Group B streptococcus (GBS) is one of the many digestive tract bacteria that live in the body. It can come and go many times throughout a person’s lifetime without it ever causing any issue or illness, and it is not a sexually transmitted infection (STI). Anywhere from 10-30% of pregnant people are “colonized” with or carry GBS in their bodies without ever knowing it.
Due to the close proximity of the rectum, vagina, and urethra, the bacteria can easily migrate from the digestive system to urogenital tracts. This means that there is a possibility that GBS can be passed to the baby during labor. This is rare and happens to 1 or 2 babies out of 100 when the pregnant person is not treated with antibiotics during labor. It is very rare for the healthy newborn to contract GBS, but the chances of them becoming ill may be lower when treated.
Screening for GBS is a part of routine prenatal care and is usually done by taking a vaginal/rectal swab culture between 35 and 37 weeks of pregnancy. You may request to take the test at 38 weeks if you are wanting more time to self-treat. If the test comes back positive for GBS colonization, an antibiotic called penicillin will be suggested/given intravenously when your birthing time begins. If you are allergic to penicillin, another similar antibiotic will be offered in its place.
If you have had a previous child with GBS disease, have GBS bacteria in your urine at any point during your pregnancy, your GBS status is not known when you go into labor, or if you have tested positive for GBS in a past pregnancy, intravenous antibiotics may also be offered/recommended.
One alternative to the universal approach is the “risk-based approach.” This is when you receive antibiotics based on other risk factors such as having a fever or your water being broken for more than 18 hours. Especially if baby is less than 37 weeks gestation. (This is the method currently employed by care providers in the UK.)
You do have the right to decline antibiotic prophylaxis in labor, and taking the watch and wait approach to see if baby develops symptoms and then treating if they do. If you are GBS positive and you decline abx, while there is an overall very low likelihood (approx 2% chance) that your baby will develop early onset GBS infection.
Now that we know a little more about GBS…Let’s talk about your vaginal microbiome!
This information is for you if you are pregnant or trying to conceive, and would like to try to try to prevent or reduce the colonization of GBS and a subsequent positive test. The possible prevention of GBS and the recommendation for antibiotics starts with optimizing your vaginal bacteria from the get-go. It’s up to you, as your care providers are probably not going to give you information beyond what GBS is, and how and why it is treated during childbirth.
By the time you get tested for GBS, it’s already late in your pregnancy. If you happen to test positive, there aren’t many options offered by medical providers besides IV antibiotics. As you can imagine, the suggestion for IV antibiotics can throw a wrench in your plans for staying home during the early phase of your birthing time. Especially if your waters have released before surges pick up. Most likely, you would be asked to come in as soon as your waters released or labor began so that you were able to receive a minimum of one dose of antibiotics at least 4 hours before the birth of your baby.
Urogenital and gastrointestinal infections are often caused by an imbalance in “good” and “bad” bacteria. Certain infections such as UTI, BV (bacterial vaginosis), and GBS… have been said to be caused by the decrease in, or depletion of the indigenous flora Lactobacilli. Studies have found that probiotic therapies containing Lactobacilli strongly inhibit the growth of GBS by increasing the acidity of the environment and that they may be effective in returning the vaginal flora microbiome to a healthy normal state. Another Study has shown Lactobacillus Salivarus greatly reduces the chance of GBS colonization. So adding that probiotic to your normal regimen of Lactobacillus Reuteri and Rhamnosus strains should be even more effective.
With all of this information about GBS, probiotics, and scientific data to back it all up, trying to decrease or prevent GBS colonization during pregnancy seems like an excellent choice for a reduction/prevention wellness protocol — especially if someone is really wanting to avoid IV antibiotics. Another good reason to prioritize your vaginal flora to prevent or reduce the chance of testing positive for GBS is because many people planning for an unmedicated birth will prefer to spend the early phases of birthing time at home to maximize comfort and to reduce the chance of unnecessary interventions at the hospital. Even those birthing in birth centers will have to worry about coming in early for antibiotics if their waters have released before birthing waves begin, and the possibility of facing a transfer of care if their birthing waves “take too long” to begin… putting them in a higher risk category and leading to the suggestion of induction for PROM (Pre-labor rupture of membranes.) This applies to everyone, but more so for those who have tested positive for GBS. Those who test positive don’t usually have the luxury of waiting for their birthing waves to really pick up and get moving, as someone who tests GBS negative might.
For more information on the benefits of avoiding IV antibiotics, Birthful has a podcast all about the microbiome. I highly recommend that everyone listen to this!!
There are many probiotics on the market. Which ones would I want to take if I am trying to reduce or prevent GBS colonization during pregnancy?
Jarrow Formulas is one brand that has been clinically tested, and contains the strains that are believed to be most effective against GBS and other urogenital infections such as BV and UTI. It can be found in many pharmacies and is also available on Amazon (of course - what can’t we find on Amazon these days?) There are a few different formulas, some with more strains and capsules that are vegetarian and non. Here are a couple different product examples. Seed is a symbiotic and has pre as well as probiotic!
There are other brands on the market, but you want to make sure that if you choose another brand that it contains Lactobacilli strains, specifically Lactobacillus rhamnosus GR-1, Lactobacillus reuteri RC-14, and Lactobacillus Salivarus. You may have to buy a separate Salivarus to add to the other combo.
What else can we do to support gastrointestinal and urogenital health during pregnancy?
Limit sugar and processed food intake. These things can feed bad bacteria colonization.
Eat a balanced diet and make sure to get enough fruits and vegetables, complex carbs, protein, and healthy fats, and even add in some cultured foods that support healthy gut and vaginal health, such as yogurt, sauerkraut, kefir, and kombucha.
Stay hydrated: Drink at least 10-12 cups of water every day.
Practice good hygiene and frequent hand-washing protocols.
Boost your immune system with vitamins and supplements
Reduce stress
Other holistic and wellness methods, such as Aviva Romm’s Protocol