Home births and Group B Streptococcus
Group B Streptococcus, also abbreviated to Group B Strep or GBS, is the
most common cause of life-threatening infections in newborn babies in
the UK affecting around 700 babies every year. It is usually treated with
IV (intravenous) antibiotics during labour so what does this mean for
you if you have GBS but want a home birth?
What is it?
- Streptococcus B is a normal bacteria present in up to 35 per cent
of women and most experts agree that the presence of this bacteria is
not a problem until labour and delivery when transmission of the organism
from mother to baby can occur
- Between 25 per cent and 50 per cent of babies born to these mothers
carry streptococcus on their skin and of these, around 1 per cent become
unwell as a result of this organism
- The presence of the bacteria itself isn't usually a problem and it
often comes and goes and may return after treatment
- The possible effects of Strep B on newborn babies are very serious
and include meningitis, pneumonia and septicaemia. The risk occurs during
labour when the baby may pick up the bacteria from the birth canal.
A very small number of these babies go on to develop Group B Strep Disease,
or to give it its official name, Early Neonatal Group B Streptococcal
Septicaemia (ENGBSS).
Can it be screened and treated?
In the UK there is no screening programme for GBS, although it is possible
to detect the bacteria during pregnancy. Babyworld Doctor Jo Lee says,
". It has been shown that 28 weeks is the best time to swab for strep
B infection, and there is no evidence to suggest that swabbing any later
helps identify further at-risk deliveries." Many people believe pregnant
women should automatically be screened for GBS but current NICE guidelines
state, "Women should not be offered routine antenatal screening for GBS
(Strep B) because evidence of its clinical effectiveness and cost effectiveness
remains uncertain."
The normal treatment for GBS is with intravenous antibiotics. Dr Jo Lee
says, "The Group B Strep Association only recommends antibiotic treatment
(intravenous) at the time of labour. The purpose of this is to protect
the baby as it passes through the birth canal. "A course of antibiotics
at an earlier stage in pregnancy might temporarily get rid of the Group
B Strep, but it would be very likely to return in the coming weeks. It
would not be advisable to take antibiotics continually from now until
the time of labour as this would pose a risk in itself, and might mean
that the antibiotic was then ineffective at the time when the baby was
most likely to be vulnerable to the infection."
Home births and GBS
Having GBS should not automatically rule out the possibility of a home
birth but will need discussing with your obstetric team. Jane Plumb, chairman
of Group B Streptococcus Support group (GBSS) believes every woman with
GBS should have the same birth choices as other women and that includes
home births. "Our medical advisory panel's recommendations for stopping
GBS infections in newborn babies are the same for home births as for hospital
births," she says. "Women whose babies are at higher risk of developing
GBS infection should be offered intravenous antibiotics from the start
of labour until delivery. "Home births are becoming increasingly popular
and, if you want a home birth with intravenous antibiotics during labour
until delivery, it may be possible for your midwife to give you intravenous
antibiotics prescribed for you by your GP."
However, not all areas allow this due to the very small risk that you
could have a severe allergic reaction to intravenous antibiotics and oral
antibiotics aren't recommended because they don't prevent GBS in babies.
Jane also adds, "Of course, around 25 per cent of women having home births
probably carry GBS in their vagina at delivery without their knowing it."
There is some evidence that antibiotics given into the muscle could be
of some benefit in preventing GBS in newborns and Jane says, "If you have
set your heart on a home birth, you may wish to consider having intramuscular
antibiotics." She adds that although they are not recommended in lieu
of intravenous antibiotics during labour, they may be better than nothing
if you are determined to have a home birth and that really is the only
alternative.
The GBSS Medical Advisory Panel comprises of Prof Philip Steer (Chairman),
Professor of Obstetrics at the Chelsea & Westminster Hospital in London,
Dr Christine McCartney FRCPath, Deputy Director of the Centre for Infections
of the Health Protection Agency and Dr Alison Bedford-Russell MRCP, Consultant
Neonatologist at Birmingham Heartlands Hospital.
Where to next?
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