Katlyn Carter

Updated 2/20/20
Informed Choice: Antibiotic Treatment for Group B Strep (GBS)
What is GBS?

Group B Strep (also known as GBS) is a bacteria that lives in the intestines of normal, healthy people without
causing disease. About 25% of women will also carry GBS in the vagina. GBS is transient – that is, it can come
and go. GBS does not pose a health risk to the pregnant woman.
Is GBS a concern?
While GBS is not dangerous for the pregnant woman, a small percentage of babies will pick up the bacteria
during labor or birth and can become ill. Early-onset infection (within the first week of life) is a very serious
condition. Of the babies who develop this infection, approximately 5% die and approximately 25% have
lifelong injuries such as hearing loss, vision loss, or learning disabilities.
How do we test for GBS?
Because GBS can come and go, the Centers for Disease Control (CDC) recommends screening at 36-38 weeks,
as close to delivery as possible while still allowing time to receive results. Of women who test positive,
approximately 84% will still have GBS in the vagina at the time of delivery. However, 16% of GBS-positive
people may be negative by the time they go into labor. Of the women who test negative, approximately 9% will
GBS-positive at the time of delivery. The closer the test is to the time of delivery, the more accurate the results
are. The test for GBS involves a q-tip-like swab which is first inserted into the vagina approximately 2cm and
then on the tissue between the vagina and anus. You can do this yourself, or you can ask the midwife to do it for
you. This swab is then sent to the lab for culturing.
If the results are positive, what does that mean? Will my baby get sick?
If you are positive at the time of labor and birth, your baby will come in contact with the bacteria. Now, you
decide if and/or how you will treat yourself for the infection prior to birth.
Rates of early-onset GBS infection without treatment (for infants born at or beyond 37 weeks):
 For all clients (this is your presumed risk if you choose to decline screening) 1:3000
 In clients who test positive and have no additional risk factors 1:770
 In clients who test positive and have >18 hours of ruptured membranes 1:150
 In clients who test positive and have fevers in labor 1:20

Rates of early-onset GBS infection with treatment (for infants born at or beyond 37 weeks):
 In clients who test positive and have no additional risk factors, after 2 doses of antibiotics 1:100,000
 In clients who test positive and receive less than two doses of antibiotics in labor 1:80,000
 In clients who test positive and have >18 hours of ruptured membranes 1:17000
 In clients who test positive and have fevers in labor 1:4000

How is it treated?
Standard of Care in the United States:
Oral antibiotics are not effective in treating GBS. The recommendation from the CDC is that women
who screen positive receive IV antibiotics in labor. Currently penicillin is the standard drug used for
 Katlyn Carter
Updated 2/20/20
treatment; for women who are allergic to penicillin, other drugs are available. The goal is to administer
at least 2 doses of penicillin by IV, 4 hours apart in labor. This can be done without attaching a
permanent IV line in labor, if you desire.
Alternative treatments
While there are theoretical alternative options such as the use of probiotics, garlic, chlorahexadine (Hibiclens),
etc., there is insufficient research, and none are FDA approved. The potential benefits and harms are unknown.
Until more research is done, there are a lot of unknowns regarding alternative treatments.

Risks of following CDC guidelines

 9% of women who screen negative will be positive at the time of birth. Practitioners often manage
situations differently based on screening results.
 If more than 10 doses of antibiotics are required, the risk of antibiotic-resistant infection in the newborn
rises.
 There is a risk of allergic reaction to the antibiotic, most often involving minor irritation but very rarely
(approximately 1:100000) involving life-threatening anaphylaxis.

I, _____________________________________, confirm that I have read the above, done research on my own, and that
my midwife, Katlyn Carter, has discussed this with me to my satisfaction. I have had the opportunity to ask questions and
they have been sufficiently answered. I understand the benefits and risks of treating or not treating GBS with antibiotics.

_______ I understand the risks of GBS infection to the newborn. (Please initial)
Please select all that apply:
 I WANT to be screened for GBS at 36-37 weeks’ gestation.
 I do NOT WANT to be screened for GBS.
 If I screen positive for GBS, I want IV antibiotics in labor.
 If I screen positive for GBS, I do NOT want IV antibiotics in labor.

Client Signature: ______________________________________ Date: ____________________

Midwife Signature: ____________________________________ Date: ____________________

Additional Resources
Association of Ontario Midwives. Group b streptococcus: prevention and management in labour. Retrieved from:
https://www.ontariomidwives.ca/sites/default/files/2017-09/CPG-GBS-Prevention-and-management-in-labour-PUB_0.pdf
Group B Strep International. Recognize the signs. Retrieved from: https://www.groupbstrepinternational.org/recognize-the-symptoms-
of-infection.html
Evidence Based Birth. The evidence on: group b strep. Retrieved from: https://evidencebasedbirth.com/groupbstrep/