Monday, 16 May 2011

Group Strep B (GSB): the story of Miss B's birth.

I had a relatively easy time during my labour with Miss B. It was much longer than expected with a bit of a frantic ending. With A, it was fast, over before I could blink or ask for drugs or unpack my hospital bag!

I won't go into the gory details because it is gory and I find that sharing birth stories compels people to share their own tale. If you tell everyone that you had a wonderful, peaceful birth then the next becomes increasingly serene until you end up with the Virgin birth, all bathed in light from the Star and three wise men offering you expensive postnatal gifts. If you are recounting a gruesome tale then it starts some kind of war story sharing competition. The tales become darker, bloodier, entire wards were taken out with you, your husband suffered shrapnel wounds (crushed fingers and the loss of his ability to play Rachmaninov's concertos forever). I'm being flippant of course but I'm sure you ladies can relate.

The only bit I would want to share is far more serious. Six weeks into my pregnancy I was admitted into hospital for bleeding. It was then that they discovered that I had a particular type of infection that may cause problems during labour and possibly beyond. I tried at the time to find out as much as possible about the infection, called Group Strep B and what could possibly happen. There really wasn't  that much information out there. I was an information pack from the hospital to warn us of the dangers and how it would add some complications to labour. I wouldn't be allowed a home birth as I would need several courses of antibiotics during labour and I wouldn't receive any internal examinations for fear of spreading the infection. I hadn't wanted a home birth anyway so that didn't bother me. My forewaters broke and they admitted me into hospital to prevent infection. Because I couldn't be examined, no one knew how dilated I was or how long it would take. Given my rapid birth with A, everyone expected it to be over in a matter of hours but I was still there 36 hours later! Everything went well and I was given another course of antibiotics and kept in another day as I had a temperature.


That's my story in short but wanted to post about GBS as now, doing some proper research into it, I've realised how dangerous it is. It is one of these things were lack of awareness is dangerous. In the UK, we do not routinely screen for it although they do in countries like Kenya. Specialists now are estimating that 1 in every 2000 babies contract GBS from it's mother during labour and sadly, 1 in 10 of these babies die. These women do not know that they are carrying the infection.


Here is some information on it and the link to the support group is here.


What is Group B streptococcus?

Group B streptococcus, or GBS, also known as group B strep, is one of many different bacteria that normally live in our bodies. Approximately one third of us "carry" GBS in our intestines without knowing.

About a quarter of women also have it in their vagina. Most don't know it's there, as it doesn't usually cause problems or symptoms.

However, in rare cases GBS can cause serious illness and even death in newborn babies. Although these cases are unusual, GBS is the most common cause of severe infection in newborns, particularly in the first week after birth (known as an early onset infection). In the UK, about 340 babies a year develop a GBS infection.

How do I know if I carry GBS?

If you do carry GBS, you won't necessarily know as there aren't usually any ill effects. There is a test available for GBS, but this isn't done routinely in pregnancy (see Why isn't there a national screening programme for GBS? below).

Pregnant women often find out that they have GBS by chance, when they have a vaginal swab taken to check for something else. Also, GBS can come and go, so even if you've had a positive test earlier in pregnancy, you may not have GBS as you approach delivery.

It's important for pregnant women and their carers to know when babies are most likely to develop a GBS infection and what the signs of GBS infection in babies are.

Now I'm pregnant, what should I know about GBS?

Most babies exposed to GBS before or during birth suffer no ill effects. However, around one in 2000 babies in the UK develops a GBS infection. Sadly, about one in 10 of these babies die.

It isn't clear why some babies develop an infection while others don't. What is clear is that most GBS infection in newborn babies can be prevented.

Women in higher-risk situations can be given intravenous antibiotics either from the start of labour or from when their waters break (whichever comes first) until their baby is born.

Caesareans are not recommended to prevent GBS infection in babies as they don't eliminate the risk of GBS to the baby.

Very occasionally GBS causes infection of the uterus or urinary tract in new mothers.

Is my baby at risk of developing GBS infection?

The Royal College of Obstetricians and Gynaecologists has identified a number of factors that help to predict whether your baby is more likely to develop a GBS infection.

These include, if:
• you go into labour prematurely (before 37 weeks of pregnancy)

• your waters break 18 hours or more before you have your baby

• you have a raised temperature (38 degrees C / 100 degrees F or higher) during labour

• you have previously had a baby infected with GBS

• you have been found to carry GBS in your vagina and/or rectum during your current pregnancy

• GBS has been found in your urine during this pregnancy (this should be treated when diagnosed, but even if you have been treated, extra precautions should still be considered during labour - see How should my labour and delivery be managed?, below).

How should my labour and delivery be managed?

If you don't fall into one of the higher-risk groups, above, your baby is very unlikely to develop a GBS infection.

If you are higher-risk, research shows that having intravenous antibiotics from the start of your labour or from when your waters break until your baby is born can prevent most GBS infections in newborn babies.

Ideally, you should have intravenous antibiotics for at least two hours before your baby is born and every four hours during labour. There are some risks with taking antibiotics for you and your baby so your doctor will discuss your particular case with you to see whether treatment is the best option for you.

If you have two or more of the above risk factors then your doctor is much more likely to recommend treatment during labour to reduce the risk of your baby developing an infection.

If you are having a planned caesarean there is no need for intravenous antibiotics unless your waters have broken or labour has already started.

If your baby is at higher risk of developing a GBS infection, once he is born:

• he should be examined by a paediatrician immediately

• if both you and he are completely healthy, and you had full treatment with intravenous antibiotics during labour, he may be given intravenous antibiotics

• if both you and he are healthy, but you have not received full treatment with intravenous antibiotics during labour, he may be started on intravenous antibiotics until he's given the all clear

• if you or he shows signs of GBS infection, he should be started on intravenous antibiotics immediately

The best way to treat newborns at risk of GBS infection is an area that doctors are still researching, which is why in some cases your baby may or may not be given antibiotics.

What are the risks of treatment?

Most women and babies can safely be given penicillin as the antibiotic treatment for GBS without any ill-effects. However, a small number of people are allergic to penicillin and could have a severe allergic reaction (anaphylaxis), which can be fatal.

Women who are known to be allergic to penicillin can be given another antibiotic instead.

Other less severe side-effects of antibiotic treatment include diarrhoea and nausea. However, there are concerns that antibiotics may affect the balance of a baby's bacterial flora in the gut.

These adverse effects make some doctors more cautious about using antibiotics if there is not a clear need to do so, particularly for newborns. Some prefer a "watch and wait" approach for the first 12 hours after birth before starting a course of antibiotics that may not be needed.

What are the signs of GBS infection in a baby?

GBS infections in babies are usually "early-onset" (within seven days of birth), with 90 per cent occurring within 12 hours of birth.

In many cases, symptoms of GBS infection in babies can be recognised at or soon after birth.

Typical signs of early-onset GBS infection include:
• grunting
• poor feeding
• lethargy
• irritability
• low blood pressure
• abnormally high or low temperature, heart rate and/or breathing rate

Although more unusual, GBS infections can also develop when the baby is seven or more days old ("late-onset" GBS), usually as meningitis with septicaemia.

Some warning signs of late-onset GBS infection may include:
• fever
• poor feeding and/or vomiting
• drowsiness

Signs of meningitis in babies may include, as well as any of the signs listed above:
• shrill or moaning cry or whimpering
• dislike of being handled, fretful or irritable
• tense or bulging fontanelle (soft spot on head)
• floppy and listless or stiff with jerky movements
• blank, staring or trance-like expression
• being difficult to wake
• low or high breathing rate
• turns away from bright lights
• skin that is pale, blotchy or turning blue

Red or purple spots that do not fade under pressure (such as when pressed firmly with the side of a glass) are a sign of septicaemia.

Early diagnosis and treatment are vital in late-onset GBS infection or meningitis. If your baby shows any of the signs above, call your GP immediately.

If your GP isn't available, go straight to your nearest accident and emergency department. The risk of your baby developing GBS decreases with age; GBS infections in babies are rare after one month of age and virtually unknown after three months.

Most babies survive with treatment, but meningitis can leave some babies with long term problems - visit The Meningitis Trust for more information.

Why isn't there a national screening programme for GBS?

There are strict criteria that have to be met before a national screening programme for any disease can be introduced. These include weighing up factors such as the accuracy of a screening test and the risks versus benefits of treatment.

In the case of GBS, experts are not convinced that a lab test screening programme would do more good than harm. Reasons for this include:

• current lab testing through the NHS in the UK is not reliable enough to recommend that all pregnant women be swabbed and tested during late pregnancy

• there are concerns that the widespread use of antibiotics during labour could increase the risks of severe allergic reactions (anaphylaxis) and make the labour and newborn period too medicalised

• the rates of bacteria resistant to antibiotics could increase

• newborns affected by antibiotics during labour may possibly be more likely to develop allergies and have poor immune systems

I'm carrying GBS - what now?

If you have been affected by GBS in a previous pregnancy, or you are found to be carrying it in your current pregnancy, talk to your midwife or obstetrician and agree a pregnancy and birth plan that will protect your baby from the infection.

In the vast majority of cases your pregnancy can be managed so your baby is protected and born healthy and free from GBS.

Your baby is not at risk of catching GBS from breastfeeding so there is no need to change your plans if you intend to breastfeed your baby.

For more information about GBS, talk to your midwife or doctor or contact Group B Strep Support

4 comments:

  1. I was really surprised to read this. Please don't mistake this for sounding flippant, I'm not saying it isn't serious because it is.

    But I was surprised because in Australia (where I had my kids) every pregnent woman is screened for it. I have it, and the conversation with the dr was literally this:

    "Your strep B came back positive. Don't worry about it, it's just a part of you and pretty common. But it's something I need to know about, that's all."

    And that was it! I was never having a home birth so it didn't affect things in the slightest. I never thought twice about it.

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  2. I know where you're coming from but I think it has to do with grades of infection! Knowing what I know now, inrealise that i wasn't examined in case they spread the infection to the baby and cause blood poisoning. I didn't realise how serious it was until i found the support group. They have a Facebook page that lists the little ones who weren't as lucky as B!

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  3. It's terrible to think you could have it and noone know until it affects your baby. I'm so surprised it isn't routinely screened here in the UK. I can only assume it's a cost-cutting measure.

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  4. The Facebook group gave me a bit of a fright to be honest. Our specialist had tried not to make too much of a fuss and scare us prior to going into labour but on the flip side, I had prepared for a birth I couldn't have. I couldn't be mobile with the IV drugs and the lack of exams meant no one really knew what was happening!

    Thanks for posting. xx

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Thanks for taking the time to comment!