And this is the issue. GBS Support is a group formed by parens whose babies have suffered morbidity or died as a result of GBS infection. That is an absolutely minute proportion of the babies born to women with GBS colonisation. Obviously, everyone wants to avoid a neonatal death from GBS, however we have to get this in perspective:

From the figures on the GBSS site, annually:

"230,000 babies are born to mothers who carry GBS; 88,000 [GBSS say that's 1:8, but by my calculation 88000:230000 is 1:2.6] babies become colonised with GBS; 700 babies develop GBS infections, usually within 24 hours of of birth; and 75 babies (11% of infected babies) die."

So, let's work through this. If you are GBS positive you have:

1:2.6 (38%) chance of having baby *colonised* (almost always benign) with GBS
1:329 (0.3%) chance of having baby *infected* with GBS (i.e. with GBS disease)
1:3066 (0.03%) chance of having baby die from GBS infection.

To put in perspective:

The *additional* risk of a stillbirth in a woman who declines induction to prevent prolonged pregnancy (beyond 42 weeks) is 0.1% (absolute risk at 42 wks c. 1:500 (0.2%), rising from c. 1:1000 (0.1%) at 41 wks)

The risk of a baby dying as a consequence of uterine rupture in a woman attempting VBAC in a unit with < 3000 births a year is approximately 1:1300 (0.07%).

Now, if there was an effective prophlyactic treatment for GBS which was completely benign (e.g. a drug administered non-invasively, which no side-effects either inherant or connected with the method of administration) there would be no problem.

However, as things stand there is no strong evidence that prophylactic treatment for GBS reduces mortalities (though it does reduce infection rates, so we might assume it reduces mortality). The treatment also is invasive (IV antibiotics), definitely impacts the labour (restricts mobility, and often local protocols will restrict things like waterbirth and homebirth, GBSS claims notwithstanding) and can have potentially nasty side-effects on the mother. To put this last point in perspective: if you treat annually 230,000 GBS positive women with prophylactic antibiotics, approximately 230 will have an anaphylactic reaction, which can be fatal.

Obviously the effects of GBS can be catastrophic - so, it's not at all a clear-cut issue. But I think midwives have to think about the interests of the 229300 GBS positive women whose babies will not develop GBS infection, as well as the 700 GBS positive women whose babies will develop GBS infection.

Given that there is no evidence that prophylactic antibiotics reduces neonatal mortality (as opposed to GBS infection), it could be that focus on prompt identification and treatment of babies with GBS infection is a better strategy than universal testing and routine prophylaxis.