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Microsoft word - sparkdocs.gbs.docGBS (Group B Streptococcus)
First, you should know that Group B Strep is a bacterium that lives in the intestines and reproductive areas of about a third of the healthy population. It is normally not something to think about. The reason the subject comes up in pregnancy is that GBS is more dangerous to certain groups of people, including infants, than to the general population. When Mom carries GBS, it may colonize her perineum and vagina, which means that Baby will come into contact with the bacteria during birth. Across the general population (i.e. if Mom has not tested for GBS), there is about a 1 in 500 chance of Baby becoming infected – referred to as GBS disease – at birth if no treatment measures (such as antibiotics) are used. GBS disease is a serious illness, fatal in about 5% of cases. So, if you do not know your status and do not choose any treatment measures, there is a 1 in 10,000 (= 5% of 1 in 500) risk of infant death due to GBS disease. More statistics on the risks of various situations are quoted here. GBS status is transient. An individual may screen positive one week and negative another. There are things you can do to help your body keep GBS in balance. It is wise to begin these measures as early as possible – ideally several weeks before your GBS swab is taken – to maximize the chance of a GBS negative result. These measures should be continued throughout your pregnancy. Take live probiotics – pills should require refrigeration; liquid supplements ones are strongest. Reduce (or eliminate) refined sugars, and minimize juices. Support your immune system with foods rich in Vitamin C. Support your immune system in ways that you usually find helpful, such as with echinacea supplements, getting lots of sleep, and eating well. Support your gut health. Grapefruit seed extract and a healthy diet will help. Keep your perineum clean. Use a squirt bottle of water to rinse your perineum away from your vagina, towards your anus, after bowel movements. Wipe front to back to prevent pushing the bacteria from your anus to your vagina. Minimize or eliminate vaginal exams during pregnancy and labour. Whatever bacteria are present on your perineum or your lower vaginal vault can be pushed towards your cervix with each exam. Mothers have several opportunities for informed choice when it comes to GBS.
Choice 1: Should you screen?
Choosing whether or not to screen is up to you. The screen is done around 34-37 weeks, at a regular prenatal appointment with your caregiver. It is very routine, and if vaginal exams are a routine part of your appointments, your caregiver may do this procedure without mentioning it. She or he will sample your anus (without penetrating your anus), perineum, and the lowest area of your birth canal with a swab that looks like a giant q-tip. Many women do not notice this sample being taken. At some clinics, women swab themselves in the privacy of the bathroom. If this is not your care provider’s practice but it is your preference, bring it up with them. Reasons to screen: You are more likely to be GBS negative than GBS positive. With a negative result, you will not need to think about this issue anymore. If your results are positive, it allows you to take action to reduce the risk to your baby. If you choose not to screen, and are birthing in the hospital, This document was prepared to help you in your quest for information. standard procedure is often to act as though you are GBS positive. So, for hospital births, choosing not to screen may not reduce the interventions proposed to you. Midwives may apply this same philosophy to homebirths, though some do not suggest antibiotics when GBS status is unknown unless risk factors develop. (Risk factors are discussed under Choice 4.) Either way, if your test had been negative, antibiotics would not be proposed; whereas if your status is unknown, there is a greater likelihood they will be proposed. Reasons not to screen: If you have decided you would not do anything differently if your results were positive, testing may not be useful. With no results, you may receive less pressure from hospital staff about consenting to antibiotics than if you have a positive result and are choosing not to take antibiotics. If you choose to screen, and your results are negative, the issue is closed.
If you choose to screen and your results are positive, you have choices.
If you choose not to screen, you have choices.
Choice 2: Will you try to eliminate the GBS bacteria from your system?
The measures described above are sometimes effective at eliminating the bacteria. Some women request that their care providers re-screen them for GBS after spending 2 – 3 weeks trying to eliminate it. Re-screening is not part of the standard model of care as far as MSP coverage is concerned, so some care providers will not offer it. Others will make an exception and offer a re-screen under MSP coverage. You may have the option of paying for the re-screen yourself. (We have no information about the rules or the costs involved with private testing.) If you choose to do this, and achieve a GBS- result on your re-screen, be mindful that the bacteria can repopulate your system. A negative result means that an external swab showed no measurable levels of GBS. It does not mean the bacteria have been completely eradicated from your body. It is prudent to continue whatever measures you have been using. Reasons to try: Fighting GBS bacteria reduces the risk of your baby contracting GBS disease. Reasons not to try: There aren’t really any reasons not to try, except that you may find the suggested measures inconvenient. Even if you won’t have the opportunity to rescreen, or do not wish to screen, any measures that reduce the chances of this bacteria being present at your birth are good. These measures are healthful options for any person, and some of them – like eating healthily and sleeping well – are free. If you re-screen and your test is negative, the issue is closed.
If you re-screen and your test is positive, you have choices.
If you can’t or don’t re-screen, your status is still positive, and you have choices.
Choice 3: Will you treat your GBS bacteria during labour? If so, what treatment option will you
The standard protocol for treating GBS in labour is with intravenous antibiotics. To achieve
maximum efficacy in preventing transmission to the baby, 2 separate doses of antibiotics must be
This document was prepared to help you in your quest for information. administered, 4 hours apart. There is a significant reduction in GBS disease even if only one dose of antibiotics is administered. (The statistics are given here.) Antibiotics can be administered in the hospital or at a homebirth. Homebirth mothers may go to the hospital for their antibiotics in early labour, before their midwife joins them at home. This is done as an outpatient procedure. Going to the hospital is inconvenient at best and may be a strong negative for some women. It does, however, have two positive aspects. First, hospital staff have more experience inserting IV’s than most midwives. Second, there is a small risk you will have a severe reaction to the antibiotics, and in that case, being in the hospital would be beneficial. Reasons to use antibiotics: They are an effective option for preventing transmission. Reasons not to use antibiotics: There is the general concern about the overuse of antibiotics. About a third of all birthing women are given antibiotics and evidence is beginning to surface that this practice has caused an increase in antibiotic-resistant illnesses (such as antibiotic-resistant e. coli) among newborns, especially those who are admitted to the hospital nursery. Antibiotics are administered by IV, which can be uncomfortable or even painful. Mothers who are not receiving any other IV medications or fluids can request that the IV be disconnected once the antibiotics have run in, which takes about 20 minutes. Once you make this request, the IV catheter is usually left in place with a sterile lock on it, restoring full mobility. You can also choose to have the catheter removed. In that case, a new catheter would be inserted for subsequent doses of antibiotics. Hospital procedure is to leave the catheter in place, and if you want it removed, you will have to advocate for yourself. There is about a 1 in 10,000 risk of anaphylaxis as a reaction to antibiotics. This can be life Antibiotic use increases your risk of yeast imbalance issues, such as vaginal yeast infections or thrush (which can complicate breastfeeding and is unpleasant for you and your baby). There is some evidence beginning to surface that antibiotics used in labour lead to a need for stronger antibiotics if your child should need them for another infection while in the hospital or as a
Another option is to use a topical antiseptic wash in labour. The generic name for this is
chlorhexidine and it can be purchased over the counter at pharmacies for about $5. (It’s not always in
stock, so call ahead.) You also need a peri-bottle (about $2) to mix up your diluted solution and apply
it. This protocol is common in parts of Europe. Small studies show it to be very nearly as effective as
antibiotics. Chlorhexidine is used to wash your birth canal and perineum every 4-6 hours in labour.
Here are some articles about the use of chlorhexidine (often referred to by the brand name Hibiclens).
Chlorhexidine and evidence-based labor management: AJOG Vol 201 Issue 2 Vaginal disinfection with chlorhexidine during childbirth: International Journal of Early Advantage Birth: Chlorhexidine Protocol For Labor Among GBS Positive Women Navel Gazing Midwife: Chlorhexidine Wash Info Mountainview Midwives: Group B Streptococcus Treating Group B Strep: Are Antibiotics Necessary? Mothering Magazine, Issue 121, This document was prepared to help you in your quest for information. Reasons to use chlorhexidine: It can be a good option for women who do not wish to use antibiotics but do wish to take active measures against GBS transmission. It is self-administered, leaving the mother in control of her treatment. Reasons not to use chlorhexidine: Research is divided on whether women need to wash only the lower vaginal vault, or the entire birth canal, to achieve the best results from chlorhexidine use. As an antiseptic, chlorhexidine sterilizes all bacteria, including healthy vaginal bacteria. If you are rinsing your entire birth canal, you risk a yeast infection. A newborn’s skin is meant to be colonized by his or her mother’s vaginal bacteria during birth, and this is compromised if you have been washing the entire birth canal. It can be difficult to remember to apply the chlorhexidine, as the responsibility for this will likely fall to the mother and her partner. It is easiest to do on the toilet, so mobility is also a factor (mother’s mobility can be impacted by an epidural or continuous electronic fetal monitoring). If choose not to treat your GBS, there are no more decisions to make.
If you choose to treat it, you have one more choice.
Choice 4: Under what circumstances will you treat your GBS?
There are risk factors that increase the likelihood of transmitting GBS to your baby. When one of the following risk factors is present and Mother is GBS positive, the chance of Baby contracting a GBS infection increases by approximately ten times (Pomegranate Midwives). You’ve had a previous baby develop GBS infection You’ve had a bladder infection caused by GBS during this pregnancy Your baby is born before 37 weeks gestation Your membranes have been ruptured over X hours (Check with your care provider – some say 18, some say 24, some say something else!) Reasons to treat regardless of risk factors: The North American medical community believes treating all GBS+ mothers provides the best protection for babies. Reasons to treat only if risk factors develop: This can be seen as a nice balance between treating and not treating, for women who are hesitant to treat but do not want to decline it all together. Some women will combine antibiotic and chlorhexidine protocols, by using chlorhexidine in labour, and then choose antibiotics if risk factors develop. This document was prepared to help you in your quest for information.
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