08 Jan 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 momÂs 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 canÂt 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.
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 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.
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 CytosolÂ extract, carrot root, ribonucleic acid, bovine bone, nutritional yeast, defatted wheat, bovine adrenal, dried alfalfa juice, oat flour, alfalfa flour, bovine kidney, veal bone PMGÂ 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.