Last week I answered some of Kirsa's questions. This week we'll cover Group Beta Strep. Apparently, Kirsa tested positive and was told she'd receive antibiotics while in labor to prevent transmitting this bacteria to her newborn. She wonders if this will keep her confined to bed since she'll have an IV and what problems this poses for her baby. These are really good questions. We can cover a lot of ground answering these.
First of all, what the heck is Group Beta Strep, also called GBS? It's usually a non-invasive, non-infectious bacteria that 10-25% of the population carry around as part of their normal flora and fauna. I think Kirsa used the term "diagnosed with Group Beta Strep." It's not like that. "Diagnosis" implies illness. She's not sick and it's not something she caught. GBS doesn't usually cause disease, symptoms or trouble; except when newborns get it. As part of routine screening, most (hopefully all) pregnant women get tested for it at around 35-37 weeks. During a pelvic exam, her practitioner will swab her cervix, vagina and rectum with a Q-tip and send it off to the lab. A few days later they'll get a report—either positive or negative for GBS. If positive, she'll be treated while in labor with IV antibiotics (usually penicillin but other antibiotics work too if Mom's allergic) to virtually eliminate the chance of her baby getting infected while passing through the vagina.
So what's the problem? Though GBS doesn't cause mom any problems, it can cause serious trouble for her newborn. It's often the cause of premature rupture of membranes and preterm labor leading to premature delivery. It's the most common cause of life threatening infections in newborns. If mom receives antibiotics in labor though, the chance of infecting baby drops from 9% (with untreated moms) to about 1%. If baby is in that 1%, infection is usually less severe and easy to treat. That's why the Centers for Disease Control recommend universal screening of all pregnant women. Babies infected with GBS get inflammation of the lungs, brain and/or spinal cord usually within hours to days of birth. Some get sick as much as a week later. It's a pretty nasty infection and as many as 15% die. The good news is? We almost always know about GBS in advance.
Treatment is pretty easy. We don't treat while you're pregnant because it's not effective for preventing infection of the baby. We wait until you're in labor. Yes, Kirsa, you will need an IV to get the antibiotics. You'll probably get at least a couple doses (every 4 hours with penicillin until delivery) while in labor but the medication drips in fairly quickly and shouldn't cut into your ability to get up and around much. If you don't need an IV for anything else, like hydration, pain management or other medications, your nurse can put a cap on the IV site between doses and you won't have to drag an IV pole around. IV poles have wheels though, so if you need to go for a walk, want to sit on a birthing ball or in a tub, the IV can go with you.
Kirsa's final questions were about how long to expect to stay in the hospital after delivery and what to bring as a thank you for her nurses? Most patients stay for about 48 hours after a vaginal delivery, especially if they're GBS positive. That gives us plenty of time to observe the baby for signs of infection, help Mom get breastfeeding established and rest up after birth. It's usually a 3-4 day stay after a cesarean, depending on how Mom's feeling. As for a thank you? Kirsa says she has a freezer full of ginger snaps ready for us. That sounds great. It's always a sweet and appreciated gesture when patients bring in cookies or treats for the staff. It's not expected and fortunately for my waistline, most patients don't bring anything. When they do, we're delighted. We put our heart and soul into our jobs and it's nice to be appreciated. Thanks for thinking of us, Kirsa and good luck with your delivery.
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