Giving birth at home with a positive GBS screening result.
Group B Streptococcus (GBS) is a common bacterium found in around 20-30% of women, which usually doesn’t cause harm. Most positive carriers will not know that they even have GBS as it is not routinely screened for here in the UK. Timing of screening is also important as it is transient and with in a matter of weeks you may no longer be carrying it. Studies have found that 13%-29% of women screened at 35-37 weeks did not screen positive again when they went into labour (Yancey et al.. 1996, Valkenburg-van den Berg, et al., 2006, & Florindo, et al,. 2014). However during childbirth, GBS can potentially infect the baby, which can lead to conditions such as sepsis or meningitis. However in order to make an informed decision about where you would like to give birth there are of course other things to consider when making your decision.
Understanding GBS Risks: Most babies born to GBS positive mothers will not develope an infection. The actual risk of a baby developing GBS-related illness is around 1-2 in 1000 births.
Antibiotics in Labour: One of the most common medical recommendations for GBS-positive women is intravenous (IV) antibiotics during labour, which is often not feasible in a home setting. However we also do not have good enough evidence to know if IV antibiotics in labour are effective at preventing GBS disease in babies. Why don’t we know? because the research data is not good enough. “Ideally the effectiveness of IAP to reduce neonatal GBS infections should be studied in adequately sized double-blind controlled trials. The opportunity to conduct such trials has likely been lost, as practise guidelines (albeit without good evidence) have been introduced in many jurisdictions.” (Ohlsson and Shah, 2014: I)
Monitoring and Midwifery care: If you choose to give birth at home, your midwife can monitor your labour and ensure that both you and your baby are healthy. Immediate postnatal monitoring can focus on watching for early signs of GBS infection, such as changes in the baby’s temperature, breathing or heartrate. If needed, timely transfer to hospital can then occur.
Preparing for the time after birth
After giving birth at home Mothers who are carrying GBS can take extra steps to ensure the health of their newborns:
Watch for signs of GBS infection: Early signs of a GBS infection can develop within the first 24-48 hours. Be alert for issues like fever, lethargy or breathing difficulties. Ask your midwife to support you with this, this may be your first baby and you can feel unsure about everything. Have a clear plan on where to access medical diagnosis if any concerns arise.
Breastfeeding: Breastfeeding is recommended, as it boosts the baby’s immune system and offers protection against infections, including GBS.
Follow-Up Care: Your midwife, especially if you have hired an independent midwife, is likely to offer daily visits in the immediate days after birth. They will keep a close eye on you and baby and support you to recognise any potential early signs of infection.
Call for help: If you are ever unsure and feeling concerned contact 999
In conclusion:
GBS infection in rare cases can have serious impacts on baby’s but there are many things to consider when choosing where to give birth. Routine treatment, which is harder to facilitate at home, is IV antibiotics but there is little supporting evidence as to their effectiveness at preventing GBS infection. You may no longer be carrying GBS. It is possible to monitor your baby for signs of infection and to act promptly if any concerns arise.
With awareness, informed decision making and support, GBS carrying women can safely give birth at home while remaining vigilant, as you would anyway, to any developing signs that your baby may need medical support in hospital.
Intrapartum antibiotics for known maternal Group B streptococcal colonization - Arne Ohlsson 1, Vibhuti S Shah
https://pubmed.ncbi.nlm.nih.gov/24915629/
The accuracy of late antenatal screening cultures in predicting genital group B streptococcal colonization at delivery - M K Yancey 1, A Schuchat, L K Brown, V L Ventura, G R Markenson
https://pubmed.ncbi.nlm.nih.gov/8885919/
Prevalence of colonisation with group B Streptococci in pregnant women of a multi-ethnic population in The Netherlands - Arijaan W Valkenburg-van den Berg 1, Arwen J Sprij, Paul M Oostvogel, Johan A E M Mutsaers, Wouter B Renes, Frits R Rosendaal, P Joep Dörr
https://pubmed.ncbi.nlm.nih.gov/16026920/
Accuracy of prenatal culture in predicting intrapartum group B streptococcus colonization status - Carlos Florindo, Vera Damia 1, Jorge Lima 2, Isabel Nogueira 3, Isilda Rocha 2, 4, Paula Caetano 2 ,5, Lurdes Ribeiro 2, Silvia Viegas 1, Joa P.Gomes1, and Maria J. Borrego1
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://core.ac.uk/download/pdf/70641648.pdf
