Getting conflicting advice about Group B Strep

[SmallMexicanChihuahua]

I’m really frustrated as I’ve just been told that I don’t need (or potentially won’t be given but maybe I misunderstood this part) antibiotics for GBS after consistently being told the opposite throughout my pregnancy.

I tested positive for GBS 6 years ago from a vaginal swab. It’s my first pregnancy and GBS was discussed several times in my midwife appointments and I was always told that I don’t need to get tested again and should just ask for the antibiotics when I get to hospital. Then at 35w I had a consultant review for an unrelated issue and she explained that the midwife would test me for GBS and I won’t need AB if it’s negative. However, at my next appointment the midwife (not my usual one) said that the NHS doesn’t test for GBS and there’s no point anyway because the result can vary every day or so. She said I could either get a private test or just have the AB anyway to be safe. I decided to do the latter.

Today I had my 41w appointment with yet another midwife who told me that it’s not their policy to give AB unless I’ve tested positive in this pregnancy or have had a baby with GBS. She said they’ll assess me when I’m admitted to the hospital but most likely won’t get the AB because of the above and that they’ll monitor me and baby anyway.

This has made me very anxious, I understand that the risk of GBS is very small but the consequences can be devastating. The hospital was recently rated as ‘inadequate’ by the CQC so I don’t know if I trust that their monitoring will be sufficient. I’m just kicking myself that I didn’t do the private GBS test and now it’s too late as I’m scheduled to be induced in 5 days.

Should I just insist that I get the antibiotics? Can they refuse?

Might be a bit difficult but can you change hospital? If you’re not happy with the care you’re receiving it should be possible.

Good luck

Sorry can't really advise as my last baby was almost 13 years ago and I'm sure advice will change every few years.

I tested positive for GBS in 1st pregnancy and had ABs during labour. For my 2nd baby 4 years later they said there was no need to test as I would be treated as having GBS due to the previous pregnancy and again had ABs in labour.

Not sure if you have seen the group b strep support website but there is a helpline on there where you could get some more solid advice.

gbss.org.uk

I had GBS in my 2nd pregnancy but not my 3rd (didn’t test with my 1st) so it’s not a given that you will have it.

I second the advice to look at the GBSS website, which has all the info. The NHS policy is as your most recent midwife has said. Personally I tested positive in pregnancy but then had a private swab shortly before delivery which was negative, and I then refused the antibiotics, which are not risk free for mother and baby either. The thing about your GBS status changing from day to day is true, but given that, why does it make sense to assume you’ve had it if you’ve ever had it in the past, but not if you’ve never had it in the past?! I felt that a negative result was actually more conclusive than the 99% of NHS patients who don’t know one way or the other, are never swabbed, and never offered antibiotics. There are other risk factors though and if I’d ticked any of those I would have made a different decision. Anyway, definitely worth a read of that website.

That is very frustrating. If the consultant said you should be tested then I think you should be asking the midwife and the consultant to review the situation and advise you of the agreed recommendation. The royal college of obstetricians has a guidance doc about Group B Strep which I was reading the other day because I was identified as having it at about 16 weeks so have been told I’ll get the antibiotics. I’m not wild about the antibiotics because of the effects on a tiny newborn gut however I think what it said is that if you do have it at the point of delivery it cuts the risk of your baby being (potentially very) sick from 1 in 400 to 1 in 4000 so have decided to just go ahead and get them. That doc is worth a read - as you say risk is very small indeed. I’d still ask for the consultant to confirm their advice in your specific case.

Put your foot down and insist.

I tested positive with my DD 10 years ago and had antibiotics in labour with her.

I told midwife this pregnancy and she put a "Group B Strep Warning" label all over my notes and said that I would be offered antibiotics in this labour - even though they will not be testing me for it again.

There is a useful guideline on the British Journal of Obstetrics and Gynaecology: obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.14821

Personally, I would ask to have it in labour. There is no harm in having the antibiotics for you or baby but could prevent infection in baby. x

Get a private test so that you know if you’re positive or not, if you can afford it
Then if positive tell the NHS

It's a tricky one. ABs are not risk free either. The 1 in 400 statistic includes all babies I believe. If you have a full term baby of healthy weight it's less, but I couldn't find a statistic for that and my midwife couldn't help either. We were very on the fence whether to have the ABs or not. The 12 hours of monitoring also reduces the risk. But then again if you didn't have them and you were one of the unlucky ones you wouldn't forgive yourself. But then again you can't prevent your kids climbing trees, swimming etc. We went round in circles like that!

In the end we had an accidental home birth (labour very fast and hosp too far) so we couldn't have ABs anyway. Midwives visited twice in the 12 hour period to do extra checks, and also showed us what to look for, how to check his heart rate etc. We would probably go for this option again, checking the baby ourselves with the extra checks from midwives too. Hopefull I'll make it to hospital next time though! We do accept that it's a risk, but so are ABs (damaging immunity to future infections) so it is a weighing up of risks.

I know you do want the ABs, so would do as pp said and press for them. But I just wanted to hopefully reassure you that if you can't (due to policy or circumstances) try not to worry too much.

Hope you can sort it!

@Sparky888

Get a private test so that you know if you’re positive or not, if you can afford it Then if positive tell the NHS

Agreed - if you have time to do so!

I tested +ve for GBS before my first labour, so got antibiotics (overseas).

For my 2nd labour (11 years ago) I was told the NHS don't test for GBS, so I ordered and did my own test at 38 weeks and sent it off. You're already 41 weeks though and could give birth any day.

Thanks so much for the advice everyone! I looked at the GBSS website and it does seem that the official guidelines are what the latest midwife told me. Just don’t understand why the other two midwifes said to get the ABs anyway. My partner thinks I should have them as better safe than sorry, but then I’m not too keen to have them unnecessarily, as several of you mentioned there are risks… I’ll call the helpline this afternoon to see what they advise.

@Fleur405 Thanks, I only had a one-off phone call with the consultant so not really under her care. Another frustrating thing is she also recommended for my bloods to be done again which the midwife also ignored

@Sparky888 Really wish I had time to do this but 41w+1 already and scheduled to be induced on Tuesday morning

OP if you don’t have any other risk factors (small baby, premature birth, prolonged rupture of membranes…there may be others) then you could always ask to stay in hospital for monitoring for 24 hours, instead of getting the abx, which is what I ended up doing. Antibiotic resistance is a real thing and it’s not an insignificant measure to entirely wipe out a newborn’s microbiome on the off chance because you had a swab 6 years ago.