I remember my friend when pregnant saying something about this.

Have saved the link for future reference, thanks.

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misscurious x

Forum buddy
PAB support worker

Salford University student midwife wannabe.

I have decide to do my pathophys and pharmacology essay on GBS. This site and its related links will really help!

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i am confussed by the web site and its treatment for GBS....or im dumb but im finding it a bit unclear

i was told by my midwife and several others that...
a) i cant have a home birth becuase i carry GBS
B)i MUST be in hospital as soon as i realize im in laboure on intravinas antibiotics

the website says i dont have to have antibiotics while in labour? unless im high risk GBS?
can someone explane please....cos i realy want a home birth next time i give birth...and im happy to hold out till i start pushing

I agree there isn't enough information out there about GBS. You definitely can have a homebirth is you are a known GBS carrier, in fact I will be pedantic and say that any pregnant woman can have a homebirth no matter what her condition is, it is just whether she will receive support in doing so.

It's such a transient condition that just because you test negative at one gestation, it doesn't mean that you will test negative at the another. Certainly in your case where you were a known GBS carrier in your last pregnancy, this should not affect your care for the next pregnancy and you should be able to 'have' your homebirth. The concern lies with active GBS positive status at the point of labour and even then, you have to weigh up the risk of subjecting yourself & unborn child to prophylactic use of antibiotics over the small risk of GBS having a detrimental effect on your baby.

Yes, we do hear about babies doing badly due to GBS infection but the truth is, in any aspect of health care, zero mortality is not something that can be achieved.

tar very much, i didnt think i was being blond but it was rather confussing i didnt realy fancy being stuck with needles all through labour

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.

What Wannabe said, which is why I am declining to sign the petition.

Thanks wannabe for outlining that aspect of the debate around GBS.

Our role here is to inform students of the existence of GBS, we will leave you make up your own minds as to whether you decide to sign the petition or not.

Does anyone want to outline the other side of the debate? and tell us why some people may want to sign the petition?

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StudentMidwife.NET Founder

"You're braver than you believe. Stronger than you seem. And smarter than you think."
Christopher Robin in Pooh's Grand Adventure

Fancy yourself as a bit of a writer? Want to contribute midwifery or SM2B articles to SMNET? If so, PM me with your thoughts/articles

Which is a fine ambition. However, by your own admission you are working with Group B Strep Support (GBSS) to raise awareness of GBS.

GBSS are not just about raising awareness, but also about campaigning for the introduction of universal screening and routine offering of prophylaxis. Currently, local protocols for GBS are a confused mess - and if GBSS proposals were adopted they would at least have the advantage of consistency. However, I think a decision on the part of studentmidwife.net to back GBSS represents more than simply "informing" students. It goes beyond raising awareness to taking a view on the correct protocols for screening, diagnosing and treating GBS.

I have already said that we are working with GBSS to raise awareness of the existence of GBS, simply because many students had not heard of GBS. If our members choose to debate the great GBS debate then all the better, that way students can make up their own minds rather than listening to one side of the argument. However many members havent started their courses yet so have no idea of GBS and you are doing a grand job of informing them of the view held my many midwives and infact the view I was taught at Uni.

__________________
StudentMidwife.NET Founder

"You're braver than you believe. Stronger than you seem. And smarter than you think."
Christopher Robin in Pooh's Grand Adventure

Fancy yourself as a bit of a writer? Want to contribute midwifery or SM2B articles to SMNET? If so, PM me with your thoughts/articles