Know your Group Beta Strep (GBS) options for your natural hospital birth plan
Blog Overview:
This 2-part blog series takes a balanced, confidence-building approach to understanding Group Beta Strep (GBS) during your pregnancy. You’ll learn how GBS relates to your body's natural microbiome, the birth process, and your natural birth plan. Let’s dive into part 2!
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What are your options for addressing GBS in pregnancy before birth?
In part 1 of this blog series on GBS, we covered how GBS, or Group Beta Streptococcus (Group B Strep), relates to your body’s natural microbial balance (aka, your microbiome) and how to weigh the big-picture pros and cons of GBS-related risks for babies and moms in pregnancy. If you haven’t read part 1 yet, we recommend reading it first for better clarity on this topic.
But if you’re ready for part 2, we’ll now look at your many options for testing and care around GBS, so you can make informed choices that align with your birth philosophy, values, and personal comfort level.
When it comes to GBS options in pregnancy, you have more options than just routine protocols.
When it comes to Group B Strep (GBS) in pregnancy, it's important to consider your options holistically, looking at both personal self-care and clinical care decisions. Thinking "upstream" can help you get ahead of potential issues, ideally before they arise. Here's an upstream flow of options to consider for GBS in pregnancy:
1. Practice essential self-care for your gut health and vaginal microbiome.
This is relevant throughout pregnancy and is best started early. Beneficially nurturing your microbiome can help reduce the risk of GBS-related problems later on. To do this, you’ll want to:
Focus on using a whole foods approach to nutrition that supports a healthy microbiome
Research probiotic food options and / or supplements, especially those containing lactobacilli to help restore balance to the gut microbiome
Make intentional care decisions to support overall gut and vaginal health, which includes your testing option decisions
Dr. Aviva Romm has a great article on protecting your baby’s microbiome from the start, which begins with yours! You can find it here: https://avivaromm.com/protecting-babys-microbiome/
Remember, gut health is connected to emotional and mental well-being, too. Stress can lead to inflammation in the gut, impacting your immune system and your body's internal harmony. Being intentional about stress reduction can support overall wellness, help manage blood pressure, and prepare you for a fear-free birth experience. So include reducing stress and processing challenging emotions in your self-care plans, as well.
2. Avoid practices that may increase GBS exposure to your cervix and uterus.
Here are three simple practices to consider that can lower the risks of GBS being translocated closer to your cervix and uterus during pregnancy:
Limit vaginal checks during pregnancy, especially during early pregnancy. These are not essential and can be declined
Be cautious with vaginal suppositories that could push bacteria closer to the cervix
Practice good vaginal hygiene, including wiping from front to back to avoid transferring bacteria from the rectum to the vagina after using the bathroom
3. Know that you have multiple testing options for GBS in pregnancy.
It’s rare for mamas to be told about all their options for how they can navigate testing for GBS in pregnancy besides the routine universal screen closer to 3rd trimester. But we’ve got you covered. Here's an in-depth look at your testing options for GBS in pregnancy:
1. Early testing via Urine Culture Analysis
There's significant value in considering early testing for GBS, especially if you have a history of UTIs or other vaginal health challenges. This can be done through a urine culture analysis, ideally in 1st or 2nd trimester before the routine screening is offered.
By testing early, you’d have the advantage of knowing your results in enough time that:
Allows you to identify if GBS is a challenge earlier in pregnancy
Provides an opportunity to make targeted care decisions for prevention, not just treatment
Gives you more time to implement self-care and clinical care strategies if needed
2. Routine screening at 36-37 weeks
In addition to early testing, or as a standalone option, you can undergo routine GBS screening between 36 and 37 weeks. This is standard prenatal care in the US and provides information about your GBS status closer to your estimated due date.
If you decide to screen at 36-37 weeks using the swab testing method, it's valuable to be proactive about the screening protocol you receive because there are different approaches used:
Some practitioners use one swab to collect specimens from both the vagina and rectum
Others use two separate swabs, one for the vagina and one for the rectum
The challenge with using just one swab is that rectal samples can increase the rate of GBS+ screening by 40%. If only one swab is used for both areas, you won't have information about whether the test result is more related to your rectal or vaginal sample. If you were only positive for your rectum sample and not your vaginal flora, this can be helpful information to consider in your self-care and clinical decisions.
Consider talking with your practitioner about their approach. You may want to specifically request that they use two swabs if that's not their normal practice, allowing you to see the test results for each swab separately for more detailed information.
3. Decide about re-testing closer to birth
GBS screening results from the 36-38 week range are considered valid for 5 weeks as a reasonable measure of likelihood for GBS status at birth. However, it's important to understand that GBS can be transient, meaning GBS can sometimes appear and then clear before birth, or it can also clear up and then reappear before birth.
Given this variability, you might consider discussing with your practitioner the possibility of re-testing closer to your EDD, especially if you initially tested positive. Keep in mind that tests usually need at least 48 hours to complete, which is why testing right as labor is beginning is often not practiced. So know ahead of time what your options might be for this if you’re interested in this approach.
4. Option to decline testing
It's important to note that you have the choice and option to not test or screen at all. Mamas may choose this option for various reasons, including:
Focusing solely on preventative measures rather than GBS test results
Trusting their intuition about what feels most peaceful for them
Deciding to navigate any possible GBS outcomes at the time of birth without prior testing
Making your decision on GBS testing should be based on your philosophy, values, and comfort.
Our primary encouragement is that, regardless of what you decide about GBS testing, you take full ownership of your decision based on your birth philosophy, values, and comfort levels. Know your "why" and ensure your choices align with your overall approach to pregnancy and birth.
Remember, GBS testing is just one aspect of your prenatal care. Consider how it fits into your broader birth plan and discuss any concerns or questions with your healthcare practitioner to give you ample time to decide and plan accordingly.
What if your natural hospital birth plan includes GBS in pregnancy? Use these questions as a guide.
If you did test positive for GBS and needed to weigh your options for your natural birth plan in the hospital, here are 4 specific areas you’ll want to consider in your prep process:
1. How do IV antibiotics fit into your natural birth philosophy and vision?
Photo by Stephen Andrews on Unsplash
How you define natural birth and set up your vision for a natural birth experience depends on your personal birth philosophy. This philosophy shapes your priorities and comfort levels with various aspects of the birthing process.
So if your natural birth vision is rooted in the idea of an "unmedicated" experience, it's important to consider how IV antibiotics align with this aspect of your philosophy.
If you also place a high value on protecting your and your baby’s microbiome, this will also likely be reflected in your birth philosophy and decisions.
So ask yourself these important questions:
Based on the research, how do I feel about the potential impact of GBS disease risks compared to my baby’s microbiome risks?
Would using IV antibiotics medicalize your birth in ways that are within your comfort level if you tested positive for GBS? Why or why not?
Knowing the possible risks and benefits of antibiotic use during labor, which outweighs the other for you based on your philosophy?
Taking time to consider these aspects in advance can help you:
Reduce the likelihood of feeling conflicted or regretful later
Make decisions that align with your values and birth philosophy
Feel more confident about your choices during the birthing process
The “right” answers to these questions will be unique to you, so take your time to consider them and feel them out in your heart, mind, and body. This introspection is key to upstream thinking and will help you clarify what you want for your birth and why you want it. Remember, choices made without a clear "why" can lead to confusion and inner conflict later, so avoid this and prepare ahead.
2. Do you want to prepare your natural birth plan using the “risk factor” approach to antibiotic use for GBS?
If you lean towards an unmedicated experience and want to minimize interventions, the risk factor approach to managing GBS during labor can be a valid alternative to universal antibiotic administration. This method involves giving antibiotics during labor only if certain risk factors are present, such as:
Premature labor
Having had a prior baby with a GBS infection after birth
Prolonged time with waters being open before labor begins (aka PROM, for 18+ hours)
Fever during labor
This approach is used in about 25 countries globally, including United Kingdom, Ireland, Norway, Sweden, and New Zealand, all of which have access to advanced healthcare options. Research shows that the risk factor approach results in roughly the same percentage of women receiving antibiotics as the universal approach.
However, it appears to be slightly less effective in preventing early-onset GBS disease, with rates of about 0.5 cases per 1,000 births compared to 0.2 cases per 1,000 births with universal screening. This relates to the fact that not all cases of high GBS colonization are symptomatic for some mamas, so no risk factor may present for a mama who may have been recommended for antibiotic use under universal screening.
Despite this difference, the risk factor approach is still a relevant option for mamas to consider who want to prioritize avoiding routine antibiotic use and its potential impacts on the microbiome. Discussing your unique circumstances and risk factors with your practitioner will help you learn more about yours and your practitioner’s comfort levels and help you determine how you’d like to approach this for your natural birth plan.
3. How will you time your arrival at the hospital to receive IV antibiotics?
Since you’re pursuing a natural birth in a hospital setting, you likely know that laboring at home for as long as possible is generally recommended to reduce the risk of unnecessary interventions. However, if you've tested positive for GBS and want to receive IV antibiotics, you'll need to consider your hospital arrival time.
The standard recommendation is to arrive at the hospital at least 4 hours before pushing to allow adequate time for antibiotic administration. Research shows that giving penicillin or another appropriate antibiotic over 4 hours before birth is effective 89% of the time in preventing GBS transmission. If antibiotics are given 2 to 4 hours before birth, they are still partially effective but 4 hours usually yields better results.
Since the exact timing of pushing isn't predictable, you’ll need to keep this in mind as you prepare your natural birth plan and consider how you’ll want to manage the latter part of your labor in the hospital with IV antibiotics. You can still have options for movement during labor, but you’ll want to discuss with your practitioner how the hospital usually manages this so you can have an advocacy plan in mind if needed.
4. What would you want to do if your waters opened before you began labor?
This question is all about having a plan regarding the premature opening of membranes (our UB version of “PROM”) and how it relates to GBS.
If your waters open before labor contractions begin (PROM) and you know you're GBS-positive, you’ll want to have a plan in place. Research indicates that having your waters open for more than 18 hours without the onset of contractions can increase the risk of GBS infection. So it is standard recommendation to receive antibiotics every 4 hours until birth to reduce the risk of infection.
As discussed in the section above, if you’ve decided to receive IV antibiotics, a PROM scenario like this can mean both an earlier transfer to the hospital and more time in the hospital than you may have originally desired.
So to think upstream about this, ask yourself how you’d want to possibly adapt your natural birth plan around:
How you’d want to be monitored at the hospital if you arrive before contractions begin
Your strategies for advocating for natural labor onset, which can take up to 48 hours for some women
Your comfort level with an extended hospital stay and advocating for minimizing any unnecessary medicalization of your labor
You’ll want to talk through this part of your natural birth plan with your practitioner in advance to know how supportive they’ll want to be of your desires around this. Research has shown that an estimated 90% of mamas will begin labor on their own after 48 hours of their waters being open, so it can be an evidence-based approach to discuss with your practitioner what it would mean to wait with the use of antibiotics.
5. What postpartum choices do you want in your natural birth plan to help your baby’s microbiome get a good start?
No matter what you choose related to using IV antibiotics for GBS, you’re a good mama to care about and plan for these important decisions in advance. And the good news is that you can optimize how you help your baby get a good start for their microbiome through your postpartum choices, too. So as you prepare your natural birth plan, consider how you may want to include these important postpartum microbiome-boosting choices for you and your baby:
Prioritizing skin-to-skin contact
If you've received IV antibiotics during labor, one of the most important things you can do postpartum is to prioritize skin-to-skin contact with your baby. This practice helps transfer beneficial bacteria from your skin to your baby, supporting the development of their microbiome. Try to have as much skin-to-skin time as possible in the first hours and days after birth.
Embrace the power of breastfeeding
Breastfeeding is one of the most optimal and holistic supports for your baby's microbiome, especially after antibiotic exposure. Breast milk contains:
Prebiotics, specifically human milk oligosaccharides (HMOs), which feed beneficial bacteria in your baby's gut
Probiotics, live beneficial bacteria that colonize your baby's digestive system
Antibodies that support your baby's developing immune system
Nutrients that promote overall health and development
If possible, try to breastfeed exclusively for at least the first six months. This can significantly help in establishing a healthy microbiome for your baby.
Consider probiotic supplementation
After discussing with your healthcare provider, you might consider giving your baby a probiotic supplement designed for infants. This can help replenish beneficial bacteria that may have been affected by antibiotic use.
Avoid unnecessary antibiotic use
In the postpartum period, be cautious about further antibiotic use for you or your baby unless medically necessary. Each course of antibiotics can impact the developing microbiome.
Focus on quality nutrition for yourself, mama!
Your diet affects the composition of your breast milk and, consequently, your baby's microbiome. Focus on a diverse, nutrient-rich diet with plenty of fruits, vegetables, whole grains, and fermented foods. This can help promote a healthy balance of bacteria in your own microbiome, which you'll pass on to your baby through skin contact and breastfeeding.
Create a supportive environment for your postpartum transition
Minimize stress and prioritize rest in your postpartum period. Stress can negatively impact your microbiome, which in turn can affect your baby. Creating a postpartum plan in advance can help with this, and we have our guide on enhancing maternal recovery that you can use to plan ahead for an easier postpartum transition.
We hope you’ll follow peace rather than fear about your GBS options in pregnancy.
Taking the time to invest in your understanding of GBS is worth the time and effort, and using the knowledge you have is where the power and potential are for having the natural birth that’s best for you, your baby, and your family.
Being proactive about your GBS care is beneficial, but it's equally important to approach these decisions with a calm and confident mindset. Remember, GBS management can vary based on your practitioner’s and hospital’s routine protocols, and you have the right to participate actively in all of your care decisions. Whether you're in your first trimester considering early testing, or you're past 37 weeks contemplating a retest, you have options.
To help you navigate these decisions and many others you'll face in your natural birth journey, you can access our free natural hospital birth plan template and mini-course.
This resource will assist you in crafting a comprehensive birth plan that addresses helpful natural birth approaches and special circumstances like GBS. Click here to access your free template and start planning for the empowered, informed natural birth you deserve.
Remember, you've got this! Stay confidently informed, trust your instincts, lean on your support system, and go with peace as you approach your GBS decisions with confidence. Your journey to motherhood is unique, and you have the power to make choices that honor both you and your baby.
