Two days before my water broke, I received an update from my midwife: My screen for Group B strep (GBS) had come back positive. Such a result is not uncommon—about one in four pregnant women carry GBS bacteria, usually asymptomatically, and medical providers generally test for it between 35 and 37 weeks of pregnancy. By that point in pregnancy, I’d already been poked and prodded enough that the GBS screen seemed like just another routine test, one that I assumed—unlike, say, gestational diabetes—would not impact me or my babe much either way, and learning I had tested positive didn’t much alter that impression. The message from my midwife ended with the note to call with any signs my bag of water may have broken—as I would do anyway. So I didn’t think much of it and went on with my day.
As it turns out, however, GBS ended up having a pretty significant impact on my birth experience: Because I not only tested positive for GBS but also was high-risk for transmitting the bacteria to my baby because my water broke early, I couldn’t wait for labor to start at home as I’d planned; I had to be induced; and to treat it, I had to have a potent antibiotic. Once my son was born, he was taken from me pretty quickly for additional testing. Ultimately, both he and I were fine, and I am grateful that this screening and treatment made that possible. Still, the experience was surprising and confusing; I didn’t take the possibility of my water breaking early seriously enough, because I didn’t really understand what GBS was at the time or why it was so risky—or why no one had explained it to me. As it turns out, according to interviews with pediatricians, families are declining antibiotic treatment—and even screening—at an increasing rate, even though Group B strep can lead to devastating problems.
Despite its familiar-sounding name, Group B Streptococcus is not related to the better-known strep throat. GBS is carried in the intestines or lower genital tract, and it can pass from mothers to infants in two ways: If the water breaks early, bacteria can travel up from the vagina and into the amniotic fluid, where the fetus may swallow some of the bacteria into the lungs; or, during labor, as the baby moves through the birth canal, the bacteria can come in contact with the baby’s skin and mucous membranes, causing infection. Researchers don’t know how the bacteria are spread to anyone other than newborns.
When GBS is transmitted from mom to baby, it can be deadly. In fact, it is the leading cause of infection-related morbidity and death for newborns. Every year, around 900 babies get early-onset GBS disease, while 1,200 babies get the late-onset version (the types, as the names suggest, are distinguished only by the time infection sets in). Of these, 4 to 6 percent will die. GBS bacteria are also a leading cause of meningitis and bloodstream infections in a newborn’s first three months of life.
Since the early 1990s, the American Congress of Obstetricians and Gynecologists has recommended screening all pregnant women for GBS and treating it intravenously with antibiotics during labor. Testing positive for GBS once during pregnancy doesn’t necessarily mean you’ll have it later, and neither does testing negative mean you’re free from it; it can come and go in a matter of weeks, or you might always have it. This is why the bacteria is treated during labor, and not before; any sooner evidently doesn’t work.
The good news is that treatment, when administered, dramatically decreases the odds of passing GBS to one’s baby during labor: from 1 in 200 without antibiotics in labor to 1 in 4,000, according to the CDC. (A recent 2014 Cochrane Review, however, has challenged the clinical recommendation to administer antibiotics, reviewing four trials involving 852 GBS positive women; in the review, Cochrane noted that while antibiotics reduced the rate of transmission, they did not reduce the death rate. It’s probably worth more study.)
“We’re just starting to appreciate the potential long-term effects of antibiotic use (both for mom and for baby, in this context), so I think those [antibiotic questions] are valid considerations. But when you come back to the pediatrician’s perspective—I’ve taken care of children who were neurologically devastated because of perinatal Group B strep infection, and it is heartbreaking. At this point, while there are certainly some unanswered questions about the true calculus of risk and benefit, intrapartum antibiotics may help prevent devastating infection in infants, and the overall risks are pretty low.”
Penicillin, that old standby, is the drug of choice to fight Group B strep, but I’m allergic to it. (It’s worth noting that 19 out of 20 people who have been told they’re allergic to penicillin may not be; it’s possible to get tested, even in pregnancy). And evidently, my Group B strep strain was resistant to the two other most common medications—clindamycin and erythromycin—which left us using vancomycin, long considered the “drug of last resort” because it is so strong.
When my water broke, I didn’t actually realize it. I was 38 weeks pregnant, and although I felt desperately ready, I didn’t really believe that I might be in labor. My son was sitting low in my pelvis, testing the limits of my pelvic floor, and, seemingly, pushing past them. Surely that was all.
But later that evening—I wince now even recalling this, because I let hours pass (and three changes of clothes)—I texted my doula: Was I suddenly, grievously incontinent, or could this be the start of labor? In general, we’d agreed that I wanted to avoid interventions where possible, but when I mentioned offhand that I’d tested positive for GBS, she became serious. She’d seen babies get off to a really rough start when they contracted GBS. I didn’t know at the time that water breaking early means higher risk for the baby contracting GBS. Premature rupture of membranes (PROM) occurs in only 8 to 10 percent of all pregnancies, meaning the combination of GBS and PROM would, at most, occur in 2.5 percent of pregnancies.
But treatment works, and, happily, getting an IV no longer means being immobilized. Many hospitals can provide a saline lock solution so that moms are free to move about in active labor. Once I got to the hospital, I was given the vancomycin. The antibiotics were administered every four hours of my 16-hour labor.
Once my son was born, after skin-to-skin and attempts to initiate breastfeeding, I was told he’d need to have some additional tests done, related to the possibility of GBS infection. He was taken away, and as my husband pushed my wheelchair as we moved from labor and delivery to the recovery room, it was without our baby. It was surreal: the first time we had been apart in nine months. We were also required to stay a few hours later than is typical for additional monitoring, to ensure that the risk of infection had passed.
Fortunately, it had, and we were both happy and healthy. I feel grateful for this outcome: glad that an alternative antibiotic, however uncomfortable, was made available to me and relieved that my son didn’t contract GBS. As I reflect back on my birth, sometimes I can’t help but worry about the alternative: What if I hadn’t called my doula and hadn’t gone to the hospital in time to get treated? Things easily could have turned out differently. Though I feel that I didn’t take GBS seriously enough, I also don’t question treating it: Once labor was under way and the arrival of my son imminent, my ability to weigh things skeptically vanished; the risk of adverse outcomes for my son, however small, were a powerful and terrifying motivator. But I wish that GBS had been explained to me, because knowledge is power. And it probably would have gotten me to the hospital quicker.
Like this piece? Subscribe to our newsletter for real stories about women on their journey to motherhood.