I have been spending a lot of time on Cafemom lately. I joined the natural birth group. They have one member in particular who has been so helpful to me. Doulala. She is always posting good information, answering my questions, etc. She usually includes a few articles on the topic in her response to my questions. I just realized, what better way to remember these and share them then posting them here. I plan on adding more as she posts. But for now here are some of her pearls of wisdom. (Oh, and this is going to be really long so bare with me. Maybe I will post it in separate posts.)
First, I had asked for information about group B strep. I was positive for it when I was pregnant with Aimee and subsequently had the IV antibiotics during labor. Aimee then had Thrush for the next 4 months. Nothing I did for her would take it away. I always wondered if it was because of the antibiotics. It turns out it probably was. Here are the articles Doulala posted for me.
Group B streptococcus (GBS) is a type of bacterial infection that can be found in a pregnant woman’s vagina or rectum. This bacteria is normally found in the vagina and/or lower intestine of 15% to 40% of all healthy, adult women.
Those women who test positive for GBS are said to be colonized. A mother can pass GBS to her baby during delivery. GBS is responsible for affecting about 1 in every 2,000 babies in the United States. Not every baby who is born to a mother who tests positive for GBS will become ill.
Although GBS is rare in pregnant women, the outcome can be severe, and therefore physicians include testing as a routine part of prenatal care.
How can I find out if I have Group B Strep infection?
The Centers for Disease Control and Prevention (CDC) has recommended routine screening for vaginal strep B for all pregnant women. This screening is performed between the 35th and 37th week of pregnancy (anytime other than this time will not be significant to show if a woman is carrying GBS during the time of her delivery).
The test involves a swab of both the vagina and the rectum. The sample is then taken to a lab where a culture is analyzed for any presence of GBS. Test results are usually available within 24 to 48 hours.
The American Academy of Pediatrics recommends that all women who have risk factors PRIOR to being screened for GBS (for example, women who have preterm labor beginning prior to 37 completed weeks' gestation) are treated with IV antibiotics until their GBS status is established.
How does someone get group B strep?
The bacteria that causes group B strep normally lives in the intestine, vagina, or rectal areas. Group B strep colonization is not a sexually transmitted disease (STD). Approximately 15-40% of all healthy women carry group B strep bacteria. For most women there are no symptoms of carrying the GBS bacteria.
What if I test positive for Group B Strep infection?
If you test positive for GBS this simply means that you are a carrier. Not every baby who is born to a mother who tests positive for GBS will become ill. Approximately one of every 100 to 200 babies whose mothers carry GBS will develop signs and symptoms of GBS disease. There are, however, symptoms that may indicate that you are at a higher risk of delivering a baby with GBS. These symptoms include:
- Labor or rupture of membrane before 37 weeks
- Rupture of membrane 18 hours or more before delivery
- Fever during labor
- A urinary tract infection as a result of GBS during your pregnancy
- A previous baby with GBS disease
In this case your physician will want to use antibiotics for prevention and protection.
According to the CDC, if you have tested positive and are not in the high risk category, then your chances of delivering a baby with GBS are:
- 1 in 200 if antibiotics are not given
- 1 in 4000 if antibiotics are given
How can I protect my baby from Group B Strep infection?
If you test positive for GBS and meet the high risk criteria, then your physician will recommend giving you antibiotics through IV during your delivery to prevent your baby from becoming ill. Taking antibiotics greatly decreases the chances of your baby becoming ill.
For women who are group B strep carriers, antibiotics before labor starts are not a good way to get rid of group B strep bacteria. Since they naturally live in the gastrointestinal tract (guts), the bacteria can come back after antibiotics. A woman may test positive at certain times and not at others. That’s why it is important for all pregnant women to be tested for group B strep between 35 to 37 weeks of every pregnancy.
If you are at a low risk, the decision to use antibiotics is up to you. There are herbal remedies that you can take 2-3 weeks before delivery that a midwife or homeopathic physician can recommend.
How does Group B Strep infection affect a newborn baby?
Babies may experience early or late-onset of GBS.
The signs and symptoms of early onset GBS include:
- Signs and symptoms occurring within hours of delivery
- Breathing problems, heart and blood pressure instability
- Gastrointestinal and kidney problems
- Sepsis, pneumonia and meningitis are the most common complications
Newborns with early-onset are treated the same as the mothers, which is through intravenous antibiotics.
The signs and symptoms of late-onset GBS include:
- Signs and symptoms occurring within a week or a few months of delivery
- Meningitis is the most common symptom
- Late-onset GBS is not as common as early-onset
Late-onset of GBS could be a result of delivery, or the baby may have contracted it by coming into contact with someone who has GBS.
Frequently Asked Questions:
How serious is GBS? GBS can cause bladder infections and womb infections for the mother. In some cases GBS can cause stillbirth. Newborns can get meningitis, sepsis, and pneumonia.
If I test positive for GBS does that mean my baby is going to get it also? No. Approximately 1 of every 100-200 babies who are born to mothers who carry GBS will become ill.
What percentage of babies born to mothers with GBS will actually become ill? Approximately 1 of every 100-200 babies born to mothers with GBS will become ill. However, there are certain symptoms that put a mother at a higher risk than others.
What can I do to prevent my baby from getting GBS disease? Intravenous antibiotics (antibiotics given through IV) are recommended during delivery to reduce the chance of your baby becoming sick.
Do I have to take antibiotics, or is there a natural alternative? It is your choice if you want to take antibiotics. There are certain herbal methods that you can take 2-3 weeks before delivery that a midwife or homeopathic physician can provide for you.
Is Group B Strep related to strep throat? No, the two are not related.
Can a woman who tests positive take oral antibiotics before delivery? Treating the mother with oral antibiotics during the pregnancy may decrease the amount of GBS for a short time, but it will not eliminate the bacteria completely and will leave the baby unprotected at birth. Also, waiting to treat the baby with antibiotics after birth is often too late to prevent illness.
Are antibiotics safe for the baby? Penicillin (Category B) is commonly used during pregnancy in non-allergic patients. There are substitute drugs for those who are allergic to penicillin, but they could still experience an allergic reaction. It is best to discuss the pros and cons with your health care provider.
Treating Group B Strep: Are Antibiotics Necessary?
By Christa Novelli
Issue 121, Nov/Dec 2003
Most women who have been pregnant in the last few years are familiar with the terms Group B Strep (for Group B Streptococcus), or GBS. The US Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) recommend that all pregnant women be screened between weeks 35 and 37 of their pregnancies to determine if they are carriers of GBS. This is done by taking a swab of the pregnant woman's vaginal and rectal areas. Studies show that approximately 30 percent of pregnant women are found to be colonized with GBS in one or both areas.
1-5
The CDC and ACOG advise all pregnant women who are found to be carriers of GBS to be treated with intravenous antibiotics during labor. Doctors and midwives have such great concern because GBS can be passed from the mother to the infant during delivery and can cause sepsis (a blood infection), pneumonia, and meningitis (an infection of the fluid and lining of the brain) in newborn infants. Therefore, most pregnant women who test positive for GBS choose to follow CDC and ACOG recommendations and attempt to avoid transmitting GBS to their newborns through treatment with IV antibiotics throughout their labors. Given all this, why would any woman choose not to accept IV antibiotics? But no woman can make a truly informed decision about this issue without taking a critical look at any recommendation that a third of all women and their infants be given antibiotics during labor.
GBS is a bacterium that normally lives in the intestinal tracts of many healthy people. A vaginal-rectal area colonized by GBS should not be termed "infected" any more than an intestinal tract colonized by GBS would be. GBS is a problem only when it is present in the genital area of a pregnant woman during labor and delivery. When this happens, there is a small risk that the bacterium will be passed on to the newborn infant, and that she or he will become sick as a result. Approximately 0.5 percent of women found to have GBS bacteria in their genital areas at 35 to 37 weeks into their pregnancies will go on to deliver a baby who becomes ill from GBS. This is 0.5 percent of women who receive no antibiotics during labor and delivery.
We should not take lightly the use of antibiotics for 200 women and their babies to prevent only a single blood infection-however serious that infection might be-especially in this age of increasing resistance to antibiotics. Concerns have arisen in several areas regarding the use of antibiotics for so many laboring women. One dilemma is that colonization of the vaginal area by GBS is, at best, a poor method of predicting whether a newborn will develop a GBS infection. As mentioned, even without any intervention during labor, fewer than 1 percent of infants born to carriers of GBS develop infections.
6,7
Some studies have shown a decrease in GBS infection in newborns whose mothers accepted IV antibiotics during labor, but no decrease in the incidence of death.
8, 9 Still other research has found that preventive use of antibiotics is not always effective.
10 In fact, one study found no decrease in GBS infection or deaths among newborns whose mothers were given IV antibiotics during labor.
11
Perhaps the greatest area of concern to medical researchers, as it should be to us all, is the alarming increase in antibiotic-resistant strains of bacteria. Antibiotic-resistant bacteria can cause infections in newborns that are very difficult to treat. Many large research studies have found not only resistant strains of GBS, but also antibiotic-resistant strains of E. coli and other bacteria caused by the use of antibiotics in laboring women.
12-21 Some strains of GBS have been found to be resistant to treatment by all currently used forms of antibiotics.
22
While many studies have found that giving antibiotics during labor to women who test positive for GBS decreases the rate of GBS infection among newborns, research is beginning to show that this benefit is being outweighed by increases in other forms of infection. One study, which looked at the rates of blood infection among newborns over a period of six years, found that the use of antibiotics during labor reduced the instance of GBS infection in newborns but increased the incidence of other forms of blood infection.
23 The overall effect was that the incidence of newborn blood infection remained unchanged.
The increase in other forms of blood infection among newborns is likely due to bacteria made drug-resistant by the overuse of antibiotics. Evidence exists that increased use of antibiotics frequently leads to increasing bacterial resistance. When a woman is given antibiotics during labor to treat GBS, the antibiotics cross the placenta and enter the amniotic fluid. While the antibiotics may have the desired effect of killing the GBS bacteria, some GBS bacteria can survive and become difficult, if not impossible, to kill with traditionally used antibiotics. Similarly, other bacteria, such as E. coli, that may be present in the mother or infant can become resistant to antibiotic treatment. These bacteria may not have presented a large risk of infection to the newborn until they were exposed to antibiotics and made into "super-bugs."
A study of 43 newborns with blood infections caused by GBS and other bacteria found that, when the mothers of the ill newborns had been given antibiotics during labor, 88 to 91 percent of the infants' infections were resistant to antibiotics. It is unlikely to be a coincidence that the drugs to which the bacteria showed resistance were the same antibiotics that had been administered during labor.
24 For the newborns who had developed blood infections without exposure to antibiotics during labor and delivery, only 18 to 20 percent of their infections were resistant to antibiotics.
E. coli, in particular, is becoming an increasing cause of bacterial infection in newborns as the use of antibiotics in labor has increased. One study, which looked at causes of newborn blood infections between 1991 and 1996, found that the incidence of infections caused by GBS decreased during this time, but that the incidence of infection caused by other bacteria, especially E. coli, increased.
25 During those years, antibiotic use during labor increased from less than 10 percent to almost 17 percent of the women included in this study. The researchers concluded that increased use of antibiotics during labor was the likely cause of increased newborn blood infections with bacteria other than GBS.
E. coli infection is particularly difficult to treat in premature babies. Unfortunately, the proportion of E. coli bacteria that are resistant to antibiotic treatment has increased astronomically in premature infants in the past few years. In a review of 70 cases of E. coli infection in newborns over a two-year period, researchers found that 29 percent of the E. coli bacteria present in premature babies were resistant to ampicillin in 1998; two years later, 84 percent of the E. coli bacteria present in premature babies were resistant to the same antibiotic.
26
Preterm labor (i.e., labor before 37 weeks) is a well-accepted risk factor for transmission of GBS to the infant during labor and delivery. Due to the larger risk of transmitting GBS to a premature baby during delivery, most women who go into early labor will opt to receive IV antibiotics during their labor. However, infants born prematurely are at a greater risk from super-bugs caused by the very antibiotics that are supposed to be reducing their risk of infection. Severe complications for the babies, even deaths, have occurred when women whose waters broke before 37 weeks were given antibiotics to prevent transmission of GBS to their newborns. St. Joseph's Hospital in Denver, Colorado, tracked four cases in which women whose waters broke before 37 weeks were given ampicillin or amoxicillin. Following the administration of antibiotics, infection of the amniotic fluid occurred in all four cases. Two of the infants died as a result of blood infections from resistant bacteria; a third was stillborn, presumably from the same cause.
27
Given the frightening results of these studies, what is a woman to do if she tests positive for GBS during her pregnancy? A closer look at the real risks of transmission, a frank talk with her provider of prenatal care, and a consideration of alternatives for eradicating GBS are all good places to start.
How great is the risk of my baby becoming sick from GBS?
There are three significant factors that place a woman at increased risk of delivering an infant who becomes ill from GBS: fever during labor, her water breaking 18 hours or more before delivery (prolonged rupture of membranes, or PROM), and/or labor or broken water before 37 weeks gestation.
28 Other factors that can contribute to a newborn's risk of contracting GBS infection include age, economic, and medical criteria, such as the following: being born to a mother who is less than 20 years of age,
29, 30 being African American,
31, 32 the mother having large amounts of GBS bacteria in her vaginal tract,33-37 and being born to a mother who has given birth to a prior sibling with GBS disease.
38-40
In the absence of the first three risk factors (fever during labor, PROM, or labor before 37 weeks), the risk of a newborn developing GBS infection is very small. The CDC estimates that, without the use of antibiotics during labor, only one out of every 200 GBS-positive women without these risk factors (0.5 percent) will deliver an infant with GBS disease. Some studies have found even lower rates of transmission. If antibiotics are given to the mother during labor, the CDC estimates that one in 4,000 GBS-positive women with no other risk factors will deliver an infant with GBS infection.
Conservative studies find that the use of antibiotics during labor fails to prevent up to 30 percent of GBS infections, and 10 percent of the deaths from GBS disease or infections.
41, 42 Although, by CDC estimations, there is a reduced risk of GBS transmission with the use of antibiotics, one must take into account the risks posed by the use of the antibiotics themselves.
For a woman who has a negative culture for GBS at 35 to 37 weeks, there is a one in 2,000 risk of her newborn developing a GBS infection, and antibiotics are not recommended by the CDC. The CDC does recommend treating all women with risk factors (fever, PROM, premature labor) with antibiotics if they have not been tested to determine whether they are carriers of GBS.
What are the symptoms of GBS infection in a baby?
There are two forms of GBS infection: early and late onset. In early-onset GBS disease, the infant will become ill within seven days of birth. Of those infants who do develop a severe early-onset GBS infection, approximately 6 percent will die from complications of the infection.
43 Full-term babies are less likely to die; 2 to 8 percent of them suffer fatal complications.
44 Premature infants have mortality rates of 25 to 30 percent.
45 Late-onset GBS infection is more complex and has not been convincingly tied to the GBS status of the mother. Late-onset GBS infection in infants occurs between seven days and three months of age.
In newborns, symptoms of early-onset GBS infection can include any of the following: fever or abnormally low body temperature, jaundice (yellowing of the skin and whites of the eyes), poor feeding, vomiting, seizures, difficulty in breathing, swelling of the abdomen, and bloody stools. Of course, any of the above symptoms can also be a sign of a sick newborn who does not have a bacterial infection. Newborns with any of these symptoms should be immediately evaluated by a medical professional.
How great is the risk from antibiotics?
The recommended antibiotic for treating GBS during labor is penicillin. Fewer bacteria currently show a resistance to penicillin than to other antibiotics used to treat GBS. The options are fewer for women known to be allergic to penicillin. Up to 29 percent of GBS strains have been shown to be resistant to non-penicillin antibiotics.
46 For women not known to be allergic to penicillin, there is a one in ten risk of a mild allergic reaction to penicillin, such as a rash. Even for those women who have no prior experience of a penicillin allergy, there is a one in 10,000 chance of developing anaphylaxis, a life-threatening allergic reaction.
We can compare this to CDC estimates that 0.5 percent of babies born to GBS-positive mothers with no treatment will develop a GBS infection, and that 6 percent of those who develop a GBS infection will die. Six percent of 0.5 percent means that three out of every 10,000 babies born to GBS-positive mothers given no antibiotics during labor will die from GBS infection. If the mother develops anaphylaxis during labor (one in 10,000 will), and it is untreated, it is likely that the infant, too, will die. So, by CDC estimates, we save the lives of two in 10,000 babies-0.02 percent-by administering antibiotics during labor to one third of all laboring women. We should also keep in mind that this figure does not take into account the infants that will die as a result of bacteria made antibiotic-resistant by the use of antibiotics during labor-infants who would not otherwise have become ill. When you take that into account, there may not be any lives saved by using antibiotics during labor.
It should be noted that antibiotics such as penicillin kill GBS as well as other bacteria that might cause a newborn to become ill. Currently, the use of penicillin during labor may be a case in which the benefits outweigh the risks, depending on your individual risk factors for passing GBS on to your baby. However, it was only a few years ago that the same could have been said about other antibiotics. Ampicillin and amoxicillin have been rendered virtually useless for treating GBS by their prior overuse in laboring women in an effort to prevent GBS infection in newborns. How long will it be before penicillin, too, becomes useless in the battle to prevent GBS infections?
More minor risks of the use of antibiotics include an increase in thrush and other yeast infections among newborns. Along with the risks of thrush and allergic reactions, women must take into consideration the risk of creating antibiotic-resistant bacteria in themselves and their newborns. It is possible that exposure to antibiotics during birth could delay establishment of healthy bacteria in the infant's intestinal tract and allow penicillin-resistant bacteria, many of which are harmful, to become established.
Each woman must weigh for herself the likelihood of GBS infection in her newborn, taking into account her individual risk factors as well as the risk of other forms of infection caused by antibiotic-resistant bacteria. This is a good discussion to have with your healthcare provider so that you can be an informed partner in your own health care.
Alternatives to Antibiotics
Many women are interested in alternatives to antibiotics that may help get rid of GBS prior to labor. Unfortunately, no scientific studies of alternative treatments have been published. Several researchers have suggested that studies are needed to determine whether alternative approaches to eradicating GBS in pregnant women would be effective. Alternate approaches that have been suggested include vaginal washing and immunotherapy.
47
At this point, however, these alternatives remain to be studied, and I am aware of no
healthcare providers that use either method.
Some practitioners of natural medicine have suggested supplements for the mother in an
effort to eradicate GBS prior to delivery. One suggestion is that, when a woman tests
positive for GBS, she should take a course of garlic, vitamin C, echinacea, and/or bee
propolis, and then be re-tested to determine if she is still carrying GBS. Any
supplements that a pregnant woman considers taking should first be discussed with a
homeopathic or naturopathic physician or other knowledgeable practitioner of natural
medicine.
Because colonization by GBS is intermittent or transient for 60 percent of carriers,
testing positive for GBS once does not indicate that a woman will always be colonized.48
However, most studies indicate that a positive culture at 35 to 37 weeks gestation is a
fairly accurate predictor of GBS colonization at delivery. Without an active effort to
eradicate the GBS colonization, it is likely that a woman will still be colonized at
delivery.
Ultimately, it is the pregnant woman herself who will have to decide what is right for her
and her baby. Deciding to follow the recommendations of ACOG and the CDC is not
necessarily the wrong choice, as long as a woman is adequately informed of the risks
that come with antibiotic use. But none of us should blindly follow recommendations to
interfere with the natural birth process without taking a good look at the risks, as well as
the benefits, of doing so.
GBS GARLIC article:
a lot of good info!
The Cochrane Collaboration Announces that
Intrapartum Antibiotics for GBS is not evidence based.
"There is lack of evidence from well designed and conducted trials to recommend IAP to reduce neonatal EOGBSD."
Translated: There is lack of evidence from well designed and conducted trials to recommend Intrapartum Antibiotics Prophylaxis to reduce neonatal Early-Onset Group B Strep Disease.
