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

Sorry roundtable I regret sounding so emotional about this.

When I had the meeting with the consultant to discuss these events I asked why wasn't i offered or even informed about the testing and she did say that the cost was the reason. It is not a one off also, to be meaningful it has to be repeated over the term of the pregnancy.

We ttc for 10 years, had 2 rounds for fresh IVF and I had a mc previously. I think we spent around 10K already and I assure all 15 or even 50 gbp price tag for the test does not scare me.

But the NHS policy (at least where I am) is not to offer it if the pregnancy is normal. Now that I have lost a dc, I will be monitored. I guess NHS thinks it is a reasonable trade off.

I have signed the petition already before and I am happy to post here about my experience when the opportunity arises.

bemybebe you shouldn't apologise for sounding emotional, you have a valid point and your emotions are tied into that point.

I guess it keeps coming back to the same point. Why isn't there more awareness about this? I'm not the only person I know now who has been affected by premature labour or stillborns. Is GBS related to more if these than given credit to?

I must go but will be back tomorrow, time difference to the UK at the moment.

bemybebe, I am sorry for your loss.

Prehaps we need more research into who to test and into stillborn and neonatal deaths in general. I think it would make sense to test any woman who goes into labour early or prehaps has early rupture of the membranes without going into labour straight away. Premie babies are so weak and are more vunerable to GBS.

I think that NICE needs to look at whether the benefits of testing all women out weigh the risks. Is a complex issue

I'm back but not sure for how long.

I think I'm thinking that more research is needed reallytired but I also think now, while they are researching then prehaps they should start with one of the problems that they know about that that they can do something about. GBS.

I feel I had to reply to this as its so close to my heart, firstly I live overseas and testing for gbs is standard, I tested positive at 36 weeks, this was my third child and had no issues with other two, my obgyn reassured that I would be given antibiotics and everything would be fine and i suppose because it was my third time around I never gave it a second thought and also, nobody I have spoken to about GBS has ever even heard of it and does'ent know what im talking about, anyway the baby turned to breach position at 37 wks and there he stayed, so I had to have a cs, it was my first one and I was a nervous wreck, no need for antibiotics I was told as the chances of GBS being passed on during a c section were virtually nil.....

Well not so baby was born grunting and was whisked away straight immediately and spent 12 days in NICU, was ventilated, had pneumonia, septacaemia, thankfully not meningitis, he had a blood transfusion, two lumbar punctures, it was a living nightmare, never in my wildest dreams did i ever think this could happen as a result of GBS, thankfully he is now 7mths old and a whopping 10kgs and is doing great, however as a result of the septacaemia he has a heart arythmia called SVT which caused him to go into heart failure at 3 weeks old, he is now on medication and has had no further episodes since he was six weeks old.

I have researched a lot since then and what I learnt is truly frightening, as another poster mentioned GBS is the biggest cause of late miscarriage and still birth and death in newborns, yet my obgyn said they do not pick up gbs while in the uterus, which i now know to be wrong, i discussed this with her at my 2wk and 6wk check up and to be honest i was an emotional wreck at the time I just left it at that.

I suppose what I'm trying to say is that they're needs to be more awareness, my cousin is a midwife back home and she never even heard of it, I mean WTF??? Testing should be standard,

Bemybabe, I'am so sorry for your loss, it could so easlily be any one of us x

abayababe a midwife that hasn't heard of GBS, that is shocking. What a stressful time that must have been for you.

I wonder how many people have heard of it, or realise it is the trigger for miscarriage, stillborns, and even meningitis?

I think it should be routinely screened for. In lots of other countries it is and deaths due to GBS are far lower - definitely worth the extra money. I mean, where do you draw the line when it comes to money? How can ANYONE say how much a newborn's life is worth? I know the NHS has it's faults as well as it's strengths compared to other health care services across the world, but as a first time mother at 32 weeks, I am not exactly thrilled with the maternity care across the country. There are so many differences that can lead to inequalities in care.

At 25 weeks, I had a 'feeling' that I was carrying GBS. I have always had discharge, even before falling pregnant, and didn't think much of it until it got heavier. I know the signs to look for (increased discharge, smelly, yellow or green, itchiness etc, etc) that can signal any kind of vaginal infection. I was diagnosed with thrush at 16 weeks and was treated, but a 'gut feeling' had me thinking I had GBS. The trouble was, my discharge was white on leakage but yellowish when it dried on my panty liner. I did not detect a smell and neither has my DH.
At 28 weeks, I told my MW. I told her the symptoms and she shrugged her shoulders and said it was normal. As a first time mother, you BELIEVE the professionals. Why else wouldn't you?
At my 31 week appointment on Weds 2nd Nov, it was a different MW. She was VERY thorough and a great deal more help than my last MW (who was lovely, but lacked knowledge as far as I was concerned). She tested my urine and said it was showing signs of an infection. She asked about coughs, colds, urinary and thrush symptoms so I told her what had happened at my 28 week appointment. I was sent to the loo to do a swab test. After my appointment I was sent to the hospital as my BP was rising (not PE) and I gave them the swab test and did another urine sample. That sample did not show any infection which led me to believe it was my vaginal swab to show up the infection as my last urine test, I did not wipe before peeing and therefore the infection had contaminated my urine.
On Friday 4th Nov, I went to the GPs as I had sinusitis and it was confirmed I do have GBS. I was pleased that I knew as it would now be dealt with but I was concerned that had I wiped before giving my first urine sample at my MW appointment, the infection would not have been picked up in the sample, led the MW toquestion me, led me to disclose information from my 28 week appointment or led me to be told to do a swab test. I shudder to think what could have happened if it had went undetected. My colleague came round an hour later and when I told her, she said that her friend had it but her baby got sick (the friend was not diagnosed until AFTER her baby got sick) and was very poorly for a week - that could have been avoided if she had been routinely tested.

It's easy to say 'no' to routine tests until it's your baby whose life is being put at risk.

mumtobe, its great that you know you carry GBS, I also knew, but my concerns were completely dismissed and I honestly didnt worry about my baby, I was that confident in my consultant, always go with your instinct and do not let anyone fob you off, midwives are great at that, I wish you all the best.

I don't think routine tests are a bad idea per se, but I do think that there needs to be more research and thought into what to do with the information that is gained from doing them. For the majority of women, GBS is a transient infection that will not cause problems. Many women who are GBS +ve in the 2nd trimester will be GBS -ve at term. The vast majority of women who are GBS +ve at term will see no ill effects to either themselves or their babies with no intervention.

My concern is that routine testing would lead to a huge surge in anti-biotic use during labour. That will lead to bacteria that are resistant to the ABs used - GBS may well be one, and it may well not be alone. Before too long we've worked our way through the complete range of ABs available, as has already happened with some strains of TB. If by overusing ABs today we create a strain of GBS that is resistant to all known ABs then we will, quite literally, be able to do nothing other than offer supportive care to babies that become infected with that strain - at which point the mortality rate would almost certainly go up dramatically :(.

I completely agree that you can't put a price on a newborn baby's life - but we also live in an environment where there are budgets and that does result in financial constraints. If we want to increase the budget for GBS testing to make it routine, what service should be cut to fund it?

Please believe that I'm not trying to belittle the experiences of anyone who has had personal experience of a GBS infection - whatever the outcome. I've held my own dead baby and have first hand experience of the anguish involved. I'm just scared by the potential longer term consequences of routine testing and AB use - I'd far rather see some decent research done to either produce a more rapid test (the current ones require a culture, which takes >24 hrs to get a result - far too long to be useful during labour, or in trying to diagnose a problem with a newborn baby) or to identify women with babies at increased risk of running into trouble.

i don't think its a cost issue - there are risks to the baby and mother of anti-b useage too (making the baby more vulnerable to non-bacterial infections) - and across a potential 25% of the population that could outweigh the benefit.

as it is higher risks groups are routinely checked.

possibly fewer VEs in labour would reduce infection rates (US has higher infection rates, same 25% general population...wider usage of scalp clips & more VE's)