This is one of those tests that can feel a bit icky and remind you that yep, the process of growing a baby is at times, undignified. Some women choose not to have the GBS test and that is totally their right. Some women have the test and wonder later “what was that for?”
Firstly, what is it?
GBS stands for Group B streptococcus and it is a bacteria that is normal to have in the vagina. About 20 percent of women will have GBS most of the time and it’s completely harmless, until it’s not.
This podcast talks about
What happens when GBS infection happens in labour
The stats on whether to treat or not treat if you have GBS
What treatment is available for GBS
What is involved in having the test
When you may be more prone to having GBS sepsis
Brigid [00:00:36] Well, welcome, everyone, to Episode 14 of the Kick Pregnancy podcast, and today we've we've had some really exciting news in our rooms, haven't we?
Patrick [00:00:47] We sure have. So our one of our wonderful reception people had her baby two weeks ago and she brought the baby in to meet everybody else this week, which was just fantastic.
Brigid [00:00:59] Oh, my God. So exciting. And a little cuddle. What was the baby? Six pound. Tiny, tiny little.
Patrick [00:01:05] Tiny little thing. And gorgeous baby. And what was hilarious. Jacki, the book keeper hogged the baby for the whole morning tea. And wouldn't let us have a go.
Brigid [00:01:18] Had about four or five women go. Give me the baby.
Brigid [00:01:22] That's the beauty of our job, isn't it? Sometimes we get these. Well, a lot. We get these newborns in that we can have a little cuddle with. And it's really it's really fantastic. Yeah, that's right. Anyway. All right.
Brigid [00:01:32] So episode 14, how amazing we were here at episode 14. We've had so many people give us feedback on our podcast and we thank everybody for listening and just giving us some feedback on DMs or, you know, if they see us in the street or whatever it might be. And we we learnt that actually we've got some overseas listeners. So that was really exciting as well. So welcome to all.
Patrick [00:01:55] Welcome, everybody. It's been terrific number of downloads so far, which we're super excited about and gives us some oomph to be back here today recording some more.
Brigid [00:02:04] So today we're going to cover should I have a GBS swab? All right. So this is one of those tests that feels a bit icky or, you know, at least I felt it was a bit icky when I was doing it. But it is one test that you should prioritize and maybe we should start Paddy with what is GBS?
Patrick [00:02:21] So GBS stands for Group B, streptococcus, and it's just the name of the bacteria that can cause some problems in pregnancy. And group B streptococcus, it's one of those unimaginative medical names, is a bacteria that is normal to have in the vagina. About 20 percent of women will have GBS in the vagina and most of the time it's completely harmless. And it's one of the normal bacteria that lives on our body.
Brigid [00:02:50] So it's not like an STI or anything. Absolutely not. OK. I can't give it to my partner or my partner didn't give it to me.
Patrick [00:02:56] No, no. Who's this partner?
Patrick [00:02:59] You know, it's a normal bacteria.
Patrick [00:03:05] One of the many bacteria that lives on our body. The relevance in pregnancy is in labour. And when the waters break, we lose some of the protection between the bacteria that are in the vagina and the baby and the water surrounding the baby. And GBS seems to be one of the bacteria that is very capable in labour of spreading up from the vagina through the break in the membranes and into the water around the baby and the baby itself.
Brigid [00:03:36] Can I just clarify that? So are you saying that a woman can be can have GBS, and 20 percent of women do, and that can be normal and not a problem during pregnancy because the waters around the baby are protecting the baby?
Patrick [00:03:49] Absolutely. So the cervix is closed. The membranes are intact. And GBS won't trouble the baby under those circumstances. But in labour, GBS seems to be able to in some circumstances, get up through the cervix, the partially dilated cervix, through the break in the membranes when the waters are broken. And infect the baby.
Brigid [00:04:09] And how come it goes from being harmless to harmful?
Patrick [00:04:13] Well, I don't think anyone knows that precisely. Any bacteria has the capacity to spread to a part of our body. That is well, it could cause harm. And of all the bacteria in the vagina, it seems to be GBS. That's the most capable of doing that. And if we look at babies that are born with severe infections, that can cause the baby to be born with septicaemia, meningitis, encephalitis, serious stuff, it's often GBS that's responsible.
Brigid [00:04:43] Right. And as do all babies get that level of severity or is there some that can be GBS positive and just be treated or is it always a really severe problem?
Patrick [00:04:55] Now, that's the problem. So we don't know exactly why it behaves the way it does. And we don't know why some babies can come out covered in GBS and be absolutely fine and other babies can get GBS from the mother's vagina on the way out and get very sick. It's very similar to an idea that people probably heard of, like meningococcal septicaemia, you know meningococcal disease. Lots of us, lots of people, perfectly healthy people have got the meningococcal bacteria living in their nose. We don't know why under certain circumstances it turns into a potentially fatal case of meningitis.
Brigid [00:05:34] And so if it's. Only when you have a vaginal delivery that the baby can be exposed to GBS. What happens in a cesarean birth?
Patrick [00:05:44] Well, caesareans are different obviously, because the baby's not coming down through the vagina. So that's a less risky situation to start with. And also caesarean section, there's only a moment between the waters breaking and the baby coming out, but in a vaginal birth situation. That might be many hours. It might be a day.
Brigid [00:06:00] All right. So when are you testing people for it or when does a woman get it tested?
Patrick [00:06:06] Well, the standard deal in Australia is to test at thirty six weeks and this is based on our knowledge of that bacteria and how it works. If we take a swab from the vagina, and sometimes from the from the woman's backside as well, we can pick up if she's got vaginal or Perianal GBS at the 36 weeks. And the microbiologist tell us that that predicts that she's likely to have it three or four weeks later when she labours. GBS is a bacteria that can come and go from the woman's reproductive tract. And if you if you tested for it at 20 weeks, some of those positive swabs, it might be gone by full term.
Brigid [00:06:48] So if you did test, why isn't it tested earlier and then treated and then, you know, eradicated.
Patrick [00:06:55] Eradication is very difficult and would require prolonged doses of antibiotics, whereas treating it in labour is pretty easy because the labour is not gonna go for that long. And yes, you have to give intravenous antibiotics, but you don't have to give them for long. What we're trying to do is not eradicate GBS by treating it. We're just trying to stop it multiplying in labour and getting on the baby and becoming more harmful.
Brigid [00:07:20] Right. And so how is it tested? What do you have to do to get it tested? I know. But tell the listeners.
Patrick [00:07:25] Sure. So you go along and have a vaginal swab. And I always say to my patients some this is this can be taken yourself. It's not a high vaginal swab. Like if you've got a vaginal discharge, it's just a low vaginal swab from the from the vaginal opening. So it's much nicer to take the swab from the people at the pathology place, go into a cubicle and take it yourself. And it just needs to be dipped into the into the outer part of the vagina. And if your doctor's also requested one from your backside, then you just touch your backside with it and then you put the lid back on. Give it back to them. It's much more dignified to give that to do that yourself rather than have the pathology nurse poking at you, because you know, pregnancy is undignified enough.
Brigid [00:08:07] And you know where your bits are.
Patrick [00:08:08] Yes. And that's right, everyone should know where their own vagina and anus are located.
Brigid [00:08:13] And I'm so glad you said anus.
Brigid [00:08:24] That's what it reminded me, because I read one of Constance Halls posts on her Facebook. Oh, gosh, she's hilarious. But anyway, she was saying the undignified nature of being pregnant. And one of it was that you always had to get an anal swab. And I'm thinking I don't think I've ever had an anal swab. So why would a doctor recommend that you have an anal swab too?
Patrick [00:08:43] Look, it's just it's just a different protocol. Some hospitals, some pathology departments like like vaginal and anal, some just vaginal swabs. And it's not terribly important, they both have good pickup and they both give a reliable result.
Brigid [00:09:03] So we just touched on how serious it is for the baby to have GBS. I just want to know what are some of the early signs of GBS and when would somebody see that in a baby?
Patrick [00:09:13] So if a woman is going to be GBS positive and the labour is taking too long, I should say the baby's taking a long time. Or if the baby is premature or there are some problems in labour, like the mother has a fever or there's an abnormality on the foetal heart rate trace, those sort of things should get us thinking that hang on, maybe, maybe GBS is playing a role here.
Patrick [00:09:34] Maybe, maybe this is the situation where baby could potentially come out with a GBS infection. And at that point, the obstetric team should be thinking about that, maybe treating the mother with some more antibiotics during the labour, maybe doing things to try and spead the labour up, and certainly alerting the pediatric team to the possibility of that baby coming out sicker than we than we wanted.
Brigid [00:10:01] And when they come out sicker, what what sort of symptoms does that baby have?
Patrick [00:10:05] Well, that's what gets a little tricky, because some sepsis or infection with GBS in newborns can be can be hard to pick. So we have to have what we call a high index of suspicion. We need to be we need just be suspicious that this might be going on and specifically look out for it. And the pediatricians would look at things like the baby's temperature and its appearance, its colour, its behaviour and and then some blood tests. White cell counts, inflammatory markers in the baby's blood and so forth. And of course, I tend to err on the side of caution and treat with antibiotics until we're sure that it's not a GBS sepsis situation. And what sort of antibiotics do they use? They use antibiotics that cover for a variety of bacteria. So broad spectrum antibiotics, because we don't know at that early stage for a fact that it's GBS. So they tend to give a couple of different antibiotics to cover all possibilities and then narrow, narrow down the antibiotics that are being given in a couple of days when we know exactly which bacteria we're dealing with.
Brigid [00:11:03] Yeah, right. So you mentioned that a woman, if she's showing signs of fever or something like that, actually during her labour, that she will have antibiotics. Now, how does she get those?
Patrick [00:11:16] Intravenously. So we're trying to get we're trying to get good penetration into this tissue through the mother's bloodstream. And so we would give them intravenously.
Brigid [00:11:26] Yes. And she hooked up to like the IV drip the whole time.
Patrick [00:11:30] No, you don't have to be stuck to a drip pole. Just have the little the little blue tap in the back of your hand. And the antibiotics are given intermittently through there.
Brigid [00:11:39] All right. So we we know that some people refuse the test because they think that it's this transient infection. You've sometimes got it and sometimes haven't got it. What do you think?
Patrick [00:11:48] Well, it's true to say the GBS. is a transient infection. It is. It'll come and go. And I think if a non pregnant woman had a swab a week for a year, some would show GBS and some would not. The problem is that in the setting of GBS in Labour, it's very serious. It can be very quick. And the consequences for the baby can be very severe. So I've never thought much of the argument that we shouldn't swab because it's normal to have GBS because this is one of those bacteria that it's normal for it to be on your body, but it can cause a lot of harm in labour.
Brigid [00:12:22] And there's an easy treatment like I.V. antibiotics. I know that some people might have a reaction. I suppose that's the risk.
Patrick [00:12:28] Yeah, that's true. So. So, you know, the antibiotics work and the studies show quite clearly that that it works. But the antibiotic that we use for a baby that some in for a woman in labour who's known to be GBS positive is penicillin. And it's in high doses. So we've got an alternative for women who are allergic to penicillin. But there'll always be a situation where that penicillin dose might be the first dose of penicillin that persons ever had. So on the labour ward, we need to be prepared for, the possibility of someone having an allergic reaction, the risk of getting a dangerous allergic reaction to a drug in the hospital is considered to be an acceptable risk, given all the good that it does to to treat women with penicillin who screened positive for GBS.
Brigid [00:13:23] Yeah, right. All right. And so do you know how likely it is for that penicillin or the antibiotics to work?
Patrick [00:13:31] Well, we do. We know that if you've done that, if you've tested or swabbed positive for IBS at 36 weeks and it's still present in the vagina during the labour, then the risk of getting a baby that's infected with GBS in a serious way is dramatically reduced by the use of in labour antibiotics. So from somewhere around 1 in 200, if you don't treat to about one in 4000 if you do treat. So there's no doubt that this intervention has been worth it, hasn't been around forever. When I very first started in obstetrics at the Royal Women's as a registrar, doing this was new. And before that, people, you know, the pediatricians, neonatologist were seeing a lot more babies with severe sepsis than we do now. So it works every intervention that we that that has been developed over the years to improve obstetric care. It has to stack up. We don't do an intervention for fun. We don't do intervention for no reason. And if we're going to interfere in some way, give a person drugs, do a procedure, somehow interfere in the otherwise natural process of childbirth, and then the data has to stack up that it's actually helpful and worthwhile and worthwhile.
Brigid [00:14:51] Absolutely. So you mentioned before that there are particular times where a woman might be at high risk of having GBS but can we just go through those again?
Patrick [00:15:00] Yeah, I wouldn't say that she is at higher risk of having GBS. So this is someone at standard risk of having GBS in the vagina. But there are some circumstances in which that she might be more of a sitting duck for that to seriously infect the baby and result in a clinically significant infection in the baby.
Patrick [00:15:19] And those are labouring earlier than 37 weeks when the waters are being broken, more than about 18 hours. Different hospitals will have different rules on that. But prolonged labour or prolonged, I should say, prolonged ruptured membranes. A fever in labour, you know, in someone who's more positive for GBS, we're going to be particularly cautious about that. A woman with a UTI, you see a urinary tract infection can be caused by GBS as well. So a GBS UTI can complicate labour, can cause the labour to come on and can certainly complicate labour and also affect the baby. And this one's a little bit controversial. Not everyone agrees with this. But if a woman had a previous pregnancy that was complicated by a significant GBS infection, then we tend to treat anyway. And some time some places will treat anyway, even if the woman is negative at 36 weeks, not everywhere.
Brigid [00:16:19] Okay, so what about the microbiome of the baby? I know this is this is the thing that people like to talk about. This is the gut health of the baby having a big dose of penicillin for the mother. Does that impact on the microbiome of the baby?
Patrick [00:16:33] Yeah, the simple answer is yes. Antibiotics don't just kill the bacteria you're trying to kill. They kill a bunch of other ones as well. And yes, the use of antibiotics in labour will be changing the gut flora. The bacteria that are on where the mother's been treated by by antibiotics. The question remains whether that actually does them any harm. We don't think it does. And we and we know that in the case of GBS, it does a lot of good. So whilst it might be true to say it changes the gut flora, we don't have any good evidence that that's harmful. We've got some evidence that if there's a transient change in the gut flora, that that's all the same later on. So if you re swab the babies at twelve months, they might be the same as every other baby. Not all the bacteria on a baby or inside a baby comes from the mother. And so the baby is gonna get all the other bacteria they get from other people in the environment anyway.
Brigid [00:17:34] So, you know, there's a lot of mums that are pretty keen on getting their babies home after birth. And sometimes they're there for twelve, 24 hours, 36 hours. What do you think about that? What should they be looking for?
Patrick [00:17:49] I have a view about the wisdom of early discharge that is separate to the GBS argument. I think that discharge within a day, especially for a woman having her first baby, unless she's surrounded by a lot of wisdom and support, is a potentially tricky thing to do to do well. And I think there are probably risks in doing that in terms of how people cope and postnatal depression rates and so forth. With GBS, so I think that if we're going to be discharging new mums early and having babies leave the hospital early, then we have to do our observations carefully within the first 24 hours. So there is a protocol within hospitals that says that if there was a prolonged labour or other risk factors are met, then the baby needs to have strict observations taken over the first 24 hours. And if the baby falls outside, expected progress even a little bit, then pediatricians would be involved and tests would be done.
Brigid [00:18:48] Yeah, and we this level of monitoring couldn't happen if you're at home, you just wouldn't have that same ability to assess the signs and symptoms, it would be very hard to do that at home.
Patrick [00:18:57] You'd have to have some expertise. But but it's the first 24 hours, the probably the most important. So if you stay in hospital for at least 24 hours, we're still going to have to do that.
Brigid [00:19:06] And is the treatment or the testing for GBS the same throughout the world?
Patrick [00:19:11] No, not really. There are different protocols. What we do in Australia with some minor variations from centre to centre is a swab at 36 weeks. And we treat everyone who is positive on that swab with antibiotics in labour. Regardless, we just assume that it will still be there in labour. There are other places where they do what's called a risk based approach, and that's that's treating people in labour only if they have known risk factors for significant GBS infection.
Brigid [00:19:44] So back to the baby again. Will it delay breastfeeding?
Patrick [00:19:48] Well, not as much as a sick baby would. So, again, it comes down to risk and benefit. You know, a very sick baby from GBS is going to be in the nursery, potentially very unwell with all sorts of problems, including delayed feeding, whereas the prevention approach is better than cure.
Brigid [00:20:06] And again, thinking about things, perhaps that a woman can do proactively. Could she be taking probiotics?
Patrick [00:20:13] There's a potential role for probiotics if you're on antibiotics. Systemic probiotics to help restore some of the bacteria to the gut that those antibiotics might be killing, the good bacteria in our gut that helps us digest our food and so forth. But I'm not aware of anything you can do preventatively to change a GBS status.
Brigid [00:20:34] Okay. Well, I think we've covered most things that I had on my list about GBS. So I hope for you, dear listeners, that this has been helpful. So just to recap, you have your GBM swab at 36 weeks and it's something that you can administer yourself. And if you're found to be positive, you'll be having some penicillin or some sort of antibiotics during your labour. All right. Well, that's it from us for this episode.
Patrick [00:21:03] We got it. Up next, and we're actually going to be talking about breech birth, which might be an interesting topic that we're ready for that one.
Brigid [00:21:09] We are. All right. I'm good to go. Good. All right. Well, thanks, everyone, for listening. And we'll catch you later. Talk to you next time.