Group B Strep: know the facts to empower your decision making
One of the most commonly asked questions in our midwife support meetings is: do I need to go private and pay for a Group B Strep test? In the US, all women are tested for Group B Strep during pregnancy, but here in the UK, it is not something the NHS currently offers, though private tests are readily available.
As with many things to do with pregnancy, I’m afraid there is no clear cut answer on this one, but as with all things we at the Positive Birth Company advise, we recommend you employ your BRAIN framework to make a decision. This stands for benefits, risks, alternatives, intuition and nothing. Anyone making a decision using this framework needs to be armed with the full facts. So here goes!
What is Group B Strep?
Group B Strep is a type of bacteria called streptococcal bacteria. It usually lives in the rectum or vagina and affects 20-40% of women, so it’s pretty common and it rarely causes any problems. Group B strep is not a sexually transmitted disease and most women carrying it will experience no symptoms.
How can Group B Strep affect your baby?
While Group B Strep is not harmful to you, it can affect your baby around the time of birth, occasionally causing a serious infection such as sepsis, pneumonia or meningitis in newborn babies. Currently in the UK and Ireland the rate of babies diagnosed with early onset (12-24 hours after birth) Group B Strep causing one of these infections is 1 in 1750. Sepsis, pneumonia and meningitis can cause newborn babies to become very unwell and in some rare cases, die. Very rarely Group B Strep can also cause babies to become unwell during pregnancy and before labour.
On average in the UK, every month:
43 babies develop early-onset GBS infection
38 babies make a full recovery
3 babies survive with long-term physical or mental disabilities
2 babies die from their early-onset GBS infection. (RCOG, 2023).
Why don’t we test for Group B Strep in the UK?
Currently in the UK, we do not routinely test for Group B Strep (GBS) in pregnancy, but it may be found during other routine tests such as urine samples or vaginal swabs – so you may be diagnosed with it following one of these tests. There are a few reasons for not routinely testing.
A large proportion of women will carry GBS and in the majority of cases their babies do not develop an infection.
Group B Strep comes and goes and is not always present. So you might test positive at 36 weeks but not have Group B Strep at the time of birth. So population-wide testing may also mean treating a large number of women unnecessarily, which could increase antibiotic resistance.
While we are not routinely testing there is a very large clinical trial currently taking place across many participating trusts called the GBS3 trial. The trial is designed to establish whether we should begin offering routine testing for GBS in pregnancy. Therefore, you may be offered the opportunity to test for Group B Strep at 36 weeks.
What’s the treatment for those diagnosed with GBS?
If you have been diagnosed with GBS, you will be offered penicillin-based antibiotics during labour, which aim to prevent baby contracting GBS and subsequent infection. If you’re allergic to penicillin, you will be offered an alternative. The antibiotics will be given from the start of active labour (4cm, or regular contractions). They will be given via a drip and cannula in your hand. The antibiotics are given every 4 hours and usually take 10-15 minutes to run through. You, therefore, won’t be attached to a drip continuously through labour, but the cannula will remain in your hand. Receiving antibiotics in labour reduces the risk of your baby developing a GBS infection in their first week of life from around 1 in 400 to 1 in 4000 (RCOG, 2023).
What are the things to consider when accepting group b strep antibiotics?
Your options for birth may be affected if you decide to accept antibiotics in labour. In most cases you will be able to birth on the midwife led unit (MLU) or consultant led unit, but birth at home is unlikely to be an option. This is the general rule of thumb, but it can vary from trust to trust so if you have been diagnosed with GBS and are wanting antibiotics in labour, it is important to ask your midwife how this might affect your birth choices. Having antibiotics in labour shouldn’t affect your ability to move around or use a birthing pool.
There can also be downsides to antibiotics that are worth bearing in mind – they can cause side effects such as nausea, vomiting and diarrhoea. They also carry a risk of allergic reaction (please make you sure you inform staff of allergies prior to accepting antibiotics). Finally, there has been some research done into antibiotics in labour affecting the colonisation of bacteria in your baby’s gut and an adverse effect on your baby’s microbiome, however, more research is still needed in this area.
If you are 37 weeks and received antibiotics in labour, your baby will not require additional monitoring after birth. If you have been diagnosed with Group B Strep and didn’t receive antibiotics in labour, your baby will require/be offered 12 hours of monitoring after birth at 2 hourly intervals, assessing heart rate, breathing rate and temperature – this does not require baby to be separated from you or go to the neonatal unit.
How to look out for the signs and symptoms of early-onset GBS?
Babies with early-onset GBS infection may have the following symptoms:
Grunting, noisy breathing, moaning, seeming to be working hard to breathe when you look at their chest or tummy or not breathing at all
Very sleepy and/or unresponsive
Crying inconsolably
Unusually floppy
Not feeding well or not keeping milk down
High or low temperature and/or their skin feels too hot or cold
Changes in their skin colour (including blotchy skin)
Abnormally fast or slow heart rate or breathing rate
Low blood pressure or low blood sugar (tests for these are done in hospital).
(Tommys.org, 2023).
If you have any concerns over your babies’ well-being you should contact your local care provider (Children’s A&E) urgently and report concerns of GBS infection.
To contextualise things, it is always important to gather information and make an informed choice regarding options for your care. It is a valid choice to either accept or decline antibiotics in labour and is completely up to you. Using the BRAIN acronym – Benefits, Risks, Alternative, Intuition and Nothing can be an extremely useful tool in decision making. There is more information on this in our hypnobirthing course.