Q&A: What is Group B strep (GBS)?

This sounds very distressing. Here you are getting the proper care for Group B strep (GBS), and then your baby goes to NICU and gets a workup as if you weren't treated. Based on this information, I am going to presume that you had a fever during labor, or that the baby showed some sign of infection after birth that made the pediatricians uncomfortable assuming that the treatment during labor was adequate. So how did things get to this point?

As you know, we all have bacteria and viruses on our skin and in our intestinal tracts and vaginas. GBS is a type of bacteria that can be present in the vagina. It isn't an infection, just one of the normal bacteria in some women. About 15 to 20 percent of women have GBS when tested, and a small number of their babies will get sick at birth if the mom isn't treated with antibiotics during labor. Treatment before labor doesn't seem to prevent newborn infection and currently isn't recommended, so a whole lot of moms get antibiotics during labor these days to prevent a few serious newborn infections.

Newborn infection with GBS can be very serious, causing meningitis and/or sepsis (blood poisoning), and can lead to grave long-term consequences. Luckily, the vast majority of newborn GBS infections can be prevented with antibiotic treatment during labor, and when infection occurs it can be treated quickly.

In addition to treatment with antibiotics during labor, a mom who carries GBS will be watched closely during labor and her baby will be watched closely after birth. If the mom starts to show signs of intrauterine infection, such as fever, or if the baby is breathing quickly or looks ill at birth, concern about GBS infection increases, and the baby may be presumed to be infected until proven otherwise. "Proving otherwise" may involve blood and spinal fluid cultures and a few days of intravenous antibiotics until the initial cultures prove negative. If the baby does test positive for Group B strep sepsis or meningitis, it is good that the antibiotics were started right away. If the baby tests negative and signs of infection resolve, treatment is sometimes discontinued after a few days.

While many modern NICUs have places for the parents to stay with the babies, it isn't the same as being with your baby in a regular mother-baby unit or at home. Sometimes it can seem like the team is totally overreacting to a minor maternal fever or temporary newborn instability, and you just can't believe all this high tech disruption is necessary. And why bother with the antibiotics during labor if they aren't going to work? But decisions about GBS prevention and treatment are based on odds, and it sounds like the team was worried about your baby. Talk to the NICU team and your OB doctor about what happened. You are the mom, and you deserve to participate in decision making and to fully understand the events that led up to the evaluation and treatments that your baby endured. Hopefully you can get answers to your good questions that will reassure you that the team had your family's best interests at heart.