Group B Strep Testing

[Ca Plane Pour Moi]

I've been asked to do a review of GBS and GBSS for my charity - we're trying to raise awareness of what it is and why women should be tested (in the UK it is not policy and the NHS thinks it is a waste of money). As background, I'd like to include policy and practice of other countries so would people please share with me what happens not just in Australia but in all the other countries we have here or that we know about? That we're not tested now may not worry people until they find out that the rest of the world is because of the seriousness of this.

Many thanks.

[Beach Mama]

I was tested at 34 or 36 weeks (sorry cant remember and it was a quick swab taken during my Dr visit. (I did midwife care with a few Dr visits scattered in between). I tested positive and as a result was given anti-biotics every 4 hours during labour to prevent Isabelle getting sick. I was also told 30% of women test positive. Some hospitals dont do the test until later in pregnancy, as you may have tested positive at 36 weeks but may not have 2-3 weeks later, or some people may test negative at this test but still be positive at birth, so the whole timing of when the test is done is questioned here as well.
Not sure if that helps or not!

[SamanthaP]

What are the rates of infection and mortality from GBS in the UK?

[Artechim]

I was never tested. No one ever mentioned anything about it.

[paradise lost]

My friend WAS tested in the UK RF (wanted to say Ryn then!), at 34 weeks. She was brought in to be induced at 38wks, so she could have anti-b's before and during labour. Her induction failed and she was given an emergency c-section. The epidural didn't work so she had to have a general, she never managed to get DS breastfeeding (which she'd really wanted to) and was treated for PND for nearly 3 years. The on-admission-to-hospital-pre-anti-b swabs, taken 4 weeks after her +ve results, came up -ve. She was, understandably, utterly devastated. That's why they don't routinely test in the UK, it can come and go.

Bx

[krisp]

I was tested at 37 weeks with my DS and have just had my swab done last week with this pregnancy. Both came back +ve. I hated having the IV ab in labour and am very dissapointed to have to have it again this time. But I'm going to go with what my OB recommends and have them.

I have a girl friend who chose not have the ab, her baby became very sick 1 day after he was born and ended up requiring massive doses of ab himself. As a result his sight and hearing have been affected and it was touch and go for him actually pulling through. He is the only one who I've ever heard of having problems though and my Mum says they didn't do the swabs when she had the 4 of us. So I don't know how necessary it is.

[Mumof8]

I had tests done on my third pregnancy only cause I had a urine infection but they weren't sure at the time what it was. It came back positive for group B strep so when my son was born they stuck a tube down into his stomach and took some fluid for testing. He was also give a single shot of penecillan when he was born. I was already on a drip cause i was induced not sure if i was given anything cause i was always told it would never affect me only the baby if delivered vag naturally birth. The test was never done on my first two or my last two only that I have told the hospital that I have it. I was also told that once you have it you are always a carrier it doesnt just go away. I think it should be done as part of the first lot of test when you find out your pregnant. I met a girl who is now 21 and was born to a mother with group B strep and she was born perfect 24hrs later her life was changed forever because her mother was not tested and they never knew. She cant talk she can barely walk and also wears nappies. She just sits there all day putting beads onto chop sticks. All because a simple test was not performed.

[rolymogs]

........

[Ca Plane Pour Moi]

In the UK, 1 in 1000 babies have a problem with Strep B and 700 babies each year die, more being disabled to some degree. Testing is suggested at about 36-38w, as that gives a decent show of if you will be strep B positive at birth.

Would it be OK if I used some of your quotes too? It will only be a short piece and I'll use some that warn of the dangers of testing too early too, but want to get permission first.

and don't worry, Bec, I wanted to keep calling you Hana for aaaages! Is it routine in Scotland to test then? Ooooh dear (or "oh duh-ear", as DS says) - another across the border conflict! I can hear the chuntering starting already.

[paradise lost]

Some hospitals offer it and some don't. It isn't routine (even a 2nd trimester scan isn't routine here!). To be honest i'm not sure why they tested her, i think she may even have paid to be tested herself, thinking it was a good idea. In scotland it is routine to give all women who have not given birth within 18 hours of rupture of membranes IV antibiotics to counteract risk of any infection, including Strep B and this is usually effective. You don't even have to have them IV - i gave birth at 6pm but if i'd been 9pm or later the midwives had oral anti-b's from the Ped for me to take JIC.

I did look into it all when i was PG - giving birth at home i thought it was a better idea to cover all my bases (because there wouldn't be a paed there to check on her), but everything i read suggested i'd be increasing my risk of intervention and not making my baby any safer. Strep B is a continuous presence but not a continously active infection, you really CAN have it one week and not the next and it is not a danger to the newborn unless it is active (like HPV). I have read of women testing +ve in week 39 and -ve at delivery just a few days later. The friend in question went on to have another elective section because, she told me "My body is infected, i can't give birth to my children", once again the spinal failed, general was needed, once again BFing was made so difficult she didn't continue past day 2, and she is still suffering with PND following this second birth (bubs is 2). I would be interested to read your paper when it's done. Are you going to look at comparative intervantion rates withing groups tested or not tested as well as neonatal mortality and morbidity?

Bx

[Schmickers]

There is no firm research to support or not support routine testing for group b strep. There are two current approaches used. The first involves performing a swab on each and every woman and treating all women who test positive to GBS with antibiotics during labour. The second involves just treating women who have certain risk factors - fever during labour and birth, or a baby who has previously had GBS.

Currently, most organisations are leaning towards treating according to risk factors, as opposed to swabbing all women, because it is more cost effective. The research indicates that you need to treat a very large number of women unnecessarily, as a result of swabs, to get the same result as treating according to risk factors.

So, in essence, the NHS's view is held up by the available research. We did not swab for our pregnancies, for this reason - even if we had tested positive, there is no guarantee that we would still be positive at birth.

Actually, hang on, I tell a lie. Victoria DID test with Olivia, and came back positive. She took a lot of homeopathics remedies to boost her immune system, and also went on a low yeast diet and added acidophilus supplements to help treat an outbreak of thrush she also had at the same time. when we swabbed later on, it came back negative. So once more, it shows that the value of routine swabbing is questionable (although it did prompt Victoria to try and combat the infection at the time).

[paradise lost]

Garlic cloves as pessaries are, i have read, very effective in treating strep B.

Bx

[Ca Plane Pour Moi]

Ooooh, that does NOT sound nice, Bec!

I admit, I looked into testing and decided against it myself while pregnant. I'm half-thinking of doing two pieces, one pro-testing, as requested, and one with my findings and why testing isn't routine. It's not a full-on paper, more a small article, but I'll do one from just the promotional leaflets and one from wider sources and see which is needed - maybe both will be used, one for Strep B awareness week and one for the charity newsletter!

[paradise lost]

To be honest i am very wary of anything that further medicalises birth. The garlic is also good for various bacterial infections and thrush, and no, it's not nice, but it sure beats the antibiotics/Pill failure/miscarriage i had the first time i had bacterial vaginosis and was misdiagnosed with Trichomoniasis.

Bx

[lee75]

I had the swab done at 30 weeks. I was told that if I didn't know my results or didn't have the test done, I would be treated as if I was positive. My sister in law had the test done, she never found out her results. A few days after her son was born, he had some troubles, ended up having convulsions because his body was silently starving himself, he had no energy to cry. He was taken to hospital where tests where done, turns out he had strep b. His development has been a bit slower than normal, but he is still developing. They may not know the full effect of it until he is a bit older. Fingers crossed he will be ok.

[Ca Plane Pour Moi]

Well, thankfully DS was awake for almost 2 hours in the middle of the night, so I have been able to think about this a lot!

700 preventable deaths a year is almost 2 a day, is a largeish secondary school and the feeder primary schools all wiped out. So that's a lot of dead babies. And many more disabled to some degree or another.

But, as you say Bec, it is medicinalising birth, which was a reason why I didn't want the test. (Is medicinalising a word, btw?) But that doesn't mean it shouldn't be routinely offered and available on the NHS to all women. If even one baby dies from something preventable we should look at preventing that death. Surely the cost to the NHS will be outweighed by fewer disabilities in growing children and adults.

That said, I won't be tested next time. But mainly because that would mean telling the NHS that I'm pregnant and I'm not going to do that.

[fionas]

I used to work for a disability charity so I am all too well aware of the profound effects on a family's life when they have a child with a disability. Often disabilities cannot be prevented but not taking a simple test to prevent disabilities arising from Strep B related stuff is inconceivable to me. My ob tests as a matter of course and it was a simple swab that I took myself so completely non-invasive.

[paradise lost]

But the test is known to be unreliable. You can test -ve and actually be +ve and vice versa.

Those figures were good Ryn thanks. That means that the mortality is, overall, about 1.3 per 100000 live births. Which is about the same as the neonatal mortality from uterine rupture during VBAC. And clearly studies have shown despite this the risks of a section outweight those of a rupture. Do you mean, with your 1 in 1000 that 0.1% of babies have lasting damage, or have active infection. I know around 70% of babies born to Strep B +ve mums culture +ve at birth, but of those only around 1-2% become ill.

I suppose for me it's about managing risk factors. I wouldn't test for it because if you test -ve you STILL get the IV antibiotics if you have ROM >18 hours before birth or have a fever during labour, and if you test +ve you cannot have a home birth, have to have IV antibiotics no matter what and have bubs taken away for observation right after birth in some hospitals, even if they seem fine. And on top of all of that you can be +ve and test -ve and vice versa. I just don't see the point in a test which is diagnostically unreliable when it can so dramatically change how your baby "has" to be birthed. In addition, StrepB was cited to my friend many times as a reason she shouldn't seek VBAC, and she is now convinced her body is infected and dirty and her vagina isn't fit for a baby to travel down it. I imagine that would happen to many women seeking VBAC with either historical or current GBS +ve test results.

What is the mortality rate in the US or in AUS where testing is routine? There are going to be many many women who are StrepB +ve whose babies are -ve or +ve but have no difficulties and women who test StrepB-ve who are actually +ve at the time of birth and whose babies will get ill. Birth is a risky business.

I can't help feeling, given the nature of the infection, that it'd be more useful to dramatically reduce the use of ARM in inductions and VE's to a bare minimum (i.e. none) than to test everyone with a dodgy test.

Bx