Trigger Warning - Infant death is discussed.
Please note that this post is for informational purposes only,
and should not be considered medical advice.
Please use your own discretion before using any of this information
& by all means do further research of your own.
Please consult with trusted health care professionals if you have any questions or concerns.
This post can be used as a discussion-starter with your primary (medical) caregiver.
A downloadable PDF of this post can be found here.
The National Screening Committee in the UK recently reviewed their policy of not universally screening women for Group B Strep (GBS) in pregnancy. They did so at the request of a family whose baby died from GBS infection, and who may have survived if the presence of GBS bacteria (and its transfer to the newborn) had been accurately detected and treated at the time of birth. After reviewing the available research, the UK NSC maintained their position that universal screening for GBS (like we do here in Canada) does more harm than good, with large numbers of women and babies unnecessarily receiving antibiotics.
Routine testing for GBS in pregnancy, and the subsequent use of antibiotics either prophylactically for all GBS+ women or using a risk-based model, is an important issue to examine for yourself before deciding how to proceed as GBS infection in the newborn can be fatal, but we are also becomingly increasingly aware of the devastating effects on an individual and global basis of antibiotic overuse and resistance, and the effect of antibiotics on the human microbiome.
Decisions like whether to test for, and then treat, GBS infection are best made when we tap into the existing research, as well as what we know from history and culture, from our own experiences, and our own intuition, so that we can each make an informed choice that is right for us. Most Canadian women choose to follow the Canadian standard of care - doing the GBS test and receiving prophylactic antibiotics in labour if they test positive, especially when told that antibiotics are an easy and low-risk way to prevent a serious or life-threatening illness in their newborn. This was not the approach I chose however.
Around 35 weeks into my first pregnancy, my midwife brought up the topic of GBS testing. She explained that while it was of course optional, in our area, the standard of care was that if you did not have a negative test result on file, the hospital would assume you were positive and you would be given IV antibiotics in labour. If you made the informed choice to decline the antibiotics (either completely, or only declining until a risk-based approach showed them to be necessary) then you would be discharged as per usual within 1 day of birth, but your baby would be kept in the special care nursery for monitoring and testing for 3 days. If you signed your baby out against medical advice you would be reported to CAS (Child Protective Services) for child endangerment. And it was no idle threat as I have spoken with social workers who genuinely believe that making informed, even evidence-based, decisions which are not in line with your personal caregiver’s advice constitutes child endangerment without exception and should be investigated as abuse. That’s not something to take lightly, and the ‘climate’ around birth and informed decision making in your own locale is absolutely something you have to take into account when making choices for yourself and your family.
I had already researched GBS testing and disease extensively, including what protocols were recommended in other countries, and was certain that declining the test and taking a risk-based approach where I counted my unknown status as 1 risk factor, was the right decision for me at that time. That was not the standard of care here though, so if for some reason I had to transfer to the hospital for my birth, then I would have to either allow them to administer IV antibiotics against my better judgement or have my baby kept in the nursery for 3 days. Neither was an acceptable option to me and so I quietly, privately, stepped off the beaten path as I did not want my midwives to be in a position where they felt compromised.
The bottom line was that I needed to have a negative test result on file. I took a number of steps to help ensure that I would have a negative result when testing and if I got a positive result despite those steps, that would indicate to me a heavy enough colonization that I would reconsider my risk-based approach. My test came back negative and I had no other risk factors in labour which would have meant I needed to re-evaluate. Like the majority of babies, my little guy thankfully did not contract a GBS infection.
Fast forward 3 years and late in my third trimester I was having the conversation about GBS testing with a new midwife. I explained how I had approached it last time and that I was considering my options this time, but that if she preferred not to know about it we could just change the subject. Again, I did not want to place my midwives in a position of feeling compromised. The local standard of care had changed thankfully so that an unknown status was not automatically grounds for assuming a positive result, and I was able to simply decline the test without any hoops or whistles. That’s just one example of why it’s important to keep lines of communication as open as possible and to always keep learning - if I had just assumed things were the same I wouldn’t have had accurate information. Still, she was pretty surprised to learn that I had been so intentional in making an alternative choice last time around. My choices were not strictly an evidence-based approach, and I am in no way suggesting you should approach it the way I did. My choices were right for me based on my evaluation of the risks and benefits, but what’s right for you may well be different….. And that’s really the key here.
The Society of Obstetricians and Gynecologists of Canada has access to the same information the UK NSC does, but they have each weighed the risks and benefits of GBS screening and treatment differently, leading them to make different care recommendations. Just because something is the standard of care in one country doesn't mean it is necessarily the right choice for you. The right decision for you is the one you’re most comfortable with after you’ve explored wide and deep <3
To learn more, please feel free to explore the following resources, references, and recommended readings as a starting point in your own decision-making process.
UK NCS on GBS Screening
AOM GBS Client Handout
AOM GBS Clinical Practice Guideline
Sarah Buckley - Gentle Birth Gentle Mothering
Evidence-Based Birth on GBS
Chris Kesser on The Gut as the Second Brain: GBS in Pregnancy
Midwife Thinking on The Human Microbiome
Midwifery Today E-News on GBS
Mommypotamus on GBS
Aviva Romm on GBS
Aviva Romm on Protecting the Human Microbiome
SOGC GBS Patient Handout
SOGC GBS Clinical Practice Guideline
Jan Tritten on Homebirth & the Human Microbiome
The Fundamental Threat of Antibiotic Resistance:
PubMed Canada Articles