Is it necessary to be induced for Group B strep?
Let me start off by saying that I am not a doctor, midwife, or other health care professional. I am a birth instructor. One of the things that I focus on in the classes I teach is to educate couples so that they can make informed decisions of the issues facing them.
I recently saw one of those baby shows that come on cable. I have a love hate relationship with these shows because I see so many things that make birth more difficult for mothers but sometimes I see something really remarkable which in essence makes them worth watching. In the show I recently watched the doctor was talking to her patient and told her that because the mom tested positive for Group B strep (GBS) they would need to induce her and the words out of the doctors mouth were something to the effect of “or something really tragic might happen”. I started talking to the TV and said, “Why is THAT a cause for induction?”!
The Academy of Obstetricians and Gynecologists (ACOG) officially recommends induction for a few reasons: Going past 42 weeks gestation, placental abruption, preeclampsia, an infection of the amniotic sac, and premature rupture of the membranes. Many women are induced for LOTS of different reasons than the ones stated above (I won’t get into that during this post) but this was the first time I had heard of a doctor wanting to induce because a woman was GBS positive!
Group B Strep is a bacteria that healthy women carry in their intestines and vagina. It is estimated that 15-40% of women carry this bacteria. If a baby comes into contact with GBS he can become infected by the bacteria and it can cause serious illness, permanent damage, or be fatal. However, there is a very small chance that it will happen. There is a .05% chance that a baby will be infected by the bacteria. Although, half of babies that are infected have serious complications. The risks increase with prolonged rupture of the membranes by allowing the bacteria to travel upward into the uterus. One way to decrease this risk is to limit or only allow 1 or 2 vaginal exams. Some doctors and nurses like to do vaginal exams every hour but this is not necessary at all: it is uncomfortable for the mother, it can be disappointing to the mom to hear that she hasn’t “progressed” in the last hour which can add to the emotional difficulty of labor, it increases the risks of infection, and it often leads doctors to use pitocin to speed labor up when a woman is just laboring at her own pace. If a mother has a fever during labor, this also increases the risk of GBS passing on to the baby.
Women should know that being induced has its own risks. Induction causes more painful labor and many doctors and nurses turn the pitocin up higher than manufacturer recommendations hoping that labor will go even faster. Because of the unnatural contractions that pitocin causes many women will opt for an epidural which comes with additional risks. Overuse of pitocin can also hyperstimulate the uterus causing the baby a lot of stress which can then lead to a c-section. Uterine hyperstimulation can also lead to postpartum hemmorage. It is also important to know that first time mothers who are induced are twice as likely to have a cesarean birth. This is (often) because their bodies are often not ready to go into labor and forcing it to happen can cause a domino effect of other interventions that can lead to a cesarean birth that could have possibly been avoided.
The standard of treatment for GBS is to receive antibiotics every 4 hours during active labor. You may be asking, “What if my labor is shorter than 4 hours?”. If you are one of the lucky women to have such a short labor you will have to remember that most likely your water will not be broken for very long, you will have fewer vaginal exams, and because the labor is so short there less chance that the bacteria traveled up into the uterus to infect the baby.
You may be wondering if you can take antibiotics during pregnancy to kill the bacteria before labor. Unfortunately, the bacteria can come back. Some are concerned about the overuse of antibiotics and how taking them for GBS may be contributing to making bacteria resistant to treatment. The studies on antibiotic treatment for GBS vary. Some show a decrease of infection but not death. Some show no difference with or without antibiotics. Some have shown an increase of other blood infections such as e. coli. Antibiotic treatment does not guarantee that your baby will not get the bacteria passed to him.
Some women choose to go an alternate route and treat the problem naturally during pregnancy if they test positive during the 35-37 week screening test. Some naturopathic doctors recommend taking garlic, Vitamin C and echinacea. Ask a homeopathic specialist or naturopathic doctor for recommended amounts. You can ask for a rapid GBS test to be done while you are in labor to see if the bacteria are present and decide then if you want antibiotics during labor.
I have given you a lot of information about GBS and induction. In my opinion partaking the risks of induction to avoid passing GBS to a baby does not make any sense. It does not seem to me that getting induced would actually decrease the very small chance that a woman would pass GBS to her baby. Not only that but from what I have read, there are not any studies showing that induction decreases the chance of GBS passing to the baby. Weighing the options of whether or not to treat GBS with or without antibiotics is up to each woman. Weighing the options of getting induced is also up to each woman. I do not see how the two go hand in hand.
More Resources:
Gentlebirth.org (do a search on Group B Strep and/or induction)
Group B strep on Mothering.com (an article about whether antibiotics are necessary for group b strep)
www.childbirthconnection.org (do a search on induction or group b strep)
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Amelia,
Yeah, sometimes I don’t get doctors. I remember when my daughter was breech, I asked my OBGYN why their group didn’t do breech deliveries, and she basically said, “Well, the ACOG came out with a study back in 2000 that said there was an increased chance of fetal distress and/or fatality during breech births (vs cephalic births), so they stopped training us to do breech births in med school.” WHAA???!!! Fortunately we did a version to flip her and it worked, so I was able to deliver her vaginally, but I was reading that opting for a c-section didn’t really reduce the risk that much AND provides a whole new set of problems. (Here’s where I got my info on breech births). Frustrating.
Another great resource: Independant Childbirth
It is unfortunate that many doctors fresh out of med school have not been trained to help birth a breech baby. Many have not even SEEN one. That is unfortunate especially if a woman has a “surprise” breech in labor. Sometimes women can find an older doctor willing to help and take her on as a client but that is getting more rare.
You are right, a c-section for a breech isn’t a guarantee that everything will will be problem free either. It is trickier to deliver a breech via c-section than a baby that is head down.
I am glad your version worked!
Thanks for the info Amelia! I wish my instructor did a better job of educating us on reasons for inducing labor and GBS. I was induced because my water broke and labor wasn’t progressing a fast as the doctor wanted. Which in turn caused stress to Little Bean so I ended up having a c-section 22 hours later. I will never be induced again.
I had GBS with my first baby and was not induced. I was given an antibiotic though. My doctor never said one thing about being induced though. This is a really interesting article!
I have 4 children and with every single one I tested positive for GBS and took antibiotics during pregnancy and during labor. Not once did my OBGYN tell me that I needed to be induced because I had GBS; although, as a precaution the Dr wrote me a prescription for the antibiotics so that I could give it to the nurse when I was in labor. My OBGYN was great on informing me of the possible complications but did not over exaggerate them.
I am glad they screen for GBS, but have not heard of them inducing for it. I was actually born and contracted GBS. My parents almost lost me because of it, but fortunately I am ok. This was 26 years ago and they didn’t screen or prepare for treatment if necessary. That’s very interesting about limiting the vaginal checks. I had very quick deliveries (that were both induced for different reasons than GBS), however if I labored long, I could totally see how hearing 3 hours in a row that I was only dilated to a 3 would be frustrating!
Wow, McKenna! I am glad you made it through that!
Amy-it is nice when you have a health care provider that offers you informed consent! I am glad that all your births ended up positively!
Thanks for the great post. I have been GBS+ with 3 of my 4 kids, one of whom did contract GBS. Although it is a serious condition, antibiotics are very effective (although not without possible negative effects also). I have to agree that the risks of induction (or an elective c-section) are greater than the risk of passing GBS to your baby during normal labor, with antibiotics.
My fourth baby was born at home after a 5 hour labor, in which my midwife administered 2 doses of antibiotics for my GBS. Although I did a rigorous homeopathic treatment to try to eradicate the GBS, I still tested positive at 38 weeks, so I received the antibiotics at the start of my labor and had a healthy, big baby boy! One thing that I believe contributed to a healthy outcome was that my midwife did NO vaginal exams during all my prenatal care, and only once during labor to check for full dilation when I was wanting to start pushing. Also, she didn’t artificially break my water but let it break spontaneously. Both these measures helped decrease the risks of infection.
Thanks again for the valuable, informative post!
I know I’m a little late getting to this discussion, but…
I have Group B Strep and my doctor never even mentioned anything about having to induce.
However, my labor didn’t progress as quickly as she would have liked once my water broke, so they did talk me into pitocin to speed things along. In hindsight, I regret that decision. It is not fair to ask a woman who is exhausted and hungry if she wants to speed the process up. I had a birth plan that said no medical interventions except to save life and it was ignored.
My next birth will be with a midwife.
My doctor did recommend that I be induced and this is why. My last labor and delivery were three hours. My doctor is afraid that I will enter the hospital and deliver before enough of the antibiotics can be administered to prevent transmission of the GBS to the baby. A ridiculous number of infants who contract GBS die, somewhere in the 10-20% range of infants who contract it very shortly after birth. I have never wanted to be induced, and I went 12 days late on my last pregnancy without being induced. I don’t want a C-section-but I also don’t want to give birth without protecting my child from this potentially fatal complication. I trust my doctor completely, but it was also explained to me why my doctor wanted to go this route. I’ll be induced before my due date, once my cervix has started dilating-hopefully we can hold out to 39 weeks.
I tested negative for GBS. In turn I was positive and my firstborn contracted it. He spent 7 days in the hospital and the Lord took care of him and he safely got home. I was induced because I was overdue. It is scary and depressing to have your first born child born with a problem. I did not know that you can have multiple test results. I tested negative and then he was posistive with it within 12 hours of birth. Did that Dr. test wrong? Is this some freak thing? I don’t know. I was induced and given IV antibiotics with my second and she was very healthy. I would rather be induced and know my baby will be healthy than to take a risk. I hardly ever felt pain during the second induction. It was a breeze. The first was horrible.