For Women Who Are Pregnant and Carry GBS
If you are reading this, you have been told that you carry group B streptococcus (GBS). This is perfectly natural and normal - a third of the adult population carries GBS in the intestines and up to a quarter of women carry GBS in their vagina.You may have heard that GBS can cause infection in newborn babies. This is true, but the bacteria don’t normally do this and just because you carry GBS does not mean that you (or your baby) will become ill. And if you know you carry GBS during pregnancy, that’s great because you can make the chance of your baby developing a GBS infection much smaller. Read this leaflet to find out how small the risk of GBS is to your baby and also to find out what to look out for during labour, birth and the first hours, days and weeks of your baby’s life.
The vast majority of babies born to women who carry GBS do not develop GBS infections. And having and using the information contained in this leaflet significantly reduces the likelihood of your baby developing GBS infection. Pregnancy can usually be managed so babies born to women who carry GBS are protected and born free from GBS infection.
You will have lots of questions and will, of course, need to talk to your medical professionals about your own circumstances. This webpage has been put together with the help of our medical experts and of other families to help you when planning your pregnancy, labour and baby’s birth, but is in no way a substitute for discussions with your doctors.
The information in this website is based on our medical advisory panel’s knowledge and on published research. Your health professionals may not have as comprehensive knowledge or experience, so please do give them a copy of this page. Sharing information about GBS with those who can make a difference in preventing GBS infection is vital.
Many busy health-care professionals are unaware how successful the preventative measures can be so some babies suffer from preventable GBS infections. Our materials aren’t copyrighted - make copies and give them to your health professionals.
Babies at greatest risk of developing GBS disease are those born to women who carry GBS during labour. Screening women during pregnancy for GBS is currently done in Australia, via a swab test done around 36 - 37 weeks of pregnancy. (A painless test done where a Q-tip is inserted in the vagina to take a sample. Scientific evidence clearly shows such screening for GBS, using reliable culture methods at 35-37 weeks’ gestation and then giving intravenous antibiotics from the onset of labour or waters breaking to all women colonised with GBS and to those women delivering prematurely or with a history of GBS, is a more effective way of preventing neonatal GBS infections than relying on risk factors alone. (One paper estimated that a risk-factor approach would prevent 50-60% of GBS infection in babies, whereas a screening approach giving intravenous antibiotics in labour to women found to be GBS positive, plus to those delivering prematurely or with a history of GBS infection, would prevent 80-90% of GBS infection in babies.)
The most common source of the bacteria causing GBS infection in newborn babies is the mother’s vagina before or during delivery. However, most babies who are exposed to the GBS bacteria do not develop infection – they successfully fight off the bacteria. But, ahead of time, there is no way of knowing which babies will be able to do this and which won’t.
There are, however, recognised ‘higher-risk’ situations that mean it is more likely that a baby will be exposed to GBS and, if the baby is susceptible, will develop an infection within the first 2 days of life (‘early-onset’ GBS infection). The key higher-risk situations are as follows:
1. Where the pregnant woman has previously had a baby who developed a GBS infection.
Mothers who carry GBS during the present pregnancy: multiplies the risk at least 4 times:
2. Where the pregnant woman has been found to carry GBS during the present pregnancy; and
3. Where the pregnant woman has GBS bacteria in her urine at any time during the pregnancy (this should be treated at the time of diagnosis).
Clinical risk factors: each one increases the risk at least 3 times:
4. Where labour or membrane rupture is preterm (prior to 37 completed weeks of pregnancy);
5. Where there is prolonged rupture of membranes (more than 18-24 hours before delivery; and
6. Where the pregnant woman has a raised temperature (37.8°C or higher) during labour*.
The chance a newborn baby will develop GBS infection for a woman with no known risk factors is around 1 in every 1,000 babies.
For a woman carrying GBS at delivery with no other risk factors, the chance her baby will develop a GBS infection rises to approximately 1 in 300. This same colonised pregnant woman being given intravenous antibiotics from the start of labour until delivery can reduce that risk to less than 1 in 6,000.
Prevention is better than treatment – waiting to give antibiotics to the baby until after delivery will sadly sometimes be too late. Clinical randomised trials have proven that most GBS infections in newborn babies can be prevented by giving intravenous antibiotics to women whose babies are at increased risk from the onset of labour or waters breaking until delivery.
The data on the time it takes for the intravenous antibiotics to be effective is limited. Research shows that antibiotic penetration of the amniotic fluid seems only to reach a maximum at 2 hours and, preferring to be conservative, GBSS therefore recommends at least 4 hours of the intravenous antibiotics prior to delivery, where possible and, ideally, the pregnant woman will have received 2 or more doses before delivery. However, lesser times have proved beneficial: something is better than nothing. If only 2 hours administration is possible, this may be sufficient and should give considerable reassurance.
To stop as many cases of GBS infection in newborn babies as possible, pregnant women in all of the above higher-risk situations should be given intravenous antibiotics in labour for at least 4 hours before delivery.
Some women will prefer not to have the antibiotics, especially if their baby’s risk is only slightly increased, as the intravenous antibiotics would inevitably complicate an otherwise natural birth, plus antibiotics are associated with rare but significant side-effects.
The risk of a GBS infection in the baby must be balanced against the wishes and beliefs of the woman in labour and against the risk of her having an adverse reaction to the antibiotics.
As yet, there are no known methods for preventing late-onset GBS infections that develop after the baby is 2 days old.
Key Prevention Recommendations:
1. Women at increased risk should be offered antibiotics immediately at the onset of labour or rupture of membranes (i.e. women known to carry GBS bacteria without other risk factors, and women not known to carry GBS but where another risk factor is present).
2. Women at particularly high risk should be strongly advised to accept intravenous antibiotics immediately at the onset of labour or rupture of membranes until delivery (i.e. women known to carry GBS with one or more other risk factors, women not known to carry GBS with multiple risk factors, and women who have previously had a baby infected with GBS, regardless of other risk factors).
3. For women in labour, the recommended doses of penicillin G are 3 g (5 MU) intravenously initially and then 1.5 g (2.5 MU) at 4-hourly intervals until delivery. For women allergic to penicillin, 900 mg of clindamycin intravenously every 8 hours until delivery is recommended.
4. Intravenous antibiotics should be given for at least 4 hours prior to delivery where possible*.
5. Babies born in situations where there is increased risk and the mother has received at least 4 hours of intravenous antibiotics before delivery should be assessed carefully by a paediatrician and, if completely healthy, intravenous antibiotics should not be given to them.
6. Babies born in situations where there is increased risk where the mother has not received at least 4 hours of intravenous antibiotics before delivery should be investigated and initially commenced on antibiotics until it is established the baby is not infected.
When you know you are pregnant, ensure the obstetrician in charge of your pregnancy is aware of your full medical history (especially relating to GBS).
Make sure they know you carry GBS. Keep a copy of this webpage in your yellow card, just incase. Not only are you helping yourself by doing this, you may be helping others too!
I have special GBS Positive Alert stickers to stick on your yellow card etc, to alert any health professionals seeing them to the fact you carry GBS, and that you should be offered intravenous antibiotics as soon as possible once your labour has started, incase you give birth in another hospital other than the one you are booked into. If you would like one of our stickers, contact us and we’ll send one to you.
If you want intravenous antibiotics in labour (whether only in certain circumstances or regardless of other risk factors), establish that you will be offered them. Your obstetrician may be able to complete the necessary hospital form authorising the intravenous antibiotics immediately on your arrival at hospital in labour to keep in your notes. This should help you receive the antibiotics as soon as possible, rather than waiting for a doctor’s authorisation after you arrive.
Caesarean sections are not recommended as a method of preventing GBS infection in babies as they do not eliminate the risk of GBS to the baby since GBS can cross intact amniotic membranes to set up an infection in the baby. Furthermore, there are significant risks associated with a Caesarean section; and the recommended intravenous antibiotics during labour are highly effective.
If you carry GBS or have previously had a baby infected with GBS and you have to have an emergency Caesarean, you should be offered the intravenous antibiotics for GBS if possible as soon as you are in labour or your membranes have ruptured. The treatment of the baby would follow the charity’s normal paediatric recommendations.
There is no evidence to show intravenous antibiotics are beneficial against GBS when a woman known to carry GBS is having an elective Caesarean unless she is in labour or her membranes have ruptured. Your baby would only need intravenous antibiotics if born prematurely or if there were signs of possible infection in either you or the baby.
If your baby is at higher risk of developing GBS infection and you are having an elective Caesarean AND you are also in labour or your waters have broken, you should be offered the recommended intravenous antibiotics, ideally for at least 4 hours before delivery. Again, your baby would only need intravenous antibiotics if born prematurely or if there are signs of possible infection in either you or the baby.
If you feel particularly anxious and want intravenous antibiotics 4 hours before the operation, discuss this with your obstetrician. He/she may be prepared to give them to you.
If Your Baby Has Been Infected With GBS
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Melanie Tisma melanietisma@bigpond.com
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Group B Strep
Working Towards Informing, Preventing and Suporting Women and Their Babies. Everywhere.
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