What is the deal with GBS and why was it never ever on your radar until the last month of pregnancy? Navigating an approach to testing options is downright confusing (did you even know you can decline testing altogether?!). Deciding what to do with positive GBS results is even more overwhelming! And then trying to find a natural treatment for GBS from your provider can make be unclear and discouraging. GBS positive pregnancies can have a huge impact on the story of your birth and we know you want to keep this experience as natural as possible.
Thankfully, like many things in midwifery, we have an approach to GBS that simplifies the options and points you towards real solutions that have deep and lasting health benefits, for you and your baby! This post is packed to the brim with answers to your most common questions about GBS and our best home treatment options. Here's what we are jumping into today:
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What is GBS/Group Beta Strep?
Group Beta Strep (GBS) is a naturally occurring strain of bacteria that lives in the digestive tract. An overgrowth of it can become detectable in the vagina (and rectum) and present a potential (small but serious) risk for baby during birth.
How Common is GBS in Pregnancy?
GBS is very common. In the US it is standard to test for GBS in pregnancy. Up to 30% of pregnant women will be GBS positive at some point in their pregnancy. GBS is transient, which means it can be detectable as an overgrowth one day, and undetectable the next.
What Causes GBS in Pregnancy?
The gut and vaginal microbiome are very well related for women. Pregnancy shifts many things in the body and can often expose an underlying imbalance of flora (the unique microorganism environment of a specific part of the body). The vagina (and gut) are in a constant "battle" for balance, using the good bacteria present to "conquer" or consume the bad bacteria. Learn more about this delicate micro-bio dance in our free Vaginal Health Masterclass HERE!
There is pathogenic (disease-causing) bacteria all over the inside and outside of our bodies, but healthy bodies are very good at keeping this in check. When the vaginal flora experience a negative shift in either decreased good bacteria or increased bad bacteria, it can cause some imbalances there, allowing certain microorganisms to grow faster than the good bacteria can keep up with. These imbalances usually cause unpleasant symptoms, like UTI, yeast, odor or vaginal irritation. Decode your vaginal odor with us in THIS post, it's probably more normal than you realize!
What are the Signs and Symptoms of GBS?
Unlike other vaginal imbalances, GBS does not have a clear set of symptoms, leading some microbiome experts to speculate on how relevant this testing is for pregnant women. GBS is one of the many, many types of pathogenic bacteria that can be found in the vagina. Women with a history of other vaginal imbalances may have a higher risk for GBS overgrowth. GBS overgrowth is only discovered and diagnosed with a bacterial culture.
How is GBS Tested for?
GBS can be detected in a urine sample or vaginal/rectal swab tested for bacterial cultures. Most results are quantitative, meaning they flag as positive when a certain amount of bacteria is detected, indicating overgrowth. At your first prenatal appointment your provider will offer a urine culture, where a small amount of your pee can be tested for bacterial overgrowth, mainly to rule out UTI (urinary tract infection) that can be problematic for pregnancy. This is often how GBS is discovered in early pregnancy.
Otherwise, it is standard care in US to offer a vaginal swab (a long q-tip type thing) to collect cells from inside the vagina and rectum to be tested for the overgrowth of GBS around 36 weeks.
GBS in the urine is a sign that the overgrowth is systemic, versus being localized to just the vagina or rectum, which in some cases increase the risks of infection.
Risks of Being GBS Positive in Pregnancy
The main risk for GBS overgrowth is passing the bacteria onto the baby during a vaginal birth and that bacteria causing an internal infection for the newborn. GBS infection of the newborn requires fast and intensive treatment in a NICU.
What are the Risks to the Baby of Being GBS Positive?
If someone who carries GBS is not treated with antibiotics during labor, the baby’s risk of becoming colonized with GBS is approximately 50% and the risk of developing a serious, life-threatening GBS infection is 1% of that 50% of babies. One of our favorite resources for sorting through these statistics is the research interpretations provided by Evidence Based Birth.
As an important distinction, being colonized as a newborn is not the same thing as having an early GBS infection– as we see statistically speaking, most (99%) colonized babies stay healthy. Remember, only 30% of women have an overgrowth at any given point, so testing negative at 36 weeks doesn't mean you will necessarily be negative at the time of birth. However, treating GBS positive moms with prophylactic IV antibiotics in labor brings the infection rate for the newborn to almost zero.
What if You're GBS positive, Should You be Worried?
The United States medical model has a very narrow approach to GBS. (Did you know MANY other first world countries, like the UK and Australia do not even screen for this bacteria?!) All women here are tested, and if positive, the woman is required to receive IV antibiotics in labor. The standard of care in the US is "once positive, always positive", which means that one positive test at any point in pregnancy will require treatment in labor, even if subsequent tests are negative. This protocol is very effective at minimizing GBS infection of the newborn but not without some consequences left in it's wake.
Risks of Treating GBS with Antibiotics:
There are many reasons women become hesitant to participate in antibiotic treatment. Here are a handful of common objections to the standard recommendation:
GBS is extremely common, about 30% of women will test positive at any given time
Diagnosis and treatment are not precise, GBS is transient and can produce a positive result one day and a negative result the next
Antibiotics are not benign for the mother or her baby
IV placement impedes physical comfort, and potentially interrupts normal labor flow
While GBS infection of the newborn is extremely serious, it's also very rare
In midwifery care, we provide informed consent. Which means we present the risks, benefits and alternatives of any offered test or procedure, and let the mother decide. One of the best tools we have, as you have heard us harping on time and time again, is prevention. Learn more about this concept HERE.
Preventing GBS Naturally
While there is no way to make absolutely certain that your baby will not contract an infection (even with antibiotic treatment... or from the dozens of other bacteria we don't fixate on in this country) we CAN do things to decrease the over-colonization of potentially harmful pathogens in the vagina. Imagine that, the concept of working on overall health and holistic wellness can impact outcomes for women in multiple areas.
This bio balancing begins with treating the root cause of the microbiome issue by influencing healthy vaginal flora from the earliest possible moment of intended fertility. In fact, what a great aspect of health to prioritize before you even start planning for your next pregnancy! If you consider yourself the plan-ahead type (aka, you are reading this post and not even pregnant yet), grab our Prep for Pregnancy Checklist right HERE and equip yourself with good health from the very start.
We prioritize supporting the microbiome in pregnancy with nourishing foods, lifestyle modification as needed and quality supplements. Jump ahead to the GBS Protocol, if you are here for the step-by-step instructions on prevention.
Some recent studies suggest that using a probiotic each day in your last trimester can cut your chance of testing positive for GBS by almost half. We recommend a women's/vaginal health specific probiotic with a high CFU. In our practice we see our positive GBS screen rate at less than 10%, which is about 3 times better than standard statistics. The best probiotic strains for this are Lactobacillus reuteri and Lactobacillus rhamnosus. THIS product has them both!
Can You Get Rid of GBS if You Test Positive?
Yes! Believe it or not there is a natural treatment to GBS in pregnancy. If you isolate (and partially ignore) the issue that the medical model provider will be unlikely to retest you or accept a newly negative result, there is simply no reason not to work on balancing your flora and increasing vaginal health in pregnancy. Although not linked to any official research (think about who pays for studies, can big pharm make money on holistic home remedies?), many women report treating GBS naturally and effectively at home. One of the main reasons we are sharing the info in the blog is to increase awareness of these options and success we see in our own practice.
Many women will work on vaginal balance after a positive test and retest after a couple weeks to "prove a cure". Some women are satisfied with working as much as they can on vaginal health and not retesting, but feeling more comfortable with declining antibiotics knowing they have been focused on building good flora. Get some inspo for declining things in pregnancy HERE. Part of the issue with GBS, that remains with treatment consideration, is the transient nature of the overgrowth, that can make testing and the response to the results somewhat capricious.
As a word of caution, we do not recommend many of the alternative treatment ideas out there that effectively reduce the good bacteria with the bad. Some of those that women may come across include hibiclens, hydrogen peroxide, or other douching protocols. Wiping out good vaginal bacteria leaves the woman open to rebound infections, something we especially want to avoid as she goes into the vulnerability of postpartum recovery. For a complete guide on postpartum planning and recovery, check out THIS resource.
Informed Consent for GBS Screening and Treatment:
To understand proper informed consent, the consumer should acknowledge that the medical model of maternity care is not reliably set up for shared and respected decision-making. The midwifery model of care is built upon a few integral premises that make informed consent for all procedures and testing possible:
Pregnancy and birth are normal life events, and both the responsibility and the joy belong to the woman and her family.
The woman is at the center of the care and the primary decision-maker. She is most qualified to make the best choices for her body and her baby, not her care provider.
Women thrive best when they are cared for holistically: physically AND emotionally, mentally, socially, spiritually.
All care providers have the duty to provide the following information before allowing the woman to decide on the best course for her:
What are the benefits of the proposed test or treatment? Is it offered as a standard or option?
What are the risks of the proposed test or treatment? What are the woman's unique clinical risk factors relative to the options?
What are the alternatives for the proposed test or treatment?
What is the provider's individual experience and personalized recommendation for this individual woman?
Are there any consequences to declining the proposed test or treatment? Will the woman or her family be treated differently in the care model because of the declination?
After collecting this information, doing your own research and self-education, and then discussing your concerns and questions with your care provider, there is no wrong decision. Women make choices for all different reasons, and what may be the right thing for someone else is not going to be the best thing for you. Ah, the beauty of informed consent right there. Dive into more of our informed consent philosophy in THIS post.
Natural Treatment Options for GBS in Pregnancy?
As an important disclaimer, there are no medically researched and accepted treatment option for GBS in pregnancy outside of the antibiotic protocol the CDC has released. We have provided a lot of food for thought on those recommendations and recognize with good informed consent, many women will desire (and deserve!) alternatives.
We have a 3 factor approach to treat GBS naturally:
Targeted vaginal support: In the form of gentle and good-bacteria-boosting suppositories and topical applications. This can include garlic, yogurt, coconut oil and probiotic capsules, among some essential oil compliments.
Nutrition density and specificity for gut health (which directly influences vaginal balance): Taking out the foods that feed bad bacteria (refined sugar and grains, preservatives, and pesticides) and concentrating on food pairings that help good bacteria multiply and flourish (whole foods, especially fiber and protein, fermented dairy and veggies, healthy fats, clean protein and immune-boosting ingredients).
Supplements and herbal regimens: Layering in essential nutrients, safe for pregnancy, to give the body what it needs to optimally restore vaginal balance and stimulate the immune system to fight the bacterial overgrowth. (Specialized probiotics, omegas, zinc, vitamin D, vitamin C, and echinacea, to name a few.)
The great news is you can absolutely replicate our approach above as you work toward a GBS-free pregnancy and birth. Find all our favorite supplement recommendations HERE. If it feels like a slightly overwhelming undertaking, you are not alone! In true Beautiful One fashion, we have the perfect checklist-style resource to share with you today.
Formulated for our own homebirth clients, our midwifery-informed protocol for reducing GBS gives you the exact instructions to optimally restore your vaginal health. Make the most out of the time you have- there is a strategy for every stage of pregnancy already included.
GBS Protocol, Instant Download
Our very own midwifery informed resource for preventing, reducing and treating GBS naturally in pregnancy and postpartum. Purchase this easy-to-implement guide and get instant access to this specified guidance:
A Preventing GBS Protocol
Vaginal Health Food Guide
Our Reducing GBS Protocol
A DIY Suppository Tutorial
Our Recovering from Antibiotics Protocol
Best Supplement Recommendations (with product links!)
We want to be a part of helping you feel comfortable and confident in the details surrounding your birthing plan, no matter where or how you plan to meet this little one. Imagine the burden of GBS being lifted, one less unknown to distract you from the importance of your birthing day... all while contributing to your overall health AND being grown in your ability to treat yourself naturally, from home!
Although we are licensed midwives by profession, we are not YOUR midwives. All content and information on this website is for informational and educational purposes only, and does not constitute medical advice. Although we strive to provide accurate general information, the information presented here is not a substitute for any kind of professional advice. For more information, click here.
Great article! Any thoughts on D- Mannose? Someone suggested it to me as a preventative,as well.