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Monday, 6 August 2012

Group B Strep in Pregnancy

One year ago...

“Did you know you have Group B Strep?” my GP asked.

“No. What’s that?” I was panicking immediately.

“Nothing to worry about really, it's a bacteria.” she explained, “We just need to make the hospital aware of it if you get pregnant again.  They’ll need to give you antibiotics when you go into labour”.

And that was that. I didn’t give it anymore thought. Until I became pregnant again.

Group B Strep is a bacteria that colonises in up to 30% of adults in the UK - but most will never know about it. Usually, it is revealed when you are tested for something else. (In my case, via a urine sample for a suspected kidney infection.)  Group B Strep comes and goes, you don’t know when you may or may not be an active carrier.  It can usually exist within our bodies without causing any harm, the exception to this is that it can be passed to newborn babies in childbirth, and sometimes cause life threatening infections. According to the charity GBSS, 75 babies die as a result of Group B Strep related infections in the UK each year. Pregnant women in the UK are not routinely tested for Group B Strep. In other countries, the US, Australia, Canada and Spain, they are.

May 2012 - Hospital Booking in Appointment.
 

Apart from the two hour wait, everything seemed to be progressing as I’d expected at my hospital booking in appointment.  When finally, I got to the front of the snail like queue to see the midwife, I felt positive.  I planned to inform her that I’d like to have my second baby in the birthing centre again and that my hope was to have a similar birth experience to the one I had with Pip.

She flicked open my hospital notes, working through the standard questions and answers at lightening speed. When we got to my GP’s referral letter everything changed.

“You’ve got Group B Strep” she said.

She made it sound like a dirty word. “Well, yes, I believe so, but I understand it shouldn’t be a problem?”  I stammered.

Silence.  She reached into the drawer by her side and pulled out a sheet of bright yellow stickers.  GROUP B STREP ALERT - emblazoned in bold caps type.  With no further words, she started to apply the stickers at pace to the front of the folder and various pages inside it.

In the conversation that followed any dreams I had of replicating the positive experiences of Pip’s birth were shattered.  A series of ‘No’s’ followed.  No birth centre. No water birth. No. No. No. "This is hospital policy for GBS patients."  I was informed I would need to have my baby on the labour ward, that I needed to admit myself as soon as my waters broke. That I would need IV antibiotics from that point and throughout the labour, to offer protection to my baby on his journey into the world. I thought back to my conversation with my GP. I'd assumed all I'd need to do was take a couple of pills.

I managed to hold on until I got to the car park, and then I phoned my husband and cried. Not just for me, but for my unborn baby, the reality of being a GBS carrier catapulting towards me like a weighty stone.
  
July 2012 - Appointment at 21 weeks

At my next appointment I asked the same questions, but of a different midwife. I got the same answers.  I left the hospital resigned to my fate, that baby no 2’s birth was going to be a very different experience.

I’m a prowler; in times of stress, tension, waiting, I like to pace. I don’t like to be still. The thought of being restricted by an IV drip fills me with dread.  During Pip’s birth, I found water gave me excellent relief from the pain of contractions, but that option is not available to me this time; they want to monitor the baby throughout and the hospital claims that will be more difficult in the water. I used hypnobirthing techniques when I had Pip and I felt they really helped. Yet, as a whole, I believe it was the combination of this and being in the water that got me through it.  I feel apprehensive that I won’t have the benefit of the water this time.  The fall back position of ‘I’ll have an epidural if it all gets too much’ is not an option for me either.  I have a scoliosis of the spine and there is no way I plan to let anyone near my back with a needle unless a dire emergency demands it.

When I think about the birth, I feel tense. I feel scared. Not just for me, but for baby too.

When I wrote the post about Pip’s birth last week, it helped. It helped to recall the positives of the hypnobirthing and how I felt as his birth approached.  To remember, in preparing for his birth, that my goal was about getting him into this world safely and not so much about me.  I’m trying to remember those feelings and feel the same way. But, this time, it feels so much harder.

At the end of the day, it’s a good thing we know I’ve got Group B Strep. Precautions can be taken, and after the birth, our baby will be monitored every couple of hours for the first 24 hours.  If he’s not thriving, he may be given antibiotics too. Even though I know the chances of our baby being infected will be reduced if I take antibiotics during labour, I'm finding it hard not to worry about the 'what if's.'

The one glimmer of hope is that there is an option to pay for a private test at 37 weeks to see if the GBS is active in my body at that point. If it isn’t, then theoretically, it shouldn't return before my due date.  If this is the case it will go a huge way towards putting my mind at rest before the birth, and will also mean I can have a more 'active' birth experience.  If the test comes back positive, then at least I know that too and will have time to mentally prepare myself.

In all of this, the thing I find most ridiculous, (given all the precautions my hospital are now taking), is that they don’t routinely test pregnant woman for GBS in this country.  Especially when one considers that taking precautions to manage potential infections can ultimately save babies lives. 

I wish it wasn’t this way, but it is, and I’ll deal with it, because I have to and the health of my unborn baby is the most important thing.  It's time to draw on my grit, practice my stiff upper lip and dust down that hypnobirthing CD again.  

Have you or your baby been affected by Group B Strep? If so, I'd be very interested to hear your story.


Further information on Group B Strep can be found at www.gbss.org.uk. GBSS is a charity campaigning for GBS testing as part of routine ante-natal care for all pregnant women in the UK.

29 comments:

  1. I've not had any experience of Group B strep (but I have heard of it - mainly due to being manic reader and worrier during pregnancy!)You sound like you have got yourself in a good place about it all now though and I'm sure you will be fine. If it's any consolation I was completely panic stricken about my second birth for absolutley no reason (maybe just because I knew what was coming!)Oh and Congratulations by the way - I have been so crap at commenting lately that I haven't even said that - two is good (mostly!)xx

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    1. Thanks RC Mum. Am looking forward to two. x

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  2. I had it with my first (and might with this but for some reason they don't have the results from last week when I had my appointment today). But as it was - it didn't make too much difference for me as you know I had an emergency section with my first and now I have to have a section with this one. They still do antibiotics but it's not really that much a risk since I won't vaginally deliver (so hear you on not getting the birth plan you want!) But before it seemed as though it wouldn't affect ANYTHING about the process I had planned other than I'd have to have an iv of antibiotics but I was still going to have a natural birth and etc. So, I wasn't that concerned.

    Anyway, I'm so sorry that you won't get that but agree with you that it's so good you know you have it because from my research and such it can lead to some serious problems for the newborn.

    And it's definitely nothing dirty! SO many of us have random high colonization of that bacteria. it comes and goes. Just because you have it with one pregnancy doesn't mean you'll have it in the next. IT's like gestational diabetes - you get hit randomly with it and there really aren't any precautions or ways to avoid it. It's just the luck of the draw! :(

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    1. Oh this childbirth business. If it's not one thing to worry about it's another! Thank you for commenting. It's very interesting to hear the perspective from the other side of the pond, as screening is routine in the US (I believe) whereas it isn't here. Probably means that it discussed/ dealt with far more often and more commonplace. I'm lucky we know I've got it. There are probably lots of pregnant women in the UK going into birth without any precautionary measures at all as testing for it is not part of routine ante-natal care here. Hope you are feeling well. x

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  3. Oh no, I'm really sorry to hear about this and how its dashed your expectations of having the birth you wanted ... I can't believe GBS isn't routinely tested in this country given the strong reaction to the birth of your baby. There's a high chance that you had it with Pip's pregnancy, and I guess, given that many people can have it, and not know about it, that there are many women having active births with GBS? Have you thought about hiring the services of a birth doula, http://doula.org.uk/ for extra added support during the birth - quite a few are now also trained in hypnobirthing too! X

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    1. Thanks for your lovely supportive comment and suggestions. I don't know if I had it with Pip as we didn't know I was a carrier then. I suspect maybe I did, as when he was a few days old he was admitted to hospital with an infection and was treated with antibiotics until he was better. (Involved a prolonged stay on the Edith Dare ward at QCH - nightmare!)

      I guess I will just have to get my head around the different birth experience. Doula is definitely something I will think about. Thank you.x

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  4. Hi. I had GBS with my second baby. As soon as he was born he was taken off to the paediatricans to be checked as he was breathing oddly, then taken to Special Care while I was in recovery. I had to make do with photos that my husband had taken of our baby for the first hour or more. We then had a few days of various tests trying to find out what was wrong, including tests for pneumonia and menengitus. Anyway, in the end he had a non-specific inflammatory infection and was fine. We had to stay in for 5 days while he had antibiotics to treat it. Apart from when he was first born, he never seemed unwell, and he did leave Special Care & come up to me on the ward the night he was born.
    It was days after the birth that I found out I had GBS, so I think your idea of a private test is a good one. I think its terrible that it isn't done routinely. I was told in passing by a midwife, just as my milk came in, that I had GBS. Then he left me to Google it on my phone, and read all the frightening statistics about how it can affect babies!!
    Good luck with it all. x

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    1. Thank you so much for taking the time to read and leave a comment about your experience. I really appreciate it. I don't understand why they don't routinely test for it either - cost to the NHS I expect. I agree, when you're told you've got it, it is frightening to look at the statistics and think what if it's my baby? Thanks so much again. x

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  5. Hi, I don't know how relevant my experience is as my Son is nearly 12. But I had GBS with him. It was discovered in a routine test for something else at about 38 weeks. I was quite scared because I'd seen a story on Corrie the year before otherwise I would never have heard of it. Anyway I had antibiotics in Labour, but not as a continuous IV - As far as I remember it was an injection and then more injections at regular intervals (4 hourly I think) during labour. My boy was swabbed and monitored etc. after birth, but all was fine, well at least nothing related to GBS.
    When I was pregnant with my daughter I asked the midwife about testing. Like you I was told it wasn't routine and they wouldn't usually do it, but in the end, as I had had it with my first baby they did do a test at 37/38 weeks and it came back negative, so no issues.
    As I say I don't know how relevant this is because it was a while ago now and I'm no medic, but it does seem odd to me that they won't do a test at 37 weeks for you and that you can't just have the antibiotics as four hourly injections - instead they would rather you were in hospital, which I'm guessing would be a far more costly option for the NHS as well as not being exactly what you want.
    Anyway I hope I haven't confused you further and I really hope it all goes well.

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    1. Thank you so much for commenting and sharing your experience. It's ridiculous that the NHS won't do a test at 37 weeks, but I am prepared to pay for it myself - at least then as the birth approaches I will know for definite what the situation is.

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  6. Hi Mummy Plum

    I'm so sorry that GBS being found before this pregnancy has resulted in all this aggro. If the UK screened pregnant women routinely for GBS, then you would know your GBS status this pregnancy AND health professionals would be so much better informed about group B Strep.

    I agree it's good to know about group B Strep. As you say, many women have their babies without knowing about it. Whilst most of their babies will be unaffected by GBS, some won't and distressingly most of their horrible infections could be prevented. Without knowing about group B Strep beforehand, you can't arrange effective preventative medicine.

    It does seem daft that the NHS pretty much insists Mums have intravenous antibiotics in labour when it is found during the current pregnancy, despite not testing for it!

    Anyway, please forgive my rant - the purpose of leaving a message (apart from agreeing with you!) was to say that I don't know of any evidence against having a waterbirth simply because you're carrying GBS. There was an article published in Practising Midwives a few years ago you can read / give to your health professionals. See http://www.gbss.org.uk/filepool/2007_04_Practising_midwife_water_birth_article.pdf.

    I'm surprised that your health professionals want to monitor you throughout, although it's certainly possible and not that difficult to monitor Mums in birthing pools.

    I don't like IVs either but it really shouldn't restrict you that much. Check with your hospital, but usually they put a cannula in the back of your hand and give the antibiotics through that at 4-hourly intervals. In between times, they leave the cannula there (so they don't have to search for a vein each top-up time), but it shouldn't mean you're immobile or anything.

    Do talk with your health team - your obstetrician and/or the supervisor of midwives should be able to give you the most up to date position on what your hospital's policy is. And do contact the guys at Group B Strep Support (01444 416176 - www.gbss.org.uk); they're very helpful and talk a lot of commonsense.

    At the end of the day, the most important things are having a healthy baby and a healthy Mum but there's no reason why you shouldn't be able to have pretty much the birth you want too as well. Good luck!

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    1. Hi Jane. Thank you very much for your helpful comments and insight. I will certainly share the article re: water birth with the health professionals at my hospital. I had already planned to talk to the supervisor of midwives, thank you, another good suggestion. I have referenced the GBSS website at the bottom of my post - agree, it's a great website with lots of useful information there.

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  7. I get tested for this at my monthly check-ups but I never really understood what it was. So sorry that it's taken away a little cheer from your pregnancy. You might not get the birth that you dreamt of but now they can at least monitor you and ensure a healthy baby and mum. If it's any consoloation I was on a drip during labour and for 48 hours afterwards and it wasn't actually that bad. I dreaded the cannula but after 5 minutes forgot it was there. So sorry xx

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    1. See, the Swiss know what they are doing. Thanks for the feedback on the drip - good to know. x

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  8. I had only heard of it when my partner's cousin's newborn was suspected to have that infection a few months ago. I too didn't realise it was as big a problem as it is, and also very surprised to find out that they don't routinely do check ups to see who is a carrier-especially when it can save the babies lives!

    So sorry that you don't get to have the positive experience you wanted to have, but every birth is different and you never know it may not have helped as much as first time around. At the end of the day as long as you and baby are ok that is the main thing-you will forget all the horrible bit of labour as soon as you hold your little one for the first time again anyway. xx

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    1. Thanks Handmade Mum for the words of support. You're right, the end goal is for us both to be ok. x

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  9. I tested positive for group b strep at 36 weeks with my 2nd daughter. I went into delivery as I thought I was leaking fluid and they took a swab. I was notified in writing, the letter was accompanied by a leaflet detailing all the scary consequences if this thing is passed onto my baby. I freaked. I had had bleeding through out this pregnancy due to a blood clot in the uterus. I thought I had lost this baby numerous times and had been on bed rest through out. This was the final kick in the teeth.my consultant decided it best I be induced at 38+3. I had the Iv antibiotics but my daughter was born in 1 hr 15 mins so I may aswell not have had them! We were kept in for monitoring for 48 hours and thankfully she was not infected.

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    1. Thank you so much for sharing your story. It sounds as though you had a difficult pregnancy, and I'm sure discovering you had GBS at later stages did not help. I'm so glad that it all worked out for you and your daughter.

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  10. Hiya. I had it with my 2nd. Had to have him in hosp after a 'perfect' (still traumatising) home birth with my first. I was told to get up to Labour Ward early for the drip, but then they told me to stay away when I first 'phoned, so ended up going in too late for the IV drip as little one arrived after half an hour after getting there (tip - stick to your hypnobirthing breathing and ignore their shouts - and see if any of them have had a baby anyway!) so it was my baby who ended up with a cannula and an IV drip for two days instead of me for two hours when he was only a few hours old - as a preventative measure. He also got woken up every few hours for routine checks for signs of infection so became irritable and it took two years to get him through the night. If I could turn back the clock I would - an IV drip for you vs. one for him? Hope that makes you feel better?! And go in much earlier and expect a quicker but more intense labour XXX

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    1. Great advice. Of course you're right, I'd much rather have an IV drip than baby. (Pip had one at 1 week old for an infection and they also had me waking him up every 3 hours to feed him - it was terrible - in all respects and funnily enough he didn't sleep for 2 years either.) Thanks again for the tips and for your lovely supportive comment.x

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  11. Hi, I had strep B with baby no 1 & 3 (not number 2). First labour was long so had the IV drip, third labour was quick so he had to have 48 hours of antibiotics, not great, but my cousins baby almost died from undiagnosed strep b, so worth it.

    I was tested free on the nhs after asking as read about it in a magazine. X

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    1. Thanks Nina. In reading everyone's experiences it seems that if it's a quick labour and Mum doesn't get time to absorb the antibiotics, in most cases all babies have been given antibiotics for the 48 hours afterwards. Will just have to make sure I get to the hospitial quickly when the time comes! Thanks for sharing your experience, hearing from others who have been through it has helped to put my mind at rest. x

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  12. I haven't but I have a friend that has. I guess the hospital want to be on the safe side but what an insensitive way of dealing with you. I'm pretty sure my friend had a water birth too...

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    1. I think policy on water birth varies from hospital to hospital. I'm going to go back and push for it again. Thanks for commenting.

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  13. I took a private test for TC's pregnancy as I read about Strep B & the NHS declined to test me. Came back negative but still glad I tested. With my first many moons ago, no-one ever mentioned it so I was none the wiser, these days with the internet I knew way more (& sometimes more than I really want to know!) so was more prepared. I had GD with TC too & refused insulin, I managed it really well with diet, but the 3-4 times daily pricking of my poor fingers to test really was tiring but I did it for her (11 long weeks of it!) and got some lovely extra free scans along the way. Have the test MP I paid £32 & got the kit free from somewhere I can't remember but Mr Google will help you. Big piece of my cake for you xx

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    1. Thanks MLM. I am definitely going to pay to have the test privately. Just really have to wait now until 37 weeks and see what the results are. Thank you for the cake. xx

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  14. I hope they can explain things better and don't make it as scary as it sounds. I hope you get to have a positive experience. Hugs x

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  15. Flipping 'eck. I need to raise a fuss about this at my next appointment at 36 weeks and a make sure they test me. Thanks for a great and informing post x

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