Available from the BirthMagic Library: Group B Strep Explained by Dr Sara Wickham (ask me to borrow it!)

About Group B Strep (GBS)

TL;DR: GBS is present in most of us, and it doesn’t normally cause any problems for mothers or their babies. However, when it does, those problems are severe for babies and sadly often fatal, which is why you’re strongly encouraged to have IV antibiotics during labour. However, these need to be administered at least 4 hours before birth, so this may not be possible if you have a quick labour. If you don’t have them for whatever reason, you should monitor baby closely for any signs of infection; you’ll be encouraged to do this in hospital as it’s easier and has greatest access to medical help if needed. This shouldn’t last longer than 12 hours, as if baby is still well after that the risk has passed.

Screening during pregnancy for Group B Strep is not currently offered everywhere in the UK, so it’s a bit of a lottery as to whether you’ll even be offered it - and if you’re not, you may well have it and not even know. That’s because Group B Strep is present in 20-40% (2-4 in 10) of women in the UK at any given time! It’s really common, and most women who have it during pregnancy won’t be screened for it, and therefore won’t know, and therefore won’t be offered the interventions that come after diagnosis in pregnancy.

Diagnosis in pregnancy will usually either come from GBS Screening (not always offered), or an active GBS infection showing up in a urine sample (treated with antibiotics).

You can decline screening if it is offered to you. The Royal College of Obstetrics and Gynaecology say:

The UK National Screening Committee does not recommend testing all pregnant women for the presence of GBS using vaginal and rectal swabs. This is because:

• many women carry the GBS bacteria and, in the majority of cases, their babies are born safely and do not develop an infection

• screening all women late in pregnancy cannot accurately predict which babies will develop GBS infection

• no screening test is entirely accurate: a negative swab test does not guarantee that you do not carry GBS

• many babies who are severely affected by GBS infection are born preterm, before the suggested time for screening (35–37 weeks)

• giving antibiotics to all women who carry GBS would mean that a very large number of women would receive treatment they do not need. 

“If you carry GBS, most of the time your baby will be born safely and will not develop an infection. However, it can rarely cause serious infection such as sepsis, pneumonia or meningitis. [The condition which causes these infections is called early-onset GBS, and] Most early-onset GBS infections are preventable.” (Royal College of Obstetrics and Gynaecology, 2017).

Usually, if you’re diagnosed with GBS, you’ll be told you need IV antibiotics during labour, through a cannula in your hand or arm. If you want to accept this and are not planning on giving birth on a Labour Ward, you’ll likely need to have conversations about this with your healthcare team. Options can include:

• GP prescribed IV-antibiotics to be administered at home for homebirth (it’s rare this will be agreed to and arranged, but it can happen!)

• Birthing at a Birth Centre, for a more cosy and homey feel but with access to more medical resources

• Planning thoroughly how to bring your coping toolkit to a labour ward to birth there in comfort and with confidence

• Declining IV antibiotics, either to birth at home or just because you don’t want them!

If you’re choosing to decline IV antibiotics, you should discuss this with your healthcare provider, particularly around monitoring for signs of infection post-birth.

“If your baby is felt to be at higher risk of GBS infection and you did not get antibiotics through a drip at least 4 hours before giving birth then your baby will be monitored closely for signs of infection for at least 12 hours. This will include assessing your baby’s general wellbeing, heart rate, temperature, breathing and feeding.” (RCOG, 2017) You will be encouraged to have this monitoring in hospital; a compromise might be birthing at home then transferring in after birth for monitoring, for example.

As ever, everything should be explained to you, you’re allowed to ask why, and you’re allowed to say no. The vital part is that you feel you understand your options, the risks, and feel informed and confident. Remember, healthcare professionals are there to support you.

Want a sounding board to discuss your options? Book a Power Hour or an Antenatal Doula Session

Signs of Early-Onset GBS in babies (RCOG):

Most babies who develop GBS infection become unwell in the first week of life (which is known as early- onset GBS infection), usually within 12–24 hours of birth. Although less common, late-onset GBS infection can affect your baby up until they are 3 months old. Having antibiotics during labour does not prevent late- onset GBS. More information on late-onset GBS infection is available here: www.gbss.org.uk/infection.

Babies with early-onset GBS infection may show the following signs:

• grunting, noisy breathing, moaning, seeming to be working hard to breathe when you look at their chest or tummy, or not breathing at all

• be very sleepy and/or unresponsive

• be crying inconsolably

• be unusually floppy

• not feeding well or not keeping milk down

• have a high or low temperature and/or their skin feels too hot or cold

• have changes in their skin colour (including blotchy skin)

• have an abnormally fast or slow heart rate or breathing rate

• have low blood pressure*

• have low blood sugar.*

*identified by tests done in hospital

If you notice any of these signs or are worried about your baby, you should urgently contact your healthcare professional and also mention GBS. If your baby has GBS infection, early diagnosis and treatment is important as delay could be very serious or even fatal.