How to Prevent Group B Strep
Discovering how to prevent Group B Strep (GBS, beta strep) is becoming more and more important. Routine treatment of Group B Strep leaves a mom tethered to an IV pole receiving antibiotics that not only attempt to wipe out beta strep bacteria, but also wipe out “good” bacteria in her system. This leaves you not only limited in your birthing choices, but may lead to thrush in you and baby because yeast overgrowth is common when good bacteria are killed. This makes breastfeeding painful and can be hard to treat. What is Group B Strep, exactly, and is it possible to prevent it in the first place?
What is GBS?
All of us have bacteria living in our bodies – we're not sterile as was once thought. The colony of bacteria within the body is called the microbiota, and generally serves many important functions in digestion and health. Sometimes, however, “bad” bacteria colonize. Group B Strep is a type of bacteria that may populate the body, typically in the rectum. It can migrate to the vagina in women. It's usually transient, meaning it comes and goes for most women (which is why testing before 36 weeks is thought to be inaccurate).
What are the Risks?
Okay, so why the worry about GBS?
There's a possibility that a mother who has GBS could pass it on to her baby during birth. If this happens it may colonize the skin, and later migrate inside the baby's body and cause infection. Sarah Buckley notes in her book, Gentle Birth, Gentle Mothering, that GBS can cause pneumonia, septicemia (a blood infection), and meningitis – though this is very rare. Beta strep can be either early-onset or late-onset. Early-onset occurs within the first week of life, and late onset begins somewhere from 2 weeks to 3 months old.
It sounds scary, but it's important to realize that the actually risks are very small. Only one baby in two thousand contracts early-onset GBS, and one in 25 babies who contract it will die. This means eighty babies per year may die from GBS.
Midwife and obstetric researcher Gail Hart outlines the numbers in this manner: of GBS positive mothers, 50% will transfer that to their newborn. 98% of those babies will be asymptomatic (meaning no infection occurs). 2% of those babies will see GBS infection, which means approximately 1% of GBS positive mothers will have a baby infected by Beta strep.
Of course, if your baby is one of those who suffer, the statistics don't matter much. The question then becomes, how is GBS currently treated, and is that working?
How Should it be Treated?
Treatment for GBS depends on where you're giving birth. In the United States, universal screening is recommended, meaning all women are swabbed for Group B Strep around 36 weeks pregnant. Swabbing is supposed to be done both vaginally and rectally, though it's typically only done vaginally. Around 30% of pregnant women will culture positive for GBS at this point. The CDC currently recommends that all women who have a positive culture, and any women whose status is “unknown,” receive antibiotics in labor.
The universal screening guidelines were implemented in the early 1990's, after the 1980's saw increasing rates of GBS-positive mothers and babies. In the mid-1990's, the recommendation was to screen all mothers, and treat those who showed high risk factors during labor. In 2002 the guidelines were revised to the current: any women with a positive culture (or “unknown” status) should receive antibiotics during labor, regardless of risk factor.
It's important to note a few things. First, GBS rates were declining sharply when the first recommended protocol was implemented (giving medications to moms with risk factors) was implemented, and had reached an incredible low when the second protocol was implemented (giving medications to all GBS+ moms). Rates actually rose slightly after this guideline, but now (as of 2007) appear to be moving downward again. Late-onset GBS rates remained about the same throughout this entire period (antibiotics for moms in labor have no effect on late-onset GSB rates, period).
We're not sure why the rates were so high in the 80's, though Gail Hart feels it may be because vaginal exams were done so frequently and widely in that period. An important point to remember along those lines is that GBS is not always transmitted by the mother. Studies have shown that babies can be colonized due to GBS cross-spreading through a maternity unit, which could have exacerbated the high rates seen in the 1980's.
Another important point to note is that not all countries follow the same stringent protocol of giving antibiotics to all GBS+ moms during labor. The UK is a notable exception. Though RCOG, the Royal College of Obstetricians and Gyneocologists, doesn't feel that screening and treating thousands of women is warranted for the small risks, their rates of GBS transmission are very close to those of the US. The rates of GBS+ women in the UK are also very similar to the US. The same is true with other countries who don't follow the same universal protocol as the US (though there are some countries with lower overall GBS+ women in the population).
The conclusion is: evidence does not support universal treatment with antibiotics during labor (called Intrapartum Antibiotic Prophylaxis or IAP – “intrapartum” means during labor, and “prophylaxis” means preventative). Here's a quote from the Cochrane Database:
“The use of IAP did not significantly reduce the incidence of all cause mortality, mortality from GBS infection, or from infections caused by bacteria other than GBS.”
In addition, there are risks to universal antibiotic usage:
- 30% of babies will be treated (100x above the rate that's actually “needed”)
- Late-onset bacterial infections in newborns are increasing
- Resistant bacterial infections in newborns are increasing
- E.Coli colonization rates are increasing as much as 500%, which may cause more mortality in preemies and compromised newborns
Now the question becomes, what do we do from here? Are there other options?(NOTE: Want Real Mom Tested Techniques for Handling Labor Pain? Use these 11 proven natural childbirth techniques to handle labor and keep things moving right along. Get them here.)
Can I Prevent It?
Stopping GBS before you ever get to labor is the most promising option for most women, especially those who want a natural birth, a home or birth center birth, or who have struggled with yeast in the past. There are a few ways to help prevent GBS colonization from taking hold:
Restore Balance in the Birth Canal
To again quote midwife Gail Hart, “vaginal health is a key to true GBS prophylaxis!”
In other words, healthy vaginal flora (microbiota) prevent GBS from colonizing in the first place. Boosting good flora has positive effects on your entire body and your entire pregnancy. There's less chance of preterm labor and birth and of preterm prelabor rupture of membranes. Plus having good microbiota in your digestive tract resolves gut imbalances, improves digestion, resolves bathroom problems, and improves overall well-being.
The vagina is an acidic environment (usually has a low pH). When it becomes unbalanced, or more alkaline, strep, bacterial vaginosis (BV, a big culture in premature labor), e. coli, gardnerela, and yeast are all able to thrive.
Lactobacilli, which you may know as the “good bacteria,” thrive in an environment of low pH, or an acidic environment. They help to create their own perfect growing conditions because they excrete acid (thus why they're lactic acid bacteria) in the form of hydrogen peroxide. They also increase oxygen levels. These lactobacilli fight off the “bad” bacteria and yeasts listed above.
In other words, you want to increase the levels of lactobacilli in your body and especially in the vagina / birth canal. Not only does this help ward off the bad guys, but it means your body will be colonized with healthy bacteria to pass on to your baby at birth.
Antibiotics do kill off the bad guys, but they also kill off good bacteria. This allows yeasts to take hold and make it more likely that bad bacteria can begin to multiply if they're introduced through cross-contamination (on care provider's hands – or even gloves, from other babies in a maternity unit, from sick visitors, etc.).
If BV is a problem, a vinegar rinse has been shown to be very effective. 2 tablespoons of vinegar in a pint of water can be poured over the vulva daily for one week.
NEVER DOUCHE! It's damaging to the mucosal lining of the vagina, even if the douching substance is something beneficial. In addition, it has been associated with preterm labor, low birth weight, infection of the amniotic sac, and more during pregnancy. It's more common in some racial and cultural groups, but is NEVER advised. Do NOT douche!
A vinegar treatment for a week or a single hydrogen peroxide flush is very effective at restoring an acidic balance to the vagina, and good to try if you're struggling with yeast or BV symptoms.
It's important, however, not to stop there.
Back to the Lactobacilli – Building Good Bacteria
As I mentioned above, you want to build up the good bacteria in your body. This is a system-wide project, and the easiest way to get started is to eat probiotic foods and take probiotic supplements. Probiotic foods are cultured with good bacteria. You probably already know that yogurt with “live, active cultures” fits this category, but it doesn't stop there. Kefir, another cultured dairy product has even more potent good cultures. Traditionally fermented sauerkraut, kimchee, and other condiments are also good choices. And drinks like kombucha and beet kvass are fermented and contain a lot of the “good guys.”
All of this brings good bacteria into your digestive system and helps prevent overgrowth by bad bacteria, include Group B. strep. As I mentioned above, there are also positive effects on your digestion, on your ability to absorb nutrients, and it also resolves many bathroom issues like constipation.
It's a good idea to minimize sweets and highly-processed grains while you're building microbiota up, but you should include resistant starches. These are starches your body cannot break down, but good bacteria really love them. An easy way to create resistant starch is to cook rice or roast cubed potatoes. Then refrigerate for at least 24 hours. This process of cooking the starches (potatoes and rice are almost pure starch) causes a chemical change the creates resistant starch. After this has happened you can reheat and use in a recipe (studies show reheating at this point may create even more resistant starch). Beans can also create resistant starch in a similar way – you must prepare them with the traditional soaking method, then cook well and allow to cool for 24 hours. Then use in a recipe.
These resistant starches feed the good bacteria and may help them establish a foothold in the digestive system even if you're starting with yeast or an overgrowth of “bad bacteria.”
You should also bring good bacteria to the vagina directly. This can be done by wiping yogurt or kefir directly onto the vulva, or, if you feel comfortable, insert slightly with clean fingers. It does't take much – just a teaspoon or so. Dr. Natasha Cambell-McBride, author of Gut and Psychology Syndrome, recommends this for pregnant women. She notes that doing it right after the daily shower is beneficial. I recommend you apply in the shower or over the toilet to let “drips” fall off, and some women like to wear a pantyliner or light-duty mamacloth for a little after application. I cover more about this in particular and more in this podcast episode: How to Give Baby Healthy Gut Flora (opens in a new tab for you). It's good to start this around 36 weeks and continue until your baby is born.
The above two sections are a great foundation for preventing GBS+ status. To sum up the benefits, again in the words of Gail Hart:
BEST. PREVENTATIVE. EVER.
An acidic vagina with a thriving culture of lactobacilli:
- helps prevent strep growth
- reduces Bacterial Vaginosis and prevents its return
- reduces preterm birth
- reduces Prelabor Rupture of Membranes
- Reduces Urinary Tract Infections
You can also work to boost your immune system overall to help prevent GBS colonization. This generally involves an oral regime of herbs, vitamins, and some moms have found success by including essential oils. Here's a sample regime:
- Echinacea tea or tincture daily
- Garlic – one clove or 6-8 capsules daily
- Vitamin C – 250mg 4x daily
- Vitamin E – 400IU per day
This is in addition to probiotic supplement and foods, and applying probiotics directly to the vulva/vagina.
Some moms have also used a peribottle with a drop of tea tree oil to gently rinse after each bowel movement (directing the stream from front to back). The mom who used essential oils used specifically Young Living products: 3 drops of Thieves to the soles of her feet, morning and night, 5 drops of Valor along her spine, morning and night. This is just anecdotal, and there may be other immune-boosting essential oils/blends to look into too. This mom also took several Young Living supplements along with her oil treatment. It's worth looking into, especially if you've got a GBS+ swab.
In addition, eating a nourishing, whole-foods diet and including other super foods like liver, homemade broths, and plenty of vegetables will boost your overall health and immune function (plus build a healthy baby and strong placenta).
Safety for Baby
Of course all of this is for the safety of your baby. It's important to remember that even though you may do everything possible to eradicate GBS, others could still introduce it. If you'll be having your baby at a hospital, total rooming in creates the safest environment for your baby. If your baby never goes to the nursery, the likelihood of cross-contamination greatly decreases. You should also insist on fresh gloves on any nurse or doctor who needs to examine baby (and you may wish to keep your baby skin-to-skin as much as possible to minimize all contact). Also insist that visitors wash their hands – and you may choose to limit visitors initially to minimize the chance that baby is exposed to anything – from GBS to the common cold.
Keeping yourself healthy keeps your milk supply high. Colostrum in the early days, then your mature milk after, contain plenty of natural immune boosters and antibodies that benefit your baby.
GBS is a complex issue, but it's clear that the current protocol of universal screening and treatment with antibiotics is not backed by evidence. It also has potential dangers in and of itself. Both of these factors make it important for you as a mom to evaluate the situation carefully, weighing the pros and cons for your own birth. Some moms have higher risk factors and opt for antibiotics.
But it's beneficial for all moms to build routines into their lifestyle to foster healthy microbiota, and to focus particularly on good flora in the vagina at the end of pregnancy. This not only helps build lifelong health for you, but it also gives your baby healthy gut flora from the start – and it's most likely far better treatment for GBS than current protocols of either antibiotics or simply doing nothing.(NOTE: Want Real Mom Tested Techniques for Handling Labor Pain? Use these 11 proven natural childbirth techniques to handle labor and keep things moving right along. Get them here.)
Gentle Birth, Gentle Mothering by Sarah Buckley (includes an excellent section on GBS and on evaluating pregnancy and birth issues in general)
Group B Strep and Vaginal Health, presentation by Gail Hart via teleconference 12/2013 | In-depth workshop, Detroit, 02/2104
Jordan HT, Farley MM, Craig A, et al. Revisiting the need for vaccine prevention of late-onset neonatal group B streptococcal disease. Pediatric Infection Disease Journal 2008; 27:1057-64
Intrapartum Antibiotics for known maternal Group B streptococcal colonization | Cochrane Summaries | summaries.cochrane.org | Ohlsson A, Shah VS Published Online: January 31, 2013
Arch Iran Med. 2006 Jul;9(3):213-7
Gut and Psychology Syndrome by Natasha Campbell-McBride