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(Disclaimer:  If you’re confused or unsure about my level of authority or my credentials–I have none!–please read my official disclaimer here.  Also, I am *not* a scientist or a researcher, and while I have included some citations, this piece is in large part my opinion, so take everything with a grain of salt, and please do your own research).

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That’s right—I’ve given birth to six babies so far, and I have never been tested for GBS.  My swab-test status is simply irrelevant to me: being GBS positive or negative will have no bearing on the course of action that I take during my pregnancies, or my birth processes, or postpartum.  I’m going to share with you why, but let’s first begin by analyzing GBS, to get a handle on why there is so much fretting about this usually benign bacteria.

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GBS refers to Group B Streptococcus, a bacteria that is present in the digestive systems of between 10-40% of individuals in a given population. GBS is not considered pathological normally, although its presence in the genital tract is a sign of over colonization—again, not in itself a disease-state, but indicative that there is an imbalance in the gut flora.  (Such an imbalance is best addressed through diet, but more on that later).

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If a mother’s body is over-colonized by GBS, the bacteria can migrate down through her urogenital tract, which means that, for mothers who test positive for GBS colonization but who do NOT accept the medically recommended course of antibiotics, their baby will have a 30-50% risk of becoming colonized.  In a small number of babies, GBS colonization can cause infection in the form of blood poisoning, Meningitis, and Pneumonia.

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There are two types of GBS disease: early-onset (between birth and 7 days of age), and late-onset (after 7 days of age). Between 60-70% of cases of GBS infection is early-onset (1) so I’ll be focusing on early-onset GBS here.

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It’s important to understand that *not* every baby who is colonized will become ill.  In fact, the risk of infection or illness is only approximately 0.5- 1% of colonized babies. Of that 0.5-1% of babies who become ill, only 2-3% of those sick babies (if born at full-term) will die.(2) Of babies who experience early-onset GBS disease, 50-70% of these will have no long-term health problems—although the long-term problems that the remainder of those babies might suffer can include learning delays, paralysis, hearing & vision loss.  So I really don’t want to minimize the seriousness of the damage that GBS-disease can do, to a very small number of infants.

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As in every area of pregnancy, birth, and life, there is risk, and we need to decide for ourselves the type of risk we are willing to take on. We must ask ourselves, as individual women (and as smart autonomous adults), where we fit into the reality that doctors are effectively administering antibiotics to 200 women, in order to prevent one case of GBS infection. Many women are not informed of the fact that antibiotics taken by ourselves and our babies during birth also involve potentially very serious risks.  I’ll be discussing some of those risks below.

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The GBS test is “offered” to every woman in North America who participates in the birth industrial complex during her pregnancy (see Part One, which refers to the failure of informed consent in instances like this). The test consists of a culture taken by a swab of the vagina and rectum, usually at 36-38 weeks’ gestation. The swab test is highly inaccurate, or rather, changeable, as a woman’s GBS status (determined by the swab) can vary day to day.  If a mother is tested as GBS negative at 36 weeks, there is a 10% chance that she may test as GBS positive at the time of her birth process. If she is tested as GBS positive at 36 weeks, there is a 30% chance that she will be tested as GBS negative at the time of her birth process. (3)

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A urine culture earlier in a pregnancy that comes back GBS positive can sometimes indicate a more serious or persistent case of colonization.  In this case, a doctor would recommend that a woman receive the prophylactic antibiotics whether she subsequently tests negative for GBS or not, the rationale for which I do not understand. It seems likely that most doctors also do not fully understand the dynamics of gut-health, or the risks of antibiotics.  The microbiome, after all, is an emerging field in science and medicine.

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Interestingly, in most (if not all) European countries, the GBS swab test is only offered to women with specific risk factors. Those risk factors include prolonged ruptured membranes, premature birth (prior to 37 weeks), or fever during the birth process.  Certain women also seem to be more statistically predisposed to GBS colonization, for reasons that are unclear to apparently everyone, including African-American women, women under the age of 20, and women with a higher BMI.  Certain situations can also increase the chances of testing positive for GBS, including recently having had sex, or receiving oral sex.  Clearly GBS protocol varies widely, and the interpretation of risk on the part of health professionals and mothers is highly inconsistent. (GBS colonization does seem to be lower in the general population of the UK vs. North America, but not to a degree that should so significantly change the approach to prophylactic treatment, in my view).

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The thing about science, and research, and statistics, especially when it comes to childbirth, is that *all* of the information gathered, is established from clinical samples.  There are no studies that are *ever* done on non-medicalized home birth.  Even the home birth studies that do exist are done in a context in which the mothers are being supervised and supported by regulated midwives, functioning under a medicalized model.  This is fine, but does not give a clear or accurate picture, in my view, of the kind of risk that is undertaken, or avoided, when it comes to non-medical home birth.

For example, vaginal exams are very prevalent, both in hospital, and during medicalized (midwife-attended) home births.  It is my experience, and my strong conviction, that not only are vaginal exams totally unnecessary, but that they are an extremely effective way of introducing, or exacerbating, infection—and that this in itself may pose a significant risk factor in the case of GBS.

Artificial rupture of the membranes (when a midwife or doctor breaks a woman’s bag of waters deliberately, rather than allowing the membranes to release spontaneously) is also a procedure that can precipitate infection.  Ruptured membranes are already known to be a risk factor for GBS colonization and disease in newborns anyway, and yet it remains a common procedure in hospital and in medicalized home birth situations.

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Hospitals also happen to be where sick people congregate.  There are many examples of babies developing infections and illnesses simply from being in the hospital environment.  Antibiotic-resistant bacteria are becoming more prevalent also, and we’ll discuss, below, some of the implications of this, when it comes to the widespread prophylactic use of antibiotics in the birth process.

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Hospital GBS protocols (which I also refer to in part 1) in most communities are utterly tyrannical.  Primarily, women who are GBS positive are *strongly* recommended to accept a continuous IV drip of antibiotics during her birth process (in some cases obstetricians or midwives may concede to women receiving an oral dose of antibiotics, but this has been found to supposedly be less effective than the drip).

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Being hooked up to an IV has an impact on a woman’s birth beyond the many downsides and risks of the antibiotics themselves.  Simply being tethered to the hospital bed is inhumane and extremely uncomfortable.  Birth is a dynamic process and complete freedom of movement is not just optimal, or appreciated by most mothers, but essential to the normal physiological unfolding of the birth process. Restricted movement is in itself a recipe for surgical birth.  Almost no woman can withstand the intensity of birth without being able to move, dance, stomp around, curl up in a ball, sit on the toilet, jump in the bath, writhe on the floor, or flail around.  Being forced to lie in a hospital bed means that a birthing mother will have to find another way to transcend the often overwhelming sensations of birth.  When straitjacketed by an IV, this transcendence will almost certainly have to come from drugs.  And how convenient!  We can just pop some demerol right into your IV, dear.

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Many hospitals have policies that “allow” mothers to “choose” between receiving a continuous IV drip of antibiotics for the duration of the birth process, or, having her baby removed from her body immediately after birth and taken to the NICU for “observation”. This, despite the fact that there is no one on earth better equipped to observe their own infant than the mother herself; as though taking a baby away from it’s natural environment (his mother’s skin), and breaking that symbiotic relationship before the new-earthling has even had a chance to figure out what hit her, isn’t dangerous for many reasons.  This separation deprives the infant and mother of those precious, never-to-be-repeated early bonding moments, as well as the essential protection of colostrum, and the exchange of hormones and pheromones from skin to skin that continues to take place during those early minutes and hours in which baby and mother imprint upon each other in so many ways.  There is generally no “science” to support the obvious, but my suspicion is that taking a newborn away from its mother puts that baby at a much higher risk of all sorts of infections, and a lowered immune response in general.  I *know* that having a baby removed from its mother creates a heartbreaking and very destructive level of stress for both the baby and their mother.

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Finally, if a mother refuses both the IV and the NICU visit, she can often expect a visit from social services.  I hope that we can all acknowledge that these do not constitute “choices”, but a form of terrible coercion.  Thus it is understandable that the enormous pressure women are under makes so many of us go out of our way to simply affect the outcome of the GBS test while still pregnant.

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Most studies do indicate that the incidents of newborn infection and death are diminished, overall, with the implementation of prophylactic antibiotics.  However, there are conflicting reports.  Some studies actually show that while the IV antibiotics can decrease the incidents of infection, they do not seem to reduce the number of infant deaths.(4)  Research from the Journal of Perinatology, published in 1994, shows that prophylactic antibiotics are often ineffective against GBS infection,(5) and a later study, again published in the Journal of Perinatology (1999) shows that IV antibiotics during the birth process do not affect either the rates of death or infection.(6)

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Another study from 1999 shows that the reduction of the transmission of vertical GBS “comes at the cost of increasing the incidence of ampicillin-resistant gram-negative neonatal sepsis with a resultant increased mortality. These data provide compelling evidence that the policy of providing ampicillin chemoprophylaxis in selected patients needs to be reconsidered.” (7) In other words, while the antibiotics may be reducing deaths from GBS, they are causing death thanks to antibiotic-resistant bacteria.

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There is a lot of hoo ha in midwifery circles, on the topic of washing the vulva and vaginal opening with Chlorhexidine (commonly known commercially as hibiclens).  Chlorhexidine is an antiseptic antibacterial agent, frequently found in mouthwashes.  There are some studies showing that a protocol involving frequent Chlorhexidine rinses of the vulva and vaginal opening can reduce the incidents of GBS colonization to a similar (or better) degree as IV antibiotics. Michel Odent appears to be a champion of this approach.(10)

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I can’t find much criticism of the Chlorhexidine protocol online, but I find the proposition horrific.  While the substance is diluted in the case of attempted GBS eradication, nonetheless, the potential side effects of Chlorhexidine, when used topically or orally, include “blistering, burning, itching, peeling, rash, redness, swelling, trouble breathing, anaphylactic shock”, etc.

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Furthermore, because Chlorhexidine is such a powerful antiseptic, it is effectively wiping out *all* vaginal bacteria, and this just can’t be good—for reasons similar to why antibiotics are so dangerous. This is just simply not an approach I would ever consider, as a preventative for GBS.

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Frequently, women will attempt to evade a GBS positive stamp on their chart by following certain “natural” protocols.  These include inserting garlic, probiotic capsules, herbs, and other substances into the vagina in the days leading up to the swab test. The problem with this is that there is really no evidence of benefit from these so-called natural measures, nor can we really be sure we are treating, or preventing anything.

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The reality is that GBS is an imbalance that originates in the gut, and in order to be properly addressed, GBS colonization needs to be treated from the inside out—starting with nutrition.  Furthermore, it is dismaying that so many women are inserting foreign substances into the vagina for the purpose of avoiding a GBS positive test outcome, because they may simply be temporarily warding off GBS from the genital tract—the site of the swab test– in order to avoid pressure from their obstetricians.  I imagine it must be the case that a number of these women will remain effectively GBS positive—although thankfully, most of these women will have healthy newborns in any case, because GBS sickness is so rare, no matter what.

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Far better, in my view, than inserting material into our vaginas, or compromising our immune systems or our baby’s with antibiotics or harsh antibacterial agents, is to *always* pay close attention to diet, and to *always* be consuming high-quality probiotic foods like fermented vegetables like sauerkraut, and *always* staying far away from sugar, refined foods, flours, and grains, and thus preventing (or rectifying) a GBS imbalance in the body just by virtue of one’s normal daily routine.  Stress is also a factor in microbial imbalances, and in the general susceptibility to disease, so I make a point of not engaging with the medical system during my pregnancies (unless there is reason to seek medical attention, and so far there has not been).

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I also see choosing to give birth spontaneously, in my home, under my own complete sovereignty, with no one present who would ever consider putting their hands or foreign objects inside my vagina, in an atmosphere of peace, and quiet, and familiarity, to be of primary importance in ensuring optimal health and safety for my baby.  I know that my body is accustomed to the rich variety of germs in my house, and I know that as soon as my baby is born, they will be receiving the necessary and highly protective experience of staying on my body, without the cortisol-spiking anxiety of separation, or pain, or testing, or the presence of strangers who are just following policy.

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GBS can certainly be dangerous, and life-threatening–in a tiny number of babies, most of whom will have significant risk factors, like prematurity.  And there are some instances in life, even during pregnancy or birth, where medical care is advisable, or desirable.  But it is the right of every woman to determine that necessity for herself.  For me, when it comes to GBS, I’m confident that I have made the right choice for my family.

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For more on the decision to give birth at home, check out my handy guide–a recipe book for an Ecstatic, Autonomous, Physiological Birth at Home.

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