Tips for GBS+ moms

(These are generally geared toward moms WITHOUT a history of GBS complications, but they work for most GBS moms who had complications in past pregnancies, too.)

1) None of the GBS prevention protocols recommend inducing labor in term GBS+ moms to control labor and get "enough" antibiotics.

If you are term (37+ weeks) and haven't had any risk factors (fever in labor, prolonged rupture of membranes, etc.) the antibiotics begin to be effective against GBS very quickly.

Two doses of antibiotics (or more) before birth are recommended as a *guideline* for doctors. If you get ANY antibiotics they can help, but doctors like to see you get at least two doses before delivery. This DOESN'T mean that the recommendation calls for induction to get that amount of antibiotics!

"Four hours" of antibiotics are recommended because the second dose is often given 4 hours after the first dose. Get the antibiotics as soon as it's reasonable to get to the hospital/birth center, but NO EXPERT recommends inducing labor just to get two or more doses of antibiotics before birth.

If you're concerned about a fast labor, be reassured -- a natural, fast labor means babies come into contact with the bacteria for a shorter amount of time.

2) Avoid "routine" internal fetal monitoring in labor.

The internal probe creates a small scrape on baby's head where the bacteria can get into the bloodstream. Routine internal monitoring is not a good idea for most GBS+ moms. If it's absolutely necessary, make sure you've had IV antibiotics for a reasonable period of time before the internal monitor is used, and talk with your provider about the risks and benefits of using the internal monitor.

3) Discuss ways to avoid excessive digital exams in labor with your provider.

The more you put something (hands, monitors, etc.) in the vagina, the more you push the bacteria toward baby. It appears that GBS lives near the entrance of the vagina in most cases. Don't push it toward the cervix by getting unnecessary cervical checks. Research indicates that having more than 6 internal exams/cervical checks might be linked with more serious infection. In general, the fewer cervical checks, the better.

4) Don't agree to let the provider rupture membranes to induce labor.

The membranes are a barrier between baby and the bacteria, and rupturing them allows access to baby, puts you on a schedule for delivery and increases the chance of prolonged rupture (a risk factor). Rupturing membranes AFTER the IV antibiotics are started LATE in labor does not seem to be as problematic.

5) Talk to your OB/midwife about her prevention strategy.

If you're using an OB or CNM, she should plan to start IV penicillin (it's recommended over ampicillin) or clindamycin/erythromycin (if allergic to penicillin) when you're admitted and continue it until delivery.

You can ask for a heparin or saline "locked" IV if your goal is an unmedicated birth. The antibiotics can be given in just a few minutes every four hours, and the rest of the time you can move around as you choose.

Remember, the antibiotics are given to you to protect baby. IVs in labor aren't fun, but the reasons for IV antibiotics in labor are compelling.

If you're birthing at home or at a birthing center, ask if they are able to give IV antibiotics. Find out what they'll do if you develop risk factors. Be sure to read the information about risks of infection to make an informed choice about preventing GBS in your chosen birth place.

6) Antibiotics BEFORE labor are not recommended EXCEPT for treatment of GBS in the urine.

Taking oral antibiotics BEFORE labor to get rid of vaginal/rectal GBS colonization (as opposed to urinary tract infection) will not reduce the risk to baby - and will use antibiotics unnecessarily.

IV antibiotics in labor are the only proven way to protect baby from GBS infection: they work when baby is at the highest risk of encountering the bacteria - during labor and delivery.

7) Consider a URINE screen for GBS during late pregnancy.

GBS in the urine indicates a higher risk of infection in baby since it correlates with high levels of GBS in the vagina. GBS urinary tract infections (u.t.i.s) are often asymptomatic (without symptoms), so you might not know it's there. Testing the urine for GBS is the only way to know if GBS is present.

GBS in the urine has been linked to preterm labor/delivery and premature rupture of membranes. It is very important to get rid of GBS in the urine immediately. It does not matter how MANY GBS are found -- GBS in the urine requires oral antibiotics when it's diagnosed.

If you have preterm labor, ask for a urine culture and vaginal/rectal culture to be sure GBS isn't a problem. A urine culture for GBS is a reasonable idea if you've had preterm labor in any pregnancy. Insist on oral antibiotics immediately if there is any GBS in the urine. Be sure to also get IV antibiotics in labor, even if the labor stops and the u.t.i. is cleared.

8) A c-section DOES NOT automatically reduce the likelihood of infecting baby and increases his risk of other infections.

Chances of GBS infection are a slightly lower for baby after a c-section, but 25% of babies who are born via c-section still have GBS on their skin, so c/s doesn't keep baby 100% safe from GBS. Also, mom is more likely to have serious complications from GBS c-section: GBS causes 50,000 maternal post-cesarean infections each year in the US. Just being a GBS carrier is not enough reason to have a c-section.

9) Talk with the pediatrician.

Advise him that you are GBS+ and talk about what this means for baby. Baby should be watched for a day or two to be sure all is well, but you should still be able to nurse, change diapers, room in, etc., if baby is well.

10) Learn all you can. Informed parents are the best defense against GBS.

You are the only parents of your baby, and it's your job to start protecting him NOW. If protecting him means standing up for what's best for you and baby, so be it. Believe me -- you won't care if you've ticked off the provider if your baby gets sick when it could have been prevented!