Davi Kaur Khalsa, Certified Nurse Midwife and Nurse Practitioner, has over 25 years experience working with women, pregnancy and childbirth. She is certified by the American College of Nurse Midwives, and works closely with several prominent OB/GYN doctors in Los Angeles, Beverly Hills, Santa Monica and across the greater Los Angeles area.
By Davi K Khalsa I CNM
Usually being positive is a good thing, but what happens if you are pregnant and you find out that you have tested positive for Group B (or beta) Strep (commonly called GBS)? First, don’t panic – a positive test for GBS is very common, and there are relatively simple ways to prevent transmitting a GBS infection to your newborn. It is still very important to understand all about GBS and what it means if you are positive during the last weeks of your pregnancy. Our body is home to approximately 100 trillion microorganisms (bacteria, fungi, protozoa, etc.), and usually we live in harmony with these microorganisms. In fact, we need them for good health. Beneficial microorganisms play an important role in strengthening our immune systems, improving metabolic function, providing anti-inflammatory support, and preventing allergies, among other benefits. In a healthy body, these beneficial microorganisms predominate and control opportunistic microorganisms, which can cause infections and disturb the body’s natural balance. The balance of beneficial and opportunistic microorganisms is very delicate, and it can be disrupted by many factors including our diets, pharmaceuticals (antibiotics and probiotics being the most obvious) and even stress. Sometimes an imbalance in our bodies allows opportunistic microorganisms, like the bacterial microflora Beta Strep, to multiply and adverse symptoms can manifest. So what about GBS and pregnancy? Why is it a significant concern during childbirth? Group B Streptococcus (GBS) is a type of bacteria that is found in the lower intestines and in the vagina of approximately 1 in 4 of all healthy adult women, usually without adverse symptoms or consequences.
GBS bacteria are not sexually transmitted, and they are not contagious. You may have GBS in your body for just a short period of time, it may come and go, or you may always have it. Normally, GBS is not treated during pregnancy unless the GBS bacteria are found to be present in urine. If it is, it then needs to be treated right away. Otherwise, if a woman is GBS positive only from the vaginal/rectal area, she is not treated until she begins labor. When a baby is born vaginally, it is exposed to and can swallow vaginal fluids containing GBS. Because their immature immune system and sterile digestive flora is not equipped to fight the GBS bacteria, the baby can quickly become very ill with GBS Disease and even die from these strong bacteria. In the U.S., GBSis the leading cause of meningitis (infection of the fluid and lining around the brain) and sepsis (infection of the blood) in a newborn’s first week of life.
DETECTION The Centers for Disease Control (CDC) recommends all pregnant women be screened for the presence of GBS with a vaginal/rectal culture at 35-37 weeks in pregnancy.
TREATMENT The United States uses the most effective strategy that has been researched: during labor, IV antibiotics are given to all women who have tested GBS positive. Women with unknown GBS status, such as those who give birth prematurely (before taking the GBS test) or who have certain other conditions, are also treated with antibiotics. Because of this strategy, the US has seen a major reduction in babies born with early onset infection. A pregnant woman who tests positive for group B strep and gets antibiotics during labor 4 hours before birth has only a 1 in 4,000 chance of delivering a baby with GBS Disease, compared to a 1 in 200 chance if she does not get antibiotics during labor. This is a huge difference! This is why most midwives and doctors are supportive of this protocol.
CONTROVERSY Many people are concerned with the overuse of antibiotics in general, which can lead to so-called ‘superbugs’ which are resistant to antibiotic strains. Antibiotics can also cause yeast overgrowth, which can impact breastfeeding and disturb the infant’s intestinal flora. Also, the woman being treated in labor may have an allergic reaction to antibiotics, up to and including anaphylactic shock, which can be fatal. The rate of a severe reaction is 1 in 10,000 for women receiving antibiotics for GBS. Some midwives recommend using chlorhexidine (Hibiclens) during labor for GBS positive women as well as garlic and probiotics.
To date, there is not enough evidence to show that washing the vagina with chlorhexidine during labor reduces GBS infections in babies. While probiotics, chlorhexadine and garlic have the potential to reduce vaginal and newborn colonization with GBS, we do not have enough evidence yet to show that these strategies can prevent early GBS infections, since GBS infection usually occurs when GBS gains access to the amniotic fluid and gets into the lungs of the fetus during labor.
Is it possible to keep your digestion flora in balance, and be negative for GBS when tested? One study found that a decrease in beneficial bacteria in the digestive system was usually accompanied by a higher prevalence of opportunistic flora. What disrupts the healthy balance? To name just a few: processed foods, refined carbohydrates, sugar, chemicals, antibiotics, other pharmaceuticals and stress.
Most mothers-to-be are guilty of a few of these “sins” (ice cream craving, anyone?). However, even if you do test positive for GBS, eating a healthy diet rich with beneficial microorganisms will be extremely beneficial to your baby if he or she is born naturally. Beneficial flora, the ‘good bacteria’ are also known simply as ‘probiotics.’ They are the housekeepers of your digestive system. Without a healthy amount of probiotic flora, your body cannot be healthy. In a healthy body these beneficial bacteria dominate and control all other microbes.
There are some simple changes you can make to restore the balance in your system:
DIET: We must eat new bacteria in order to replace bacterial species lost by antibiotics or unhealthy diets. It is beneficial to eat:
• Spices and herbs
• Fresh vegetables and fruits
• Fermented foods, like sauerkraut, yogurt, and cottage cheese
• Avoid processed foods, sugar, saturated fats and man-made chemicals, as these will not help your gut flora to stay healthy.
• Wear cotton underwear
• AVOID thong underwear (it is like a wick from the anus to your meatus)
• Women…always, always, always wipe front to back after urination or a BM
• After a BM use a wet wipe…and wipe front to back until clean
Even if you are GBS positive, there are many simple and effective ways to prevent transmission to your baby. Understanding this process is important to reduce fear and stress before, during and after labor and birth.