I said a few posts back that I was intending to do a post about Group B Strep (GBS) which I was diagnosed with last month. This is that post.
DISCLAIMER:- I am not a medic, in fact I only got a D in GCSE Science. Whatever I write about GBS here is just a mix of information I've learnt from different websites and leaflets from the hospital.
Seriously if you type 'Group B Strep+pregnancy' into Google you will find scores of sites. You'll find medical advice from different countries and forum debates. In amongst these are people's stories and experiences about perfectly healthy babies, illnesses caught and treated and also experiences of infant death or disability caused by GBS.
Some of the best info I've got has come from
Mumsnet forum but I am slightly biased as I love this site for every sort of debate, advice and time-wasting imaginable.
Also good is the UK based
Group B Strep Support and the hospital info I was given was taken from this site.
If you're looking for some medical info about the use of IV anti-biotics for treating GBS in pregnancy then you could do worse than read this
Cochrane Summary. To be honest I have only skimmed it, but will read it fully closer to the time of my due date and before speaking to the Consultant next month.
When I was diagnosed with GBS it was following an internal examination and resulted in me being given a 5 day course of oral anti-biotics. GBS is a common bacteria found in around 1 in 3 women at any one time, in itself it isn't harmful and people rarely are aware they carry it. The only reason it was an issue for me is as I'm pregnant.
www.sogc.org says "It is estimated that 15 - 40% of all pregnant
women are GBS colonized (which is have tested positive for the infection). Between 40 - 70% of
colonized mothers pass the bacteria onto their
babies during the birthing process. While most
babies are not affected by the bacteria, a very
small number (1- 2%) of these babies will go
on to develop a GBS infection. Babies who are
infected with GBS may have mild to severe problems
which may affect their blood, brain, lungs and
spinal cord. No one method of screening (testing)
and treatment will prevent all GBS infant deaths." (2011)
The way in which the baby is exposed to the infection is after the women's waters have broken, as till then they are a protective sac for the baby. Due to this, myself (and other women in my position) have been advised to go straight to hospital when our waters break so they can start off the IV treatment to best effect.
When my waters broke with Adam's labour I hung about at home for a few hours before the pain got too bad and I wanted to go to hospital. This time I just have to go straight in, which already worries me as I'm concerned about who I'll leave Adam with, what time of day it will be and if I'll have a long labour like I did last time (Adam's labour was 17 hours from waters breaking-his birth). Furthermore, waters breaking is only the first sign of labour for a % of women, but I suppose I'll find out what way this labour will go when it actually starts. All I know is, I need to be ready to get myself to hospital swiftly.
Some women are at higher risk of passing the infection on to their babies:
- If labour starts pre-term (which is before 37 weeks)
- Those who have labours lasting +18 hours
- If they have a fever during labour.
- If they have had a previous pregnancy with GBS
Likely there are other risk factors, but these are the main ones listed. To be honest at this stage I don't have any of these risk factors, but I suppose I'm still only 27 weeks, so don't know when I'll go into labour with this baby.
The treatment I've received so far has been to get those oral anti-biotics, to have 2 big 'Group B Strep ALERT' stickers put on my ante-natal notes (not quite a leper but still it certainly marks me out), and to be told by the midwife at my scan that I won't be under midwife led hospital care when in labour, but rather I'll be treated by a Consultant. We have a meeting with this Consultant next month and I'm looking forward to hearing what she has to say.
When I'm in labour I'll get IV anti-biotics every 4 hours (I think) and this is a preventative measure to ensure that the baby can have the treatment but without actually having to have the anti-biotics him/herself. If for some reason my labour is really quick and I don't get the IV, then he/she will have to be treated directly, which I really don't want.
I've read a bit about risks of anti-biotics for newborns, basically there is a slight chance their body could be allergic or reject the meds which could mess them up, but my thinking is that the chance is that small that it's worth the risk. I'm prepared to be swayed on this, but currently that's my thinking.
The hope is that this IV during labour will prevent the baby having the infection passed into their system. The hospital will keep baby and I in for around 48 hours after birth for observation. This is quite a nice thing and I think being in hospital will settle my nerves a bit, plus give me time to get used to breastfeeding again and to have some 1-1 time with this baby before I go home. Of course I'll miss Andrew and Adam (and Matilda the cat!!) but I know it's important to be in hospital.
The observation in hospital is really to look out for the 'early-onset' infection,
(ibid) "There are two types of GBS infections
that can happen to newborn babies. The most
common type is called early-onset disease. In
this case, the babies are almost always infected
during their journey down the birth canal because
the bacteria were in their mother's vagina.
The symptoms of early-onset infections show
up before the baby is seven days old. Some babies
show signs of this infection as early is six
hours after birth. Early-onset disease can cause
infections in a baby's lungs, brain, spinal
cord or blood. This type of GBS infection can
be very serious and frequently hard for a newborn
baby to fight off. This is the infection that
antibiotic treatment in labour is aimed at preventing."
The types of illnesses a baby can have range from meningitis, swelling of the brain, blood poisoning or infant death. Have read a few stories about these online, which is upsetting and worrying, but the vast majority of them have been in babies where in the infection wasn't know about in the pregnant mother and thus not treated during labour.
(ibid) "The second type is called late-onset
disease. In this case, the babies don't show
signs of a GBS infection until after they are
more than seven days old. About half of these
babies were also infected during their birth.
The other half became infected after the birth
by being in contact with their GBS positive
mother, or another person who is a carrier of
the disease. Late-onset infections can also
cause serious problems for the newborn. The
most common problem is meningitis - an infection
of the membranes which surround the brain and
spinal cord. The risk of late-onset disease
is not decreased by antibiotic treatment in
labour but antibiotics are available for the
baby once it is born. Babies with early-onset
disease are more likely to die than those babies
with late-onset disease."
I am sad to have GBS. I know there are many other issues I could have, but still I really didn't want to have GBS. On the other hand, I'm thankful that it was picked up because it means I can be treated. Screening for GBS is not routine in Northern Ireland, although it is in various other countries. There are campaigns to roll out routine testing in NI following the deaths/illnesses of babies in recent years:
I've been told that getting the IV during labour isn't a big deal, and I agree it isn't. I've had IV treatment before (with fluids and pain killers) when I was hospitalised with hyperemesis, and I'm not afraid of having a drip in my arm. I'm just worried about the possibility of what could happen to my baby, that unknown 'what if?' is hanging over me and I won't be able to settle till he/she is born and I see a picture of health.
I'm trying to just focus on each step:- getting through the final trimester of pregnancy, getting to hospital when my labour starts, ensuring Adam is well looked after, getting through labour and all the related blood and gore of that, and having my little newborn placed on my chest when it's all over.
I just want to be alright and for the newest addition to our family to be alright too.
Pray for us, please! Now while I'm pregnant and onwards till August comes.