, ProDoula Certified Labor and Postpartum Doula, and ProDoula Certified Postpartum Placenta Specialist

 

  1. Group B Strep Infection: GBS, American Pregnancy Association: http://americanpregnancy.org/pregnancy-complications/group-b-strep-infection/
  2. Group B Strep in Pregnancy: Evidence for Antibiotics and Alternatives,  Rebecca Dekker, PhD, RN, APRN, Evidence Based Birth, https://evidencebasedbirth.com/groupbstrep/
  3. Group B Strep in Newborns: Prevention, Centers For Disease Control: https://www.cdc.gov/groupbstrep/about/newborns-pregnant.html

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