What you need to know about Group Beta Strep (GBS)

What is Group Beta Strep (GBS) and why do we test for it?

Group Beta Strep (GBS) is a type of bacteria that is found in the lower intestine and/or vagina of 10-35% of all healthy adult women. GBS bacteria are a normal part of the commonly found bacteria of the human body. Ordinarily, the presence of GBS does not cause problems, however, in certain circumstances, GBS bacteria can invade the body and cause serious infection; this is referred to as Group B disease. Group B strep should not be confused with Group A Strep, which causes strep throat. A person whose body carries GBS bacteria but who does not show signs of infection is said to be “colonized”, however, GBS colonization is not contagious. GBS is naturally occurring in the bacteria of both women and men. Since it is commonly found in the vagina of women, however, it is not a sexually transmitted disease. GBS bacteria usually do not usually cause genital symptoms or discomfort and are not linked with increased sexual activity. Women who carry GBS do not need to change their sexual practices.

What is the testing procedure?

The testing recommended: during 35^th to 37^th week of pregnancy. The test involves collecting mucous with a cotton swab from the lower vagina. It takes a moment. The culture is then sent to a laboratory for evaluation. The test results are usually ready in 3 days.

Unfortunately, the test is not perfect and it may miss approximately 5% of women who carry GBS. The bacteria tend be transient (to come and go in cycles) and a woman may test negative at the time of the culture and have colonization at the time of delivery. Fortunately, the test is accurate and will not give a false positive result. A positive culture means that a woman is colonized with GBS. It does not mean that she has GBS disease or that her baby will become ill. Rather, it means that the care provider must plan labor and delivery and newborn care with this in mind.

My Consent form for GBS includes these options:

□ I choose to screen for GBS between 35-37 weeks.  If I am GBS positive, I will accept intravenous antibiotics in active labor.  I may also use alternative therapies if I desire, but I am fully aware that there is no research to document any efficacy in preventing GBS infection. 

□  I choose to screen for GBS between 35-37 weeks.  If I am GBS positive, I decline intravenous antibiotics in active labor.  I may also use alternative therapies if I desire, but I am fully aware that there is no research to document any efficacy in preventing GBS infection. 

□ I decline to screen for GBS.  Instead I choose the risk-based GBS management strategy.  If I develop any of the risks for increased GBS infection, I will accept intravenous antibiotics.  I may also use alternative therapies if I desire, but I am fully aware that there is no research to document any efficacy in preventing GBS infection. 

□ I decline to screen for GBS and I decline to accept intravenous antibiotics should I develop any of the risks for increased GBS infection.  I may use alternative therapies if I desire, but I am fully aware that there is no research to document any efficacy in preventing GBS infection.

According to the CDC, if you have tested positive and are not in the high risk category, then your chances of delivering a baby with GBS are (8):

·       1 in 200 if antibiotics are not given

·       1 in 4000 if antibiotics are given

Are certain babies more likely to develop GBS disease?

Premature babies, with their less mature immune systems are more vulnerable than term babies. However, since most babies are born at term, 70% of babies who develop the disease are term.

Risk Based Management

Which women are more likely to develop GBS disease?

·       Women who test positive for GBS colonization at 35-37 weeks

·       Having already given birth to a baby who had GBS infection

·       GBS bacteria in the urine (bacteriuria, either with or without symptoms)

·       Having the water bag break for more than 18 hours prior to delivery

·       Onset of labor or the water bag breaking before 37 weeks

·       Developing a fever higher than 100.4 F

How is the baby tested for GBS disease?

Babies who develop the signs of GBS disease (stiffness, limpness, inconsolable screaming, fever, refusal to feed) must be evaluated immediately by a pediatrician. Blood tests, cultures and x-rays determine whether the baby has GBS disease, and treatment should begin immediately.

How can GBS disease be prevented?

Antibiotics such as penicillin administered through the vein (an IV) 4 to 6 hours prior to delivery to women who have a positive GBS test or who have certain risk factors will effectively prevent most GBS infections in women and their babies.

Antibiotics can cause side effects, which are usually mild, but can be severe; their use should be limited to women who have one or more of the risk factors. Alternatives to penicillin may be used. Risks and benefits of antibiotics should be considered.

Cesarean sections are not likely to prevent GBS disease.

Unfortunately, no plan is 100% effective. Some women with GBS escape detection because they do not have the risk factors. Therefore, medical standard of care dictates that all women be tested with each pregnancy. According to the Centers for Disease Prevention and Control and the American College of Obstetricians and Gynecologists, routine prenatal culture at 35-37 weeks along with IV antibiotics during labor for women who culture positive for GBS offers the very best protection available to the newborn.

Women with GBS colonization may breastfeed their babies.

Garlic protocol for GBS prevention:

Garlic is a natural antibiotic

Garlic has been shown in vitro (in laboratory petri dishes) to kill bacteria and also yeast. In some important research done in China (1), garlic was shown to inhibit the growth of all of the following microorganisms: Escherichia coli, Salmonella typhimurium, Vibrio parahaemolyticus, Pseudomonas aeruginosa, Proteus vulgaris, Staphylococcus aureus, Mycobacterium phlei, Streptococcus faecalis, Bacillus cereus and Micrococcus luteus.

Break a fresh, dry, hard clove from a bulb of garlic and peel off the paper-like cover. Cut in half.  A whole clove will NOT work.  A crushed clove releases more allicin, but is harder to insert.  Tie very tightly (so it cuts a bit into the garlic) a piece of white thread and leave the thread hanging out, as if it was a tampon thread. That way it can easily be removed with very little effort. Putting the clove in gauze will prevent direct contact and decrease effectiveness. Put damaged garlic clove in your vagina in the evening before you go to sleep. Many women taste garlic in their mouths as soon as it is in their vagina- so it is less pleasant to treat while awake.  You can grind up garlic and insert the mush.  This would have the most effectiveness because it increases is the dosage the more surface area of the garlic is exposed. You can put it on the end of a tampon for example. In the morning, the garlic may come out when you poop. If not, many women find it is easiest to take it out on the toilet. Circle the vagina with a finger, till you find it. It cannot enter the uterus through the cervix. It cannot get lost- but it can get pushed into the pocket between the cervix and the vaginal wall. Most people will taste the garlic as long as it is in there. So if you still taste it, it is probably still in there. Most women have trouble getting it out the first time.

For easy retrieval sew a string through the middle of the clove before you put it in- You don’t want to get irritated in the process of getting rid of the GBS. Be gentle. Don’t scratch yourself with long nails.  Repeat this for 8 nights (around week 36). Or for 2 nights on, 1 night off, for 5 times (8 nights in 15 days)

After the eight night of treatment, get cultured at the health care place you go to. Before you go to get the culture, wash perineum and rectal area with soap and put on clean cotton underwear.  GBS usually lives in your large intestine, and from there contaminates the vagina.  A Rectal/Vaginal culture is done with a cotton swab inserted into the vagina and then into the anus.

How often do you find that this remedy is effective? I tell my clients to go ahead and try it if they chose to test at all and really want to be sure that they are negative. Some do and some do not. It is a new option. The more they do the more evidence I will have to give. Currently there is no funding for this natural remedy option so there are very few studies to see. (9)

Does raw garlic tend to cause irritation of the vagina?

Not usually but women say they can taste it while they have it in the vagina. They can also try some oral garlic or other ways to boost immune system. I have all my moms take probiotics to keep healthy flora first off.

Is there a way to prevent this or an alternative treatment? Oh So Many….

Ideally, you will begin treatment at about 32 weeks, on confirmation of the presence of beta-strep in a vaginal culture, a urine sample that showed beta-strep, or a rectal sample. (Some doctors will do both a vaginal and rectal swab.) Treatment will include taking herbs orally that strengthen your immune system and applying herbs vaginally that will restore your healthy vaginal flora, that will enable your body to reduce bacterial overgrowth, and also that will directly fight the bacteria. As you enter the last few weeks of pregnancy, from 37 weeks onward (since your baby is unlikely to be premature), most midwives will be willing to assist you at home if this is your plan. In the hospital, your baby will also be considered close to full term and will not be treated as premature in most circumstances. At 37 weeks, you can therefore begin to use certain herbs both orally and vaginally that are sometimes considered labor stimulants, but are nonetheless effective for reducing bacterial infections.

At 32 weeks, begin to take a supplement of 500 mg of vitamin C, and 1 cup of burdock root and echinacea root infusion. To prepare the infusion, steep 1/2 ounce of each of these herbs in 4 cups of boiling water for 2 hours. Strain and take the above dose, storing the rest in the refrigerator for the next day.

Eat a lot of fresh garlic every day.

Take 1/2 teaspoon each of echinacea and astragalus tinctures twice daily. You can also get dried astragalus in the herb department of your health food store and cook two strips into a pot of rice or soup two to three times per week. Remove the strips when done cooking and eat the rice or soup. Astragalus is an immune system tonic well known in the Chinese pharmacopoeia, but also grows in America.

Garlic Remedies
Chop a clove of fresh garlic and mix with a teaspoon of honey. Swallow this without chewing it. This can be done several times a day, preferably with a meal.

Make a garlic elixir by blending 1/2 cup of honey, 1/4 cup of apple cider vinegar, and half a bulb of fresh garlic in your blender until liquidy. Take 1/2 teaspoon up to twice a day. Adjust the taste as necessary with more or less of the honey or vinegar. Chop fresh garlic onto a salad, or mix with olive oil to use as a dressing or dip French bread into this as a condiment.

Take garlic pearls according to the dosage on the brand you purchase.

If garlic doesn't work, there are other options to consider:

Tea tree oil 2% oil to 98% olive oil soaked tampon. Place tampon in vagina for 4 hours daily times 1 week, then retest for GBS.

Rinse your vaginal area every six hours for one week before your GBS test with a chlorhexidine wash (which can be purchased from your local drug store under the brand name Hibiclens), diluted as four tablespoons Hibiclens to 2 ¼ cups water. I put a bottle in each birth kit and rarely need it.

“Other practitioners of herbal remedies and supplements have found GREAT success rates of the following strict regime to eradicate GBS from their bodies all together: a daily regiment of douches and oral remedies. Oral acidophilus and a grapefruit seed extract douche in the morning. Garlic capsules inserted vaginally in the afternoon. And an oral once a day garlic capsule in the afternoon. Finally a goldenseal root powder douche at night along with another oral acidophilus.” (7)

Constance Rock LM Protocol:

The following treatment plan is designed to boost your immune system. For most women, this helps reduce or even eliminate the growth of Group Beta Strep.  We’ve had excellent results with this protocol. Nearly all of our clients who have cultured positive at 36 weeks have been able to completely eliminate the GBS by the time they delivered. Some clients have only been able to minimize the growth, but the large dose of vitamin C causes their amniotic sack to thicken, thus preventing the bag from rupturing until they’re pushing which significantly reduces the baby’s time of exposure and the likelihood of infection. For those women who test positive, we recommend culturing once a week until delivery so we can see the positive effect the protocol is having.

Twice a day, with breakfast and dinner:

• Acidophilus – 4 billion cells per dose
• Echinacea – 350 mg capsules – 2 capsules
• Garlic – 580 mg capsules – 2 capsules (you may also
• Vitamin C – 1000 mg with 200 mg bioflavonoids
• Grapefruit Seed Extract – 15 drops
•  Zinc 50mg a day
•  Also douche with wheatgrass 2x per week
•  Insert plain yogurt vaginally 2x week
•  Colloidal Silver, 1 dropper a day, low dose

If you are successful at eliminating the Group Beta Strep, we suggest continuing the treatment until your baby is born to give yourself the best possible chance that the bacteria will not be present at the time of birth.

References:

1. Chen, H.C., Chang, M.D., Chang, T.J. (1985) Antibacterial Properties of Some Spice Plants Before and After Heat Treatment. [English translation of Chinese article]. Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi 18: 190–5.
2. Klein, J.O. (1999) Management of Acute Otitis Media in an Era of Increasing Antibiotic Resistance. Int J Pediatr Otorhinolaryngol 49: S15–17.
3. Honig, E., Mouton J.W., van der Meijden, W.I. (1999) Can Group B Streptococci Cause Symptomatic Vaginitis? Infect Dis Obstet Gynecol 7: 206–09.
4. Christensen, K.K, Dykes, A.K., Christensen, P. (1985) Reduced Colonization of Newborns with Group B Streptococci Following Washing of the Birth Canal with Chlorhexidine. J Perinat Med 13: 239–43.
5. Irving, W.L. Best Practice in Labour Ward Management. Edited by L.H. Kean, P.N. Baker and D. Edelstone. London: WB Saunders, 2000.
6. Albandar, J.M., Gjermo, P., Preus, H.R. (1994) Chlorhexidine Use after Two Decades of Over-the-counter Availability. J Periodontol 65: 109–12.
7.  http://wonderfullymadebelliesandbabies.blogspot.com/2007/08/gbs-giant-bothersome-stumblingblock.html
8. http://www.americanpregnancy.org/pregnancycomplications/groupbstrepinfection.html
9. http://www.ncbi.nlm.nih.gov/pubmed/15651446

The Ricki Lake Show - Wed: The Business of Being Born

The Ricki Lake Show - Wed: The Business of Being Born

Art of Nursing Care, Inc. Total Pregnancy Mentoring Misson Statement

Art of Nursing has a Mission to educate and empower women and care providers about preventing complications of pregnancy and premature birth and promoting a healthy lifestyle.

We intend to do this by:

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Increasing awareness of risk factors for developing complications of pregnancy while promoting self-care practices that will promote wellness and prevent complications

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Developing an early detection and support program to educate and promote maternal and fetal wellness and protect our new generation from diseases affecting pregnancy

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Preventing and reducing serious complications of diseases in pregnancy by promoting collaboration with all healthcare practitioners including physicians, midwives and holistic practitioners as well as physical therapy and all alternative modalities

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Reducing mortality of infants and mothers who are affected by many diseases by educating them about early signs and risk-taking behaviors that may affect their pregnancy outcomes

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Improving the health and quality of life of pregnant women of all ages and economic circumstances

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Ultimately improving the wellbeing of all mothers and babies in our care

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Total Pregnancy mentoring
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Meet the AONC Midwives

About Us:

Owner:

Amy Tinney is a Registered Nurse, Licensed Midwife, and Certified Professional Midwife. She is mother to a teenage boy. She earned her Midwifery license from the California Medical Board in 2009. Amy has worked with mothers and babies since 1990. She has worked as a Registered Nurse in clinics, hospital settings, and in home health. During her work as a Nurse she attended over 2000 births both in and out of the hospital. She also worked with clients as a Doula/Monitrice, childbirth educator. Amy’s path to midwifery included an apprenticeship in a busy home birth practice in Los Angeles, CA. Amy’s apprenticeship included attending families beginning with prenatal care through birth and postpartum with over 70 new babies. Her extensive previous birth related experience allowed her to progress faster than usual through her apprenticeship. In addition to her hands on apprenticeship experience, Amy completed her Midwifery education with The National Registry of Midwives (NARM) and the National Midwifery Institute's (NMI) Challenge process. Amy teaches Nursing and Midwifery students as well as other care providers, and enjoys sharing her knowledge and expertise. Amy's experience as a care provider for women combined with her love for the beauty and sacredness of birth makes her a uniquely intuitive and confident care provider.

AONC Staff Midwives:

Sarah Shealy is a Registered Nurse, Certified Nurse Midwife (CNM), Internationally Board Certified Lactation Consultant, and mother of two amazing girls, both born at home. She has served women and caught babies in both home and hospital settings since 1995. She has practiced in Connecticut, New York, Utah, and California. Sarah has caught over 800 babies during her career as a Nurse Midwife, and attended countless more. She has also assisted in over 120 c-sections. Sarah's Midwifery education began at Yale University. At Yale, there were few opportunities for out of hospital birth experience and she sought out a local direct entry Midwife who was generous enough to mentor her in the art of homebirth. Another CNM with a homebirth practice offered mentorship and a CNM was her first partner in a homebirth practice in Colorado. Sarah has worked with low risk and high-risk women, in community and private practice settings, in and out of the hospital. She is an expert in normal birth and passionate about supporting women and families in their choices whatever they may be. Recently her love of the art and science of lactation prompted her to become a Lactation Consultant. She is especially fascinated with the postpartum experience in our culture. This extensive experience she has had with women in different settings brings a quiet observant knowing to her style. She is a perceptive and seasoned care provider.

Sarah Unkap is currently a Registered Midwife (RM) and Doula who received her training for Midwifery at the University of Nottingham, UK. She most recently worked in a busy maternity unit in Central London, providing prenatal, labor and delivery and post partum care for women, in both inpatient and outpatient settings. She recently decided to make the move to California to be with her husband and to pursue her career in Midwifery. She is currently apprenticing at AONC since September 2010, and her goal is to gain her California Midwifery license and remain with their team. She is passionate about the art of Midwifery and is dedicated to maintaining the safety, sanctity and sacredness of birth. Her passion lies with providing holistic prenatal care and empowering women to believe in themselves and their bodies. Her belief is that each woman has the right to define her own birthing needs and support system, in order to create a unique and personal birth experience for all those privileged to be involved. Her dedication is to provide high quality care tailored to the needs of each woman and their family, enabling informed choice. She delivers care in a manner that promotes individualized and family centered care.

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Offering Doula Monitrice services that can be covered by insurance.

If your labor support is provided by a Registered Nurse or a Midwife, your insurance may reimburse a portion of your cost. We have many options for care by our midwifery team. Doula Monitrice service offers 2 (one hour) prenatal visits being on call for your birth and one Postpartum visit. With this service you have 24 hour access to the Midwives and Nurses who can give advice and guidance during your pregnancy, birth and postpartum time.

What can a Doula Monitrice do that a Doula can't?

Doula's can provide emotional and physical support during pregnancy, birth and postpartum. Medical advice and providing medical treatment of any kind is not in their scope of practice.

A Monitrice (Either a Midwife or a Nurse) can monitor you and your baby during labor at home. Home is one of the most optimal places to help you get into active labor before traveling to your birth destination. If you feel that you would like to spend some of your labor at home this is a good option to be sure that you and the baby are doing well during your labor.

As Midwives and labor and delivery Nurses we also have the option to examine you for cervical change. In our experience it is rarely necessary to examine a woman in labor unless she requests it or she starts feeling an urge to push. Having this option before going into the hospital or birth center can be very helpful. In the case of ruptured membranes we will not examine you, due to the risk of infection. The less exams done after the membranes rupture the better.

Once we go to the hospital or birth center we remain your advocate but we are no longer able to act as your Midwife or Nurse. We can help navigate the hospital environment helping you understand interventions offered, and standard procedures and how to ask for and get what you want from the staff. All decision making about you and your baby rests with you and we will not speak for you. In the Hospital setting we play the traditional role of a Doula as a support person.

We wish for you a beautiful and empowering birth experience.

Blessings,

Art of Nursing Team;

Amy Tinney CPM LM RN