Understanding a baby’s group B Strepp infection Risk

Deciding how to proceed with a GBS+ swab result is murky waters for most families. I am happy to share balanced resources whenever I find them to hopefully help in the decision making. This PDF is from the UK

A couple thing I feel to highlight from the attached PDF flyer:

1. The UK doesn't not currently screen all pregnant women for GBS

Although the Group B Strep Support, a national charity, does recommend routine screening.

2. The Numbers

The over all risk of GBS infection for a newborn assuming no mums are taking antibiotics in labor is 1 in 1000. And 1 baby in 10,000 will die from GBS infection.

If a mum has known GBS+ the over all risk increases to somewhere around 1 in 300 babies developing an infection and 1 in 3000 will die from this infection. 

"Early-onset group B Strep infection is more frequently associated with prematurity, rupture of membranes (watersbreaking) for more than 18 hours, with Mum having a fever in labour and with Mum carrying group B Strep. Early- onset group B Strep infection is approximately 8-9 times more common than late onset infection. Most babies willfully recover from their early-onset group B Strep infection but, even with the best medical care, approximately 10% die, with a small number of survivors sustaining permanent mental and/or physical problems."

As we will look at later, these numbers are always gathered from interventive hospital births occurring on land (not in water). I am curious to know are no/low intervention water births similar or different in GBS infection risk numbers?

3. Oral Antibiotics in Pregnancy for GBS are not evidenced based

There are some doctors who recommend oral antibiotics during pregnancy once a GBS+ result is discover, 'just incase' waters release. I have know many mums who have been on oral antibiotics for WEEKS following this protocol from their doctors.

Mumma's this is not supported by research, it is ok to decline if that is offered and find a new practitioner who is following evidenced based practices...  

4. ALL Newborns Should be Closely Observed 

My experience is parents who choose to decline the use of routine antibiotics during labor receive a lot of fear passed on from their paediatrician. I have heard advise which includes: monitoring baby's temperature daily for the first 30 days, and sometimes, for the first 3 months and always: "you will need to monitor your baby very closely for 3 months because late onset GBS can happen at any time."

I wonder: isn't it natural to closely monitor a newborn in the first 3 months? What mum isn't noticing every fart and slight variation her newborn takes? Is this recommendation causing heightened levels of anxiety and is that helpful for new mums?

Comparatively I found the below recommendation quite refreshing as well as a good reminder that most infections will turn up early, first 24 hours and then within 6days, and close monitoring is recommend for the first 24 hours specifically and for BOTH newborns who received the antibiotics and those who didn't.

"Two thirds of babies who develop group B Strep infection show signs in their first 6 days of life (early-onset). Of these, almost nine out of every ten show signs within 12 hours of birth."

5. Baby's Can Develop Late Onset GBS Infection even if mum is GBS-

All babies; not only those who have a GBS+ mum; benefit from staying home, not being in crowds and not being passed around heaps in the first months. Keeping visitors to a minimum to start with, not allowing strangers to pinch cheeks and  cuddle baby is also part of the GBS conversation.

"In the UK, up to 30% of adults carry group B Strep in the intestines and up to 25% of women carry group B Strep in both their vagina and intestines."

6. Routine Hospital Practices Increasing the Infection Risk?   

Routine vaginal exams. Too many hospitals have hourly or several hourly vaginal exams as part of their routine practices. Women are having 3-6+ vaginal exams for one labor/birth.

On the contrary, at home midwives are not doing extra vaginal exams and especially not if a risk factor (for vaginal exams) is present like open waters. It makes sense that keeping fingers out lowers the risk and vaginal exams - pushing what is out and around up into the cervix- would increase infection risk.

I have worked with several OB's who have commented, "because you are not doing vaginal exams at home, GBS+ status and up to 24hours of open waters is fine with no antibiotics, because your risk is low".
This is not studied though so while it makes sense, we can't fully rely on this.

Routinely opening water bag. This interventions is apart of a large % of hospital births. I personally have never heard a doctor recommend waters not to be artificially opened because a woman is GBS+ even though it makes sense to keep the bag intact for as long as possible in this instance.

Curious to know if you have experienced otherwise?

Not to mention vacuums and forceps, common routine interventions that can and often break babies skin on the way out. Could this increase baby's infection risk?

I want to know, do we know that gently birthed babies with low(no) interventions have the same infection risk percentages as babies born by intervention filled births in the hospital?  Sadly there is very little research in this direction (see the study below) .  

As part of planning for birth, please discuss with your doctor/midwife protocols for birth that including reducing to a bare minimum  vaginal exams and not routinely, artificially opening the water bag; especially for GBS+.

7. Does Water Birth Help Reduce GBS Infection Rates?

There was a small study out of Canada that showed birthing in water reduced rates of GBS infection in babies...

Waterbirth and GBS - Cohain JS.

Abstract

The literature provides a single case of early onset newborn Group B Strep (GBS) among 4432 waterbirths, suggesting that low-risk women who give birth in water may have a far lower rate of newborn GBS than women who have a dry birth. The last reported rate of newborn GBS for dry births was 1 in 1450. Several theories for this phenomenon are suggested in this article: (1) inoculating the baby with mother's intestinal flora at birth protects against GBS infection; (2) water washes off the GBS bacteria acquired during the descent through the vagina; (3) the water dilutes the GBS bacteria and mixes it with a multitude of other intestinal bacteria that compete with GBS; (4) early onset GBS is elicited by complications and interventions at birth, which occur less often at water-births; (5) kangaroo care at birth promotes healthy newborns; (6) GBS and antibiotic-resistant GBS are more prevalent in hospital environments, where waterbirths are not an option; (7) a higher rate of underreporting of adverse events at waterbirths compared to dry births; and/or (8) a massively successful international campaign has covered up the reporting of all deaths and disease from GBS after waterbirths.