Group B Strep

Group B strep (GBS) is a bacteria that is carried in the vagina and/or rectum of about 25% of pregnant women at any given time. It normally doesn't cause any problems or symptoms in the mother, but when she gives birth, she has a higher chance of passing the bacteria along to her newborn than an non-colonized mother. This can cause GBS infection in the newborn, which can be very serious or even fatal.

Here is more information about GBS infection, screening, and treatment from the CDC. Here is an article that presents an alternative view regarding treatment, from Mothering magazine.

With Littles
I was screened for GBS at my 36-week checkup, via a swab of my vagina and rectum.

I tested positive.

I was devastated. This was the first real curveball thrown at my med-free birth plans. (It wouldn't be the last.) It meant that I needed to get IV antibiotics during labor -- ideally, at least two doses, at least four hours apart, prior to the birth. I didn't like the idea of having to get to the hospital early to ensure I got the first dose of antibiotics in time. I didn't like being required to get an IV. I didn't like that Littles would get antibiotics before she even took her first breath.

I talked it over with Dr. K at my next appointment. She made me feel a little better by saying that I could get a saline lock (also called a hep lock), rather than a constant IV. This would allow me to be hooked up to the antibiotics when needed -- that is, for roughly 10-15 minutes every 4 hours -- and then disconnected, to give me freedom of movement until it was time for my next dose.

She also wasn't overly concerned about changing when I left for the hospital. Since I was a first-time mom, she was pretty confident that as long as I followed the standard 5-1-1 rule for leaving for the hospital (contractions every 5 minutes, lasting for at least one minute, for at least one hour), I'd end up getting there in time for my two doses regardless.

I asked her about alternative treatments, such as a chlorhexidine wash or even declining antibiotics completely. (Even with no antibiotics at all, fewer than 1% of babies born to GBS+ mothers actually develop GBS disease.) She had never heard of a chlorhexidine wash. She said that I could decline antibiotics, but added that if Littles developed any symptoms of possible GBS disease, she would be treated very aggressively. "Spinal taps on a newborn are no fun," she cautioned. I decided that it made sense to do the antibiotics, rather than risk any unnecessary discomfort for Littles.

As it turns out, I had to be induced, and so the GBS thing was not a big deal at all compared to everything that came along with the induction. Induction eliminated any concerns about getting to the hospital in time, and since I had a constant IV for Pitocin, I barely even noticed when they added the bag of antibiotics to the mix.

And, of course, Littles was fine. Hardly surprising. The antibiotics cut her risk of developing GBS infection from about 1 in 100 to about 1 in 4000.

In retrospect, even if I had gone into labor on my own, the whole GBS thing really wouldn't have affected it much at all. I really had no reason to be as upset as I was when I first found out.

With Noob
Some doctors treat a mother who has tested positive for GBS in past pregnancies as being GBS+ for any subsequent pregnancies as well. Early in my pregnancy with Noob, I asked my midwives if they did this, and they answered no. So my history with Littles made no difference: I'd be screened at 36 weeks again, and as long as I tested negative, there would be no need for antibiotics.

When I relayed this to my doula, she told me about a regimen of vitamins and herbs that her own homebirth midwife suggested to fight GBS prior to the screening. It consisted of probiotics, echinacea, vitamin C, and garlic, starting around 32 weeks. All of these things are naturally antibacterial, so they can potentially kill off GBS bacteria in a colonized mother. They also carry no known risks. I figured it was worth a try.

Some people consider this to be "cheating the test." I disagree. If this stuff does in fact kill off the GBS bacteria in advance of the test, presumably it will keep killing off any new GBS bacteria for as long as you continue taking it. For this reason, I opted not to take garlic: It's a blood thinner, so you need to discontinue use of it at 37 weeks, to avoid any bleeding issues during birth. I started on everything else, fully intending to continue taking until I gave birth.

At the time, I didn't know that I'd be switching to homebirth. I made the switch at 36 weeks, so I never did the GBS screening with my hospital-based midwives. Instead, I did the screening with C at 37 weeks. She handled it differently from the OBs I had with Littles:

• C left it entirely up to me as to whether I even wanted to do the screening. She gave me a paper with all sorts of information about GBS screening and treatment to ensure I could give truly informed consent. I opted to do it. In my eyes, there was no downside to screening: Even if I tested positive, as long as I birthed with C, I was free to choose my preferred course of treatment, including no treatment at all. And there was a potential downside to not screening: If I ended up having to transfer to the hospital for any reason and my GBS status was unknown, I'd be treated as positive regardless.
  
• C had me swab myself. It's really easy to do, no need for years of medical school to learn how, honest. And as far as I'm concerned, it's good to minimize how often I take off my clothes unnecessarily :)
  
• C instructed me to only swab my vagina, not my vagina and rectum. Rectums have more bacteria in general, so it's hardly a surprise that women who have both swabbed will be more likely to test positive than women who have only their vaginas swabbed. In case there was any doubt, this is backed up by studies, such as this one and this one. But those studies only looked at the number of women who tested positive from a vaginal swab vs. vaginal + rectal swab, not the actual incidence of GBS infection in their babies. And, well, last I checked, the baby doesn't come out your rectum. The reason generally given for doing the rectal swab is that a woman with GBS colonization in her rectum is more likely to develop GBS colonization in her vagina as well, but if that's the case, wouldn't a vaginal swab pick that up, at least the vast majority of the time?
  
• If I tested positive, C was not able to give IV antibiotics during labor. For better or worse. She offered a couple of alternative options, such as a chlorhexidine wash (which has been shown to be effective, e.g. in this study and this study), various herbal treatments, or no treatment at all, simply observation of the newborn in the early postpartum period. If I really wanted IV antibiotics, I would've had to go to the hospital myself.

C knew I was anxious about the results, so she called me as soon as they came in, even though it was just a day before my next appointment and she could've easily waited till then to let me know.

I was negative.

Of course, I have no way of knowing whether it was the vitamins/herbs that made the difference, or if it was skipping the rectal swab, or if I just wasn't carrying the bacteria this time around. (It does come and go.) Whatever the reason, it was a huge relief for me.

I continued taking everything until I gave birth.

With Q
Since I was with C from the start, I asked her for her preferred GBS-fighting regimen. Hers was similar to what my doula had suggested with Noob:

• Vitamin C (at least 500 mg/day)
• Echinacea (without goldenseal, following the dosage on the container)
• Optionally, garlic oil capsules (following the dosage on the container, stopping at 37 weeks).

Again, I opted out of the garlic, but took the other two, starting at 35 weeks. Again, I tested negative at 37 weeks.