Homebirth and GBS

Louise asked a very good question in her comment to a recent post. How would a positive GBS (Group B streptococcus) test impact plans to homebirth?

"GBS is a type of bacterial infection that can be found in a pregnant woman’s vagina or rectum. This bacteria is normally found in the vagina and/or lower intestine of 15% to 40% of all healthy, adult women." (American Pregnancy Association website)

GBS is not a problem or risk to the woman herself, but it is possible that the baby may become infected during the birth and become seriously ill or even die. For this reason many countries have a protocol to test women at approimately the 37th week of pregnancy. If they test positive for GBS, then antibiotics are administered intravenously during labour.

Antibiotics have proven quite effective at reducing the chance of baby becoming ill. However, the Cochrane Collaboration database indicates that there is not an impact on infant mortality. That is to say, though fewer infants get sick from GBS infections as a result of the mother receiving antibiotics during labour, the same number of GBS-related infant deaths occur regardless of whether antibiotics are administered or not.

There are a number of factors which indicate an increased risk of infant GBS infection:

- fever during labor
- rupture of membranes (water breaking) 18 hours or more before delivery
- labor or rupture of membranes before 37 weeks
- A urinary tract infection as a result of GBS during your pregnancy
- A previous baby with GBS disease

According to the CDC, if you have tested positive and are not in the high risk category, then your chances of delivering a baby with GBS are:

1 in 200 if antibiotics are not given
1 in 4000 if antibiotics are given

So. Less than 1% of babies will be born with GBS to a GBS positive woman who has not received antibiotics. What are the risks to the 99.5% of women taking antibiotics unnecessarily? According to Lisa Barrett's blog :

1 in 10 chance of an allergic reaction.
1 in 10,000 chance of a severe allergic reaction like anaphylaxis.
1 in 100,000 chance of death from taking antibiotics.

Also important to consider are the risks and impact of messing with the newborn's gut flora, and adding to the antibiotic-resistant bug problem.

Is there anything a pregnant woman can do to reduce her risk of testing positive for GBS? There are a number of home remedies that women have found effective at eliminating GBS. Natural substances used for treatment include probiotics, garlic, vitamin C, vitamin B6, grape seed oil, colloidal silver, and tea tree oil. Antibiotic treatment prior to labour will not protect the baby during birth, since the GBS could recolonize between the time of treatment and when labour begins.

I can't find the source of this percentage right now, but I believe that 90% of babies experience early onset GBS infection, where symptoms present within hours of birth. They include:

- Breathing problems, heart and blood pressure instability
- Gastrointestinal and kidney problems
- Sepsis, pneumonia and meningitis are the most common complications

Baby is then treated with antibiotics.

When I was pregnant with Eva, I believed that if I tested positive for GBS at 37 weeks, there was no way around IV antibiotics. If I had only known, I could have tried some of the natural remedies and been retested prior to going into labour. As it was I dragged around an IV for the 14 hours of active labour, had at least two courses of antibiotics, and I blew up like a balloon from all the fluids. Unattractive and uncomfortable. I would have at least asked them to turn off the IV between course of antibiotics. I was so relieved when I tested negative when I was pregnant with Micah. But who is to say that I wasn't positive at 39 weeks- GBS comes and goes, without symptoms. Or that I wasn't negative by the time Eva was born.

The protocol isn't perfect, that's for sure. It tries to reduce risk, but it also assumes that antibiotics are free of risk. Which isn't true.

So to answer the question. If I tested positive (and continued to test positive- because I would aggressively pursue the home remedies and retest at least weekly) and chose to accept antibiotics, then probably my OB could hook me up to an IV here at home. In Canada or the US it may be a different story as I don't believe midwives are allowed to administer drugs. I have read of labouring women going to the hospital for their antibiotic treatment, then returning home to give birth. And there are also women who refuse the antibiotic treatment despite a positive test.

If I tested positive right up to going into labour, and didn't have any of the high risk factors, I'd think long and hard about accepting antibiotics. It's just not such a straightforward decision as many of us have been led to believe.