8.16.2007

GBS: Giant Bothersome Stumblingblock??


Ok - So I cheated. But it's about all I could come up with after 3 hours of sleep. Yep, 3 hours. A friend called yesterday evening and some stuff we talked about kept me up much of the night.

Ok back to the subject of this particular blog...

GBS. To flip the coin on the body of thought that GBS is an 'infection', GBS is a normal bacterium that colonizes in the body of healthy people everywhere. To term it 'infection' deems that 70% or greater of our population is 'infected'. Rather, perhaps GBS is PART of the human race and should be treated as part of a pregnant woman's body, not an evil, a shortcoming, or an infection. Infection has such negative connotations with it and can make a woman feel unrest, disquiet, or ill toward her body - as if it were harboring a foriegn malicious body or had failed her in some way.

For those readers who don't know what it is, Group Beta Streptococcus is a naturally occuring bacteria that lives in the colon and sometimes gets transmitted to the vagina (through thong underwear, wiping, hygiene habits, or intercourse). GBS in the vagina does nothing to mom, though, IF transmitted to baby, it COULD cause sepsis, meningitis, or pneumonia in the baby.

GBS testing is done by swabbing the rectal opening and then, separately, swabbing the vagina. If the vaginal swab comes back GBS positive (colonized with GBS), they consider you GBS positive at the time of birth. There are a number of issues with this thinking, though.

- Just because you are GBS positive when they do the test does not mean that you will be GBS positive when it is time for birth. The vagina, being a hostile environment for GBS, frequently kills off the GBS of the vagina in GBS positive women - making it necessary for the body to 're-infect' the vagina in order for the baby to be at risk. If you have a highly active sex life with your partner, you are even less likely to have many 'outbreaks' as semen contains anti-biotical properties that very effectively kills GBS. Approximately 0.5 percent of women found to have GBS bacteria in their genital areas at 35 to 37 weeks into their pregnancies and who are not treated with antibiotics will go on to deliver a baby who becomes ill from GBS.

- Just because you are GBS positive at the time of birth does not mean that your baby will be infected. Out of every 100 women who are GBS positive (in the vagina) at the time of birth (not the time of screening) and are not given antibiotics, only 1-2 will have a baby born infected with GBS.

- Just because your baby is infected does not mean that they will be harmed. Out of those few that are infected (1-2 per 100), only a small percentage of THOSE (20-30%) are infected to the point of needing any type of deviated medical attention. There are indications and symptoms that caregivers watch for to see if baby is infected to the point of needing treatment and can start treatment at that time to combat GBS effectively in their systems.

In other words, infection alone does not mean your baby will be at risk. And those few who do develop issues can be treated at that time if the parents and caregivers are diligent to watch for symptoms. Preventative antibiotics during labor are not the only option.

That said, if you are GBS positive, to reduce the risks of baby becoming infected, regardless if you opt for antibiotics or not, here are statements put out by the ACOG regarding the matter.

- internal fetal monitoring may create a small scrape on baby's head where the bacteria can get into the bloodstream. Routine internal monitoring is not a good idea for most Group B strep positive moms. talk with your physician about the risks and benefits of using the internal monitor.

- Discuss ways to avoid excessive digital exams in labor with your provider, as inserting anything into the vagina may push the bacteria closer toward the baby.

- Don't agree to let the provider rupture membranes to induce labor. Rupturing membranes allows access to baby, puts you on a schedule for delivery and increases the chance of prolonged rupture (a risk factor). Rupturing membranes AFTER the IV antibiotics are started LATE in labor may not be as problematic. Keeping your bag of waters intact reduces the risk to baby.

- Taking oral antibiotics before labor to get rid of Group B Strep colonization will not reduce the risk to baby. IV antibiotics in labor are the only proven way to protect baby from GBS infection.

Some practitioners of natural medicine will prescribe supplements for the mother during pregnancy in an effort to decolonized the mother of GBS prior to delivery. If the mother tests positive for GBS, some suggest she begin a course of treatment that involves vitamin C, garlic, and Echinacea and then be retested to determine if she is still carrying GBS.

Other practitioners of herbal remedies and supplements have found GREAT success rates of the following strict regime to eradicate GBS from their bodies all together: a daily regiment of douches and oral remedies. Oral acidophilus and a grapefruit seed extract douche in the morning. Garlic capsules inserted vaginally in the afternoon. And an oral once a day garlic capsule in the afternoon. Finally a goldenseal root powder douche at night along with another oral acidophilus.

Another issue as to why IV antibiotics may not be the best option is the resultant spike in other newborn blood infections.

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 six-year period, 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 shows 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 it not impossible, to kill with traditionally used antibiotics. Similarly, other bacteria that may be present in the mother of infant, such as E. coli, 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 "superbugs."

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)
- Christa Novelli

There are so many other issues as well, such as premature GBS positive births, PROM and GBS, maternal fever in labor, and the like. These are all discussed in the above linked article, but my fuzzy sleep deprived brain is shutting down. So...

If this has spurred your interest in whether, if you are faced with this issue, you would accept antibiotics, I recommend the above linked article as well as these additional resources:
GBS and Alternatives
Birth Preparation with GBS - Mothering Magazine
Hospital Infections vs GBS Colonization

4 comments:

kris said...

well i learned alot from that! and i especially appreciate how it began, if only i had known those things 8 years ago. i was told i had "it" and scared to death about it for weeks until finally a close family friend and dr. put me at ease.....thank you for this

Nicole D said...

no problem, knowledge truly is power!

mm said...

My midwives were out of testing swabs... so I never did find out in my second pregnancy. Just watched babe like a hawk (like that is a problem!). Third thankfully came back negative... which made everyone sigh in relief. They'd have had to get special stuff from the hospital because I'm deathly allergic to penicillin and all it's cousins...
Would have made my 2nd hbac a little more complicated! kinda...
Found you via Sarah the doula! Now... on to reading the rest of your posts! WOO HOOOOO!

Adel said...

Thanks, great info. I'm deciding to opt out of the test or not. It seems like the only reason to take it is to appease a provider who might otherwise want to do all manner of bloodwork and lengthy observation on my baby, if I don't get tested. Phooey on them...

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