**sign this petition to get strep B test made routine in the NHS**

[fairylights]

this is a petition on the downing st website asking for the test for group B strep to be a routine test for all pregnant mums..
i am no expert on this but it sounds like a good idea to me!
petitions.pm.gov.uk/groupbstrep/

gives you so much faith when even the consultants don't know what they are talkin about!!

OK, if we accept the mortality rates are not significantly different, but they are different....let us assume that there is a small decrease in the newborn mortality rate with routine testing and administration of abx during labour. So some babies will be saved. Great, really, wonderful, hat's what we wall want, healthy, happy babies.

But what if the cost of saving those babies lives of preventing their admission to NICU came at the cost of endangering and losing those babies - and others - just due to different causes?

A couple of examples of what I'm talking about:

In the US, where approximately 30% of labouring women are treated with the abx for positive GBS screens in the 36th week of pregnancy, some strains of GBS are becoming antibiotic- resistant. This means that if it is passed to the baby (and the antibiotics do not always prevent this) there is no treatment. Some strains have been discovered that are resistant to ALL known antibiotics. Routine administration has created this superbug from a bacterium that naturally manifests in the vaginal and rectal region of many women.

The use of antibiotics during labour reduces the indidence of GBS infection - but it increases the likelihood of other blood infections such as E.Coli, and those are harder to treat as the infection has already been exposed to the abx and become resistant.

These considerations do not even touch on the fact that for the 30% of women who would test positive, their options for labour, pain management, and birth location would be severely curtailed. For women who test positive, there is extra worry in late pregnancy, extra hours in the hospital arriving early to administer abx, less chance of an active labour or of managing the pain with water or positioning due to IV abx. This means increased likelihood of other interventions, drugs, assisted deliveries, CS, and all those attendant complications, side effects, mental health problems, Bfing issues, and problems conceiving, keeping or birthing future pregnancies.... All worth it OF COURSE if this improved outcomes for your child. But if it doesn't, really? Is it worth doing?

It's not just a matter of offering a test. There are very far reaching implications of tethering 30% of labouring women to intravenous antibiotic in today's enviroment of antibiotic resistant superbugs.

i did not know that some strains of gbs are resistant to anti-b's. that does somewhat alter my opinion.

This is a great article on GBS
here

I'm afraid I also have major misgivings about universal screening for GBS because of the issue of antibiotic resistence.

Thankyou

Nappyaddict - it's really important for every mother to know about this issue, but to know both sides. The petition is well intentioned - but too many people don't look into it any further. Just hear 'dead babies' and sign right up. When the reality is more babies could be endangered now and in the future if what the petition supports comes to pass.

Apologies for knowing far too much about this issue, and for typos

don't apologise. i am glad you are so well-informed. i have read and looked into this lots but as you said the information all seems to be one-sided. never once have i read about resistance to anti-b's which is ridiculous as it is obviously a very important part of the story.

I am a junior doctor who got pregnant shortly after doing a paediatrics job which involved a lot of time working on scbu, and just before I went off on maternity leave, was doing an obs and gynae job. As a couple of pps have said, all the evidence suggests that routine screening for group b strep, even if you use a reliable method, is not necessarily helpful in reducing perinatal mortality, and is certainly not cost effective (which is important in a cash strapped nhs - we can all think of things related to healthcare which need much, much more money spent on them). Treating someone with antibiotics in labour is also far from risk free - antibiotic resistance, severe reactions to antibiotics, infections at the site of a drip insertion, immobility during labour leading to other problems etc etc. So, at the time, I didn't - and still don't - support universal screening - it has far too many down sides, no proven effectiveness and would be very expensive.
However, having seen babies very ill on scbu with group b strep, I decided that I would have private screening - simply for my own emotional reasons that if my baby had got group B strep, and I thought there was anything I could have done about it I wouldn't have been able to cope. I tested positive, had my IV antibiotics in my (otherwise very low risk) labour and 3 hours later became extremely unwell with group B strep septicaemia which ended up with an emergency section and a 7 litre PPH. The bug that caused the septicaemia was (luckily for me) sensitive to penicillin, which was what I'd had at the start of labour. I think having prophylactic antibiotics probably made the infection less severe for me, and stopped my baby getting it (although she went to scbu and had blood tests and lumbar puncture and antibiotics, she didn't actually ever get group B strep) - so I think my illogical, non-evidence based decision probably saved my life and my baby.
Having said that, there are probably other mothers out there who have died because of a severe allergic reaction to antibiotics they never actually needed.
So, I think I agree with rohan - universal screening isn't the answer, it's an issue mothers need to know about and decide for themselves, having been as fully informed as possible, because there isn't one right answer.
sorry for long post, as you can imagine, this is an issue I have thought a lot about!

Good post smileyhappymummy. I believe the same too. I do feel that it is really important that people feel that they have made the decision themselves either way and not pushed in to it.

how does antibiotic resistance happen? is it because gbs carriers have antibiotics when the gbs may not actually be present at the time of labour? or am i totally off the mark with that? or is it to do with overuse of antibiotics in general. i remember from a-level bio something about if you over use antiobiotics then the harmless bacteria like that in your intestine becomes resistant to antiobiotics which in itself is fine but they can then pass on their resistance to harmless bacteria (like gbs i suppose?)

Every time you use antibiotics, a few bacteria will probably not be killed, just because they have a random mutation that makes them immune to the effects of the antibiotic. Though there may not be enough bacteria to make you unwell at the time, they will then be the ones that go on to multiply and spread the resistant genes - basically just natural selection and evolution. So, even using antibiotics when they are needed contributes to resistance developing, but the more they are used, the quicker resistance develops, and the more likely we are to run out of antibiotics that the bacteria is sensitive to. If you give penicillin to 30% of women having a baby, it won't be that long before most of the bacteria that have survived are resistant to penicillin - and then we have to move onto the next antibiotic and the next one, and so on, - until we run out of options - scary thought! This is basically how MRSA has developed and why it's such a worry - the bug itself isn't any more dangerous than it was before, but it's resistant to more and more antibiotics, so if someone does get a severe infection, we have very few ways to treat it. Hope that makes a bit of sense!

We're forgetting that GBS is a transient infection. So if we advocate universal screening when are we going to do it? If you test a woman at 34 wks and she's positive, then it may well have resolved itself by 37 without treatment.

If a woman tests positive to gbs between 35 - 37 weeks of pregnancy there is a high chance that she will be a carrier at the time of the birth. Can't remember exact figures but it is something like 95%.

I'm not sure simple screening / profilactic anti-bs are the answer either.

they do have it in spain, but then they have lots of unneccessary testing in spain (5 scans, diabetes testing for all etc) and actually, it's very stressful for women, reults in a lot of unneccessary anti-bs (asd mentioned). They do have a lower neonatal death rate, but I suspect that's mostly to do with pretty much all births being in hospital, and high early intervention rates.

also I seem to remember that for normal, quick births, the risk for babies of infected mothers is actually very low. I wonder if the best solution would be to test all women, and then test the babies of those whose waters break early or who have long labours.

i started this thread originally (ages ago!) because a friend of mine who had had GBS/a GBS affected baby told me about it and asked me to post it. But its been really interesting to read everything that people here have said.. thanks for all the info, esp from you maxbear!
As i have only had a homebirth so far i am not sure if routine testing would have impacted upon me anyway, although I guess I could have been "asked" to go to hospital instead?? hmmm...

thank you too, Rohan and smileyhappymummy - really glad you and your baby are ok now, very interesting to hear your very real perspective.

i don't know about gbs having to be cultured cos i know someone who was tested during labour due to prom and it went for emergency testing. pretty sure they didn't wait 24 hours for the result.

In Cambridge it's done routinely in late pregnancy as part of a general MOT. I asked my GP if it was worth getting a private test, and she said no, our Trust does it routinely. (She's referred me privately for a nf scan, which they don't offer at all.)

I just want to say thank you for all of you for this informed and interesting debate. I was certain, until I read this, that I was going to get tested, but now I'm going to counsel more advice from my obs consultant cos I think that I could be wasting my time or making things worse.

I'm still confused but feel better informed - if that makes sense!

ECM is expensive but most reliable.

From where I'm standing (just finished 9 weeks on PN ward) it appears to me that you're lucky if you or your baby manages to leave PN ward without having abx - surely screening all women would wipe out the costs accrued by all this 'just in case' screening and treatment, and of course the overuse of antibiotics.