Somewhere between 35 and 37 gestation the topic of GBS testing will arise. What is GBS? Well, Group B Streptococcus, or group B strep (GBS) is part of normal vaginal flora; all female humans carry it at some point in their lifetime. According to research, the gastrointestinal tract acts as a reservoir for GBS and is most likely the source of vaginal colonization during pregnancy.  In the 1970’s GBS was a leading cause of infection and neonatal morbidity (disease,) and mortality (death,) which is why this test is offered today.
 
The test is a simple vaginal-rectal swab. If you are under the care of a midwife, they will likely explain how to do the swab and encourage you to do it yourself. If so, you can scurry your little butt of to the loo to administer it. If you are under the care of a physician, they quite often encourage you to be more passive and lay down while they themselves do the swab. However, you can advocate for yourself and say no, and do it yourself in private. Does it hurt? NO, not generally. It’s nothing like a pap if that’s what your thinking!
 
Once the swab has been completed it is sent to a lab to be cultured and tested for GBS. You're either positive or negitive. You’re likely thinking, okay so what does that really mean? Well, GBS if left untreated can transfer to the baby and cause health issues, remember above….the leading cause of morbidity (disease) or mortality (death) in the 1970’s.
 
Let’s break this down so you don’t freak out because we are no longer in the 1970’s! My goal is to encourage informed choice and empowerment, remember. The Ontario Association of Midwives has taken the data and translated it into simple terms. I'm going to borrow their written details below. The prevalence of GBS positive, meaning the number of people who test positive lingers between 10%-35%. Of that, between 40%-50% of babies born are colonized by GBS, of that 1%-2% of the 40%-50% will develop something called Early Onset Group B Streptococcus Disease (EOGBSD). Of that 1%-2% of babies with EOGBSD, there is a 5%-9% mortality rate.
 
Yes, babies sometimes pass away. It’s terrible and unfair and for anyone who has experienced this, I’m sorry. However, I’m going to present this from a bigger picture for all the first-time parents out there who are either considering a GBS test, or know they are positive. I am aware that the language around this subject is hella freaky!
 
Using the stats above, if you were to apply this to a group of 17 500 – 50 000 pregnant people:

• 5000 pregnant people would test positive
• 2000 - 2500 babies would be colonized by GBS
• 20 – 50 babies would develop EOGBSD presenting as:

                                Bactermia (64% - 83%)
                                Pneumonia (9% - 23%)
                                Meningitis (7% - 12.5%)

• Of the 20 – 50 babies with EOGBS, 1 – 4.5 will pass away from the initial 17 500 – 50 000 births.

 
Still hella scary? Hopefully not as much. The numbers and risks are really low, but they are there nonetheless and the results can be devastating. However, I’d like to brush on prevention as solutions are much more helpful than fear. Historically, strategies such as oral maternal antibiotics, an intramuscular injection of penicillin or a vaginal disinfection with chlorhexidine were administered and tested. While the above had some success, none were statistically significant enough to bring it into full scale evidence-based practice.

Those of you who are more holistically minded.  Probiotics, which affect gut health, have been shown to prevent GBS growth and MAY be a positive prevention with little to no side effects, therefore safe (AOM, 2010).  Keep in mind there is an absence of research and therefore a lack of efficacy data.  You can make your own call there, but I do remember my care providers talking about good strains of probiotics such as kimchi, kombucha and yogurts to help keep GBS levels normal. Alternatively, Genestra makes a clean line of oral probiotics.

Moving forward, it is recommended that all pregnant people be offered Group B Strep testing between 35-37 weeks gestation and a re-screening if 5 weeks has passed since their last test and they have not delivered. Today, the most common way to treat people who are GPS positive in Canada (note, not all industrialized countries even test for GBS) is with antibiotics during labour. This can be done both in hospital or during a home-birth. There are essentially three approaches to antibiotic use.

1) Universal screening, meaning everyone completes the GBS test and those who are positive receive antibiotics during labour.

2) Risk-factor screening, meaning anyone who tests positive AND presents with one of the following risk factors should be offered antibiotics:
          pre-term labour (before 37 weeks gestation)
          prolonged rupture (18 hours +) of the membranes (water)
         or a maternal fever
         also offered to any person who has delivered a previously infected baby

3) Any one who declines a GBS test is considered “unknown” and those who develop the above risk factors should be offered antibiotics during labour.
 
The approach isn’t perfect, and "women should be informed that there is limited research upon which to compare the relative efficacy of this approach to a screening strategy, nor are there well-designed randomized controlled trials that compare this approach against no treatment" (AOM, 2010.) You can test positive for GBS AND then test negative a week/day later. You might also only have GBS in your colon and not your vagina based upon the current testing standards. Needless to say, the use of antibiotics is a point of contention for many. Some care providers are much more inclined to frame antibiotic use from a universal perspective, whereas some are more comfortable practicing from a risk-factor screening model.

There are so many variables to consider as part of informed care. For instance, if a GBS positive person, or any person for that matter, declines  antibiotics and tested positive or was "unknown" and the baby experiences delays during normal transition in the immediate post-partum, experiences any fever or signs of infection, they WILL most likely be treated as if they have EOGBS disease. That means your infant receives IV antibiotics for 48h in the nicu and potentially further testing which can be very invasive.

I’d really encourage you to do some deeper research. There are certain risks/benefits to not using antibiotics and with using antibiotics during labour. Resistance, postnatal thrush, mobility issues in labour etc. There are also variables that you cannot predict, such as what happens if you test positive, but didn't have tine to have antibiotics administered? There are also things to consider such as what happens if you decline a test an a baby shows symptoms etc. This published article from the Ontario Association of Midwives is detailed, but it will help you understand the full risk/benefit picture.

In the end, you as a pregnant person, must balance out the benefits and risks to any procedure, test or prenatal screening. Taking into account the short and long term benefits and risks, many of which I do not discuss in this blog. As always, be sure to have a detailed conversation with your care provider about the whole picture as I can in no way replace medical advice or current community standards. The point of this blog was to simply introduce you to GBS and a few of the complexities that may present themselves around this topic.

With gratitude and gumption,
Rhea

I found this article on-line years ago. I cannot recall the author. However, the recommendations and details still apply years later.

2. Be Assertive About Your Care
Stand up for yourself and your baby! Don't accept anything less than wonderful care. Don't be bullied or pressured into any tests or procedures that you are not sure of, or out of anything that you feel would be best for you and your baby. Become your own best advocate. You do not have to do anything you don't want to agree to.. YOU are the employer, and they are your employee.  If you are not satisfied, speak up and try to work things out; often there is a compromise position that can be worked out. Do whatever you need to, to feel safe and respected and listened to. Your baby is depending on you!

3. Research Pregnancy And Childbirth Issues
Become an informed health consumer. There are many controversies in childbirth care, and even the experts disagree strongly among themselves about some things. You will not get the same care if you go to different providers; you'd be surprised how much care decisions will differ between providers! Research pregnancy and childbirth issues so that you know what you why a proposed procedure or intervention may be beneficial or harmful, what the trade off of risks and benefits are, and what impact the decision may have on your and your baby. Women who are more involved in their care tend to have happier and more satisfying birth experiences. Form a partnership with your provider and share responsibility for your care.

4. Be Proactive; Practice Excellent Nutrition And Exercise Habits
Taking care of your baby doesn't start at birth; it starts long before then! Do everything you can ahead of time to prevent problems from happening. Utilize prevention now instead of intervention later! Get serious about minimizing stress in your life, get regular exercise, and practice excellent nutrition. Remember that everything you are doing now may be influencing your baby. You don't have to be absolutely perfect, but do work hard towards being as proactive as possible. Taking great care of your self now can prevent or minimize lots of problems later on. This is one of the most powerful tools for a healthy pregnancy and birth you have, and it's entirely under your control. Really work hard to do the absolute best job you can!

5. Choose A Midwife For Your Care If Possible
Strongly consider a midwife for your care.  You can watch my informative video below to learn a ton of details! Midwives have a much lower rate of intervention, take more time to talk to you about your concerns and choices, and are much more likely to be size-friendly. In some studies, you cut your chances for a caesarean nearly in half by choosing a midwife, and strongly lower your chances for an episiotomy too. OBs are appropriate if you are high-risk (pre-existing diabetes, heart problems, etc.) but they are mostly trained in birth abnormalities and not how best to foster a normal vaginal birth. Midwives are the expert in normal birth, and are much more likely to work with you to help prevent complications, take time to listen to your fears, and give you lots of choices and alternatives in your care.

6. Hire A Doula To Assist You And Your Partner
Consider hiring a professional labour support person ("doula") to help both you and your partner through the labour and birth. Doulas are especially helpful for first-time moms, and for women with special concerns, such as those with a lot of birthing fears, a history of negative contact with doctors, a prior difficult birth, a past history of abuse, or a history of infertility/pregnancy loss. The presence of a doula is known to cut the caesarean rate significantly, lower the rate of women needing drugs during labour, increase the chances for breastfeeding success, and improve maternal satisfaction with the birth. Although many fathers fear that hiring a doula would displace them or make them feel uncomfortable at the birth, a doula actively works to support both the father and the mother during the birth. Fathers who were initially dubious about hiring a doula almost universally report a high level of satisfaction with that choice afterwards; they were surprised at how much it helped, and at how much they appreciated extra emotional and physical support. Doulas are experts in birth, and have many 'labour tricks' they can suggest to help if the going gets tough. You do not have to be committed to a completely all-natural birth in order to hire a Doula; Doulas support your birthing preferences, and work to help you achieve the birthing experience you desire

7. Attend Non-Hospital Childbirth Classes
Choose childbirth education classes that occur outside of the hospital setting as part of your preparation for birth. Although you will pay more for these classes, you are more likely to get exposure to a wider variety of viewpoints and choices, and more in-depth assistance in methods of coping with labour contractions. Although some hospital classes are good, many hospital-based classes are simply exercises in how to be a good, compliant patient and not question your treatment.