6.

6 Informed Choice: GBS Testing and Treatment 

Rachel Twelmeyer 
 
WHAT DOES IT MEAN TO BE GBS POSITIVE? 
&  
HOW DO YOU TEST FOR GBS STATUS? 

Group B Streptococcus (GBS) is a type of bacteria that exists in the digestive tract. Although it usually 
stays in the intestines, it can come down to the rectum, where it may move to the vagina and urinary 
tract. Most people with GBS do not have any GBS infections or symptoms. 
 
However, if the bacteria gets into your baby’s body it can grow rapidly and cause other conditions like 
infection of the brain, lungs, or blood (Dekker, 2017). So if you’re GBS positive, it means that you have a 
higher-than-normal amount of the GBS bacteria in your body​, especially in the low intestines, rectum, 
vagina, or urinary tract. 
 
The Center for Disease Control (CDC) recommends measuring GBS with a culture test at 36-37 weeks 
of pregnancy. This is done by ​swabbing the rectum and vagina with a Q-tip​, and then the lab tests it to 
see if GBS grows. This tells us whether there is too much GBS, and whether we should consider 
treatment. 

 
WHAT HAPPENS TO MY BABY IF I’M GBS POSITIVE? 

If your ​baby is colonized by GBS​ (meaning, it enters her body during the birth) there is a chance that it 
can turn into an infection. The death rate from early GBS infection is estimated at 2 to 3% for full-term 
infants. This means of 100 babies who actually have a GBS infection, 2-3 will die. 
 
Although the death rate of GBS is relatively low, infants with early GBS infections can still experience 
long term complications, developmental problems, and there may be increased expenses for the family. 

 
WHAT TREATMENT OPTIONS DO I HAVE? 

The CDC’s Recommendation: 

The CDC recommends that ​antibiotics be given every 4 hours through an IV​, starting more than 4 hours 
before birth. Penicillin is the antibiotic of choice, with other options for people allergic to penicillin. This 
recommendation was first given when there were a lot more cases of GBS, and they wanted to create a 
way to treat every woman to stop early GBS infections. ​Since implementing this treatment, there has 
been ​a huge drop in the number of early GBS​ infections in the U.S.—from 1.7 cases per 1,000 births in 
the early 1990’s, to 0.25 cases per 1,000 births today.  
 
As licensed midwives in the state of Utah, we are licensed to administer these antibiotics. Our protocol is 
to administer the medication, then disconnect you from the IV line to facilitate mobility during labor. 

 
Below are some alternative treatments. Research has not proven that these are effective at reducing 
transmission rates of GBS, but they may be helpful in reducing your level of GBS colonization. 
  
Alternative Treatments 
Although not proven in clinical studies, there are some other options that can help lessen the impact of 
GBS. 

● The first is something called a ​Chlorhexidine​ (also known as Hibiclens) wash. This is an 
antibacterial soap that isn’t irritating for most people. We typically rinse your vagina with 
Chlorhexidine in the last part of labor. 
● Garlic ​has antibacterial properties, and some websites recommend putting garlic in the vagina to 
eliminate GBS before the GBS test.  
● Probiotics ​are live bacteria and yeasts that are good for you, especially your digestive system. 
When you take a probiotic, it introduces these good bacteria into places like your intestines and 
vagina, and the more good bacteria there is, the less space there is for the bacteria like GBS to 
invade. 

 
WHAT ARE THE RISKS AND BENEFITS OF EACH OPTION? 

Potential benefits of antibiotics: 

● Decrease GBS growth/transmission: 
○ In clinical trials, using antibiotics (penicillin or ampicillin) during labor decreases the risk 
of early GBS infection by 83% (Dekker, 2017). 
○ Penicillin rapidly crosses the placenta into the fetal circulation (at non-toxic levels) and 
can prevent GBS from growing in the fetus or newborn. 
Potential risks of antibiotics: 
● Allergic reaction 
● Yeast Infections 
● Medicalization of birth 
● Temporarily decreasing the flora of the baby’s microbiome  
 
Each of the alternative treatments can help decrease the GBS, and help improve the natural flora of your 
microbiome. However, these methods have not been proven to kill the GBS effectively and for long 
enough to have an impact during the birth. 

 
WHAT IF I CHOOSE TO NOT TEST FOR GBS? 
& 
WHAT IF I CHOOSE TO NOT TREAT IF I’M POSITIVE? 

IF YOU CHOOSE NOT TO TEST: 

● The primary outcome of not testing is that you and your baby may not receive treatment to 
prevent transmission of GBS. 
● If you need to transfer, the hospital may need to do a test during labor to determine your GBS 
status.  
 
IF YOU CHOOSE NOT TREAT: 
● The risk of your baby becoming colonized with GBS is approximately 50% and the risk of 
developing a serious, life-threatening GBS infection is 1 to 2%. (Antibiotics during labor 
decreases the risk of your baby catching early GBS infection by 83%). 
 
 NOTE: Certain clinical situations may warrant a conversation about reconsidering the benefits of 
treatment (these may include having broken waters for > 24 hours, early rupture of membranes, etc.) 

 
LOOKING FOR MORE RESOURCES? 

❏ Evidence Based Birth has great information on the topic: 

https://evidencebasedbirth.com/groupbstrep/ 

❏ The CDC has very thorough information: ​https://www.cdc.gov/groupbstrep/index.html 

❏ The American Academy of Pediatrics discusses in depth the repercussions on infants: 

https://pediatrics.aappublications.org/content/early/2019/07/04/peds.2019-1881 

 
Please choose one: 
 
❏ I choose to screen for GBS. 
 
❏ I choose to decline screening for GBS status. 
________________________________________________________________________________________________________ 
 
❏ I choose to receive IV antibiotic treatment during labor per the CDC’s recommendation. 
 
❏ I will consult with my midwife as to an alternative treatment (this may include no 
treatment.) 
  
Parent Name: ________________________________________________________________ Date: _____________________ 
 
 
Parent Signature: _______________________________________________________________ 
 
 
 
Midwife Name: __________________________________________________________ Date: _____________________ 
 
 
Signature: _______________________________________________________________ 
 
 
References: 

Dekker, R. (2017, June 25). Evidence on Group B Strep in Pregnancy. Retrieved from  
 
https://evidencebasedbirth.com/groupbstrep/.