Download GroupBStrep - Birthroot Midwifery

Birthroot Midwifery LLC
PO Box 1493 Shepherdstown, WV 25443 [email protected] Group B Strep Informed Consent
Group B Strep (GBS) is a bacteria that all people carry in their bowels and about 15% 40% of women carry in their vagina. The presence of the bacteria is called colonization.
The colonization can vary in each individual and change from heavy to non-detectable.
In this way it is similar to yeast, normal women having it from time to time but only
causing a problem when heavily colonized. However, GBS does not cause any
symptoms of infection to the woman, so it is impossible to be aware of carrying it without
being tested.
A woman who has GBS in her vagina may pass this bacteria on to her baby during birth,
which at times can lead to infection in the baby.
Risks of GBS:
Colonization in the baby does not guarantee the development of an infection but it could
possibly cause one. The rate of colonization in the baby in a low count colonized mother
is 30%, in a moderate count colonized mother is 50%, and in a high count colonized
mother it is 88%.
Only 1-2% of babies who become colonized will develop infection. The rate of early
onset infection (in the first week of life) is 5.1 per 1,000, or 0.5%. However it approaches
40 per 1,000, or 4% in women who have risk factors.
Risk factors:
Preterm birth, less than 37 weeks
Ruptured membranes greater than 18 hours
High maternal colonization of GBS
Internal fetal monitoring for more than 12 hours
Chorioamnioitis- infection of the uterus during labor
If baby does develop sepsis, the death rate is 55% without treatment but falls to 6% with
prompt treatment in the hospital. In a woman without risk factors the overall chance of
baby dying due to GBS is 6 in 10,000, or .06%. For a woman with one risk factor the
chance becomes 24 in 10,000 or, .24%. The more risk factors the higher the rate of
infection in the baby.
Considerations:
GROUP B STREP 03/14
Birthroot Midwifery LLC
PO Box 1493 Shepherdstown, WV 25443 [email protected] The American medical community tests all pregnant women at 35-37 weeks of
pregnancy for GBS. If a woman tests positive, she will receive IV antibiotics every 4
hours to prevent an infection in the baby.
It is possible for GBS to come and go. Women who test positive at 37 weeks can be
negative at the time of the birth and vice versa. It also happens that women who
cultured negative and without risk factors can have a baby that develops an infection.
In addition, 4% of strains of GBS are now antibiotic-resistant. If you carry a resistant
strain of GBS, the antibiotics will kill off the innocuous, normal bacteria that would keep
the antibiotic-resistant GBS in check, leaving the resistant strain, which tends to be
more virulent than the regular strain. This is a horrible situation for a newborn with an
immature immune system.
Not only can GBS become antibiotic-resistant, but other bacteria in the body can as
well. The increased administration of antibiotics to pregnant women may be responsible
for the increased incidence of early onset infection with E. Coli bacteria that are reisitant
to antibiotics. A study presented at the Society for Maternal-Fetal Medicine found
antibiotic resistance in 45% of infected babies who had been exposed to antibiotics in
the prenatal or labor and birth period. Antibiotic resistance was found in 50.1% of
preterm babies, compared to 20.6% of term babies.
A large retrospective study showed that antibiotics given during labor did not change
the severity of or delay the onset of GBS disease in those babies that did contract it.
Prevention:
As homebirth midwives I DO provide the option of testing but CANNOT provide
antibiotics in labor.
The following measures can prevent or kill GBS bacteria from inhabiting the vagina and
limit exposure to the newborn:
• Use the following treatment between 36 and 38 weeks to prevent or clear GBS
colonization. If a woman tests positive, also have the husband take this regimen to
prevent re-exposure with intimacy.
Twice daily:
Acidophilus- 4 billion cells per dose
Echinacea- 350 mg capsule x 2
GROUP B STREP 03/14
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Birthroot Midwifery LLC
PO Box 1493 Shepherdstown, WV 25443 [email protected] Garlic- 580 mg capsules x 2
Vitamin C- 500 mg with 200 mg bioflavinoids
Grapefruit Seed Extract- 15 drops
• Keep vaginal exams to a minimum during labor
• Women with known GBS colonization, or women with the following risk factors, should
use Hibiclense vaginal washes during labor. This has been shown to be as effective
as antibiotics given during labor at preventing GBS in multiple European studies.
Risk Factors: preterm birth, ruptured membranes greater than 18 hours, maternal
history of GBS infection, maternal GBS urinary tract infection. Serious risk factors such
as signs of infection in the mother (fever, foul amniotic fluid) or a preterm baby would
indicate that the mother should give birth in a hospital with IV antibiotic treatment.
**Please sign the ROUTINE PRENTAL TESTING INFORMED CONSENT form
(found in your welcome folder) to acknowledge that you have read this
information and for you to indicate what your testing preferences are**
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