Group B Strep: what you need to know

We are told that the concern about Strep B involves two groups at high risk of infection:
1. Premature infants under 37 weeks gestation
2. Any infant in utero with membranes released longer than 18 hours

Contractions are a possible indicator of infection, but this situation is a concern in weeks 0-36. After 36 weeks, Braxton Hicks are normal and a good sign of a healthy toned uterus getting ready to push a baby out.

A culture that shows Strep B in the vagina is not necessarily illness related. Just as we commonly have Strep A in our throats on a swab and have no sore throat symptoms (no strep throat), from one day to the next we can all culture positive for Strep B without any symptoms or danger to our unborn babies. This is why many practitioners refuse to test for it and simply wait to test until such time as the above two “at-risk infant scenarios” show up. One day a woman might test positive and the next be negative. To treat with antibiotics before labour would NOT be recommended. Why?
The woman’s body could build up a resistance to the antibiotics and so could her baby’s body. Then if either got a more serious infection after the birth, the antibiotics might be ineffective.

Taking antibiotics can also lead to thrush, vaginal yeast and severe colic in the months after birth. There is some indication that antibiotic use can lead to Vitamin K deficiencies in the baby.

I would advise pregnant women to do as many things as possible to minimize their risk of ANY infections and maximize their immune systems. Some safe suggestions:

1. Boost vitamin C in your diet—e.g., eat 2 grapefruit per day. Other good sources of Vitamin C are red peppers, oranges, kiwi fruit.

orange, grapefruit, kiwi

Boost Your Vitamin C

2. Drink a cup of echinacea tea or take 2 capsules of echinacea every day.

3. Get extra sleep before midnight. Slow down your schedule.

4. Take 1 tsp colloidal silver per day. Take it between meals. Hold the liquid in your mouth a few minutes before swallowing. Colloidal silver can be purchased in most health food stores. It is silver suspended in water. It is antibiotic in nature and safe in pregnancy if you limit the daily intake to 3 tsps or less. Do not take more because there is a danger of turning your skin permanently blue by overdosing.

5. Plan ahead for extra warmth after the birth for both the mother and baby. Hot water bottles, heating pads, hot packs, big towels dried in a hot dryer during the pushing phase all help keep the mamatoto extra toasty after birth and reduce stress. Have a friend or family member assigned to be in charge of the mother/baby warmth team. Colostrum is the best antibiotic treatment the baby could ever get.

6. Other good prevention tips: Keep vaginal exams to a minimum — 0 is best. Do not allow membrane stripping to start the birth (a.k.a. membrane sweeping). Do not permit artificial rupture of the membranes. Do not allow children of other families to visit the new baby for the first three weeks. Keep the older kids healthy so they are not sneezing and coughing on the new baby.

I often think we must have had a lot of women who were Strep B positive in the 1000 plus births I have attended. We do not test unless we have long rupture of membranes and/or a preemie. Once the baby is born, we keep all women warm and baby skin-to-skin with the cord intact and, of course, all our mothers breastfeed. I have never had a baby sick with Strep B in thirty years. Unfortunately, the use of high dose antibiotics on so many pregnant women has resulted in an increase in infant deaths due to E Coli. *Group B strep/antibiotics

Prevent the diagnosis of positive for GBS: If your care provider wants you to go for GBS testing to comply with their protocols, read this article by a Certified Nurse Midwife about the use of garlic in the vagina to knock out bacteria. Do this regimen prior to testing.

Be sure to check out Lisa Barrett’s blogpost (and the comments) about the Cochrane Review regarding GBS and Antibiotics at
(1.) E. M. Levine et al., “Intrapartum Antibiotic Prophylaxis Increases the Incidence of Gram Negative Neonatal Sepsis,” Infectious Disease Obstetric Gynecology 7, no. 4 (1999): 210-213.
(2.) C. V. Towers and G. G. Briggs, “Antepartum Use of Antibiotics and Early-Onset Neonatal Sepsis: The Next Four Years,” American Journal of Obstetric Gynecology 187, no. 2 (2002): 495-500.
(3.) C. V. Towers et al., “Potential Consequences of Widespread Antepartal Use of Ampicillin,” American Journal of Obstetric Gynecology 179, no. 4 (1998): 879-883.
(4.) R. S. McDuffie Jr. et al., “Adverse Perinatal Outcome and Resistant Enterobacteriaceae after Antibiotic Usage for Premature Rupture of Membranes and Group B Streptococcus Carriage,” Obstetric Gynecology 82, no. 4, pt. 1 (1993): 487-489.
(5.) T. B. Hyde ct al., “Trends in Incidence and Antimicrobial Resistance of Early-Onset Sepsis: Population-Based Surveillance in San Francisco and Atlanta,” Pediatrics 110, no. 4 (2002): 690-695.
(6.) M. L. Bland et al., “Antibiotic Resistance Patterns of Group B Streptococci in Late Third Trimester Rectovaginal Cultures,” American Journal of Obstetric Gynecology 184. no, 6 (2001): 1125-1126.
(7.) M. Dabrowska-Szponar and J. Galinski. “Drug Resistance of Group 9 Streptococci,” Pol Merkuriusz Lek 10, no. 60(2001): 442-444.
(8.) R. K. Edwards et al., “Intrapartum Antibiotic Prophylaxis 2: Positive Predictive Value Antenatal Group B Streptococci Cultures and Antibiotic Susceptibility of Clinical Isolates,” Obstetric Gynecology 100, no. 3 (2002): 540-544.
(9.) S. D. Manning et al., “Correlates of Antibiotic-Resistant Group B Streptococcus Isolated from Pregnant Women,” Obstetric Gynecology 101, no. 1 (2003): 74-79
(10.)Cochrane Database: Jan. 2013 “Maternal colonization with group B streptococcus (GBS) during pregnancy increases the risk of neonatal infection by vertical transmission. Administration of intrapartum antibiotic prophylaxis (IAP) during labor has been associated with a reduction in early onset GBS disease (EOGBSD). However, treating all colonized women during labor exposes a large number of women and infants to possible adverse effects without benefit.”

UPDATE: Cochrane Library, June 10, 2014
Intrapartum antibiotics for known maternal Group B streptococcal colonization
Women, men and children of all ages can be colonized with Group B streptococcus (GBS) bacteria without having any symptoms. Group B streptococcus are particularly found in the gastrointestinal tract, vagina and urethra. This is the situation in both developed and developing countries. About one in 2000 newborn babies have GBS bacterial infections, usually evident as respiratory disease, general sepsis, or meningitis within the first week. The baby contracts the infection from the mother during labor. Giving the mother an antibiotic directly into a vein during labor causes bacterial counts to fall rapidly, which suggests possible benefits but pregnant women need to be screened. Many countries have guidelines on screening for GBS in pregnancy and treatment with antibiotics. Some risk factors for an affected baby are preterm and low birthweight; prolonged labor; prolonged rupture of the membranes (more than 12 hours); severe changes in fetal heart rate during the first stage of labor; and gestational diabetes. Very few of the women in labor who are GBS positive give birth to babies who are infected with GBS and antibiotics can have harmful effects such as severe maternal allergic reactions, increase in drug-resistant organisms and exposure of newborn infants to resistant bacteria, and postnatal maternal and neonatal yeast infections.

This review finds that giving antibiotics is not supported by conclusive evidence. The review identified four trials involving 852 GBS positive women. Three trials, which were more than 20 years old, compared ampicillin or penicillin to no treatment and found no clear differences in newborn deaths although the occurrence of early GBS infection in the newborn was reduced with antibiotics. The antibiotics ampicillin and penicillin were no different from each other in one trial with 352 GBS positive women. All cases of perinatal GBS infections are unlikely to be prevented even if an effective vaccine is developed.

21 thoughts on “Group B Strep: what you need to know

  1. Thanks Gloria- informative as always… another issue of concern regarding routine testing and in-labour IV antibiotic (AB) treatment for positive GBS culture is the risk of anaphylactic reaction. In essence we ‘shift the risk’, simplisitically forgetting that a labouring woman experiencing anaphylaxis is still the life support system of her unborn babe… “Approximately 1 in 5000 exposures to a parenteral dose of a penicillin or cephalosporin antibiotic causes anaphylaxis”. In my own mothering journey I developed a severe antibiotic allergy after taking ABs for breast infections I couldn’t clear any other way- I have often reflected how my natural home-births would have unfolded if that dramatic reaction had occured in labour instead of 6 weeks postpartum! As a homebirth midwife I do not feel comfortable administering IV ABs at home (though many of my colleagues do) and advise my clients that if they want treatment for GBS the most appropriate setting for their birth is the hospital.

  2. Hi Gloria! I am curious about waiting to culture for high risk clients, particularly those ruptured more than 18 hours. Once they reach this point, and you send a culture, do you begin treatment as you await results? Wouldn’t a known negative result decrease interventions in the majority of women who PROM?
    Blessings, Penny

  3. I find it interesting that the recommendations say antibiotics if you test +, but if you havent been tested then antibiotics are only given for preterm, rom >18 hours or fever.

    Of course, no hospital that I know of follows the second half of those guidelines. If you haven’t been tested you and your baby will get antibiotics. And you risk a visit from CPS if you refuse. >:(

    • I tested positive at week 38 with my birth center MW and refused abx for any reason and when I ended up transferring to birth in the hospital I refused any abx treatment there, too. CPS was not called and no one gave me a hassle. I think many women refuse abx treatment for this and with good reason! I don’t see how calling CPS would even be considered unless of course the baby showed signs of infection and parents were refusing treatment–maybe then, but CPS for refusing abx teatment that isn’t necessary is just silly and I wouldn’t care even if they did make that call. Women shouldn’t be afraid of CPS when they are exercising their informed refusal for unnecessary procedures.

  4. The Strep B issue makes me really angry. It is yet another way that western medicine puts women on their backs for labor. I tested positive and ended up hooked to an IV for 30 hours (I was induced at 41 weeks), rather than being able to walk around freely for labor. Plus I am allergic to most antibiotics, so I don’t even know if what they gave me was really tested for infants. And now I have read that Strep B is only an issue with early births?! The stupid IV really messed with my labor. I felt completely defeated by not going into labor spontaneously and all the medical interventions just depressed me more.

    As for recommending colloidal silver during pregnancy, while I have used very high quality CS as an alternative to antibiotics, I would never use it or any other metal during pregnancy. Some of the stuff out there is junk and it is the stuff that leads to the reaction of turning your skin permanently blue. I would want to see some serious peer reviewed articles to convince me of the safety of using even the good stuff while pregnant though it would be tempting to fake out the Strep B test, I must admit. However, I now know that you can do that with topical yogurt (even better — garlic yogurt) and probably a dozen other things rather than taking something non-food internally. You’re better off taking NOTHING. I didn’t even treat my migraines during pregnancy. I am wicked-pissed they made me take the antibiotics during labor.

  5. I wish I knew this before my 1st was born. I tested positive at 38? weeks and got the AB during labor :( I wonder if I should have refused – what can CPS do? If it was a home birth they wouldn’t even know.
    I had pre-term contractions all day every day since week 30, and cervical change starting at week 33, but my munchkin was late, coming week 41 and a day. Is that the kind of contractions that are a possible indicator of infection?
    What is PROM?
    My biggest question though is why is fever during labor a reason to put the baby in NICU for 48hrs and treat with prophylatics? I had an emercency C after 12hrs and failing to progress past 5cm but I think thats because they gave me an epidural at 3cm that made me pass out so they gave me ephedrin, then the pitocin (or maybe the ephedrin?) brought the baby’s pulse/pressure down & mine up, then the epidural failed once the pitocin was back to full strength (ouch). I’m thinking all that nonsense is why I got a fever, and why I failed to progress. (regret, regret, regret, and guilt & sadness for being ignorant). Is NICU neccessary? Can I refuse if it happens with baby #2? How is it handled at a home birth?

  6. I wish I had had this resource during my last two pregnancies! This is the best article I have read on this topic. It is comprehensive and evidence based and taps into 30 years of personal experience. Well footnoted. Thank you! I will definitely link this on our site~and if I have any more babies I will know where to come for info!
    (I had my midwife administer the antibiotics via IV and then remove the IV completely, and re-poke four hours later. I didn’t want to labour with that IV contraption in my hand, and especially if I had to keep it dry. Water was my best friend for both my vbacs!)
    Anyways, excellent resource, thank you!

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  8. What can you tell me about a woman who has a UTI caused by GBS in pregnancy? I’m 11 weeks and have this, and am told they will assume I’m GBS+ for the whole pregnancy. I’m not sure IV abx would be an option even if I want tht, since my labours re fast (last one was 4ish hours). I’m told having a GBS UTI in pregnancy presents a higher risk factor, but I don’t know exactly why, other than it being assumed you have lots of GBS to gt the UTI. Any info is appreciated. I want o know as much as possible to make an informed choice.

  9. Pingback: Group B Strep (GBS) Information and Resources

  10. I was tested positive for Strep B during my first pregnancy. I’d like to know if this bacteria ever leaves the body? Can it come and go?

  11. Vitamin C helps create a stronger amniotic sac – the stronger and stretchier it is, the less likely it will be to release in the absence of term contractions.

    Vitamin C is actually a complex that includes bioflavinoids and more. Supplementation of vitamin C complex in pregnancy seems reasonable as a way to avoid induction because of PROM and will help reduce Group B Strep (GBS comes and goes depending on stress levels, sugar intake, general nutrition and more).

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  13. Dear Gloria,

    I also read about using garlic to prevent strep infection. Insert one clove of garlic into your vagina. What do you think about that? And when to use it or not.
    thanx for this article!

  14. Hello everyone,

    I’m not pregnant and not planning to be for a few years. I have searched Strep b in non-pregnant woman but can’t seem to find much information on it. It all began with urinary tract infections and then one day my obgyn said i had a high count of Strep B.
    I went to the urologist and they recommend taking one anti-biotic right after I have intercourse. The urologist thinks that i get urinary tract infections by having sex. But i’m still not sure how i got strep b. My husband and I use condoms all the time + I’m tamoxifin. Anyone have any information that might help me figure out what is going on please email me. Thank you:O)

  15. Pingback: New Thinking in OBGYN | Wise Woman Way of Birth | by Gloria Lemay

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