A Holistic Approach to managing GBS (Group B Streptococcus)
Apr 19, 2024
We have collaborated with Laura Rose who is a Registered Nurse and an experienced Midwife at The Royal Hospital for Women in Randwick for her clinical view and Midwife perspective alongside Bree Wallace, a Certified Nutrition Consultant through Oh Baby Academy.
This blog is to provide women with evidence based ways to manage GBS if you do happen to test positive, or if you are deciding whether to be tested or not, particularly if you wish to avoid Antibiotics if they aren't necessary.
Group B Streptococcus (GBS) is a common bacterial infection that can be present in a woman's vagina, rectum, and intestines, with approximately 25% of healthy adult women carrying the bacteria without symptoms. While routine testing for GBS is done during pregnancy, not every baby born to a GBS-positive mother will become infected. However, if transmission occurs during birth, it can lead to serious complications for the baby, including sepsis, pneumonia, or meningitis.
Traditionally, medical management of GBS involves administering antibiotics during labour to reduce the risk of transmission. However, for women who wish to have a minimal antibiotic or medical approach in their pregnancy this can feel overwhelming. This approach can impact a mother's and baby's microbiomes by overuse of antibiotics unnecessarily, we will explain why shortly. Research suggests that antibiotics can disrupt the balance of beneficial bacteria, which play a crucial role in birth and breastfeeding.
Here is the thing...GSB is a transient bacteria and can usually correct by 36 weeks if holistically managed. The bacteria can come and go. Routine screening recommendation at 35-37 weeks however if a women's tests positive, it is not routine to retest so women can make an informed decision. Unfortunately, most women aren’t provided with the evidence and just told about hospital policies and then feel obliged to abide by the recommendation which is disappointing.
When a woman declines screening or treatment it should always be respected. The main thing is to ensure she is well informed – A midwife has an obligation to provide non-bias adequate evidence-based information to support women to make an informed choice and provide appropriate care.
Hospital policy recommends women who have not screened - “GBS unknown” to have antibiotics when there is another risk factor present for example preterm labour, fever, and when waters have been broken for over 18hrs.
It can be common for women who have declined hospital recommendations to screen at 35-37 weeks, but then requested to screen at 39-40 weeks if still pregnant. Also, the other way around who have screened positive at 35-37 weeks, and then retested closer 40 weeks and made a choice then re consideration of antibiotics, however, depending on the model of care, this may not be health provider led, it must be requested.
As discussed, GBS Bacteria can be transient which means it is possible to have a proactive, holistic approach to managing GBS which may involve supporting the microbiome through nutrition and lifestyle changes. Studies have shown that probiotic supplementation can reduce GBS colonisation and inhibit its growth. Additionally, consuming fermented foods, high-potency probiotics, and adopting a low-sugar diet can help nourish the microbiome and reduce the likelihood of GBS colonisation.
For women who test positive for GBS, an elimination protocol can be implemented alongside the prophylactic protocol. This includes consuming raw garlic, using raw apple cider vinegar in baths or rinses, and ensuring adequate vitamin C intake. These measures, when combined with a focus on reducing risk factors during labour, can help support the microbiome and reduce the risk of GBS transmission.
Empowering women with knowledge about their bodies and providing holistic support during pregnancy can lead to better outcomes for both mother and baby. Engaging a naturopath or nutritionist to support you holistically during pregnancy and by focusing on nutrition and lifestyle changes, women can take an active role in managing GBS and supporting their overall health and well-being during pregnancy and childbirth.
References:
If you want to dive deeper: https://evidencebasedbirth.com/groupbstrep/
This is an example of a hospital policy: https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/GBSprophylaxis%202020.pdf
https://www.cdc.gov/groupbstrep/about/index.html
https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm?s_cid=rr5910a1_w
https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/group-b-strep-infection/
https://pubmed.ncbi.nlm.nih.gov/21864820/
https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm?s_cid=rr5910a1_w
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464665/
https://pubmed.ncbi.nlm.nih.gov/11799376/
