Group B Strep: Guidelines for Pregnancy

This blog entry was recently given to me from a New York City Midwife. The topic of Group B Strep is often confusing to people and not usually explained very well. I invite you to read about what Group B Strep is and how you can prevent it.

I hope you enjoy!

What is GBS?

Group B Streptococci (GBS, Group B strep, Beta Strep) can be present asymptomatically in the vagina. It can cause inflammation of the amniotic sac, the uterine lining or lead to a urinary tract infection in the mother. Occasionally a newborn will have a local infection, septicemia or meningitis as a result of Group B strep. There are five serotypes of Group B strep, with type III as the most associated with meningitis. However, all types may cause disease.

What is the risk?
Between 15-40% of all women have GBS present in the vagina. As many as 75% of their babies contract strep, but only 3 to 4 percent per 1000 get sick as a result. Of these sick babies, 7% of them are under 1000 gm (around 2 lbs). Babies born before 37 weeks gestation are at much higher risk of infection than full term babies. There is an increased risk for the baby with premature rupture of membranes (PROM) or surgical delivery. In other words: Of the 15-40% of mom’s who test + only 2-3 babies will actually become ill (15-40% is between 150 – 400 babies and out of those 75% or 142 -300 will contract GBS but only 3-4% will get ill or somewhere around 4-12 babies.)

If recurrent prematurity has been a problem for the mother or a urinary tract infection (UTI) is present, a culture may be done to determine if strep B is present. In a hospital setting, when premature rupture of membranes is being checked, a culture can be done at that time. In clinical practice, vaginal strep culture is usually offered to women at 34-36 weeks.

If the client has a past medical history with a baby who was ill from Group B strep, or had a UTI with Group B strep, membranes ruptured more than 18 hours, this baby is less than 37 weeks gestation, then the risk to this baby is higher.
If the result is positive, the midwife should discuss management options.

Babies and Infection

Risk Factors that increase the likelihood of infection for the baby:

1. Labor is premature (less than 37 weeks)
2. A prolonged rupture of membranes, greater than 12 to 19 hours.
3. Maternal fever before or during labor.
4. There are signs or symptoms of maternal or fetal infection.
5. Group B strep in the urine of the Mom
6. Multiple vaginal exams in labor

In a hospital, if strep is present, the baby is cultured immediately after birth. If strep is found, antibiotics are begun. In a well-nourished mother the baby will be more resistant to infection. Remember, problems only manifest in a small number of cases.

How is it treated?

My preferred methods for treating GBS before labor are below. Begin treatment as soon as you know that you are GBS positive.

1) First to treat the vaginal area, there are two options. Both involve a vaginal suppository combined with an anti- bacterial wash. One is with tree oil suppositories & the other is with an antibiotic suppository. If you prefer to use tea tree oil suppositories, go to a health food store or Vitamin Shoppe to purchase it. At night, before you go to sleep, insert one tea tree oil suppository for 7 nights.

2) At the same time we must treat the source of the bacterial contamination. This is where the anti-microbial wash comes in. Go to a pharmacy with a good medical supply section and buy Hibiclens anti-bacterial soap. The generic name of the soap is chlorhexadine. It will be with first aid and medical supplies, not with bath soap. If you can’t find it, ask the pharmacist. To use the Hibiclens, you will also need an 8 ounce squeeze bottle or peri-bottle. Your birth kit comes with one, but if you have not received it you may be able to buy one at the pharmacy, or we can give you one. To use, pour one ounce of Hibiclens into the peri-bottle and fill the rest with clean water. After all bowel movements, squirt the soapy water from front to back, in the way that you wipe. Don’t rinse, just wipe gently (front to back). Do this until the baby is born. I also recommend the wash before sex.

Cultures will be repeated each week until the birth. If the first one is still positive, and tea tree oil suppositories were used, I recommend going right to the antibiotic suppository, Cleocin, and continuing the wash.
If the first culture is negative, continue the wash until the birth. But we will continue to culture at each visit to be sure we are still clear of the bacteria. I am usually comfortable with not using IV antibiotics if I have a negative cultures

What if the above treatment does not work?

If we do not have a negative culture for GBS before your labor begins, we will discuss the mainstream treatment, IV antibiotics during labor. If we get a negative culture and it returns to positive then I think this is an indication of a higher colony count of the bacteria and that alone increases the risk of illness for the baby. IV antibiotic treatment does not preclude homebirth. It does not mean you must walk around with an IV.


Nutritional and Lifestyle Recommendations for GBS

1. Boost Vitamin C in your diet, such as eating 2 grapefruit per day. Other good sources of Vit C: red peppers, oranges, kiwi fruit.

2. Drink a cup of Echinacea tea or take Grapefruit Seed daily.

3. Get extra sleep before midnight. Slow down your schedule. Take it easy and eat well. Follow a nutritious Pregnancy Diet.

3. As a precautionary measure, oral sex should be avoided whenever a strep infection is present in the throat of a partner (this is usually strep A).

4. Plan ahead for extra warmth after the birth for both you and baby. Hot water bottles, heating pads, hot packs, big towels dried in a hot dryer during the pushing phase–will all help you and baby keep extra toasty after birth and reduce stress. Have a friend or family member assigned to be in charge of the “Mother/baby warmth team”.

5. The colostrum from your breasts is the best antibiotic treatment your baby could ever get. The colostrum is very important for your baby. Breastfeeding your baby is the best thing you can do to keep your baby healthy since you pass on your immunities to your baby through the breastmilk.

6. Do not allow children of other families to visit the new baby for the first 3 weeks. Keep your older kids healthy so they are not sneezing and coughing on new baby.

The rest of this packet contains other techniques of treating GBS that I do not have personal experience with. The information is collected from other midwives.

HERBS
Propolus can be taken daily, either in capsules or tincture, 3 to 4 times daily.

Echinacea root (Augustofloria) can be taken either as a tea or tincture, 3 times daily. To make the tea, use 1 oz of the root to 1 pint of boiling water and steep for 6 to 8 hours. Echinacea root is specific to staph and strep infections. It stimulates the body’s defense mechanisms as well. A strong tea may also be diluted and used as a douche. When douching in pregnancy, extra care must be taken to avoid forcing water up into the uterus, causing infection and other problems.

Safe Douching During Pregnancy:

Fill douche bag with cooled tea, attach cleaned vaginal tip. Hang bag 10 inches or less from the floor. Lay in the bathtub and gently insert the nozzle into the vagina no more than half way in.
Very gently release the hose clamp and allow tea to run in and out of the vagina, do NOT attempt to retain water in the vagina in pregnancy.
When finished, clean the equipment thoroughly.
Douching should never be attempted if there is any question that cervical dilation, placenta previa or prematurely ruptured membranes are present.

At home, Echinacea tincture can be given prophylactically if desired. The infant dose is 1 drop tincture every 3 hours. Symptoms of neonatal infection often begin with respiratory distress which gradually worsens. Evaluate other signs of infection, e.g., alertness, nursing, etc., and if the midwife suspects trouble, the client’s pediatrician should be consulted by the client immediately.

ESSENTIAL OILS
Essential Oil Protocol to get rid of GBS (From: www.thebirthsource.homestead.com/gbs.html )
It’s imperative that the oils are of highest quality. Young Living oils from Essential Oils R Us are one source that has been recommended.

Put the following in a Double “O” gelatin or vegetable capsule:

5 drops Lemon Essential oil
3 drops Oregano Essential oil
5 drops Mountain Savory Essential oil

Take one capsule 3 times daily.
Additionally do the following:
Soak an ORGANIC tampon in…

15 drops Lemon Essential oil
9 drops Oregeno Essential oil
15 drops Mountain Savory Essential oil
1 tsp carrier (V-6) oil
Leave soaked tampon in overnight. Insist on being retested. Do this daily for the last six weeks of pregnancy.

Insert a small ORGANIC tampon or a cotton ball, whichever is more comfortable, soaked in a combination of 10 drops of tea tree essential oil and Olive oil. Leave the tampon in for 4 hours each day for 6 days. There are Tea Tree Oil suppositories in most health food stores.


MISCELLANEOUS

V-6 Mixing Oil combines food-grade vegetable oils for mixing with essential oils to create blends, formulas and massage oils. Grape seed oil, wheat germ oil and vitamin E are nurturing to the skin as natural antioxidants. V-6 is also excellent for cooking and making salad dressings. Blendi 15-30 drops of an essential oil to 1 oz. mixing oil. V-6 is good for mixing massage oils, creating your own blends and formulas, for cooking and making salad dressings, etc. The ingredients of V-6 Mixing Oil are sesame seed oil, grape seed oil, almond oil, wheat germ oil, sunflower seed oil and vitamin E.

 Another GBS Remedy (From the archives at http://www.gentlebirth.org/archives/gbs.html :
3 capsules of Congaplex by Standard Brands 3 times a day for a week, then reculture. If negative, no more Congaplex. If positive, 1 cap a day until the end of pregnancy.

Congaplex Ingredients: Bovine thymus Cytosol™ extract, carrot root, ribonucleic acid, bovine bone, nutritional yeast, defatted wheat, bovine adrenal, dried alfalfa juice, oat flour, alfalfa flour, bovine kidney, veal bone PMG™ extract, mushroom, dried buckwheat juice, buckwheat, peanut, soy bean lecithin, mixed tocopherols and carrot oil.
Do not take if you have food allergies to any of these ingredients.
Congaplex is available at:
http://www.humandiamond.com/hdpub3/store/store0100.html (1-800-366-5992) Congaplex Supplier

Take 500 mg Vitamin C every 4 waking hours.
1 acidophilus (4 billion micro-organisms or higher) capsule every 4 waking hours.

Acidophilus is available as:
Probiotics High Potency Acidophilus
Friendly Colonizer Acidophilus Powder
Take Congaplex, vitamin C and acidophilus daily for the last six weeks.

:
EHB by NF Formulas given over a 10 day period (6 caps per day) (E.H.B. by NF Formulas, Inc.), and Tea tree oil vaginal suppositories 3 to 4 x daily for that time (see above). This mom was re-tested at two weeks after positive culture (3 to 4 days after last EHB taken), two weeks after that (2 1/2 weeks after first positive culture), and on one occasion was tested again 2 1/2 weeks later (5 weeks after positive culture) because of a prolonged ROM with no labor.
Then insist on retesting to see if the GBS has gone away. Midwives have seen heavy colonization completely cleared with these treatments, although there is no scientific study to support it.

This entry was posted in Group B Strep: Guidelines for Pregnancy and tagged by Deb. Bookmark the permalink.

About Deb

Debra is a graduate of the Boston Conservatory of Music with a degree in Musical Theater. She has spent most of her life performing and was introduced to yoga through a choreographer in 1997. After several years as a yoga student, she decided to continue her education and became certified as a Bikram Yoga instructor. In 2001 Debra headed out to Seattle to study with renowned prenatal yoga teacher Colette Crawford, R.N., at the Seattle Holistic Center. Debra has received a certificate for Vinyasa Yoga from Shiva Rea, with whom she continues to study. Debra has also been certified in the Maternal Fitness Method with Julie Tupler. In 2004, Debra completed the OM Yoga advanced teacher training with Cyndi Lee. Debra currently studies with Cyndi Lee, Genevieve Kapular, and Susan "Lip" Orem. After being witness to several "typical" hospital births, Debra felt it was important to move beyond the yoga room and be present in the birthing room. In 2003, Debra attended her first birth as a DONA certified labor support doula. In that short period of time, Debra has attended about 40 births. She is continuously in awe of the beauty and brilliance of birth. Most recently, Debra received her certification as a Lamaze Certified Childbirth Educator. Drawing on her experience as a prenatal yoga teacher, labor support doula and childbirth educator, Debra looks to establish a safe and effective class for pregnancy and beyond.

7 thoughts on “Group B Strep: Guidelines for Pregnancy

  1. What evidence is there that the alternative approach works?

    She talks about treating the source of the bacteria, but then just describes washing the outside of the rectum. This won’t treat the colonization of the intestines, so isn’t likely to be effective.

    Seems like a lot of nice ideas which might work but which are unproven are being put forward here, rather than evidence based solutions.

  2. Thank you for your comment and inquiry to the source. I will forward your question to the midwife that provided me with the blog entry.

    She may not have evidence to her alternative approach other then being an experienced midwife and suggesting or using these methods with her clients.

    Thank you
    Deb

  3. My first born baby girl passed away due to late onset GBS on June 20, 2009. She was 17 days old. I received the full dosage of antibiotics during labor and thought she was healthy. However, no one mentioned the dangers of late-onset.
    I am now expecting again and am 26 weeks. I am currently trying to decide between a vaginal birth or a c-section. I am concerned about not getting enough antibiotic before a vaginal delivery. It seems as though a c-sec. may be safer. Do you have an opinion? Thank you!

  4. Hi Ashley,

    I am so sorry to hear of the loss of your daughter. I can not imagine how devastating that must have been.

    I would like to address your request for my opinion on elective cesarean births. While they do carry I higher risk then vaginal births in some ways, the loss you suffered should not be discounted when making your decision.

    Just factually there are pros and cons to an elective c-section. I would like to refer you to my blog, “Elective Surgery: Nose Job. Breast Augmentation. Cesarean???? ” Which discusses these issues as well as http://www.webmd.com/baby/tc/cesarean-section-risks-and-complications.

    But again, I stress, that suffering the loss of one child can be difficult to over come while going through labor. Remember that part of birthing is being able to let go and trust the body’s ability to give birth safely. If a mother has already experienced a previous infant death or major birth injury to a previous child, she may have lost that confidence and may feel safer with undergoing a scheduled c-section.

    I hope this helps and I wish you happy, healthy birthing and a happy, healthy baby!

    Warmly,
    Deb

  5. I am GBS+ despite trying MANY alternative therapies. I also have it in my urine (again despite Vitamin C, garlic, cranberry, etc.) but I do not want antibiotics because this is my 5th child and I think it will be a fast labor, not allowing for more than one dose.
    I plan on using Tea tree suppositories during this last week (I’m 39 weeks today) as well as the hibiclens wash during labor.
    I also plan on giving the baby Echinacea tincture as described here, and on another midwife site, but am confused about the directions. Your post says, “At home, Echinacea tincture can be given prophylactically if desired. The infant dose is 1 drop tincture every 3 hours. “.
    Do you have any information as to how long one suggest giving the tincture? I see its every 3 hours but for 1 day, 3, 5???
    I have attempted to contact many midwives who also had this information on their site to no avail. I’ve also attempted to find information on it myself but have not been successful and would be EXTREMELY grateful for any additional info you may have.
    I trust herbal remedies completely, and giving him this tincture would truly reassure me about all these GBS concerns.
    THANK YOU in advance for your assistance.

    • Hi Pamela! Over 2 years ago you posted on GBS and the pregnancy of your 5th child. I’m on my 3rd and in my 38th week and just got a positive GBS test from my midwife. Can I ask did the TTO suppositories work? How did you make out long term? I hope all went well and you’re now up to your 6th or7th by now. :D

  6. Hi Pamela

    This information came from a midwife that one of our teachers used as her home birth midwife. I did not research and write this entry.

    I will reach out to the midwife to inquire about your question. Once I receive an answer, I will post it for you.

    Take care
    Deb

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