What is Group B Strep?
Group B strep, also called Strep B or GBS, is a fairly common strain of streptococcus found in the rectum and lower vaginal tract of many adult women. In most cases, it's harmless, and most women don't even realize they carry it. It is generally tested for in the 3rd Trimester of pregnancy by swabbing the vagina and anus. As many as 25% of women tested in pregnancy are positive for this strain of bacteria, which simply means they are colonized by it. It is not a sexually transmitted disease, and can come and go throughout a woman's life, or stay consistently.
Group B Strep in Infants.
GBS can be passed from Mother to Infant during a normal vaginal delivery. As many as 25% of Mothers will test positive, and of those, around 0.05% of Infants will become infected from the Mother's colonization.
GBS infection in Infants is categorized as either Early Onset (symptoms appear within 6 hours of birth, but most often, appear at birth in infected Infants) and Late Onset (symptoms appear anywhere from the week to first few months after birth). Late Onset infection is an even lower risk than Early Onset infection.
Symptoms of GBS Infection in Infants may include:
fever
low body temperature
difficulty feeding
sluggish, limp, or weak muscle tone
difficulty breathing
irritability
jitteriness
seizures
rash
jaundice
Potential severe symptoms of GBS Infection in Infants may include:
pneumonia
meningitis
sepsis
Standard prevention of GBS transmission from Mother to Infant
Firstly, remember that infection is rare, even in the case of Mother testing positive for GBS, and Late Onset infection is even less likely than Early Onset infection. That being said, the risk of infection is never 0%.
Antibiotics during labor, usually a Broad Spectrum Antibiotic like Penicillin is the routinely used route when preventatively trying to decrease the risk of infection. The routine use of Antibiotics is common in most hospital births when the Mother tests positive for GBS.
The easiest way to administer Antibiotics to the Mother is through an IV during labor. They are generally administered several hours before the pushing stage begins. In some hospitals, the Mother is required to be hooked to a Continuous Fetal Monitor, or CFM when any IV medication is administered. CFM comes with it's own set of risks and benefits.
Other hospitals may instead choose to administer Antibiotics through a single injection. This would be more useful if the Mother came into the hospital already in an advanced stage of labor, and there was less time to complete the full IV Antibiotic treatment before the pushing stage begins.
The Human Microbiome
The Human Microbiome is the collection of microbes and bacteria that colonize on and within the human body. While society as a whole frequently vilifies bacteria, medical science has proven time and again that the trillions of microbes that human's host not only do not harm us, but actually have a host of life long benefits. Some such beneficial microbes are created during a natural, unmedicated labor in the Mother for the express benefit of the Infant. These particular microbes are transferred from the Mother to the Infant, also called 'seeding', via a vaginal delivery and subsequent breastfeeding. As the Infant swallows these bacteria, they help to colonize the Infant's gut, which will help to kick start the immune system.
The Human Gut contains millions of bacteria as well, that aid in a variety of important bodily functions. This is not only limited to digestion, but also immune function, hormone regulation and production, and a more recent discovery, our mental health, especially in relation to anxiety (more on that later on).
Antibiotics and The Human Microbiome
Antibiotics, by their very nature, kill bacteria and microbes, such as those responsible for GBS infection. There's no doubt that Antibiotics have saved millions of lives from infection and death since their discovery and wide-spread use in modern medicine. But because their main (and entire) use is killing or inhibiting bacterial growth, it stands to reason that they would also destroy any beneficial bacteria, thus paving the way for a harmful bacterial overgrowth, if not properly used and controlled.
The overuse of Preventative Antibiotics in modern medicine has created an alarming trend of Antibiotic-resistant strains of bacteria, essentially creating 'super-bugs'. While life expectancy has gone up dramatically since the adoption of clinically used Penicillin, it hasn't come without consequences. We must understand how the attempt to control and prevent harmful bacteria also kills the beneficial bacteria; the very same bacteria that builds our immune systems, and thus help fight off and prevent further infection. The vicious cycle is that killing the harmful bacteria can reduce or destroy the beneficial bacteria, leaving the host open to an overgrowth of yet more harmful bacteria. One such preventative use (or perhaps overuse) of Antibiotics often happens during labor, in an attempt to prevent Early Onset GBS infection in Infants whose Mothers test positive for GBS before birth.
While routine Antibiotics may help prevent Early Onset GBS infection, research from AAP Publications suggests that Infants who develop Late Onset GBS infections have a resistance to Broad Spectrum Antibiotics that can make infection harder to treat. The pathogens that cause GBS can still infect Infants whose Mother had prior Antibiotic treatment during labor, and the subsequent infection was harder to treat than for the control Infants. This means that while Antibiotics use can help to prevent an Early Onset infection, which can also be treated immediately after birth, the Antibiotics themselves can make infection more difficult to treat in Late Onset cases.
Because Antibiotics kill all bacteria in their path, it stands to reason that it also will kill the extremely beneficial bacteria in the Mother's vaginal canal and on her breasts at the time of birth, thus depriving the Infant of these crucial kick starter bacteria. This could put the Infant at higher risk of harmful bacteria taking over in the absence of beneficial bacteria. It puts the Mother at risk for the same issue. So for the first several weeks of life for the Infant, and the first several weeks of recovery for the Mother, they are both deprived of the natural and useful Human Microbiome and it's benefits. Now, instead of working towards growth and healing, both Mother and Infant are starting at Ground 0 to reproduce (or in the Infant's case, begin producing) the essential bacteria needed for healthy digestion, hormone production and regulation, immune function, and serotonin production; all incredibly crucial at this stage of their lives. Consider the Mother's sudden drop in pregnancy related hormones, and the uptick in breastfeeding and Postpartum hormones that come with giving birth. Suddenly, her hormone production is off kilter because her gut is depleted of the microbiome needed to help with regulation in an already critical system.
A Retrospective Data study performed by Samaritan Health Services suggest that Antibiotic use in the week leading up to delivery, up to the first 5 weeks Postpartum, has a potential to cause a 2.8% increase in diagnosis of Postpartum Depression for the Mothers. While the study is somewhat limited, the conclusion does make logical sense, since we know there is a connection between mental health response and the gut microbiome, which is destroyed by the use of Antibiotics. Since up to 95% of the hormone serotonin, which is responsible in helping regulate mood, cognition, memory, and learning, all of which are invaluable during the weeks and months after birth for both Infant and Mother, is made in the gut, it only makes sense that these mood regulating hormones that assist Mother in bonding and general wellbeing would be greatly suppressed, thus leading to mood instability, and a possible mental health crisis.
Conclusion
Informed Consent cannot happen without being first well informed. Information should include the possible effects of any actions proposed, which in this case, is either the use of Broad Spectrum Antibiotics during or just before labor and delivery, or declining the use of preventative Antibiotic treatment, either before or during labor and delivery for the express treatment or prevention of GBS Infection.
Ideally, GBS can possibly be prevented prior to testing in the 3rd Trimester. There are some non-scientific studies, with observational data that suggest that taking preventative pre and pro biotics during pregnancy may reduce the risk of GBS population in the Mother in the first place. This includes things such as garlic, yogurt, fermented foods, and even probiotic pills, sometimes used vaginally. These 'studies' are mostly conducted by Mothers themselves, when they have previously had pregnancies that test positive for GBS, and so their chances of being populated by it again are increased with every pregnancy. This observational data can't be taken as scientific proof, as no observational data can, but it certainly doesn't hurt to eat pre and pro biotic rich foods during pregnancy one way or another.
However, regardless of the Mother's diet during pregnancy or her best attempts to prevent it, in cases when GBS is present in the Mother at the time of delivery, she must make an informed choice, and be willing to accept the inherent risk and consequence of her choice either way.
Using Preventative Antibiotics in GBS positive Mothers is currently the Standard Medical Practice in a routine hospital birth in the United States, and most of Western Medicine. The Mother must understand, while making her informed choice that most doctors are generally more comfortable when their patient cooperates with Standard Medical Practice. It's simply far easier for the doctor, and they often have had little to no experience with stepping outside of it. The Mother refusing a Standard Medical Practice can meet with annoyance, fear, or even hostility on the side of the doctor or birthing hospital, partly because it opens them up to the potential risk of a lawsuit if things don't go well, and they were working outside of the accepted medical advice. However, as the Mother, it's important to remember that only she takes ultimate responsibility for her own health, and the health of her baby, and whatever consequences arise from her choice rest squarely on her shoulders. The doctor and hospital won't be living with her choices years down the road. And as far as trust in the Standard Medical Practice purely because it is the standard, don't forget, it was also once standard to X-ray a pregnant woman to determine whether or not her pelvis was big enough to allow the Infant's head to pass through the outlet. Obviously we now know there are inherent risks in the use of an x-ray during pregnancy, and we also know that the pelvis expands during labor, thus making a preemptive x-ray completely useless. It took a fair amount of convincing for Obstetrics to abandon the dated and dangerous practice, simply because it was the accepted Standard Medical Practice and so some Obstetricians were unwilling to stop on the grounds that it was a standard procedure so it must be useful.
Preventative Antibiotics during labor only prevents Early Onset infection of GBS.
Infants who have already been exposed to Broad Spectrum Antibiotics may have a harder time being treated should Late Onset infection occur.
Antibiotics prevent Early Onset infection in the 0.05% of Infants who would have otherwise become infected with GBS.
Severe GBS infections can lead to life-altering problems, for example, those associated with meningitis, such as cognitive deficiencies or motor dysfunction later in life.
Antibiotics kill the important Human Microbiome in both Mother and Infant alike.
A lack of healthy bacteria can lead to stomach and digestive problems, a weakened immune system, decreased hormone function and regulation, and possibly an increased risk for Postpartum Depression and other severe mood fluctuations for several week or months following the use of Antibiotics.
In conclusion, there are inherent risks either way. It is my hope that this gathering of research can facilitate more Mothers to have truly informed consent, and a starting place for their own research on the subject of Group B Strep infection in Infants, and the use of routine Antibiotics to preventatively treat potential infection.
*Studies referenced are linked.
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