Should Group B Strep testing be routine for all pregnant women?

[roundtable]

This is inspired by the CS thread and giving women the choice as it got me thinking about my own birth experience 6 weeks ago.

To cut a long story short (because I wrote out a post and then it disappeared into the ether!) I found out I had Group B Strep 3 days after my waters broke and 45 minutes before I was taken in for a CS.

Previous to this I had never heard of it and was quite shocked after leaving hospital to find out it was potentially life threatening for newborns. As they had tested my so late (or the results took so long to come back, I'm not sure which) it meant that I could not get the 4 hours of antibiotics needed during labour and my baby was taken away to neonatal where he stayed for hours as they were so busy. It also meant we had to stay in for 3 days so we were both able to have antibiotics. Apparently it is a £15 test which has reliable results from 35 weeks. I'm sure our stay in hospital cost much more than £15, apart from the separation upset and I think interference with breastfeeding.

So is my view tainted by my own experience or should Group B Strep be a routine test for all pregnant women in the UK? Other countries seem to test for it but is this because it is only affordable through private insurance? There are companies that will test for it in the UK but I didn't know about this until after childbirth and by looking at thewebsite at the bottom of this post. I did sign the petition but now I wonder is it affordable in the long run or does the potential saving of lives and distress outweigh the very small cost? I'd really love to see more than 3142 names on the petition, 100,000 is needed for it to be raised for debate in parliament.

www.gbss.org.uk/index.php

Its a balance of risk between over medicalisation and reducing risk.

It affects 1 in 1000 babies, yet 1 in 4 women have group strep.

www.aims.org.uk/Journal/Vol12No3/gbs.htm

I wonder if the money is better spent on postnatal care to detect the babies who are actually ill and need treatment.

I looked in to this in detail several years ago when pregnant with dd (after a positive test at 32 weeks), there are developed countries that test routinely and there rates of death and serious morbidity are no better than here. I personally decided not to have the antibiotics unless I had an additional risk factor such as temp in labour, prolonged rupture of membranes, pre term labour. I have had three children since without any problems, I didn't get tested with the second and third as it caused me so much stress with the first. I pretty much agree with reallytired. The hospital policy where I work states that the risk to a mum of having a severe reaction to intravenous antibiotics is similar to the risk of a baby having major problems, obviously if a pg mum has a severe reaction to the abx this might well severely affect the baby. This was the conclusion I came to seven years ago when I spent hours poring over medical journals to decide whether to have the antibiotics or not. So no I don't think everyone should get tested but I think individual circumstances should be taken in to consideration a bit more than they sometimes are. In other words women whose waters have been broken for longer than a certain period of time (maybe 36 or 48 hours) should automatically be offered antibiotics in labour. This would have solved the OP's problems as she would have been offered them earlier.

I agree with the above posts. Plus £15 may not sound a lot but with the birth rate of more than 700,000 a year, that adds up to a ridiculous amount of money, much better spent on generally improving services IMO.

It is routine in Australia in the public health system, but overall the public health system here is nowhere near as good as the NHS.

Interesting points. I think this is what I found difficult is the amount of information. I really didn't know anything about it except for a short paragraph on it it in the pregnancy book. The GBSS wbsite is useful but really, when I think about it, rightly or wrongly, they do have an agenda.

It hadn't even occured to me maxbear that the antibiotics might be dangerous. I think as you say, if things had been organised to take place earlier then it wouldn't have been such an issue.

I definately agree reallytired about postnatal care. I was lucky enough to stay in a private room on the labour ward and they kept me there for three day post birth also. I went late on the last day to the postnatal ward and it was horrible and very badly organised and again I was lucky enough to be given a private room again so I dread to think what it was like on the actual ward. But in the midwives defense, they were so over stretched it was unbelievable.

Of course it should. I have two friends whose babies died shortly after birth from GBS. It sickens me that they prioritise testing for things like Hepatitis over this. I just don't understand it.

Marie sorry to hear about your friends loss, it must have been horrible. Should anyone have to suffer like that for something that is so easily treatable?

I find the issue so confusing, on one hand, it is such a simple test and is so easy to save babies lives before there is an issue but I don't know where it lines up with other childhood infections.

Moneywise, would the money spent helping those 1 in 1000 babies actually justify the cost. Are there more cases of GBS that hepatitis B, syphilis, rubella or HIV? I can't seem to track down the information but if anyone can I'd be interested to look at it.

Moneywise, would the money spent helping those 1 in 1000 babies actually justify the cost.

I guess that's a question for those whose babies have died.

I keep thinking Marie that thank god it took nearly 3 days since my waters broke as otherwise they'd have no idea I had GBS and I might not be holding my gorgeous boy now. Emotionally, I think that does justfy the cost but I guess it could be argued that NHS doesn't make emotional decisions maybe?

I really understand how it isn't as important as the other things they test for? Are they even more common?

I don't know why they test for all the other things. HIV yes, as they can treat the baby from birth if need be. But Hepatitis? Rubella? Why? What's the point?

I was also tested for sickle cell, even though I had been tested as a child with negative results. As far as I'm aware, you don't catch it, so a pointless test.

I'm torn on the GBS issue - on the one hand I tend to think data is useful, as how else can we make informed decisions? But unless or until such time as that data is handled by HCP's in a pragmatic fashion I'm more ambivalent on whether it is universally useful or nor (so in this instance - knowledge of being GBS +ve would be useful and allow a care plan that mother and MW were happy with, but NOT if the MW sees the +ve result and presents the most extreme situation along the lines of "its essential you come in as soon as you go into labour so that we can start the IVAB's, otherwise your baby will have to have them and stay in hospital...", which is incorrect (and not necessarily advisable in the absence of other risk factors).

As a mother who's lost a baby at near term (for other reasons) my heart goes out to anyone who's baby has died, and I can understand the urge to be pro-active and try and stop the same thing happening to others. I'm just not sure that universal testing is the answer at the moment - especially given the way the results seem to be handled in many units.

Sadly, until the NHS has limitless resources and can offer every treatment for every condition, money does have to be taken into consideration. Should GBS screening be made standard if the only way to afford it is to reduce MW staffing levels?

Some of the other tests are discussed here. In summary:

• If a woman is infected with Hep B, the baby can be infected - resulting in liver issues for life. If the infection is identified before birth then treatment, in the form of vaccination, can be given started within 24 hours of birth to try and prevent the baby developing the condition - which has been found to be an effective strategy.
• If a woman is infected with Syphilis then it increases the risk of miscarriage, stillbirth, perinatal death, IUGR and assorted other fun things. The infection is effectively treated with ABs during pregnancy, protecting the baby.
• Women are screened for rubella antibodies to try and protect any future pregnancies by encouraging the mother to be vaccinated once she's given birth. If rubella is going to cause a problem for a pregnancy it will usually do so in the first 3 to 4 months, making it hard to be proactive for the current pregnancy.

re. Sickle Cell and Thalassaemia, my understanding was that the tests were only offered to women where their (or their partner's) ethnic origin made their baby at higher risk of the condition. Unless tests have become more accurate, I can't see a good reason for re-testing (other than the form says to if this condition is met).

You have between a 25% and 50% chance of carrying strep B at any given time.

My midwife suggested that you could test positive (as a carrier) one day and not the next (though I haven't seen back up evidence/ references of this)

If you are carrying group B strep at birth, there is something like a 1 in 300 chance of it leading to serious illness in your baby.

(reference the doctors laboratory website that supplies free swab tests, which they process for a cost of £32 www.tdlpathology.com/gbs)

I weighed up personally the effects of prophylactic intravenous antibiotics (on both me and my baby - digestive upset, thrush, potential reactions etc) against the risk of serious illness occurring.

It is also worth finding out what intravenous antibiotics mean in your hospital/area - in terms of mobility during labour, and whether you need to be consultant or midwife led.

It's totally personal decision - and if you have £32 you can get tested. I'm sure I might be swayed by personal experiences of close friends relatives.

Thanks for the info, Tangle. That lead to to this link here

It seems HCP professionals seem to be very conflicted themselves but I found this statement very interesting.
Although it is rare, GBS is the most common cause of life-threatening infection in babies during the first week after birth.

Why is this? Is it because the others are treated? If this is the case then shouldn't something be done about it? Plus if they are so conflicted, surely they should err on the side of caution?

I'm really backwards and forwards about this and I think the fact that we are not really told about it (I have had to explain to everyone what Group B Strep is when they asked why we were in hospital so long postnatally) makes it even odder. It's the most common form of life threatening infection in newborns, yet it is not much spoken about IME. Doesn't seem to correlate.

Woodifer I had read that GBS can come and go also. I think testing would really need to be done when a woman goes into labour but not sure how that'll work for home births or fast labours?

Its also worth noting that even if you have never been a carrier - your baby can acquire GBS after birth.

I think you need to have 4 hours of IV antibiotics for them to get to your baby.

roundtable - ^"Although it is rare, GBS is the most common cause of life-threatening infection in babies during the first week after birth."

Why is this? Is it because the others are treated? If this is the case then shouldn't something be done about it? Plus if they are so conflicted, surely they should err on the side of caution?"

I'm not sure its that the others are treated so much as that we are fortunate to live in a country where, if babies make it to birth, they are very likely to be healthy and thrive and there is support in place to try and ensure this happens. If an infant is diagnosed as having a GBS infection then it still has a 9/10 chance of surviving.

I completely agree that the general population in general and women in specific should be more aware of issues like this - when DD2 died in utero I was horrified to discover that she was one of 17 babies that day to have died between 24 weeks gestation and 4 weeks post-birth. 17 babies per day = 6,205 babies each year. GBS may be the largest individual identified cause of neonatal death within the first week, but that still only accounts for 34 of those >6,000 babies. In the UK we have one of the highest rates of stillbirth rates in the developed world - we don't know why so many babies have died and we don't know what the risk factors are that might allow a baby to be put on a watch list. Again, if it comes down to balancing budgets, do you spend the money on research to try and bring down the total of 6,207 stillbirths and neonatal deaths each year, or on screening and treatment to try and save the 34 babies that die each year from GBS (taken from the page you linked to)?

Re. testing in labour - the results would take too long to be returned to be useful in all except the longest of labours. I think the recommendation is to test between 35 and 37 weeks to try and ensure that its early enough you'll have the results before going into labour but late enough that that results should still be valid.

I have lost my dd at 3 week because she was born prem due to an aggressive strepB that infected the membranes.

My consultant said I will be tested throughout the pregnancy at 12weeks upwards "next time" as if I can just wipe the slate clean and start afresh. And yes, not routine testing is an immediate cost issue.

I was quoted by the same consultant the stats that 30% of prem labour is due to this infection with the obvious consequences for the babies, which is high likelihood of death or serious disability.

Those quoting costs as reason, I am very happy to swap places with you. You can visit your dc grave on a regular basis and I will be quoting you the stats from my high horse...

Tangle so sorry for your loss and it is shocking, the UK seems to be very backwards in it's research into stillbirths, other developed countries seem to be leading in this area so I believe.

Perhaps the emphasis shouldn't only focus on GBS but into the time period you mentioned and infant death. Dreadful. :(

France test everyone and maternity care is covered at 100%. They will also consider giving the mother ABs and retesting after the course is completed. It's less reliable but potentially more cost effective. Potentially because IVs in labour are routine here so most women don't fuss about having the ABs. I fussed about the IV though.

I think it's a simple, cost effective test but there are other things which could be done routinely to improve neonatal outcomes more.

Be careful with the numbers - my dd is not part of the strepB victim statistic, because, strictly speaking she died from necrotizing enterocolitis - a condition that typically kills prem babies. But my prem labour was triggered by chorioamnionitis, which strepB is responsible for. Asymptomatic until it was too late may i add (my labour was first stopped then I was induced as tests showed the degree of infection from which we would have both died - too late for antibiotics).

Btw, the cost of care for me was 10,000GBP (2,5 week hospital stay), for dd 50,000GBP (3,5 week hospital stay and 3 operations). NHS was lucky - I happen to be abroad for a week and my private ins picked up most of the bill. That is 60,000 GBP in total. Would have been a lot more if my girl lived longer.

bemybebe how terrible and what an awful time for you. I hope you haven't been offended, I didn't start the thread to be controversial, just my own birth experience opened up my eyes to issues that I didn't even know existed. I think that is shameful. Please do go on the website and sign the petition if you haven't done so already. I'm very sorry for what must have been dreadful.

I thought there were links with GBS and premature labour but I didn't want to say so incase I was wrong but that is certainly something that should be investigated, along with the horrendous stillbirth issue.

I wish more people would express an opinion on this or start to find out about it. This could affect them or their children. (Sorry I don't mean for that to sound patronising I know what I mean to say, I'm not sure if I am expressing myself coherently as I find it a very emotional subject). Things need to be sorted in terms of our maternity care it seems to be woefully lacking in some areas. I am a big supporter of the NHS but this doesn't seem right at all.

bemybebe that was precisely my reasoning over costs. Sorry to be crass but the NHS will work it by cost and result I would imagine. Surely £15 averaged out is much less than all the hospital bills of a severely ill baby?

Interesting point about figures and your dd not being part of the GBS statistics. Why do so many other developed countries see it as a priority, yet ours does not?

The authorities just don't seem to care about GBS and stillbirth. I don't buy the lack of funds excuse at all. If they want to save some money, then stop providing nappies and formula milk. Divert the funds elsewhere to something that actually save lives.