If you haven't already, you may want to read Part I of this post, which includes a fabulous article by Judy Slome Cohain, CNM.
***REMEMBER THAT NEITHER ANTIBIOTICS NOR HERBS, NOR CHLORHEXIDINE/HIBICLENS WILL GUARANTEE THAT YOUR BABY WILL BE GBS FREE.***
Babies born with GBS (from mom) have been shown to be protected from antibodies passed on by mom1 (Please read this footnote. It is very informative and also mentions that babies have less protection from E Coli then GBS. Read below on why we should be concerned about E Coli). Babies who get sick are babies whose moms lack the antibodies to the GBS bacteria. Even if you are treated with antibiotics in labor, your baby may still develop GBS disease (click here for a brief discussion of late-onset GBS disease including a potential connection between intrapartum antibiotics and increased rates of late on-set GBS). In other words, there is no easy answer to the question, "I am positive for Group Beta Strep, what should I do?"
If you plan to test for GBS, you still have options...
The goal of treatment with antibiotics is to reduce the colony count in the vagina. So why not try alternative methods to reduce the colony count before testing? Below are some options...
Option 1: Understanding that GBS comes and goes, you might follow an herbal regimen hoping to restore balance to your body (i.e. reduce GBS colonization) and then test, hoping for negative results. You continue to maintain a diet that optimizes a healthy gut throughout the remainder of your pregnancy.
Option 2: You can choose to wash with chlorhexidine/hibiclens and then test.
Option 3: Do nothing and test. Understand that GBS comes and goes.
If You Test Positive:
You can take antibiotics (or use hibiclens) while in labor. Understand that neither of them completely remove the risk to your baby, that antibiotics are not without risk, and that hibiclens is a harsh substance.
If you test positive and are birthing at home with a midwife who will support your choice, you can repeat option 1 or 2 (above) and retest, hoping for a negative result.
If you test positive you can do nothing, understanding that the risk to your newborn will increase with prolonged rupture of membranes and repeated vaginal exams.
If you test positive, you can wait to use antibiotics or hibiclens after prolonged rupture of membranes.
Why Would You Want a Negative Test?
Why you may ask, is a negative test important? A negative test means that if you birth in (or are transferred to) the hospital, your newborn will not be required to undergo a septic work up. AND (perhaps more significant) a negative test means that if you are transferred to the hospital in labor, you will not automatically receive antibiotics. Why should we be concerned about antibiotics? Because research has shown that with the increase of intrapartum antibiotic prophylaxis (IAP) for GBS, there has been an increase in neonatal gram negative (e coli) sepsis which has led to an over all UNCHANGED rate of neonatal sepsis. In addition, with the increase of IAP, there has been a corresponding increase in ampicillin resistant e coli (not a good thing!). As mentioned here, babies have less protection against E Coli. And remember, the Cochrane review has found no conclusive evidence to support giving antibiotics.
Herbal Protocols for Reducing GBS Colonization:
Midwife Judy Slome Cohain uses a Garlic Protocol. If you are interested in garlic (and/or would like to learn more about GBS), it would be worth paying to download and read this research on GBS and garlic. Or read Judy's article on treating vaginal infections with garlic.
From Midwife Maria Iorillo as found in Elizabeth Davis' Heart and Hands, 4th Edition:
Twice a day, with breakfast and dinner:
2 capsules lactobacillus acidophilus (2 billion per capsule- try Natures Plus)
1 capsule echinacea 350 mg
1 capsule garlic, 580mg
1 capsule or gel vitamin E, 500 mg
Also place one clove peeled, unnicked garlic in vagina every other night, remove in the morning
From midwife and herbalist Helena Wu:
I don't follow a specific herbal regimen but choose herbs that are mentioned in the books (Aviva Romm, Rosemary Gladstar, Amanda McQuade Crawford, Kathi Keville- well known experienced herbalists who have women/herbals written) for vaginal infections. Different ones work. I usually put in at least one that is anti-microbial, one to soothe. Also have mom eat yogurt with living cultures and put some in the vagina. You can make boluses (vaginal suppositories). It is messy but so far it has worked. On retest they are negative. Mom also should cut out sugars (simple carbs, juice, fruit). Do this for a week or two and retest.I give them all the options, antibiotics, hibiclens, herbal and let them choose.
Other Things You Can Do:
Avoid Vaginal Exams!
Avoid hospital bugs (and frequent vaginal exams) by having your baby at home.
And of course the real question is why do we have such a high rate of GBS disease (as opposed to other countries) in the U.S? Could it be that the American diet leads to low rates of antibody production in moms? Of course that is another can of worms and not my area of expertise but as a huge fan/consumer of probiotics, I am a firm believer in maintaining a healthy gut.
1 Maternal Fetal & Neonatal Physiology A Clinical Perspective, by Susan Blackburn http://books.google.com/books?id=2y6zOSQcn14C&pg=PA504&lpg=PA504&dq=GBS+mother+protection+antibodies+newborn&source=bl&ots=yHGbs78PKl&sig=4e9mDFgnBjEc0l-EzrpW3CZ4t2k&hl=en&ei=OEo-TN7rDcP88Aauq_SyBA&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBYQ6AEwADgK#v=onepage&q=GBS%20mother%20protection%20antibodies%20newborn&f=false
2 Current Controversies in Midwifery Care, by Saraswathi Vedam, CNM, audio from 2009 MANA Conference
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