Group B Strep (GBS) in Pregnancy and Birth: What’s a Mom to Do?


This article was first published online in October 2015, originally excerpted from my textbook, Botanical Medicine for Women’s Health (Elsevier, 2009), now in its second edition (Elsevier, 2017), and this article has been updated as of July 2020,


It’s practically impossible to pick up a newspaper or magazine, or browse the internet these days, without coming across an article on the importance of a healthy microbiome for our overall health. If you’ve been educating yourself about the microbiome, you’ve probably learned that antibiotics are one of the things that can have a negative impact on it. You may also have heard that when young babies are exposed to antibiotics, it can increase their risk for eczema, allergies, and asthma in childhood, and even obesity and diabetes later in life, an issue that has gotten significant attention because of its relationship to birth by cesarean section, which keeps baby from being exposed to the mom’s vaginal flora during birth. So it’s understandable that pregnant moms, and even some health care professionals, are concerned about antibiotic overuse, particularly during pregnancy, labor, and for babies in the newborn period or early childhood.

So what do you do if testing shows you have Group B Strep (GBS) in pregnancy and are facing the decision about using antibiotics in labor (intrapartum antibiotic prophylaxis, or IAP) as preventative treatment. Many women are unsure which is the greater risk – take the chance on your baby developing a GBS infection if you don't do the antibiotics, or take an antibiotic that can impact your baby's microbiome.

This article answers the numerous questions mommas have sent to me, explains what Group B Strep is, reviews the risks to baby if untreated, and will discuss the validity and safety of some of the common GBS testing “hacks” being used in pregnancy, as well as alternative methods of preventing/reducing GBS colonization to achieve a negative prenatal test.

GBS is a complex issue, and while I can’t give you “the answer to what you should do,” because in truth there is no one right answer, and much of what we know about the impact of antibiotics on the infant microbiome is still emerging, my hope is to give you enough information (this is a comprehensive blog!) to make the most educated decision possible that is also within your comfort zone.

What is GBS and Why Is it Important to Understand?

Group B Streptococcus, specifically, Streptococcus agalactiae, also known as Group B Strep or GBS for short, is one of the trillions of organisms that normally inhabit the human intestinal tract. Via migration from the intestines, it also colonizes the rectum, bladder, and vaginal tracts of many women. At any given time, worldwide, as many as 35% of people are colonized with this bacteria. While it can cause infection in people of any age, GBS doesn’t seem to play a particularly beneficial role in human health, nor, when kept in check by healthy gut, vaginal, or bladder flora, does it usually cause harm to adults who are colonized with it, and in fact, most people colonized with it will never develop infection – that is, illness caused by it.

So what's the fuss?

In the 1970s, GBS was recognized as a leading cause of serious infection in newborns and infants. Two well-established syndromes exist for GBS disease

  • Early-onset disease (GBS EOD), which occurs when baby is less than 7 days old, and
  • Late-onset disease (GBS LOD), which occurs when baby is between 7-90 days old.

Either can cause pneumonia, sepsis, and meningitis, though meningitis is more common with late onset disease (7% of cases of EOD, 25-30% of LOD.

Early onset disease is the one that can be transmitted vertically, that is, from mother to baby during labor and birth, and is responsible for potentially serious adverse events in the baby, most commonly sepsis, pneumonia, and less often meningitis, which is more typically associated with late onset disease.

Late-onset disease develops through contact other than via vertical transmission – for example, it can occur as a result of transmission from a member of the hospital team, for example, nursery personnel, or a member of your community who has contact with the baby.  Up to 45% of health care workers may carry the bacteria on their skin and may transmit the infection to newborns. Other sources can include members of your community who have contact with baby. Meticulous hand-washing practices in the hospital are essential for prevention of infection transmission, and for anyone who is going to hold and care for the baby after birth, including friends, family members, nannies, etc.

A third category of GBS infection has now been postulated: Prenatal Onset of GBS (POGBS). Currently, babies who are born already infected with group B strep are classified as “early-onset” regardless of when the infection began. However, according to a 2012 study, it was hypothesized that “data support the concept that early-onset GBS represents a spectrum of infection that often precedes birth.” According to the CDC 2010 MMWR,  “The burden of prenatal-onset GBS disease has not been assessed adequately and no effective prevention tools have been identified before the intrapartum period.” A 2o15  systematic review suggested that Group B Streptococcus causes up to 12.1% of stillbirths, but that more research is needed. While I don't mean to be scary, this infection can be asymptomatic and still lead to stillbirth. Unless you have a GBS positive urine result, you're unlikely to know you have GBS until 35 week's gestation, and no treatment is offered for earlier GBS colonization unless it causes a UTI. That's why further research on GBS colonization prevention is so important, and why, as I discuss later in this article, I recommend pregnant women take probiotics to at least try to minimize colonization. 

Impact of GBS in Pregnancy

GBS in pregnancy can also cause bladder and uterine infections, miscarriage, and it increases the risk of premature labor and premature rupture of membranes (PROM) and stillbirth. This is important as the early-onset prevention strategy of using antibiotics in labor doesn't prevent GBS infections beginning before a woman's labor starts or her water breaks, and don't prevent these problems prenatally.

What are the Risks of Baby Developing GBS Infection at Birth and How Serious is It?

When a baby is exposed to GBS in labor or during the birth, he or she has a 50% chance of becoming colonized with GBS. Most healthy, full-term babies will just develop their own colonization of the skin and gut as a result, without developing infection – in other words, they don’t get sick.

However, a small percentage who get exposed will become infected – meaning they get sick. The risk of a baby developing a serious, life-threatening GBS infection, according to the Centers for Disease Control and Prevention (CDC), is 1 to 2%. GBS infection in the newborn can lead to very long stays in the NICU (Neonatal Intensive Care Unit), and up to 44% of infants who survive GBS meningitis (infection in the brain and spinal cord) end up with long-term health problems, including developmental disabilities, paralysis, seizure disorders, hearing loss, and vision loss – though again, this complication is more common with late onset disease.

The mortality rate (number of babies that die) among babies with GBS EOD is 2 to 3% for full-term infants (I know that sounds low, but as I always tell my patients, it’s 100% if it’s your baby). For premature newborns (born before 33 weeks gestation), it’s as high as 18-35% with an average of 21.6%. A quick look at CDC's GBS page says an infection rate of 0.22 per 1000. With approximately 4 million births in the US last year, we'd expect <1000 infections per year, and with a case fatality rate (CFR) or about 2-3%, we'd expect about 25 deaths/year, despite antibiotic prophylaxis in labor. This is in part due to false negative results that occur with testing, leading some women who are GBS positive to be untreated in labor, and in part because IAP isn't 100% effective.

IAP given to the mother during labor is used to prevent early-onset infection – I'll discuss its effectiveness below.

Who “Gets” GBS? & Which Babies Get GBS Infection?

While anyone can be colonized with GBS, and again, up to 30% of people are, the following factors are associated with a higher likelihood of a positive GBS test:

While any baby can develop GBS infection if the mother is colonized, the following factors increase a baby’s risk:

  • Birth prior to 37 weeks
  • Very low birth weight
  • High temperature in the mom during labor,
  • Rupture of membranes before entering labor (prom)
  • A prolonged time between membrane rupture and birth,
  • Chorioamnionitis (infection of the membranous sac surrounding the baby)
  • Intrauterine monitoring in labor (fetal scalp monitor, intrauterine pressure monitor)
  • African-American descent

Most bacterial transmission to the newborn occurs during birth via passage of the baby through the birth canal, or through bacteria that ascend the birth canal when the membranes have ruptured (broken “bag of waters”). In one large study of 148,000 infants born between 2000 and 2008, nearly all of the 94 infants who developed early GBS infection were diagnosed within an hour after birth – suggesting that early onset GBS infection probably begins even before birth.

The increased risk for Black mothers and babies is likely in large part due to inherent systemic racism leading to overall higher maternal and infant mortality for black mothers and babies, less access to prenatal testing, and greater likelihood, again based on factors due to systemic racism, to have preexiting diabets or hypertension – or both.

There is also some epidemiological evidence that while Lactobacillus is considered the most predominant and protective genus of vaginal flora in women, this is a bias, as this is true in white women, but not necessarily in Black women who may have different and equally healthy predominant species but that perhaps are less protective against GBS. This has not been elucidated in the medical literature and should be studied.

While there have been conflicting results when studies looking at the impact of frequent vaginal exams on GBS EOD have been evaluated, with no impact shown from three or more vaginal examinations, some studies have shown an increased risk as the number of vaginal exams goes up, particularly if the mother does not receive IAP. In any case, vaginal exams should not be performed unnecessarily, and should be minimized to the extent possible in women with GBS or ruptured membranes.

Artificial Rupture of Membranes (AROM) is usually performed to augment (speed labor) up. It can be effective for prolonged labor, modestly reducing the need for cesarean section, but like so many other procedures in labor, is over performed, isn’t always effective, and can increase a mother’s and baby’s risk of infection, which may include GBS. If AROM is recommended to augment labor in a GBS positive mother, it’s optimal, whenever possible, to postpone doing it until antibiotic prophylaxis has been given, with ideally 4 hours of time before baby is born, to reduce the risk of GBS EOD.

 


GBS Testing: Is it Recommended and Is It Reliable?

GBS testing was first initiated in the early 1990s, and from 2002 through early 2020, it's been recommended that pregnant women be tested for GBS between 35 and 37 weeks of pregnancy. As of 2020, the American College of Obstetricians and Gynecologists (ACOG) now states that the best time to test for GBS presence is between the 36th and 37th weeks of pregnancy. Testing at this time is thought to provide coverage for women who don’t go into labor until in their 41st week. The test consists of obtaining a bacterial culture of a sample collected from a simultaneous vaginal and rectal swab. This is usually done by your obstetrician, family doctor, or midwife, however,  a recent study shows that women can self-test equally as effectively with a little bit of instruction. so if you’re not comfortable having your provider do the swab, you can request instruction on doing it yourself.

Studies suggest that GBS positive cultures have a high degree of accuracy in predicting GBS colonization status at birth if cultures are collected within 5 weeks of birth and test results are positive. A negative test, however, does not mean you do not have the infection; it could be what is called a “false negative” meaning that the test missed the infection. In fact, 2/3 of cases of GBS EOD are now the result of  false negative testing in pregnancy. You can also become colonized after the test was done, so while your test could have been negative in pregnancy, you could in fact be positive at the time of labor. As a result, a substantial number of women who are ultimately GBS positive at the time of birth will not receive IAP because the presence of the bacteria was missed in pregnancy.

An FDA approved rapid test can diagnose GBS in pregnant women in about an hour. It is currently used only in labor when a woman’s GBS status is unknown and testing needs to be done rapidly for medical reasons such as premature rupture of membranes (PROM). Some studies have shown the test to be up to 91% sensitive, even more so than the 36-37 week culture, which catches about 69% of cases. More research on the pros and cons of switching to rapid testing is needed, as this could potentially be a shift in current practice to a new best practice.

GBS is also found in the urine of 2%-7% of pregnant women. A positive urine test for GBS is considered a marker of heavy rectal and vaginal colonization in the mother, and is a risk factor for GBS EOD in the newborn. Thus it is considered an indication for antibiotic use in labor, and precludes the need for testing at 36-37 weeks pregnancy. Antibiotic treatment of GBS bacteriuria during pregnancy does not eliminate GBS from the genitourinary and gastrointestinal tracts, and recolonization after a course of antibiotics is typical, so this does not offset the recommendation that pregnant women with GBS in their urine receive antibiotics in labor.

Because GBS resistance to specific antibiotics has developed, especially to those used for penicillin-allergic women, culture and sensitivity testing is recommended as part of the testing process.

Can’t I Just Skip the Test to Avoid Antibiotics in Labor?

Skipping the test to avoid a positive result is one strategy many women ask me about, and it’s certainly within your legal right to do so. But here’s the thing: if you don’t know whether you are positive and you're having your baby in the hospital, or have to transport from a home birth to the hospital with any risk factors for GBS including early broken waters, prolonged broken waters (> 18 hours), or an elevated temperature, you’re still going to be prescribed the antibiotic. On the other hand, if you've been tested and have had a negative test result, then the antibiotic isn’t indicated and you're sort of in the clear from the decision. Having a negative test result can actually be an advantage and can put your mind at ease if you're worried about being GBS positive.

Further, if you are positive and know it, you can get educated about your decision and will likely be more mindful of signs of possible GBS infection in your baby, should you choose to forego the antibiotic. So while I am not saying everyone should get testing, simply declining the test to avoid knowing the results isn’t necessarily more effective for avoiding the antibiotic in labor. It’s sort of the same with gaming the test by using natural treatments for the few weeks before the test to achieve a negative test result – you might have just reduced the colonization so that it was low enough to give you a negative, but you might still be colonized at the time of birth and not know it.

Some women have raised the fact that not all countries test routinely, and that is true. The United Kingdom National Screening Committee, for example, states that pregnant people in the UK should not be screened for GBS. But the UK follows the risk-based approach; this includes giving antibiotics in-labor to all women who have fever, prolonged rupture of membranes >18 hours, GBS in urine at any time during pregnancy, preterm labor, or a prior infant with GBS. At the end of the day, the data shows that about the same number of women (about 30% of all laboring women) will receive antibiotics either way.

What if I Test Positive But, Later a Test Comes Back Negative?

When it comes to GBS infection in pregnancy, once you test positive, even if you  test negative later in the same pregnancy, you are still considered to be positive and antibiotic treatment is recommended by the CDC (note if you are negative in this pregnancy, but were positive in a previous pregnancy, you do not require antibiotics unless your previous baby developed GBS infection, in which case IAP is considered appropriate).

So while you might use natural approaches to try to reduce your colonization, if you are having your baby in a hospital or birthing center, the standard protocol would still be to administer antibiotics. It's therefore preferable to use natural strategies to reduce colonization and hopefully achieve a negative GBS test, rather than have a positive result and then try to treat and retest – which is not recommended other than for research purposes.


What's the Treatment & Is It Recommended for Me?

Universal prophylaxis with IV antibiotics (usually penicillin or ampicillin, or an alternative for penicillin-allergic women) is recommended if you meet any of the following criteria:

  • If you test positive for GBS in your urine during this pregnancy
  • If you previously had a baby who had GBS infection
  • If your vaginal-rectal cultures at 36 0/7-37 6/7 weeks of gestation are positive for GBS, unless a cesarean is performed before you go into labor, and your bag of waters was intact (no ruptured membranes) at the time of the cesarean.

It’s recommended that women receive antibiotics at least 4  hours before baby is born for maximum effectiveness in preventing infection in baby, however recent studies have shown that antibiotics given at least two hours before birth has been shown to reduce GBS vaginal colony counts and decrease the frequency of neonatal sepsis.Since the time of birth can't be predicted, it's recommended that antibiotics be started when you arrive at the hospital, and given every four hours until baby is born.

IAP is also recommended if your prenatal GBS culture result is unknown when labor starts, but you have risk factors for GBS EOD including:

  • Preterm birth
  • Preterm prelabor rupture of membranes (PPROM)
  • Rupture of membranes for 18 or more hours at term
  • You have a fever in labor (temperature 100.4°F [38°C] or higher)
  • GBS colonization in a previous pregnancy

If you have a positive prenatal GBS culture, but have a cesarean before you go into labor, with intact membranes at the start of the cesarean, you do not require GBS antibiotic prophylaxis.

How Effective is Antibiotic Prophylaxis in Labor?

Overall, IAP has been highly effective for reducing the numbers of newborns that develop GBS EOD. If a GBS positive woman is treated with antibiotics during labor, her infant’s risk of developing early onset GBS infection decreases by about 80%.

For example, the risk could drop from 1% down to to 0.2%.  As a result of routine testing in pregnancy, and treatment protocols using antibiotics given to positive moms during labor that began in 2002, the rate of early-onset infection decreased from 1.7 cases per 1,000 live births (1993) to 0.22 cases per 1,000 live births (2016).

This has not been without some controversy, though. An excellent review of this controversy was done by Dekker at Evidence Based Birth.

Will Antibiotics in Labor Harm My Baby’s Microbiome

There is evidence from a number of studies demonstrating that use of antibiotics during pregnancy and delivery can affect the microbiome of your baby, for example in one study of 52 newborns, half of whose mothers received IAP for GBS in labor and half didn’t (this group of mothers was negative for GBS), there were decreased in the beneficial bacteria Bifidobacterium in the antibiotic group. But how this links to long-term health impacts is still not well understood. Some studies show that the newborn microbiome changes resolve within two months.

Evidence to date suggests that the use of antibiotics for less than 24 hours during labor is not a source of long-term microbiome damage, nor risk of later eczema. Studies also suggest that any short-term damage can be mitigated by breastfeeding and possibly the use of probiotics given to the newborn. One study of over 4800 Canadian women found no association between childhood obesity and GBS antibiotic exposure during delivery. However, greater than 24 hours of antibiotic exposure in labor was associated with an increase in eczema at 2 years of age.

One study by Azad et al. done in 2016, found that while yes, at 3 months old, there were differences between the microbiomes of babies who had versus had not been exposed to antibiotics, breastfeeding was an important factor – babies exposed to antibiotics and who were exclusively breastfed for at least 3 months had more similar microbiomes to those not exposed to antibiotics than babies who had been exposed but were not exclusively breastfed. Some babies did have persistent changes even at 1 year after birth, after which the microbiomes of babies tend to become similar regardless of type of birth or whether antibiotics were used. While this is overall reassuring, it does not take into account the impact of microbiome alterations in the first year of life on the development of the immune, digestive or nervous systems, thus much more research is needed to be able to compare the long-term health effects of these early microbiome perturbations.

Overall, my review of the literature suggests that antibiotics used IV during labor by the mother can impact the baby's microbiome unfavorably, however it appears that if antibiotics are used for less than 24 hours the risk is short-term. If baby is breastfed for ideally about 6 months, the risk is mitigated, and it's also possible to give baby an infant probiotic that might also prevent some of the potential impact of microbiome disruption, for example, eczema, allergies, and asthma that have been associated with antibiotic use in pregnancy. Cesarean birth seems to compound the risk of antibiotics used during labor, as baby is not receiving exposure to the immune enhancing flora that would naturally occur during vaginal birth. In these babies not only are there deficits in healthy microbial species and diversity, but overgrowth of pathogenic organisms including Clostridium Enterococcus, and Streptococcus have been measured in their stool.

In babies born by cesarean, where there is also antibiotic exposure through mom, a probiotic given to baby has been shown in some studies to prevent atopic conditions, and is something I also recommend in my medical practice when mothers had antibiotics in labor for GBS.

Bottom line: At this time, I consider the typically recommended use of IAP for GBS  to be low risk for the baby's longterm microbiome health as long as the baby is breastfed.

Are There Other Risks to Antibiotics in Labor I Should Be Aware Of?

Adverse events from IAP are thought to be poorly documented. All medications carry risks of adverse events; the greatest risks with GBS prophylaxis are an antibiotic reaction and potential to develop a yeast infection after birth (vaginal yeast infection and nipple infections – or thrush in your newborn – sometimes occur) which can cause nipple pain, cracking, and bleeding, having a harmful effect on your breastfeeding experience.

Allergic reactions can generally be prevented by making sure you're getting the appropriate antibiotic for you – particularly if you have a penicillin allergy or have had a prior reaction to any antibiotics. Taking a probiotic starting in pregnancy, or if you have not, immediately postpartum to support your gut health, and vaginal and skin (nipple) flora, may prevent thrush and other yeast infections, which, according to one study, occur in 15% of women receiving GBS antibiotic prophylaxis, more than double the rate of women who don't.

While many women are concerned about having to be immobilized during labor to receive the antibiotics, in fact they can be delivered over about 30 minutes via IV, and only need to be repeated at 4 hour intervals throughout labor. You can move around while receiving the IV, and have the IV drip disconnected between doses, the IV port saline or heparin locked so you can move about and do your thing.

Can I Decline Antibiotics & What are the Risks of Doing So?

First of all, for women choosing to birth at home, the use of IV antibiotics in labor may not be a realistic option because in many states, home birth midwives do not administer IV medications. Home birth midwives in this situation, therefore, often use a risk-assessment model, transporting to the hospital for IV antibiotics should indications arise, including rupture of membranes longer than 18-24 hours (length of time varies with the protocol of different medical and midwifery communities) or any signs of infection.

If you're having your baby in the hospital, you do have the right to decline antibiotic prophylaxis in labor, and you should not be bullied, harassed, or coerced, including with the threat of social services being called on you. The right to informed refusal is codified in the ACOG Refusal of Medically Recommended Treatment During Pregnancy.

If you decline, while there is an overall very low likelihood (1-2% chance) that your baby will develop early onset GBS infection it’s important to know that the risk is about 5 times higher than if you did accept the antibiotic.

I have also seen a few situations get legally complicated, including social work being called to assess for negligence and child abuse, when parents declined antibiotic prophylaxis in labor, and one case where the parents were forced to let the baby be given the antibiotic after birth, since mom had declined to receive the antibiotic in labor, even though the baby had no signs of infection. While hopefully you’d not be met by that vitriolic response by your care provider or hospital risk management team, having the discussion with your obstetrician, family doctor, or midwife at the time of the positive test result, rather than during labor, is strongly advised so you don’t face any surprises.

It's important to be fully aware of the risks of GBS before choosing to pass on the antibiotic prophylaxis. There is also no natural substitute for antibiotics in women who are GBS positive, with signs of infection and prolonged rupture of membranes (>24 hours rupture) – and all newborns exhibiting signs of GBS infection must receive immediate antibiotic therapy.

If I Don’t Accept Antibiotics, Does My Baby Need Special Testing or Observation?

If your baby is otherwise healthy and full-term, no additional or special monitoring aside from the usual care and attention given to a newborn is usually needed, whether or not you accept routine IAP. However, I do recommend paying close attention during the first 48 hours; remember, from the study above, though, most babies who developed GBS EOD were diagnosed within the hour after birth.

Signs of sepsis are nonspecific and include irritability, lethargy, respiratory symptoms (eg, tachypnea, grunting, hypoxia), temperature instability, poor perfusion, and hypotension. Baby may or may not have fever. Should baby develop any unusual symptoms it's important to get immediate medical care as baby can become compromised very quickly.  Let any care providers know that you tested GBS positive in pregnancy, and if you did not accept antibiotics, let them know so they know how to best evaluate and treat your baby should a workup or medical care be indicated.

Are There Alternatives to Antibiotics in Labor? What about Hibiclens?

An alternative treatment to IV antibiotics that has been investigated in Europe and is used in resource challenged countries, but is not employed in the United States other than by some homebirth midwives, is the use of chlorhexidine, a topical antiseptic solution that kills GBS. While some studies have shown that chlorhexidine does reduce colonization and infection compared with conventional antibiotic treatment, other studies have shown only a reduction in colonization but not in the rates of GBS EOD. The most recent review by the Cochrane Database in 2014 concludes that there is no difference in rates of GBS infection with chlorhexadine use compared to non-use. The only possible effective protocol, which should be reserved for use in resource limited countries only, is a combination of vaginal chlorhexadine washes with newborn chlorhexadine skin wiping. It is unlikely to help in the prevention of infection when there is prolonged rupture of membranes, as it can’t keep bacteria from ascending. Hibiclens, which contains chlorhexidine, is the form that is typically used by midwives in the US.

Keep in mind that Hibiclens and chlorhexidine will also wipe out healthy vaginal flora, likely for many hours after each application, and not just selectively eliminate the GBS, so while you might avoid the antibiotic, you may be defeating the purpose of avoiding it without a better outcome, which is keeping the vaginal flora healthy so baby gets optimally colonized with mom’s flora at birth.


Can Group B Strep Colonization Be Reduced or Prevented?

Really common questions I receive are ‘Are there natural things I can do to test negative for GBS during pregnancy?' or ‘Can GBS colonization be prevented & treated naturally?' The answer is, yes, there do seem to be some things you can do based on the research evidence, and there are definitely things my clients/patients have done over the years!

A Healthy Microbiome: Natural Defense Against GBS?

New research is regularly being published on the role of a healthy vaginal and gut microbiome in preventing vaginal infection in general, and that the presence – or absence – of certain vaginal microorganisms may prevent or contribute to the likelihood of GBS colonization.

A healthy microbiome has also been found to mitigate risk of miscarriage, preterm labor, vaginal, and bladder infections during labor, so addressing vaginal microbiome health during pregnancy has been a part of my prenatal protocols for the past 10 or so years. When my textbook, Botanical Medicine for Women's Health, was originally published in 2010, the research was nearly absent – and talking about the microbiome was fringe! The evidence to support this approach now continues to grow, but more research is absolutely warranted.

Steps I recommend to support a healthy microbiome include:

  • Eliminate processed sugar and junk foods from the diet, as these have been shown to disrupt the gut microbiome
  • Increase leafy greens, and other fruits and vegetables to ensure 8 servings, day, to get adequate fiber which is beneficial for gut health
  • Take a prenatal vitamin to insure that you are getting all the nutrients you need, especially zinc, vitamin D, vitamin A, and vitamin C, to keep your immunity boosted
  • Reduce stress through meditation, journaling, getting massage, and other relaxing activities – high stress impairs immunity, gut health, and the microbiome
  • Eat lacto-fermented foods (sauerkraut, yogurt if you tolerate dairy) daily
  • Use of oral and vaginal probiotics throughout pregnancy for women at higher risk – GBS colonization in a prior pregnancy, frequent UTIs or vaginal infections for example yeast or Bacterial vaginosis, history of preterm labor, or early rupture of membranes

If you meet criteria for an antibiotic in labor, this does not change your status; however, it may have a protective effect against GBS-related prenatal complications that are not prevented by in-labor antibiotics, and if you have never tested positive before, or have never had a baby with GBS EOD, this may prevent GBS colonization and the need for antibiotic prophylaxis.

Using Probiotics Prenatally: Why and How

Many species of Lactobacillus have been shown to be beneficial to the vaginal flora; Lactobacillus reuteri and Lactobacillus rhamnosis are species known to be especially helpful for supporting healthy vaginal (and bladder) flora, while these and others, including L crispatus and L. salivarius strains, have been shown to to inhibit the growth of vaginal pathogens including Gardnerella vaginalis and Candida albicans, and also reducing the frequency of bladder infections in addition to vaginal infection. The reduction in yeast infections is important; a 2020 study found that the presence of Candida albicans vaginally promotes bladder colonization of Group B Streptococcus, which, if you recall, is considered an indication for treatment with IAP.

While not all studies have shown conclusively positive effects in reducing GBS colonization in pregnancy, some have been shown specifically to inhibit GBS  through a variety of mechanisms including reducing the numbers of GBS by changing the vaginal pH to one that is inhospitable to that bacteria, and reducing the ability of GBS to adhere to the vaginal lining.

In one study, 110 pregnant women at 35-37 weeks of gestation who were diagnosed by GBS culture as being GBS positive for both vaginal and rectal GBS colonization were randomly assigned to be orally treated with two placebo capsules or two probiotic capsules (containing L. rhamnosus and L. reuteri ) before bedtime until delivery. All women were tested for vaginal and rectal GBS colonization again by GBS culture on admission for delivery. Of the 99 who completed the study (49 in the probiotic group and 50 in the placebo group), the GBS colonization results changed from positive to negative in 21 women in the probiotic group (42.9%) and in nine women in the placebo group (18.0%) during this period. The researchers concluded that an oral probiotic containing L. rhamnosus and L. reuteri could reduce the vaginal and rectal GBS colonization rate in pregnant women.

In another study involving 57 healthy pregnant women, L. salivarus was taken daily by the 25 GBS positive women in the group from weeks 26 to 38 of pregnancy. At the end of the trial (week 38), 72% and 68% of the women were GBS-negative in the rectal and vaginal samples, respectively. The researchers concluded that this seemed to be an efficient method to reduce the number of GBS-positive women during pregnancy, decreasing the number of women receiving antibiotic treatment during labor and birth.

In another small clinical trial, researchers randomly assigned healthy, fertile, non-pregnant women to wear panty liners that were impregnated with a probiotic with the species L. plantarum, or to wear placebo panty liners. The results showed that it is possible to transfer probiotics to the labial folds and vagina using panty liners. The researchers also found that people who had higher levels of Lactobacilli in the vagina had lower levels of GBS. They concluded that high numbers of Lactobacilli may contribute to a low vaginal pH and seem to have a negative influence on Group B streptococci.

Further, antibiotics in labor can't prevent prenatal risks, for example, it does not prevent GBS-related miscarriages, stillbirths and preterm births.  And even though the risks seem tolerable and microbiome disruption in the newborn short term, both do occur. So overall, given the potentially beneficial and protective effects of probiotics against UTI, preterm labor, and also protection of the baby's microbiome when taken by the pregnant mother, it seems reasonable to include a probiotic starting in the first or second trimester in any woman who has tested positive for GBS in previous pregnancies, who has had a history of urinary tract infections, miscarriage, or other problems that may be reduced by probiotic use, and for prevention of GBS colonization in the mother and need for antibiotics in labor.

How to Use Probiotics

A typical dose is 1 to 2 capsules of a probiotic containing at least 10 billion CFUs, to be taken orally, daily during pregnancy, and especially in the 3rd trimester, not just to help prevent GBS, but also because it has been shown to reduce the risk of atopic conditions in kids (allergies, eczema, asthma) when taken by mom in the last third of the pregnancy. In addition, a capsule can  be inserted vaginally, nightly before bed, starting at the onset of the the 3rd trimester and continuing until just prior to GBS testing.

Are Probiotics Safe in Pregnancy? 

One of the most important criteria for using any supplements in pregnancy is safety; these and other strains of probiotics have been consistently found to be safe and well-tolerated, including in the limited number of studies done for use during pregnancy.

What about Using Garlic or Essential Oils Vaginally

Garlic has been used as an antimicrobial for millennia and research does support its antibiotic and anti-fungal  effects. There's much debate over the effectiveness and even safety of using garlic as a vaginal suppository for the treatment of vaginal yeast infection, and also for GBS prevention; on her website, one childbirth educator posits a risk of rupture of membranes from its use. However, to my knowledge and research, including as the author of the primary textbook available on women's herbal medicine,  I was able to find no evidence of harm; there is significant evidence of empirical use by midwives around the US, for decades. That said, there is no evidence of safety or efficacy either, so it is a personal decision as to whether this is something you would consider. One small study of questionable quality, reported that for yeast infection, a vaginal cream containing garlic and thyme was as effective as much as clotrimazole vaginal cream for the treatment.

The traditional use is to insert a single clove (not a bulb, just a clove!) of carefully peeled, un-nicked garlic into the vagina each night, using your finger to push it in about 2-3 inches. It can be dipped in a small amount of olive oil to coat it prior to insertion. You then remove with your finger the next day. It's typically recommended for a few weeks prior to GBS testing. One risk that one has to consider is that  you temporarily reduce colonization and are able to achieve a negative test, but it is possible that bacterial levels will creep back up and then you wouldn't know whether you were GBS colonized. In contrast, the use of probiotics does improve the vaginal flora over time, in a way that can abate or may eliminate GBS colonization.

Essential oils also have a long history of use for treating bacterial infections, as well as vaginal infections. Herbal suppositories may be beneficial – clinically I have found them to be – but while the suppositories themselves are safe and the herbs have shown in vivo effectiveness against many organisms, including GBS, there is again, no western scientific evidence supporting their effectiveness or safety in pregnancy, other than empirical evidence.  in the human body

VJ Suppository

To prepare:

  • Melt ¼ cup of coconut oil and ¼ cup of cocoa butter in a small saucepan
  • Turn off the heat and add:
    • 2 Tbsp. of calendula oil
    • 1/4 tsp. of thyme or oregano essential oil
    • Optional 1 tsp each myrrh and goldenseal powders
  • Optionally, 2 Tbsp. of probiotic powder containing some combination of L reuteri, L rhamnosus, L. plantarum, L crispatus, and L salivarius

Pour the warm, slightly thick liquid into a suppository mold (you can order affordable silicon ones online). Put the whole mold into the fridge and let the suppositories harden for about an hour, then pop them out of the mold and store in the fridge in a container. Suppository molds can easily be prepared at home by using aluminum foil that has been folded several times lengthwise, and then widthwise, to form a trough approximately 8 inches in length and 1/2 inch in width. This mixture is then poured into the mold, refrigerated to harden, cut into pieces the size of the patient's pinky finger, and inserted as needed.

Wear a light menstrual pad each night to protect underwear and bedding, as the oil can stain as the suppository melts. These herbal products can be purchased from Mountain Rose Herbs online.

Of course, discuss use of any of these alternative approaches, including probiotics, with your midwife or physician, prior to use.

Why I Strongly Advise Against Colloidal Silver

One popular remedy, called colloidal silver, recommended in this case for topical vaginal use, is imbued with many claims about its ability to prevent and cure all manner of infections, but colloidal silver has not been proven safe and effective, and taken orally can cause toxic effects. Vaginal mucosa is highly absorptive, so I really recommend against it, even though I know it is popular amongst midwives. The FDA also warned in 1999 that colloidal silver isn’t safe or effective for treating any disease or condition, and it can cause argyria, a bluish-gray discoloration of the skin, which is usually permanent.


If You Need/Choose an Antibiotic in Labor, It’s Okay!

While we do need to be concerned about the health of our babies' microbiomes, and it's not ideal to give our babies an antibiotic as part of their welcome to the world, antibiotics do play a role in preventing serious infections, and prevention in this case can mean preventing drastic consequences. Further, it does appear possible to mitigate the impact of antibiotics both by breastfeeding and possibly also by giving baby a probiotic daily for the first 6 months after birth.

It's important to make the decision that you are most comfortable living with and that is best for your baby, and not feel swayed by any pressure to avoid an antibiotic because of the desire to go “all natural.” There's an appropriate time and place for most things, and while right now the jury is still out on the severity of the implications of giving antibiotics to newborns via mom, or directly, it would not be an inappropriate choice at all to decide to use an antibiotic in labor.

Wishing you a healthy pregnancy, birth, and baby, with peace of mind about your decisions.

If you'd like to listen to my podcast Protecting Baby's Microbiome: Right From the Start on Natural MD Radio on this topic, click here.

 

References

ACOG Committee Opinion; Prevention of Group B Streptococcal Early-Onset Disease in Newborns. Obstetrics & Gynecology. February 2020 – Volume 135 – Issue 2 – p e51-e72.

ACOG Committee Opinion; Prevention of early-onset group B streptococcal disease in newborns. Int J Gyn. 54(2):197-205, 1996.

Adair, C. E., L. Kowalsky, et al. Risk factors for early-onset group B streptococcal disease in neonates: a population-based case- control study. CMAJ 169(3):2003;198-203.

Aloisio, I. et al. Influence of intrapartum antibiotic prophylaxis against group B Streptococcus on the early newborn gut composition and evaluation of the anti-Streptococcus activity of Bifidobacterium strains. Appl Microbiol Biotechnol 98, 6051–6060 (2014).

American Academy of Pediatrics: Committee on Fetus and Newborn: Revised guidelines for prevention of early-onset group B streptococcal (GBS) infection, Pediatrics. 99:1997; 489–496.

Azad, MD et al. Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study. BJOG. 2015.

Aziz N et al. Evaluation of probiotic oral supplementation effects on group B streptococcus rectovaginal colonization in pregnant women: a randomized double-blind placebo-controlled trial.

Bahadoran P. et al. Investigating the therapeutic effect of vaginal cream containing garlic and thyme compared to clotrimazole cream for the treatment of mycotic vaginitis. Iran J Nurs Midwifery Res. 2010 Dec; 15(Suppl1): 343–349.

Bayó, M, et al. Vaginal microbiota in healthy pregnant women and prenatal screening of group B streptococci (GBS). Int Microbiol 5, 87–90 (2002).

Berardi, A. et al.Group B Streptococcus Late-Onset Disease: 2003-2010. Pediatrics. 2013 Feb;131(2):e361-8.

Burman L, Christensen P and Christensen K, et al.Prevention of excess neonatal morbidity associated with group B streptococci by vaginal chlorhexidine disinfection during labor, Lancet. 340(8811):1992; 65–69.

Centers for Disease Control and Prevention. Prevention of perinatal group b streptococcal disease. MMWR:2010;59: 1-32.

Christensen K, Christensen P and Dykes A, et al.:Chlorhexidine for prevention of neonatal colonization with group B streptococci, Eur J Obstet Gynecol Reprod Biol. 19(4):1985; 231–236.

Cohain. Long-term symptomatic group B streptococcal vulvovaginitis: eight cases resolved with freshly cut garlic. European Journal of Obstetrics & Gynecology and Reproductive Biology 146(1):2009; 110-111.

Crombleholme W: Obstetrics, In (Tierney L, McPhee S and Papadakis M eds.) Current Medical Diagnosis and Treatment. 2007; New York: McGraw-Hill.

Dinsmoor N et al.Use of intrapartum antibiotics and the incidence of postnatal maternal and neonatal yeast infections. Obstet Gynecol. 2005 Jul;106(1):19-22.

Dekker, R. Group B Strep in Pregnancy: Evidence for Antibiotics and Alternatives. 2017.

Edwards J et al.  Group B Streptococcus (GBS) Colonization and Disease among Pregnant Women: A Historical Cohort Study. Infectious Disease in Obstetrics and Gynecology. Volume 2019 |Article ID 5430493. 6 pages

Facchinetti F, et al. S: Chlorhexidine vaginal flushings vs. systemic ampicillin in the prevention of vertical transmission of neonatal group B streptococcus, at term, J Matern Fetal Neonatal Med. 11(2):2002; 84–88.

Fairlie, T, et al.  Effectiveness of intrapartum antibiotic prophylaxis for prevention of early-onset group b streptococcal disease. Obstetrics and Gynecology 121(3): 2013; 570-577.

Seedat F et al. Adverse events in women and children who have received intrapartum antibiotic prophylaxis treatment: a systematic review. BMC Pregnancy Childbirth. 2017 Jul 26;17(1):247.

Goldenberg, RL, et al. Use of vaginally administered chlorhexidine during labor to improve pregnancy outcomes. Obstetrics and Gynecology 107(5): 2006; 1139-1146.

Håkansson S, et al. Group B Streptococcal carriage in Sweden: a national study on risk factors for mother and infant colonisation. Acta obstetricia et gynecologica scandinavica. 2008;87(1):50–58..

Hicks P, Diaz-Perez MJ. Patient self-collection of group B streptococcal specimens during pregnancy. J Am Board Fam Med 2009;22:136–40.

Ho M. et al.  Oral Lactobacillus rhamnosus Gr-1 and Lactobacillus reuteri Rc-14 to reduce Group B Streptococcus colonization in pregnant women: a randomized controlled trial. Taiwan J Obstet Gynecol. 2016 Aug;55(4):515-8.

Johri, AK, et al. Group B Streptococcus: global incidence and vaccine development. Nat Rev Microbiol 4(12): 2006; 932-942.

Kubec R, et al. Isolation of S-n-butyl cysteine sulfoxide and six n-butyl-containing thiosulfinates from Allium spiculum, J Nat Prod. 65(7):2002; 960–964.

Libster, R.,et al. Long-term outcomes of group B streptococcal meningitis. Pediatrics 130(1): 2012; e8-15.

Martin V. et al. Rectal and Vaginal Eradication of Streptococcus agalactiae (GBS) in Pregnant Women by Using Lactobacillus salivarius CECT 9145, A Target-specific Probiotic Strain. Nutrients. 2019 Apr 10;11(4):810.

Metz T. et al. Exposure to group B Streptococcal antibiotic prophylaxis and early childhood body mass index in a vaginal birth cohort. J Matern Fetal Neonatal Med. 2019 Feb 7;1-6.

Meyn, L et al. Rectal colonization by group B Streptococcus as a predictor of vaginal colonization. American Journal of Obstetrics and Gynecology. Volume 201, Issue 1, July 2009, Pages 76.e1-76.e7
C Nan. Maternal group B Streptococcus-related stillbirth: a systematic review. BJOG. 2015 Oct;122(11):1437-45.

Nanduri S, et al. Epidemiology of invasive early-onset and late-onset group b streptococcal disease in the United States, 2006 to 2015 multistate laboratory and population-based surveillance. JAMA Pediatr. 2019;173(3):224-233.

Ohlsson, A. and V. S. Shah . Intrapartum antibiotics for known maternal Group B streptococcal colonization. Cochrane Database Syst Rev 1: CD007467, 2013.

Ohlsson A, et al. Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD003520.

Price D, et al. Self-sampling for group B streptococcus in women 35 to 37 weeks pregnant is accurate and acceptable: a randomized cross-over trial. J Obstet Gynaecol Can 2006;28:1083–8.

Ronnqvist, P.D., et al. Lactobacilli in the female genital tract in relation to other genital microbes and vaginal pH. Acta Obstet Gynecol Scand 85(6):2006; 726-735.

Schrag S, Zell E and Lynfield R: A population-based comparison of strategies to prevent early-onset group B streptococcal disease in neonates, NEJM. 347; 2002; 233-239.

Shing SR, et al. The Fungal Pathogen Candida albicans Promotes Bladder Colonization of Group B Streptococcus. Front. Cell. Infect. Microbiol., 10 January 2020

Stade, B., V. Shah, et al. Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection. Cochrane Database Syst Rev(3): CD003520, 2004.

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Tudela, CM.et al. Intrapartum evidence of early-onset group B streptococcus. Obstetrics and Gynecology 119(3): 2012; 626-629.

Wohl DL, et al. Intrapartum antibiotics and childhood atopic dermatitis. J Am Board Fam Med. Jan-Feb 2015;28(1):82-9..

Zarate, G. and Nader-Macias, M. E.. Influence of probiotic vaginal lactobacilli on in vitro adhesion of urogenital pathogens to vaginal epithelial cells. Lett Appl Microbiol 43(2):2006; 174-178.

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Charmaine Koehler-Lodge

This is a wonderful article that came too late for my daughter's baby who was born last February. My daughter, who tested positive for GBS, was given an iv antibiotic while in labor. She has been struggling with a persistent yeast infection in her daughter ever since. She has been trying to treat it with probiotics and other natural remedies to no avail. Do you have a protocol that you can recommend to her?

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    aviva

    Hi Charmaine. This is probably when I'd recommend a consult with me. Congrats on your grandbaby and sorry she's struggling with yeast...

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      Silvana

      Thank you for your article. I tested GBS positive at 8 weeks (now 18 weeks) and am struggling with the decision of what to do about antibiotics in labor. Am I reading correctly that the chances of my baby having a GBS infection is 2-3% if a decline antibiotics vs. 1-1.5% if I accept antibiotics? Also, is there any research to show the difference in risk with vs. without antibiotics if there are other factors involved such as PROM? I had PROM at 36 weeks with my first so am keeping this possibility, and what I'd feel comfortable doing in relation to it, in mind. Thank you for your help!

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        aviva

        Hi Silvana, From my training and research, women who test positive in early pregnancy have a higher rate of having a baby with GBS infection; the 2-3% is severe infection in those who get colonized (50% of babies), so half of that for all babies. But yes, the rate is much less if antibiotics are taken. PROM itself is a higher risk for having GBS colonization, and infection, so yes, the need for antibiotics is even higher in that case again... A lot to think about, I know! Keep in mind that the risks are overall low, but also the risks of causing some terrible damage to your baby from the antibiotic is also low! :)

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      Linda Honey

      Thank you Aviva!

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Ashley

thank you so much for the information. I am GBS positive and am having my first baby sometime in December. Move decided that I will take the antibiotic, so am now looking for information about administering probiotics to my baby afterward, and also how I can reduce my own risk of yeast infection, etc afterward. Do you have any recommendations?

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    aviva

    hi ashley, a probiotic can really make a huge difference; also see my blog on yeast infections for extra support. sending lots of love for a wonderful healthy birth!!! warmly, aviva

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Lily

Thank you for your informative and balanced approach! I did test positive and, while I avoid antibiotics and opt for colloidal silver/garlic/oil of oregano for average infections, I did not want to take any chances and was perfectly fine w/ receiving the prescribed antibiotics. Afterwards, I re-plenished with intensive pro-biotic use (for myself AND baby) to re-balance.

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Cynthia Castro

Are the suppositories to be used during pregnancy then? Thanks for discussing this, it's difficult to find information from "our" point of view :)

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    aviva

    I use Pro-Flora women's probiotic because it has the recommended species. Warmly, Aviva

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Paula

Hi Aviva! Your suppository recipe is fabulous. When do you recommend doing this? The reason I ask is that I could see women using this before testing, which could result in a false negative. So, to be clear, do you recommend this at the start of the 3rd trimester? Second? Or is it specifically designed for 3 weeks prior to GBS testing? I've also heard another remedy for overall vaginal health (including protection of the microbiome) is vaginal steams, which can also be done in the 3rd trimester. I'd love to know your thoughts on that. Thanks! Paula

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    aviva

    Hi Paula, I don't know that it would result in a false negative, though I've wondered, so what I do if mom pretreats and has a negative is test again a couple of weeks later if in doubt. I now thing negative is negative and in such cases just keep my mind on a risk management approach as an intermediary plan. Aviva

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Kerry

I am 35 weeks pregnant. Do you have a certain probiotic your suggest. I am vegan. Thanks for this article. I was just tested for GBS yesterday.

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    aviva

    Hi Kerry, I recommend ProFlora Women's Probiotic just because it's one with the strains I recommend in the article. Be well! Aviva

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Jan

Aviva, I'm a homebirth midwife that deals with this issue all the time too. I used to use the chlorhexidine protocol, but after considering the microbiome more seriously, feel uncomfortable using that strong antibacterial soap and potentially disrupting the beneficial bacteria that the baby needs. I don't have the option of running IV abx for my clients in the out-of-hospital setting (and lots of them wouldn't want it anyway.) Besides offering a similar prenatal protocol of probiotics, immune system boosters, and vaginal suppositories, I have started carrying colloidal silver gel and spray with me to births. This particular product by ACS claims that it won't disrupt the beneficial bacteria but will have an effect against the harmful ones. I don't know exactly how that is possible ..... but it's an option I feel more comfortable with. Just thought I'd share.

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Dana

Hi Aviva, Again, an article I really liked, well explained and well documented. Thank you! I've tested positive to GBS and chose to have the antibiotic. While I knew that it was risky for my baby's microbiome, I thought that the benefit of having the antibiotic was outweighing the risk. I was just wondering what kind of probiotic you recommend for infants. Is there a particular brand you would recommend? Cordially, Dana.

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    aviva

    Hi Diana, A good and reasonable choice indeed! For the infant probiotic I recommend Klaire Therbiotic Infant because it contains the Lactobacillus and Bifido strains, but other brands that contain these and are made for infants should also be fine. Warmly, Aviva

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      Dana

      Just ordered it. Thank you so much for your help! Dana.

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      Amity

      Hi Aviva, I too had an antibiotic during labor for GBS and my daughter has eczema/food allergies which we started to realize around 4 months old. She's now 21 months old. Is there a good probiotic for her age group that you recommend? She's allergic to dairy but does eat coconut yogurt occasionally. Can you add liquid probiotic into recipes or will the probiotics be killed with heat? Thank you. Amity

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        aviva

        Hi Amity, The probiotic should not be cooked. I like Klaire Therbiotic Infant even for children your daughter's age. Also, check out my course, The Allergy Epidemic! Warmly, Aviva

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Vicky Miller

Thank you for this very balanced article on GBS colonization and treatment in labor! I test all of my clients. Many prefer not to use antibiotics although I do offer to administer them and let them know it is the safest option. The back up OB prescribes them. I am sending the link to your blog to all of my clients. BTW I live and have a homebirth practice in Costa Rica. Universal GBS testing is not standard of care here and there are not good protocols in place to deal with infants of GBS positive mothers, treated or not!

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    aviva

    Thank you Vicky! A HB practice in Costa Rica sounds dreamy except for the lack of protocols... which sounds super challenging! Love that you wrote in. Aviva

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Feenanda

Great article! Thank you! Which probiotic would you recommend for the baby, which dose? Thank you!

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    aviva

    Klaire Therbiotic Infant as recommended on the package, x 6 months. :)

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Kalanete

Aviva, what product do you recommend for a probiotic for the newborn? I was recently asked this by a mom who had given birth by cesarean and was not sure what to recommend for correct dosing of a newborn. Thanks for your input.

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    aviva

    I use Klaire Therbiotic Infant, but I am sure there are other wonderful brands as well!

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Anna Kauffman

I tested positive for Group B Strep for my first born and was put on antibiotics during labor. It was a hard labor and the baby was born not doing well. It took her a week to give her first good cry. She's 10 and still has a lot of issues. I don't blame all her issues on those antibiotics, but I am sure they didn't help her. When I again tested positive for Group B Strep four weeks before the due date of my fourth child, I decided to try a few things and then retest. My midwife gave me permission but warned me that others had tried things and no one really succeeded. My husband grows our own heirloom garlic, I took a clove and pressed it with a knife to activate the medicinal properties. I inserted the flattened garlic into my vagina and fished it out after 24 hours. I repeated that every day with a fresh garlic clove and when I retested for Group B Strep a week later, everything was clear! Not only was everything clear, but I could tell the vaginal fluid was healthier. In fact, when I gave birth to to my daughter, she was the healthiest infant I have had! I would love to see a midwife do a research on this method of treatment for Group Strep B!

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    aviva

    Yes, this would be an important area of research. Thank you so much for sharing your story. <3

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Diana

Hello Aviva, Great article! I like the diplomatic tone with which you handle the sometimes overly natural oriented moms-to-be. Indeed getting antibiotics to prevent a severe illness in the baby is sometimes the best way to go. My question is: what if I test GBS positive and accept the antibiotics during my labour, what kind of probiotics would you recommend for the baby? Same one as for adults? Different one? Aldo fir newborn babies, any ideas on the best brand of vitamin D drops? So far in pharmacies I have seen only horrible alternatives with plenty of added chemicals and did not buy any yet. Thanks for for great blog Aviva, it is really useful! Cheers, Diana

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    aviva

    Hi Diana, The data supports the use of probiotics with Lactobacillus and Bifidobacterium species for baby after cesarean. I use a product called Klaire Therbiotic Infant. Best, Aviva

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      susan bradford

      Hello Aviva, Thank you for this very complete and updated information on GBS+. I will be using it to inform my holistic childbirth preparation classes. I would like to hear what you have to say about using the C Reactive Protein test for newborns born of GBS+ mothers instead of using IV Antibiotics during labor. I understand that babies who are born of GBS+ mamas are tested after birth even tho they have received antibiotics during labor and are given more antibiotics then if they are positive for GBS. Why not just test all the babies of GBS +mamas soon after birth to decide whether to use antibiotics or not?

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        aviva

        Probably because it's hard to tell the difference between infection and colonization - until infection appears which can happen really fast and furious in a newborn. So prevention trumps identification and treatment.... But great Q.

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Alyssa

Is there any risk in using the vaginal probiotic, yogurt or garlic? Thank you so much for the information! Does the capsule of probiotic just dissolve and is safe?

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    aviva

    Yes, the probiotic capsule does dissolve. One can get a little irritated from the garlic if not peeled carefully. Never heard of any adverse reaction from yogurt. Anyone of course can react to anything, but in my 35 years of experience I've not heard of any problems with these.

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Renee Stewart

Thank you for this wonderful article. I would love to have it in a printable to give to my midwifery clients. Is this possible?

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    aviva

    Hi Renee, Yes, it is! Please contact my office at [email protected] for a reprintable copy. Warmly, Aviva

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Maria Leon

Great article! Thank you. Do you have a probiotic that you use for infants?

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    aviva

    Klaire Therbiotic Infant is the one I use in my practice; make sure whatever product you select has Lactobacillus and Bifidobacterium species. Warmly, Aviva

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Lisa Stachura

Thanks for all of the really great info!! I did the garlic CLOVE and yogurt inserts on my last pregnancy and intend to do them again for this one. This article was a great reminder and I love the simple recipe for the homemade suppositories. I will try those as well. ❤️

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Gumboots

Thank you so much! Well researched, succinct and easy to understand. Your balanced approach is much appreciated, and it is so helpful to have some context and clarification of risk factors in this issue.

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Al

Hello, thank you for your article, you recommend using the IV probiotic but also imply there is some infection that can occur before birth begins. Can this bacteria cross to the naby before a broken membrane? Should a mother take oral antibiotics leading up to pregnancy to prevent this early onset?

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    aviva

    Antibiotics are only indicated if the mom is GBS positive, or unknown status with risk factors as I mention in the article. It is not too likely to cross a healthy intact membrane and I've not heard of this happening before labor.

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      April

      Here is one of the websites which discuss intrauterine GBS. I'm interested in your thoughts. http://www.groupbstrepinternational.org/what-is-group-b-strep/prenatal-onset-3/

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      Ashley

      Prenatal Onset GBS is a real and fatal type of GBS that can and does occur. My daughter Gwyneth was born stillborn this September on my due date from GBS in Utero which caused pneumonia. My life will never be the same. I was never in labor, did not have my water broken, did not have a fever, did not have any signs of infection, etc, except for testing positive for GBS 3 weeks prior at 37 weeks. GBS bacteria has a mechanism that "spits" out a chemical which can make holes in an intact placenta and amniotic sac. I don't mean to scare people, but I do like to spread the word so that mothers like me know how deadly GBS truly is. I am now 6 weeks pregnant again and still testing positive for GBS. I am going to be following a lot of the recommendations here and have been since September. I am hoping to be negative in the next few months and eliminate the risk of death for my next child.

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        Ashley

        And just wanted to add thank you so much Aviva for supplying this type of natural information to mothers like us. Even after my daughter's death, none of my doctors or GBS specialists can give me an answer on how to eradicate this bacteria from my body - without taking antibiotics throughout my pregnancy or do nothing. It makes sense if it originates in the gut, that it is effected by what you put in your gut. I have been at this probiotic/fermented diet (not garlic suppositories yet but will start now) for 4 months and still positive. I believe it takes time to change your gut and vaginal bacteria, but I am confident I can beat this bacteria this time around. I truly appreciate your information on how to do so.

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          Vittoria

          Ashley - thank you so much for sharing your story. This really hammers home the risks of GBS. I can't even imagine how hard that must have been, and still must be. My heart goes out to you and your partner and I am sending lots of love and energy your way for a healthy pregnancy this time. Much, much love to you.


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Christy

I just want to mention that as a midwife I've seen a drastic increase in the number of women testing positive for GBS in my practice in the last several months. The lab we use upgraded their testing to a newer form of testing for GBS and we're seeing a 50-90% GBS positive rate. Of course that doesn't mean we see more babies getting sick with GBS, but it does mean more women wrestling through the issue of receiving IV antibiotics in labor or not.

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Julie

Hi Aviva, Thank you so much for your very interesting article on GBS. I don't have a question but I do have a comment. I had 3 daughters and on my third pregnancy, I had the GBS testing and was found positive. Neither of my first two pregnancies were problematic. My first pregnancy my membranes had to be ruptured by my doctor about a half hour prior to my delivery and my second pregnancy they ruptured spontaneously at 2 am and the baby was born by about 6 am. I had a midwife for my 3rd pregnancy and she recommended IV antibiotics for me while in labour to protect my baby, I agreed although I knew I was likely low risk for complications. The way she explained it and pressured me to have the IV antibiotics I would have felt so guilty if anything had happened to my baby. The frustrating thing was my midwife did a stretch and sweep and my 3rd baby was delivered before the IV antibiotics could even kick in. My midwife even said to me while I was in transitional labour, "Can't you hold on to give the antibiotics time to work?". It was absurd. My baby was fine but would have been without the antibiotics as well. Looking back I often think I should not have had the IV antibiotics as I wasn't in a high risk group. I hated having the IV, and pushing the IV pole around the L&D ward as I walked through my contractions, only to find out the delivery occurred too fast to allow the antibiotics to work. I think high risk patients should definitely have IV antibiotics but I still think those who are low risk should not be guilted into having IV antibiotics when the risks are so low. Just an opinion but thought readers of your article might be interested in my story as well!

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    Rowen

    And the "stretch and sweep" increases the chance of premature release of membranes and infection! Sounds like your midwife didn't really give you true informed consent.

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April

Aviva, thank you so much for continuing to share your knowledge so freely. Can you please comment on whether the insertion of garlic, or the suppository you describe, could have a negative impact on the vaginal flora that is so important for colonizing the baby at birth? I know of women using garlic as a preventative measure, and I worry about the risk to the flora that the baby needs.

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    aviva

    Hi April, I haven't seen any studies that look that the changes in healthy flora when these supplements are used, but they target the harmful, not beneficial organisms overall, so shouldn't be a problem especially when the diet is healthy and a probiotic or lactofermented foods are being taken.

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Kristen

I was wondering how long the IV antibiotic has to be in the system before the birth to be effective. I tested positive with my third, and I had the IV. With my fourth, I don't think I was positive, but I was barely at the hospital an hour before delivering. There was not much time to have had an antibiotic especially since I am allergic to penicillin. As I enter my fifth pregnancy, I am researching all over again. Thank you for this article.

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    aviva

    In hospital we try to make sure mom is being infused with antibiotics within 4 hours of the birth.

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      Keri

      Are oral antibiotics at home effective? I only see Information about IV.

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        aviva

        IV antibiotics are the standard for effectively treating GBS in labor; oral has not been found to be nearly as effective.

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Karen

Great article! I'm curious about the risk of other nosocomial infections - eg MRSA - following antibiotic use. Thanks also for pointing out that most late-onset GBS infections are carried by hospital workers' hands. Another reason to insist that hospital personnel handle baby as little as possible and that hands and equipment are properly cleaned.

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    aviva

    Yes, other infections can arise as a result of antibiotic use - especially resistant ones, which are commonly picked up just from being in the hospital for a procedure...

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Erica

Hi Aviva, I tested + for GBS and received 3 rounds of Ampicillin during labor. My baby is now 4 and a 1/2 months old and I am just now seeing this helpful article. Is it too late now to treat my baby with probiotics? Thanks!

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    aviva

    Not too late!!! Not all babies have problems -- some have quick gut flora restoration -- but yes, add in a probiotic! Congrats on your new baby!!!

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Christina

What is your list of fruit you recommend if most fruit is to be avoided? I don't eat processed anything and fruit is the only sweet thing I eat. I am due this December and am working on my goal of controlling this worry by diet, probiotic and maintaining an active lifestyle. Thanks for elaborating on this.

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    aviva

    Berries berries berries! Fresh or frozen. Lowest glycemic fruit and highest antioxidant content. :)

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Linda

I have a comment, wouldn't it be wise for women to include fermented foods and drinks into their diet before trying to conceive and continuing throughout pregnancy and for the rest of their life? Great article!

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    aviva

    ABSOLUTELY! :)

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angelica

If a vaginal birth is so important because of the friendly flora that a child receives during birth, I don't understand how antibiotics could be non-detrimental. I just heard a study that if this protocol is followed so much of the bacteria is killed that some of the beneficial strains can never be redeemed. Pretty scary stat with how often this procedure is being done. This bacteria is very common and our daughters MD said that he doesn't recommend the antibiotics... our daughter tested positive and then we did a protocol with silver and then retested. The second test was negative.. no antibiotics required. Another very personal decision...

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    Elle

    Hi Angelica, I hope you get this! I'm pregnant with my third child, was told I tested negative, but then today was told they made a mistake and I'm actually positive. I'm very distraught as I tested positive with my first, did antibiotics, and he's got thrush and staph shortly after birth. A doctor I was seeing in addition to my OB during my second pregnancy recommended I cleanse with colloidal silver and squirt around the walls of my vagina as well just before the test. I did, and it was negative. I did the same thing this time, but with a different brand of colloidal silver. I'm very confused since I was told in one breath I was negative, then a week later, told they made a mistake and I'm positive. I was also told I HAD to get the antibiotics, even if I tested negative in a follow up test. My question to you, what was the silver protocol your daughter followed? Thank you!

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Rebecca

Thanks for this article! I'm 39 weeks now, have tested GBS positive and have decided to go with the antibiotics at my planned home birth. I haven't made a decision about what I'd like to do with the placenta yet... Do you know if taking the antibiotics during labor effects the placenta in such a way that it shouldn't be ingested? Thanks!

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    aviva

    I don't recommend placentaphagy if mom has had any medications - including antibiotics.

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      Lisa

      Hi aviva, Thanks fo the article. Just out of curiosity, why would you not recommend it after use of abx? New midwife here and it is popular in my practice.

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Andrea

Hi Aviva, Thank you for your article. I know that Midwifery Today had an article on GBS and water birth. It showed having a water birth worked better to prevent GBS in baby, then antibiotics. I'm just curious as to your thoughts on that. Thanks

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    aviva

    Wow- I really highly doubt that this is effective in preventing GBS infection in baby, or has been scientifically proven -- but I'd be interested in seeing that data. I wouldn't use water birth as a preventative, though,personally...

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Jessica

Hello, Thank you for the great article and feedback to questions. If a little garlic gets "lost" in the vagina, will it find its way out eventually? I assume so, but just want to be sure. Also, should garlic only be used once a week? Thank you!

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    Megan Liebmann

    Hi Jessica, This is Megan from Dr. Aviva's team. It can get pretty yucky — you’ll want to get that out…either yourself, your partner, or your gyne can do… Warmly, Megan- Dr. Aviva Romm Nutritionist

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Marissa

Hi Aviva! I received your newsletter email at the same time that my midwife's office was calling to say that I tested positive for GBS...for the second time during this pregnancy! I am 21 weeks pregnant and just started my second round of ampicillin. The first positive test was at 12 weeks and I took a round of the ampicillin then. I usually never use medicine so this hasn't been easy. My first son Harry is 16 months old. I had no issues during that pregnancy. I started battling mild yeast infections shortly after Harry's birth. I stopped nursing him when he was about 15 months. I take a daily probiotic and eat yogurt every day. I was too nervous to try the garlic but after reading this article I am ready to try you're recommended routine. Thank you! I was also just told that I have placenta previa (complete coverage). I am going to start acupuncture but am wondering if you know of any other natural options to try and "help" my placenta move away from my cervix. I would really like to avoid a cesarean and any accompanying complications. I am told that with the "complete coverage" there is not a good chance of things being corrected. ANY advice is appreciated. Thank you in advance for taking the time to read this lengthy comment. Much love, Marissa

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Rebecca

Hi, I am about to have my second girl in about 3 weeks and the first pregnancy I was negative for GBS. I always go through a birthing center and on this pregnancy I was tested positive at around 12 weeks for GBS in my urine. I didn't really realize they tested that early. So I asked to be tested again at 36 weeks and my results came back negative. When I was tested positive at 12 weeks they had me take antibiotics until I was negative again and that took about 2 rounds of antibiotics. I am not a fan of taking any type of medication. I have done a tone of research on this topic and I keep feeling like I shouldn't take the antibiotic. This is such a hard decision and a lot of people recommend taking the antibiotics. Just wanted to know your opinion on it. I just get a little confused because I was positive early on but now I am negative.

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Elizabeth

It really frustrates me that the laboratory will only give you a positive or negative test result. I want to know exactly how many colonies were present so that I can make a better educated decision about what to do. For example, in the case of a positive result, if the number of colonies is significantly greater than the cut off for a +/- result, I might choose treatment; whereas, if the results show barely enough colonies to warrant a positive result, I might choose to forego treatment. Knowledge is power and it is wrong for laboratories to withhold this knowledge.

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susan bradford

Hi Aviva, I wrote a question in your comment box yesterday and went back today to see if you had answered it but i don't see my question here now. Not sure what happened but I am really interested in knowing what your thoughts are so I will write it again. I want to hear what you have to say about the protocol of using the C Reactive Protein test for the newborns of mama's who are GBS+ in lieu of prophylactic IV antibiotics during labor. Then only babies that test positive to that test would be treated with antibiotics. Could you please write your response to this protocol?

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    aviva

    Hi Susan, Don't know what happened to your Q, which is a great one. According to the CDC, measuring acute phase reactants is not considered part of the full diagnostic evaluation of infants with suspected sepsis. The sensitivity and specificity of these tests are too low in infants for them to be consistently useful in decisions to initiate treatment for suspected sepsis. However, some experts have argued that acute phase reactants may be useful in decisions to stop antibiotic treatment for suspected cases of sepsis.The problem is that it's really only meaningful 8-24 hrs after birth, and by then, baby could be on the way to full blown sepsis. So unless that test becomes more sensitive early on, I don't think it's a sub for prophylaxis. Best, Aviva

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Krishna

Hello, Thanks for the great article.My sister is pregnant, I suggested a GBS test to her by reading this.This article was really helpful. Thanks

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Amy

I tested positive for GBS at 37wks. Antibiotics were administered during labour. I had a beautiful thriving baby boy. At 3mos he became ill with GBS. I noticed it around 10am one morning. He wasn't as hungry as normal but wasn't fevered. By mid afternoon he still wasn't fevered but was sleepy. I took him to the ER, by this time he was already septic. I'm told that minutes more and the outcome could have been very different. We spent 2 weeks in the hospital undergoing bone scans, spinal taps and other tests. Today he is a bright, fun and wonderful 5 year old. The percentage of your baby having GBS might be low... but it's not impossible. Be informed. Be proactive. Don't take chances.

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Jess

THank you Thank you Thank you for the handout! A fantastic resource for my mama clients :)

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Memrie

I was +GBS with my 6th child. Had PROM and she came so fast I never made it out of the house. Sadly we were part of the low percentage that got sick. I was very sick and she almost died going septic. She was the only child i was ever positive with out of 7. She has learning disabilities and several health problems. I only share this experience because I never believed it would happen to me. I just knew she would be fine and it was not until she stopped breathing before i even let her go to the nursery. And I am a believer in informed decisions, but if my experience can save just one baby from this I will share it. Yes it happened to us.

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Ktmae

Hi, Thank you for such a great article! I tested positive for GBS early in my last pregnancy and received ABX while in labor. I am expecting again and GBS was found in my urine sample at 8wks. My question is: should I plan on the ABX again during labor or if I do the routine suggested and test negative at the end of my pregnancy, is it really okay to forgo the ABX while in labor? Meaning, am I really negative? Thanks, KT

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    aviva

    If you test positive in early pregnancy, this is considered positive -- because it's higher risk for having GBS at birth and higher risk for baby. Sorry...

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Ashley A

Hi Aviva! Thank you for the breakdown in this post. It really helped me better understand GBS. I tested positive for it in my first pregnancy even while taking a probiotic. I'm not pregnant with #2 and due in May. I'd really love to avoid GBS again especially since I'm trying for a vbac. I'd love to start your recommended probiotics now but they're on the pricier side. Would you say 30 weeks is the suggested time frame to start them if I don't start them now?

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Rhoda Baughman CPM

Hello Aviva! I have a question regarding your herbal suppository. The amounts you list here, are they to make enough for one 3 week treatment span? Or will this make many suppositories? I just want to make sure that I'm not 'stretching' the herbs to thin. Would love your input. Much love, Rhoda Baughman CPM

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    aviva

    You'll get about a 10 day - 2 week supply.

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Sydney

I am 38 1/2 weeks pregnant with my first child and was tested positive for GBS. I have been battling with the decision to go to a hospital and receive treatment or continue my plans of a home birth with my midwife and birthing team. It's a very tough decision. My boyfriend and I really want to do our home birth, but the fear of our son catching GBS during birth is a lot for me to wrap my mind around. I just don't really know what to do. Your article was very helpful and informative. I did learn that either way the baby can have health problems....antibiotics or not. I really need help making an informed decision. Are there any statistics that I can research? Any further info that could help me make a decision? I'm reaching the end and I could really use all the info I can get to make an informed decision. I really want to do the birth at home like we planned.

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Poetess

I tested positive for a uti in November caused by gbs. Colonization was 100,000 so I took Macrobid. I was told yesterday I have another uti caused by gbs with the same colonization number. Now my ob prescribed Clindamycin and I am too scared to take it, but I want to get rid of or at least lower the colony. How can I do this naturally? I would appreciate any advice, Thanks!

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    aviva

    Dear J, Thank you for writing to me and valuing my opinion with your important question. I would so love to be able to answer, and in fact, this is something I address with women in my practice and have for years, but because this is a complex pregnancy situation, I can do much better justice to health questions in an appointment...and just can't electronically. To become a patient in my medical practice, Thrive Health, you can find out more here: http://avivaromm.wpengine.com/health-consultations With warmest wishes, Aviva Romm

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Ashley

Hi! Thank you so much for this balanced article. I tested positive at 36 weeks. I've never had antibiotics in my life, and was hoping labor wouldn't be the first time, So I started taking a probiotic, eating sauerkraut, taking vitamin c, as well as elimating all sugar, dairy, and white flour from my diet. I retested at 38 weeks (just this week) and the teat is now negative. I'm still not sure if I should take the antibiotics or not. The doctor said gbs can come back, so they still recommend that I take it. They also said it could be present in another part of my body? My question is, if I keep up this strict regimen through labor, what are the odds that it could come back?

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    Sara B.

    I’m so inspired by your action. I just got a positive result and I’m ready to put this plan into action. Even if they convince me to do the antibiotic at labor, my mind will be at ease that my GBS and risk to my baby is in check. Thanks for sharing.

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KDS

Knowing that the risk for EOBGS is 2-3% w/o ABX and roughly 1-1.5% with, but also that the risk is much higher with delivery at <37 wk, am I correct in assuming a large chunk of that 2-3% is for preterm babies? I'm interested in comparison for the risk vs universal approach in term infants w/o PROM. I'm 37 wks GBS+ w/ my 3rd, my first 2 being born within 30 min of water breaking. With my 2nd (born at 39w6d), I tested + in urine in 1st trimester, opted for ABX, but my entire labor was less than 1 hour, and my home birth midwife never arrived in time to administer ABX. My daughter was born quickly and perfectly healthy. I am considering the risk-based approach with this home birth but am having trouble finding hard #s that pertain to my situation.

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Kelsey

Hi there! Thanks for this fantastic article. I was GBS - first baby, but GBS+ last pregnancy and the antibiotic's triggered IBS for me and a resistant thrush that caused me to abandon breastfeeding by 6months :(. I'm in the second trimester with my third and taking garlic and vit c and natures bounty 10 probiotic. It has the L. Rhamnosis but not Reuteri... Can you recommend a better brand to use? There are so many out there and some are so pricey... it's overwhelming! A friend of mine in a similar situation and was told even if she tests negative she would still get antibiotic's since she was positive last pregnancy. (No complications) Isn't that unecessary? She's afraid to refuse but her son developed a lot of GI issues and dietary allergies that she suspects was from the antibiotic's last time. Thanks for any advice!

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Mel

This is a wonderful balanced article. I wish I'd had this while pregnant. I first went to a doctors office and got labs done before switching to a home birth midwife. My test at 10 weeks was positive. I got on probiotics, did the garlic insertion (you can thread a string through the clove to make it easier to remove), tea tree oil tampons, etc. and was negative at 36 weeks. I had to transfer to the hospital and as soon as they pulled up that 10 week positive after my daughter was born the hospital staff freaked out. I mean i was treated like a villain. One doctor told me what I did (not getting antibiotics) was akin to her letting her own daughter go out and get shot. I was bullied and gossiped about. It was devastating. I've never cried so hard in my life. They kept my daughter and extra week on harsh antibiotics and traveling to and from the hospital with a broken tailbone was horrible. As soon as she got home I got her on probiotics. I really wish i could do it over again. I wish I'd done it their way to just avoid the emotional trauma. I had no clue it was such an issue. My sister in law in England and another friend that had a home birth hadn't even heard of GBS. It's a confusing topic but the results can be devastating. Please read this and consider your treatment for refusing to do what the hospital wants or if you transfer to a hospital.

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Laura

Hello, I was diagnosed with GBS in 1999 when my first daughter was born. I was administred an antibotic during vagina delivery. She was full term and weighed 6.1 lbs. My daughter is now 17 and strugges with urinary and vagina odor problems. I had my second daughter in 2002 c-section due to being breech. She was full term and weighed 6.3 lbs. She at age 2 got really sick we thought she had rotavirus but it was negative. After that she rapidly started gaining weigth. She is now 13 and is very obese. I believe it their issues are caused by my GBS. Do you have any suggestions??

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    Megan Liebmann

    Hi Laura, Thank you for reaching out and I am sorry to hear your daughters are struggling. As mamas seeing our children struggle is so incredibly hard. Honestly the answer goes beyond the scope of what we can provide in a blog comment, but, a good place to start is to find a functional doctor in your community or a functional nutritionist. We recommend looking on the website of the Institute for Functional Medicine (https://www.functionalmedicine.org/) for a practitioner. There are so many steps that you can take, it just takes a bit a guidance. I hope this helps. Warm wishes, Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

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Kristin

Hi Aviva, Im 9 weeks pregant and Im currently on antibiotics as the dr said i had a UTI, due to the bacteria GBS. I also tested positive to this at 37 weeks with my first born and had the antibioctics during labour which was a quick 4 hour birth' which i dont think that was enough time for it to take affect. Since then 2 years later i was dianosed with leaky gut, and i have been taking polybac 8, eating fermented foods, apple cidar vinegar, slippery elm and hemp seed oil. Would you suggest to keep at this during antibioctics and after? And is there anything else you can suggest to help undo any damage caused by the antibioctics? Thanks

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    aviva

    Please see my leaky gut blogs and look for my 4R plans. Great for healing leaky gut.

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Katherine Waliser

Loved your article! Do you have a specific brand of probiotic that you recommend for newborns after the mother has been on IV antibiotics due to Group B Strep? I'm having trouble finding much online along the lines of specific recommendations. Thank you!

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    Megan Liebmann

    Hi Katherine, If you scroll through the comments you will see Aviva's response to your question! Warm wishes, Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

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Jennifer Green

Thank you so much for this article! It's nice to have a moderate perspective on this. I am training as a midwife, hoping to take my test this fall. I'm wondering why you advise pregnant women to boost their immune systems to minimize GBS, if this is seen by the body as an innocuous bacteria? I understand doing all you can to promote the growth of healthy bacteria, but I don't understand how taking things such as vitamin A, zinc... would help. Thanks in advance!

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Jacqueline Phillips

H Aviva! Thanks so much for the article. There was a woman who posted earlier saying she had a stillbirth due to Group B Strep. This makes me nervous because I tested positive for Group B in my first trimester (even though my number was really low) and again now at 36 weeks. I have been taking Fem Dophilus and Klaire Labs Probiotic for Infants (the lady at our local health food store said I could start taking it before baby arrives). Should I also be doing the garlic and a vaginal probiotic? I will be taking the antibiotics as well. Thanks so much!

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    Aviva

    Hi Jacqueline, Yes this would be scary to read - sorry I didn't see your comment sooner. GBS would be a rare cause of stillbirth and is not a usual outcome unless baby got infected early in a long labor, for example, which would be prevented only by being on antibiotics from super early on in labor, which isn't even the typical medical protocol in most cases. Using the probiotic is a great idea; you can do the other herbal approaches, but this wouldn't have been enough to prevent the other woman's situation...Do chat with your midwife or doc so she/he is aware of your fears and can help reassure you as again, this is an unusual outcome not typically due to usual levels of GBS infection, and especially if antibiotics are used in labor. Wishing you the happiest best rest of your pregnancy, and a wonderful birth and new momma experience!

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Erin

What about sex!!? Are all the benefits of the probiotics and vaginal preparations and suppositories wiped out if you have intercourse with your partner!?

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    Aviva

    Not at all. Just don't use right before or after...

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Julie

This is the most balanced article I've encountered on the topic. Thank you so very much. I was just tested positive and am due in 4 weeks with my second baby. Last pregnancy, my midwife prescribed Cleocin antibiotic suppository cream to treat in advance of labor. I tested negative after this treatment, but am hesitant to take this route now for fear of destroying important flora in the canal. Would you mind please sharing your thoughts on this course of treatment? My labor was less than 7 hours last time, and I'm hoping for the same to reduce risk of colonization/infection to baby. Will you also please share what probiotic suppository you recommend? Thank you so very much for this abundance of information!

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    Julie

    Also, I this will be my 2nd home birth in NY. My midwife does have the capability admin the antibiotic from home; however, I very much want to avoid this. Thanks again!

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May

Is there any data about the effectiveness of antibiotics during a very fast labor? Everything says they need 4 hours to be effective, what about those of us whose babies come in 2 hours or less?

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    Aviva Romm

    Since we don't know how long labor we'll be, they are still given in labor - but if baby hasn't been exposed for the full length of time, a watch and wait approach with baby is appropriate and direct treatment for baby if needed is recommended.

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E.G.

Hi, Great, great article. I tapped into your recommendations for my last pregnancy and am trying preventative measures this time around. Last time, I started the garlic clove at the end of week 37. After one night I read somewhere the clove needed to be bruised or scored to have affect. So I bruised it and woke up the next day with cramping. I tried again the next night and had cramping and appeared to lose some mucous plug. Then after a day went into labor and had my baby 2 weeks early. I can't help but feel they were related. Is it possible the garlic irritated things or just odd coincidence that all happened back to back? I want to be proactive this time but now I am scared of the garlic!

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    Aviva Romm

    I never bruise the clove - that can cause irritation and burning - but enough to cause labor onset? Not too likely...But for you, maybe avoid the garlic - and definitely don't bruise it! GBS itself, however, can cause early labor. Best wishes!

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Qiaraau

Thank you Aviva.. Taking probiotics daily may assist in restoring beneficial flora levels and prevent further problems from a disrupted microbiome.

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Emily

Thank you for this article! I’ve just been notified by my midwife that I had a positive urine test for GBS at 10 weeks. She wrote me a prescription for antibiotics to take now. Do you think this is necessary? I’m very hesitant to take them. She also said we will do IV antibiotics during labor. I’m extremely disappointed by this because I was positive for GBS in my first pregnancy and had the IV antibiotics during labor. For this second pregnancy I’ve been planning To try the natural remedies before the test at 35 weeks and wasn’t even aware that there was a urine test this early on. I plan to do some more thinking and researching about the antibiotics during labor but do you see any reason for me to take antibiotics now? (11.5 weeks). Thank you for your insight!

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    Aviva Romm

    Hi Emily, Early positive does indicated a high count for bacteria and antibiotics are prudent especially during labor when this occurs.

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jen

Great article! I tried to download the pdf at the bottom of the article to share with my students but it's not there. Is that pdf still available? Thanks!

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    Tracy Romm

    Hi Jen, you are quite right. When we upgraded the website a few months ago the link must have been broken. But we have also added a Print function (just under the title) and an Email function (look for the colored boxes under the title where you Like or Share - there is an email function there also).

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Lauren

I am reading conflicting information on the use of goldenseal during pregnancy, can it cause preterm labor when inserted vaginally? It is an ingredient listed in your suppository.

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    Aviva Romm

    It is not associated with PTL when inserted vaginally; however, GBS is associated with PTL - this it can happen concurrently with use - but that's more likely due to the GBA. IT should not be used ORALLY during pregnnacy.

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Bridget Lynch

Also women who take the antibiotics have an increased risk for other infections such as C.diff

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Lisa Goldstein

hi there, we met several times many years ago at the Herb Conference in Black Mountain, NC. I am a midwife, retired now after 3 strokes. I am SO happy that you have written this. I have know of GBS + babies that died, and it is such a terrible thing for the parents. Now a days many expectant couples are naive about the birth & PP process, and I worry about newborn deaths with GBS, and how it affects the public opinion of Home Births! I am very grateful to you for putting all of this GBS stuff in proportion to the RISKS to the baby. Thank you SO MUCH. Gratefully, Lisa Goldstein, LM, CPM/Ret, CNM/Ret in WNC...

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Ilknur Aydin

Thanks, Dr. Aviva. I was tested positive through a urine test and they told me that if I wanted a hospital birth taking antibiotics were required. Thankfully, I wasnt on it for 4 hours, it was just one dose because by the time I got to the hospital I was already 9cm and needed to push shortly after. But, even with that one dose my baby got oral thrush and I got nipple thrush that I couldnt get rid of for months and that ruined my early motherhood experience as well as caused many breastfeeding issues. I wish I wasnt forced to taking the antibiotics, given that I was tested negative after following a good regimen similar to what you described: nightly garlic suppositories alternating with probiotics, taking and eating lots of probiotic and using dmammose (I was using it for infection so I dont know how much it helped).

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