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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 2 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** GROUP B STREP 03/14 3