Disclaimer: nothing in this article and nothing shared by Aligned Motherhood Co. is ever to be taken or misconstrued as medical advice. The following information reflects only the thoughts and opinions of Aligned Motherhood Collective, but is NEVER medical diagnosis, prescription, or recommendation. GBS is a medical condition and must be discussed with a medical professional. Always consult your doctor.
GBS stands for Group B Streptococcus. It is a common bacteria that can live in the intestines or lower genital tract of both men and women, and it is estimated that 25% of all healthy women carry GBS bacteria. When it comes to having GBS, you can quite literally be positive for it one day, and negative for it the next day. GBS colonization is transient (which means temporary), meaning the bacteria can naturally come and go from your body. Many of us have probably had GBS come and go without ever knowing it was there (or not) in the first place.
But when it comes to pregnancy, GBS is treated like an emergent condition, with a lot of fear and pressure surrounding the decision of how to move forward with a GBS “diagnosis”, as well as being told that GBS is an extremely serious and potentially life-threatening bacteria, should your newborn come in contact with it during a vaginal birth.
Therefore, a “GBS-positive” mother will be recommended (read: pressured & coerced) into taking IV antibiotics when she goes into labor. Of course, IV antibiotic treatment during labor is not harmless, and we’ll get more into that later in this article.
Additionally, if a mother tests positive for GBS and then her water breaks prior to labor (which is called PROM - premature rupture of membranes), in a hospital setting, she will usually be put on a clock for labor to start. If labor doesn’t start, she will be recommended (read: pressured & coerced) into coming in for an induction and IV antibiotics.
The flaws with GBS testing:
If you are pregnant, you can expect to start hearing about the GBS test in the latter part of your third trimester, because it is routinely performed between 35-37 weeks. This is important, because this means since GBS comes and goes, if you were to test positive, you could be negative by the time you give birth, since that will usually be between 5-7 weeks after your test. However, providers usually do not allow re-testing, and they also do not test at the time of delivery. Once you test, and if you test positive, you are labeled and treated as positive for the rest of your pregnancy and delivery.
In our opinion, this is a very strange way to handle GBS testing, because what if a mom who tested negative for GBS at 36 weeks was actually positive at the time of delivery? No one would know, and she wouldn’t have the option to take measures to try to prevent GBS at the time of delivery if she wanted to. The reason for this is because the way the GBS test is performed, a swab or urine sample has to be sent to a lab, where it has to sit to see if it grows the GBS bacteria or not. Testing and getting results is not a quick process, which is why moms aren’t tested at the time of delivery, and why they are usually not allowed to re-test.
We think it’s important for moms to be aware of this, because the entire testing and treatment process for GBS is not black and white. There are a lot of of flaws with the testing and treatment system of this condition.
And just like every other test, screening, treatment, and “condition” in pregnancy, there’s a lot more to the story than than what we’re told. In this article, we are going to dive into the prevention, testing, and treatment options for GBS, as well as the actual statistics and numbers when it comes to the complications for babies born to GBS “positive” mothers (positive is in quotations because again, the bacteria is transient and we never know if the mother is still positive at the time of delivery).
GBS in Newborns - Statistics, Symptoms, and Treatment
The biggest way we can achieve freedom from the fear surrounding topics such as GBS risks for a newborn is to learn what the actual numbers say, and learn more about how it would look if our newborn was one of the 0.05% who did get GBS from vaginal delivery from a GBS-positive mom who declined IV antibiotics.
Often times, in cases like GBS, babies going past their due dates, etc., we are told scary sounding statistics such as “the risks of stillbirth double if you go over 41 weeks”. You find, however, when you look at the actual numbers, that there’s a lot more to the story. And that it’s a lot less scary than it initially sounds.
So let’s dive in.
First and foremost, a baby born to a mother who tested positive for GBS has a 50% chance of being colonized with the bacteria. And it’s important to note that being colonized is very different than the baby actually getting infected with the bacteria. A baby being colonized with GBS bacteria does not always equal a baby getting sick from GBS.
According to the American Pregnancy Association, “If you test positive for GBS, this simply means you are a carrier. Not every baby who is born to a mother who tests positive for GBS will become ill. Approximately 1 out of every 200 babies whose mothers carry GBS and are not treated with antibiotics will develop signs and symptoms of GBS.”
“For a mom with a positive GBS test that doesn’t receive group B strep antibiotics during labor, a baby’s mortality risk from GBS is 0.001% when born at term or 0.01% when born preterm.” Source: Tiny Health
If a baby is born showing signs and symptoms of GBS, it is a very serious condition, and usually does result in a NICU stay and treatment for the baby. Depending on the severity of the infection, the treatment and time in the hospital will look different for each baby.
According to Cedars Sinai, here are the signs and symptoms of a GBS infection in a newborn:
Newborn babies with GBS usually have signs in the first 24 hours after birth. These signs may include:
Being fussy, very sleepy, and having breathing problems (signs of sepsis)
Breathing fast and making grunting noises (signs of pneumonia)
Having breathing problems and periods of not breathing (signs of meningitis)
Having a change in blood pressure
Having convulsions (seizure)
Babies who get GBS a week or so after birth may have signs such as:
Decreased movement of an arm or leg
Pain with movement of an arm or leg
Breathing problems
Fever
Red area on the face or other part of the body
If you notice any of these signs, you should of course call your doctor/pediatrician immediately.
Did you know… many other countries DO NOT routinely test for GBS?
The Royal College of Obstetrics and Gynaecologists states: “The UK National Screening Committee does not recommend testing all pregnant women for the presence of GBS using vaginal and rectal swabs. This is because:
Many women carry the GBS bacteria and, in the majority of cases, their babies are born safely and do not develop an infection
Screening all women late in pregnancy cannot accurately predict which babies will develop GBS infection
No screening test is entirely accurate: a negative swab test does not guarantee that you do not carry GBS
Many babies who are severely affected by GBS infection are born preterm, before the suggested time for screening (35–37 weeks)
Giving antibiotics to all women who carry GBS would mean that a very large number of women would receive treatment they do not need.”
Source: The Royal College of Obstetrics and Gynaecologists
This makes you wonder why the US screens every single woman for GBS. It makes you wonder if money is somehow involved… (spoiler alert, it is. Keep reading).
Preventing GBS
As with anything, we cannot definitively say there is a way to prevent GBS. However, there are ways you can support your body through nutrition and high-quality fermented foods that support your gut and vaginal microbiome throughout pregnancy. When you create a healthy internal environment in your body, that lowers the chances of having an unhealthy imbalance or overgrowth of unwanted bacteria, such as GBS.
Here’s how we recommend supporting your vaginal and gut microbiome during pregnancy to decrease your odds of developing an overgrowth of GBS bacteria:
Eating a very nutrient-dense, mineral rich diet - eating a low quality diet with foods that contain chemical ingredients like artificial sweeteners, food dyes, preservatives, etc (AKA - most foods in the Standard American Diet) are shown to disrupt the microbiome and lead to overall less healthy mothers and babies.
“In conclusion, maternal nutritional and mental health profoundly affect child health during pregnancy.” Source: PMID 38098932. We recommend eating the most nutrient-dense diet possible, especially during your fertile years, which we discuss in-depth (and teach you how to do) in our 170-page eBook, Eat Your Prenatal.
An NCBI study on the consumption of ultra-processed foods and the health of the gut microbiome concluded “Artificial sweeteners, emulsifiers, preservatives, and food additives disrupt the delicate equilibrium of the gut microbial ecosystem, reducing microbial diversity, promoting a pro-inflammatory environment, increasing intestinal permeability, and contributing to inflammation and dysbiosis”.
Eating fermented foods - foods like sauerkraut, yogurt, sourdough bread, and small amounts of kombucha and kefir, etc. are all foods that are rich in probiotics and can help support a healthy microbiome. These foods are very important and should be included during pregnancy. There is more information on this topic in Eat Your Prenatal.
Taking a high-quality probiotic that focuses on vaginal health - one of the probiotics we love and recommend for vaginal-health support in pregnancy is Flora-V by Organic Olivia. Be sure to consult with your midwife or OB before taking this probiotic. (Side note - this probiotic has been shown to be really helpful for yeast infections & UTIs as well).
If you feel your vaginal health is in a good place during pregnancy, you do not need to take this your entire pregnancy. We recommend starting a probiotic like this in the third trimester, or around the 30-week mark, as you approach your GBS testing date and get closer to delivery.
Your GBS Testing Options
Now that you understand the actual risks of your baby being born with a positive GBS test and how they would be treated, and how to create the best possible environment to prevent GBS, let’s explore your options of how you can navigate GBS testing and treatment.
The way we see it at Aligned Motherhood Collective, you have four options that we’ll break down in the following sections:
Option 1: Decline GBS testing altogether
Option 2: Accept GBS testing, but take measures to reduce your chances of being GBS positive prior to testing
Option 3: Accept GBS testing, and if you are positive, follow a certain protocol to help reduce your chances of GBS being present when you give birth
Option 4: Accept GBS testing, and if you are positive, take IV antibiotics during labor with informed consent of the downsides and risks of IV antibiotics
Before we get into this, it is very important that you understand the GBS protocol of your birth providers (aka - how they handle a positive GBS and the “rules” they have in their practice). Let me explain.
A friend of mine had decided to give birth at a birth center with midwives. She accepted the GBS test, was positive, and was planning on declining IV antibiotics. However, she didn’t learn until it was too late that the birth center required her to take the IV antibiotics in labor. If she didn’t, they were going to force her to transfer to the hospital.
Since she didn’t learn this until she was in labor, she felt forced into taking the antibiotics so she didn’t have to transfer care during labor. She had a successful birth at the birth center, but felt that many of the gut issues her son experienced later in life were due to the the IV antibiotics (more on this topic at the end of the article).
I share this story to encourage you to immediately ask your provider what their protocol for GBS is, so that if you don’t feel comfortable with it, you have the time and ability to switch to a provider who is more aligned with your desires for birth.
Now let’s get into your options.
Option 1: Decline GBS testing altogether
Your first option when it comes to GBS testing is to decline testing altogether. Just like everything else in pregnancy, you have the right to accept or decline any offered screenings or interventions. Again, just be aware if your provider has a strict GBS protocol, and be sure to make note of that before moving forward with working with them if you plan to decline testing.
Declining GBS testing has benefits, especially if you don’t plan on accepting the standard “treatment”, which is IV antibiotics. I (Annika) declined GBS screening because my midwife fully supported my decision and did not have any further requirements for me. She simply offered it, and that was it. In a home birth setting anyways, midwifes cannot provide IV antibiotics. So the reason for taking the test was for two reasons: so I had the knowledge of whether or not I was positive if I wanted it for personal reasons, OR in the case of needing to transfer, so the hospital knew and could recommend the IV antibiotics. If you decline testing and are transferred to the hospital, you are treated as positive and recommended IV antibiotics.
The reason I declined the test is because I did ask if they would allow me to re-test if I was positive (and I was planning to follow a protocol if I was positive, to lower the chances of having it at birth) and my midwives told me that wasn’t an option (again, due to the extended testing length since test has to be sent to a lab to see if it grows a bacteria).
Second, I knew that worst-case scenario, if I were to need to transfer to the hospital in labor, I would not accept IV antibiotics. The only reason I was considering testing in the first place was to hopefully get a negative test result to avoid getting pressure from the hospital staff if I had to transfer.
I also felt confident that I had been taking the right steps to ensure I had the healthiest gut and vaginal microbiome possible. I had been following the steps listed above (nutrient-dense diet, fermented foods, and Flora-V probiotic in third trimester), had a very healthy pregnancy, and was feeling great.
Option 2: Accept GBS testing, but take measures to reduce your chances of being GBS positive prior to testing.
As discussed above, there are measures that may support your body in maintaining a healthy balance of bacteria and potentially reducing the likelihood of testing positive for GBS. Remember, is not possible to completely prevent GBS colonization, but there are some practices that offer additional gut and vaginal health support prior to testing. One reason some women choose this approach is to reduce the likelihood of pressure to receive IV antibiotics if they transfer to the hospital during labor or are planning a hospital birth.
These same measures discussed above, such as: eating a nutrient-dense diet, regularly consuming fermented foods, taking a high-quality probiotic with a focus on vaginal health, and prioritizing overall gut and vaginal health through nutrition and lifestyle, can be implemented or intensified in the weeks leading up to your GBS screening to increase the chances of a negative result.
You can also take a more targeted approach, and the one we would personally do is a preemptive garlic treatment. This involves placing a clove of garlic vaginally overnight for several days prior to the test. An NCBI article states “Garlic kills GBS, but because no profit can be made from its use, no research exists on the use of garlic to prevent GBS in newborns.” Makes you wonder why the official protocol for GBS is IV antibiotics during labor (something that can be profited from), and not garlic (something that cannot be profited from)…. follow the money, right?
Since the above article was published nearly 25 years ago, some additional research has been done on garlic at this point, which continues to show the benefits of garlic as a GBS treatment.
A quote from a study from the American Society of Microbiology states:
“This study found that two peptides and an ajoene (E and Z) mixture were the most efficient compounds isolated from garlic with respect to antimicrobial activity against GBS (S. agalactiae). These are extremely important findings, as they contribute to the possible development of a new medication for the topical treatment of S. agalactiae infection during pregnancy, instead of using prophylactic prevention methods during childbirth. The future development of such a treatment could help to avoid the indiscriminate use of antibiotics and the associated growth in bacterial resistance.
We hope that garlic as a treatment for GBS can become more mainstream in conventional and hospital birth settings, as garlic has been a recommendation that home birth midwives have been aware of for a while now:
“Some midwives recommend increasing the consumption of garlic as a more traditional way to fight GBS infection. Another recommendation is to insert a freshly cut garlic clove into the vagina (2 to 3 inches in) at bedtime and remove it in the morning, for 3-6 weeks, which can also help with long-term GBS infections in non-pregnant women.” Source: Tiny Health
If I (Annika) was going to have the GBS test, I was planning on preemptively inserting a garlic clove prior to testing, to help increase my chances of the test being negative for GBS.
Option 3: Accept GBS testing, and if you are positive, follow the same preventative protocol to help reduce your chances of GBS being present when you give birth (even though you won’t be able to know if you’re positive at the time of birth or not).
If you were to take the GBS test and be positive, the steps we would personally take would be:
Increase fermented food consumption
Start taking a vaginally-supportive probiotic if you haven’t already
Follow the garlic protocol above
Decide whether or not you will consent to IV antibiotics, knowing you will likely be pressured to take them (more info in the next section)
Option 4: Accept GBS testing, and if you are positive, take IV antibiotics during labor with informed consent on the downsides to IV antibiotics.
Research has shown that IV antibiotics given during labor do negatively impact the baby’s and mother’s gut microbiome.
Before consenting to antibiotics during labor, please be sure to read this section so you are fully informed, and have a plan for restoring both yours and your baby’s gut microbiome post-delivery. Let’s look at some research:
“Antibiotics given to mothers during childbirth could alter the infants’ gut microbiota, a new study finds. The research, published in Scientific Reports, suggests that the effects of childbirth antibiotics on newborns’ health may be more marked than anticipated.”
Birth is a critical time window for bacterial colonization of the gut. Previous studies have shown that Caesarean section reduces the diversity of the gut microbiota, and fetal and early-life exposure to antibiotics have been associated with the development of asthma in children.” Source: The Microbiome Post
“At three months of age, vaginally born babies whose moms received intrapartum antibiotics (IV antibiotics during labor) had significantly lower abundance of beneficial Bifidobacterium than unexposed babies.” Source: Tiny Health quoting an NCBI Study
“Babies whose moms received intrapartum antibiotics had higher levels of Firmicutes at 10 and 90 days of age and lower levels of Actinobacteria at 10 days of age [25]. An example of Firmicutes are Enterococcus bacteria, which ideally are not present in high levels in babies. An example of Actinobacteria are Bifidobacterium species, which provide many benefits for babies.” Source: Tiny Health
Mothers who accept IV antibiotics during labor do not get out unscathed either. We know that antibiotics disrupt the microbiome significantly:
“This review has summarized the importance of the gut microbiota in host metabolism and immune functions such as immunity development, colonization resistance, cell signaling, and with the help of advanced omics technologies, the complex interactions between host and microbiota are now becoming clear. Antibiotics disrupt the microbial balance and hence the networking within the bacterial community, and that with the host.” Source: PMID 35212478
You accepted IV Antibiotics… Now What?
If you did accept IV antibiotics during labor for GBS (or any other reason), please know that our intention is not to make you feel like you made a mistake, but rather, to help you navigate how to support yourself and your baby going forward.
When it comes to your baby, here’s how we (Annika and Emmalee) would handle restoring our baby’s gut microbiome post-IV antibiotics in labor:
Breastfeeding - breastfeeding is hands-down the best way to support your baby’s delicate microbiome. An NCBI study even showed that breastfeeding helps reduce some of the negative implications from IV antibiotics during labor: “Intrapartum antibiotics in caesarean and vaginal delivery are associated with infant gut microbiota dysbiosis, and breastfeeding modifies some of these effects. Further research is warranted to explore the health consequences of these associations.”
Take a probiotic as a breastfeeding mother - did you know that the mother’s microbiome influences breastmilk quality? An NCBI study states: “Maternal diet can impact the milk microbiome, and maternal diet can impact the infant gut microbiome, both negatively and positively.” Mom’s microbiome is established by the food she eats and environment she lives in, which is why supporting your body and microbiome as a mother is so important in determining the quality of your breastmilk and the health of your child.
Give your baby a probiotic - if your baby needs support over and above breastfeeding, a high-quality infant probiotic is what we would recommend next. A brand we have heard good things about (but neither have us have needed to use personally) is Smidge. Additionally, here is an article that can help you pick the best probiotic or answer questions on choosing a probiotic.
An infant gut test - if breastfeeding and a probiotic have been implemented but your baby is still showing they need additional gut support, we would personally move to a gut test for our baby. We recommend Tiny Health for gut testing. Not only do they offer the testing, but with the purchase of each test kit, is an included personalized results review session with a microbiome specialist. So you won’t just be getting test results and guessing what you should do from there.
Don’t forget that you’ll need support too! If you accepted IV antibiotics during labor, please be sure to focus on all the steps we’ve discussed previously in this article to support your gut microbiome. Those steps are:
Eat a nutrient-dense, mineral-rich diet devoid of processed foods. This is critically important postpartum, whether or not you’ve had IV antibiotics. You can purchase Annika’s postpartum meal prep course + cookbook here: The Postpartum Kitchen Meal Prep Course + Cookbook.Use code AMC at checkout to save $30 (get it for $39 instead of $69).
Include high-quality fermented foods
Take a high-quality probiotic
Before You Go…
Remember that Aligned Motherhood Collective is a community space. We’d love to hear from you in the comments. Please feel free to ask any questions and share your experience with us below.
In alignment,
Annika & Emmalee
Disclaimer: nothing in this article and nothing shared by Aligned Motherhood Co. is ever to be taken or misconstrued as medical advice. The following information reflects only the thoughts and opinions of Aligned Motherhood Collective, but is NEVER medical diagnosis, prescription, or recommendation. GBS is a medical condition and must be discussed with a medical professional. Always consult your doctor.
Sources:
American Pregnancy Association - GBS Information & Stats
Cedar’s Sinai - GBS Signs, Symptoms, and Treatments
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