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    since 26Mar02
  • Homebirth and GBS

    The problem of GBS prevention at home might be one of the greatest ironies in childbirth. The hands-off approach to homebirth reduces the likelihood of "introduced infection", yet most babies acquire the bacteria as they pass through the birth canal, so homebirth alone does not offer complete protection. Unfortunately, many homebirth midwives limit their clients' options for GBS treatment at home by failing to provide IV antibiotics during labor. They are left weighing the possibilities and risks of introducing complications in a hospital with the possibilities and risks of a Group B Strep infection at home.

    What are the options for GBS prevention at home? What are the risks?

    All pregnant women, regardless of where they birth should know the risk factors for infection and the symptoms of the disease in newborns.

    see Straight Talk: Am I at risk of infecting my baby? (the notes added are my own) and Alternative and Complimentary Remedies.

    Summary of GBS Stats

    Risk Group CDC Statistic
    GBS baby for GBS pos (+) mom, no risk factors, no antibiotics 1:200
    GBS baby for GBS pos (+) mom, WITH risk factors, no antibiotics 1:25
    GBS baby for GBS neg (-) mom, no risk factors, no antibiotics 3:10,000
    GBS baby for GBS neg (-) mom, WITH risk factors, no antibiotics 1:900
    GBS baby for mom treated with IV antibiotics in labour 1:4000 see Note 1

    Straight Talk: Am I at risk of infecting my baby?

    by Lisa Porter


    This is an overview of the basic information (taken from the CDC prevention guidelines:

    It is useful to know whether a risk is large or small before making choices about prevention strategies. All of the information below assumes that the GBS test was done at 35+ weeks by swabbing the lower vagina (not cervix) and rectum using a test specifically for GBS. If you were tested earlier, it's safest to assume that you will carry GBS at delivery. Don't assume that all will be fine if you later test GBS negative - if you carry GBS during pregnancy, it is likely that you will not be able to pass on immunity to GBS to baby -- IMO it's safest to assume you're GBS+.

    Women who are GBS+ are 29 times more likely to deliver an infected child than GBS negative women.

    Risk of infected baby no antibiotics if:
    GBS+ WITH risk factors: 1/25
    Women who are GBS+ and have risk factors (labor or delivery before 37 weeks, fever in labor >100.3F, rupture of membranes >12-18 hrs before delivery, previous GBS infected baby, GBS urinary tract infection) have a 1/25 chance of having an infected child if they are not given antibiotics in labor.
    GBS+ WITHOUT risk factors: 1/200
    Knowing that you carry GBS tells you that your risk is 1/25 or 1/200, depending on whether risk factors occur.

    Bear in mind that 46% of the women who deliver GBS infected babies had no risk factor(s). This means that 1/2 of the women who had sick GBS babies had no warning or chance to begin antibiotics before problems developed. - see Note 2

    GBS negative WITH risk factors: 1/900
    In other words, there is a 1/900 chance that a woman who tests GBS negative who develops risk factors actually carries GBS and might infect her baby.
    GBS negative WITHOUT risk factors: 3/10,000
    A GBS negative woman without a risk factor has a 3/10,000 (.3/1,000) chance of having a sick child.
    Risks of antibiotics: - see Note 3

    Risk of a minor reaction (like a rash): 1/10

    Risk of a serious complication (shock or death) 1/10,000 - see Note 4

    The risk of infecting baby is much greater than the risk of antibiotics for GBS+ moms. No one wants to use antibiotics unnecessarily, but they are worth consideration if you carry GBS.

    Vaginal/rectal cultures are at least 90% accurate in predicting who will be GBS+ at delivery if done at 35-37 weeks gestation. So, if a woman is GBS+ at 35+ weeks, the odds are 90% or better that she will be GBS+ at delivery. The reliability of the test is much lower if the test is done too early.

    Screening for GBS at 35-37 wks and OFFERING antibiotics in labor to GBS+ moms can prevent more than 88% of the cases of GBS in the first week of life - a huge number.

    If women are NOT screened and are only treated if risk factors develop, the number is cases prevented is much lower (69%).

    A woman has the right to choose whether or not to be screened for GBS as well as the right to choose whether or not to be treated if she is GBS+, but she MUST consider all of the information to make an informed choice.

    Warning -- the following is my **opinion**: I think it's fair for GBS+ moms to choose EITHER hospital or home birth, but each couple must decide for themselves what level of risk is acceptable. If you have had an uneventful pregnancy without preterm or a GBS urinary tract infection, the risk of having problems from GBS is about 1/200 (if you are not treated with IV antibiotics in labor). If you develop a risk factor, that number goes 1/25.

    Since most GBS urinary tract infections do not cause any symptoms, moms whose providers cannot administer IV antibiotics during labor should STRONGLY consider getting a GBS *urine* culture to be sure their risk of infection is as low as possible. If the urine culture is negative, home birth might w/o antibiotics might still be a reasonable choice if you and your husband are comfortable with the risks and benefits of your choices.

    If the urine culture shows GBS, the risk of having an infected baby is no longer 1/200 if you don't get antibiotics - it's 1/25 or more. In my opinion, home birth without IV antibiotics is not a responsible choice if you have GBS in the urine during pregnancy or have any other risk factors.

    In addition, it's worth noting that "waiting for risk factors" before administering IV antibiotics is much less effective than treating before risk factors occur because only half of the moms of GBS-infected babies show ANY risk factors. In addition, if you wait to start IV antibiotics until the risk factors have occurred, baby is already possibly sick. This means that you're not *PREVENTING* infection - you're now treating an active infection.

    Most of the cases where baby "got sick despite antibiotics" were due to waiting for risk factors instead of treating proactively. Some websites claim that IV antibiotics do not work -- this is patently FALSE. IV antibiotics in labor prevent more than 85% of the cases of GBS disease in the first week of life.

    In case you wondered, ORAL antibiotics are NEVER recommended for use instead of IV antibiotics in labor. This is because digestion slows down (or stops) during labor, and the drugs cannot get to baby to help baby. IV antibiotics are recommended b/c they get to baby very fast (perhaps as little as 15-30 minutes). ORAL antibiotics in labor are not an acceptable alternative to IV antibiotics.

    ORAL antibiotics ARE useful if you have a urinary tract infection (u.t.i) though. If your urine tests GBS+, you should be treated with oral antibiotics IMMEDIATELY. Some doctors treat only high numbers of GBS in the urine, but in my opinion, ALL GBS in the urine should be immediately treated with oral antibiotics unless there is reason to think that the urine sample was contaminated by GBS from the perineum.It is especially important to still get IV antibiotics in labor if you had a GBS urinary tract infection!

    The information about prevention tips will be sent in a separate message.


    Risk Factors

  • less than 37 weeks' gestation
  • duration of membrane rupture greater than or equal to 18 hours
  • temperature greater than or equal to 100.4 F {greater than or equal to 38.0 C}
  • GBS in the urine (bacteriuria)
  • previous baby with invasive GBS disease

  • Symptoms of GBS in newborns

  • Grunting (as though constipated)
  • Irritability
  • Stops feeding or feeds poorly
  • High or low temperature (Babies up to 6 months should not have a fever above 100.3. This is a sign to take your baby to your doctor or E.R.)
  • Fast or slow breathing
  • Blueness of skin due to lack of oxygen (this can go from blueness to pink then back and forth.)
  • Blotchy skin coloring
  • Very high or low heart rate
  • Sleeping too much, not acting like a normal newborn (can't wake up for feedings)
  • Uncontrollable crying, cannot be consoled
    from the Jesse Cause GBS pamphlet

  • Other notes

    Note 1 - Approximately 1 in 4000 babies where mom has antibiotics will become ill

    The babies who become ill DESPITE antibiotics (the 1:4000) ~90% of them are infected PRIOR to administration of the antibiotics. This can be further reduced by getting the antibiotics on board soon after ROM and by keeping invasive procedures a minimum to nil. Vaginal Exams in late pregnancy and stripping membranes can contribute to this statistic. Most homebirth moms take care of this anyway. A homebirth mom who has antibiotics for GBS+ will probably have a much lower odds than 1:4000. There's LOTS of proof that the antibiotics work and when they don't, it can almost always be attributed to invasive procedures, inadequate antibiotics (with a long labour) etc.

    In case you missed it, administering antibiotics reduces the odds of infection in a GBS+ moms without risk factors from 1:200 to 1:4000. To use a common denominator, that's 5:1000 to 0.25:1000

    Note 2 - Only half of infected babies involve a labour with Identifiable risk factors

    Knowing you are GBS+ and waiting for the presence of risk factors to treat means that you are waiting for infection to begin and signs of it before doing anything about it. And, on top of that, only 45% of moms who end up having a GBS baby will ever have risk factors. GBS, when it happens is devastating. That's why the current recommendations suggest prophylactic antibiotics rather than after the fact.

    Note 3 - You can still have antibiotics at home

    The antibiotics can be administered (even at home) as an IV or a heplock. There's one hb mom who arranged a pediatric butterfly. With a heplock, you are only connected for the duration of the prophylaxis ~ 20 minutes every 4-6 hours. Oral antibiotics are not strong enough to do the job of eradicating the birth canal of the bacteria. In labour, they are even less effective as digestion slows. IM antibiotics take longer to reach the amniotic fluid/baby and also cannot be administered in a strong enough dose.

    Note 4 - The risks of antibiotics

    Antibiotics are not without risk, but the relative risk of the antibiotics if taken as recommended are miniscule next to the risks of GBS. Sure, there's a 1:10 chance of a rash - weigh a 1:10 risk of a temporary rash with a 1:200 risk of permanent damage to your child.

    Nobody wants to upset the natural balance of normal flora in their bodies and antibiotics will surely do this, but what's the risk of something truly devastating because of upsetting the natural flora in your body as compared with the risk of something truly devastating resulting from untreated GBS? That's up to you. But remember, there are ways to maintain a healthy flora while on antibiotics.

    The risks associated with other non-GBS infections as a result of taking antibiotics are less of a concern if they are taken as recommended.

    Since the current GBS guidelines were introduced, there's only been one documented case of antibiotic anaphylaxis and the guidelines were not strictly followed. The mom qualified for antibiotics based on risk factors, not screening results and the outcome was good overall.


    GBS and Homebirth - messageboard response from Midwive Peggy, Peg Plumbo
    Midwife Archives on GBS - a collection of emails from midwives
    Holistic Approach to Group B Strep by Gloria Lemay on BirthLove
    GBS and Homebirth - notes from Midwifery Today
    Mulling It Over: GBS, Are There Problems With Antibiotic Prophylactic Strategies? - not homebirth specific, but you might find it interesting