Preventing GBS and knowing your options (Group Beta Strep)

Jun 7

Preparing for Birth

As you prepare for your beautiful birth, you may hear (among all of the other tests) of the Group Beta Strep test at 36wks. GBS is a bacteria that has been around since the 1880s when it was found in cows. By the 1960s, people began seeing that GBS infection was affecting the health of newborn babies.

GBS bacteria spreads very easily and 1/3 of all people carry GBS. It can spread during birth, someone’s spit, tampon use, sex or even skin to skin contact. When a mom with GBS gives birth, 50% of the time, the baby will catch it too. The reason GBS is a major topic of women’s health today is because of the 50% of babies who get GBS, 1-2% of those babies (so 1 in 1000) will have a hard time recovering (trouble breathing, sepsis, pneumonia, meningitis, or seizures).

Here’s everything you need to know.

Testing for GBS

This test is given typically at your 36wk visit. You will get a test tuber with a long cotton swab inside. You then swab around your perineum and inside your vagina. Some midwives reccomend that you swab in your anus as well, but in birth, the baby does not come into contact with anal bacteria; therefore, the presence of GBS bacteria in the anus essentially useless information. Swabbing around your perineum, vagina and the areas when your baby will actually come into contact with at birth for more accurate results. If you do choose to swab rectally, make sure to swab your vagina first and rectum last to avoid contaminating the vagina unneccesarily.

If you wish to deny this test you must simply ask for an AMA form to sign agreeing to your informed refusal (you will most likely need to sign another AMA form to deny standard IV antibiotics in labor).

You should know your results in the next few days.

In the hospital, the standard protocol for a GBS positive mom at 36wks is to:

Take a culture test for GBS vaginally and/or anally at 36wks

Get IV antibiotics every 4-6 hours in labor if test came back positive
Start an induction if water is broken for longer than 24hrs
Give antibiotics to baby after birth if-needed

Your Options

Prenatally:

Try to prevent active GBS before testing at 36wks (probiotic use, hibiclens, etc.)
Deny testing altogether (you may need to sign an AMA form at the hospital to do so)
Test for GBS (typical is at 36wks but you can customize it to best fit your needs)

At Birth:

Do nothing
Induction (when water has been broken over 24hrs or at the start of a fever)
- Natural Induction: semen, spicy foods, organic castor oil, acupuncture
- Medical Induction: pitocin, cytotec, folly bulb
Use hibiclens during labor instead of antibiotics
IV antibiotics (you can choose how many doses of antibiotics you would like. Standard is a dose every 4 hours. You may need to sign an AMA form if you deny antibiotic use)
Minimize the effects of antibiotic use at birth (probiotics, bone broth, tea, etc.)

Postpartum:

Heal after the use of IV antibiotics
Give your baby antibiotics

Preventing active GBS

The first thing I tell my clients is to enjoy their pregnancy by growing a healthy, happy, well-nourished, baby. Preventing the spread of GBS will come as a result of this. Eating a healthy, whole-foods diet prevents the growth of bacteria vaginally by creating an acidic environment. This diet should include lots of fiber, organic fruits, meats and vegetables as well as a plethora of fermented foods. In fact, taking a probiotic with the strains Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14, actually reduces your chance of a positive test by 50%.

When your baby passes through your vaginal canal at birth, they not only ingest all of your good and harmful bacteria. So eating healthy ensures that your baby is born with minimal exposure to bad bacteria and maximum to the good vaginal flora that sets the foundation of your baby’s microbiome health as they grow and fight of infections down the road. This is why we also reccomend skin-to-skin contact, not using body wash, no baby bath, no baby hats and bringing your own clothes from home to the hospital to find ways so as to not disrupt this natural process of forming the gut microbiome. Having a healthy diet ensures that your vaginal flora is full of plenty of good bacteria to help fight of infections and so does your baby’s. Make sure that your partner takes a probiotic as well (if you have sex, your partner could pass GBS onto you).

The midwife’s reccomendation:

Take a probiotic with the strains Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 (reduces your chance of a positive test by 50%). Try Femdophilus
Eat fermented foods (sauerkraut, yogurt, kimchi, keifir, kombucha, pickles) daily
Take vitamin C and zinc to help keep the water intact (when your bag of waters is weak, it can break earlier than normal. If you choose vaginal checks and your bag of waters has been broken for over 24 hours, you have an increased risk of risk of infection)
No vaginal checks in pregnancy or labor for any reason to avoid unnecessary contamination
Restore oil massaged on your perineum daily for 7 days can help remove GBS, yeast and bacteria

What are my options if I test positive?

You have a few options at this point. You can either nothing at all, try your best to keep bacteria low and retest again in 4 weeks, take antibiotics in labor or use alternatives to antibiotics.

Retesting for GBS

Not all providers will offer this but it is always an option. While you may be positive for GBS now, that does not mean that you will be positive at the time of your labor. The results for the PCR test take a couple of days to come back so if you were to retest at 40wks and go into labot at 41wks, you may have enough time to change the results of your test in time for birth. You can even ask your provider for a rapid GBS test to take at the time of labor to see if you are negative by chance. Remember though that like any rapid test, the results are not as accurate as those of a PCR test.

Antibiotics

There are a lot of reasons to deny antibiotics, especially with the rising infections of E. Coli due to antibiotic resistance. However, antibiotics can be a powerful tool when necessary. Aviva Romm mentions in her podcast episode about GBS that it takes the body about 3 months to rebuild your gut bacteria after antibiotics. So if you do get the antibiotics you can set yourself up with a hefty probiotic protocol and begin restoring your gut health. There are also things you can do to mitigate the negative effects of antibiotics, which I mention below.

Just one dose of IV antibiotics reduces the colonization of GBS by 80%. There is little evidence that shows that more doses than 1 are more effective at treating GBS. Also, while the antibiotics reduce the chance of your baby getting GBS, the 20% who do get colonized with gbs, 98-99% of those babies will be totally fine. However, 1-2% will have a serious reaction at which antibiotics will be prescribed to the baby.

In the hospital, the antibiotics are reccomended every 6 hours from the point of water breaking. Once a mom’s bag of waters breaks, GBS could go from the mom’s birth canal and into hole in the amniotic sac and infect the baby. Now, a woman has two bags of waters. It is very possible for leaking to be a sign of the first bag of water breaking. As long as one bag of waters is intact, GBS will not be able to spread. I had this happen to one of my clients. Her 1st bag of waters had been leaking for a few days and she went into the hospital for induction and to begin antibiotics. She got about 6 doses of IV antibiotics. When the baby finally came out, we saw a fully intact bag of waters surrounding his body. The perfect safe haven. So if you have a bit of leaking waters and it is confirmed to be your amniotic fluid, check the baby’s heartrate and your fluid levels by getting a Non-Stress test to ensure that it was both bags of waters borken before beginning antibiotics. And make sure that you deny any and all cervical checks at the point of water breaking to ensure that no other bacteria is getting inside.

If you decide to deny IV antibiotics, simply ask for an Against Medical Advice form to sign as informed consent.

Alternatives to antibiotics

There is a product called hibiclens which contains chlorhexidine is used to reduce bacteria count. It seems to be very comparable to the IV antibiotics that are routinely administered to moms in labor. There was a study done with 244 moms who had GBS at 36wks. They were split into two groups: IV antibiotics and chlorhexidine. The chlorhexidine group rinsed their perineum with chlorhexidine every 6 hours in labor while the IV antibiotic group was given ampicillin every 6 hours. This continued until birth was imminent. Of the two groups, the rate of newborns with GBS after birth for the chlorhexidine group was 15.6%, while the colonization for the antibiotic group was 12%. What I found interesting as well was that E. Coli was significantly more prevalent in babies who’s moms had gotten the antibiotics in labor by 7.4% as opposed to the moms who had only done the chlorhexidine rinse at 1.8%. While the infection of GBS was 3.6 percent more for the chlorhexidine group, I still think it is a very good alternative to the antibiotics. Especially when taking into account the rate of E. coli infection, long-term antibiotic resistance and the benefits of a healthy microbiome in newborns.

If you do in fact choose to get the antibiotics, your gut will be out of whack for a while and will need some major r&r. The good news is there are many things you can do to minimize the harsh effects of IV antibiotics that fitness guru and health fanatic Ben Greenfield has currated to give you the best results when healing.

1. Eat foods rich in probiotics: sauerkraut, kimchi, kombucha, keifir

2. Drink collagen-rich bone broth to help heal your gut lining

3. Take a probiotics: make sure that it has Sacharomyces Boulardii in it. Femdophilous is a good option.

*Timing probiotics: ideally, you would consume probiotics opposite to when you consume your antibiotics. With IV antibiotics scheduled for every 6 hours in the hospital, this is a lot trickier. After your IV antibiotic dose has been administered, wait about 2 hours and take a probiotic. This should give you enough of a gap before you next dose of antibiotics.

4. Drink Milk Thistle Tea (I love to put this into my postpartum tea), to help nourish your liver

5. Drink Alow Vera

5. Eat a lot of fiber-rich foods to help off-set the negative side effects of antibiotics such as yeast growth. I reccomend having a smoothie, veggies, fruit and salad at your birth (even if birthing at the hospital, home foods are much better than the coke and popsicles the hospital has to offer!).

6. Add raw spinach and raw beets to your smoothies, they are high in the amino acid glutamine which helps to fight of infection. Cooking foods destroys most of the glutamine so making sure these foods are raw is important.

7. Drink fresh made ginger tea if you are feeling nauseous from the antibiotics

8. Continue all of the above postpartum as you heal and rebuild your microbiome after birth.

Keeping an eye on baby after birth

Recognizing a reaction:

Make sure to keep an eye on your baby after birth. Most reactions happen within the first day or around 3 months. If they are having trouble breathing or breathing fast, they could be having a reaction to GBS.