Can you explain (briefly) what you'd say if antenatal GBS screening were introduced in the UK?

[JaneEliz]

We want to be able to quote online/in press releases/other documents what routine GBS screening would mean to families who have in one way or another been affected by group B Strep. If you're willing to do this, please

[Ali-x]

It's about time this country protected it's children.. I was completely unaware of Group B Strep in my pregnancy.. I was given no information whatsoever. My son died an hour old and for months, we were in the dark about his death. Post mortem results proved that Strep B was the cause. A completely preventable death.

A simple swab and antibiotics could have sparred his life! Introducing routine testing would not bring my son back, but it would help to prevent further heartache to other families.

[Hidden]

At last, we're catching up with other developed countries. It means women in UK will have same choices for their babies. Shocking it's taken so long to offer screening esp as, if positive, the baby's delivery can be managed to minimise risk.

[Marb]

At last it has happened I prayed it would before I die.It is seven and half years since my first grand child Rosie Frances Birkett died from Group B Strep the heartache although still there I can now stop feeling angry that babies will not be dying needlessly or be left severely disabled any more.It beggars belief that a modern health service such as ours has buried its head in the sand and allowed this to continue to happen for so long. The cost to the NHS alone for the care required for the disabled children from GBS must far out way the cost to include the GBS screening into antenatal care, now that expense will vastly diminish. Finally we have joined the first world countries that include GBS testing in there antenatal care and have vastly reduced the number of babies affected by GBS. Our Country now obviously want these babies to live and be healthy as they are part of this Countries future. It is a very long awaited day for me and 1000's of others affected by GBS . I can die knowing that families will not go through the devastating effects of GBS that mine and countless other families did.

[JaneEliz Group B Strep Support Volunteer]

Thank you so much for sharing your comments. We'll be sharing these, and other comments, with the NSC to show the strength of feeling there is that introducing routine antenatal GBS screening in the UK would be a positive step forward.

Thank you!

[smessager]

I would be concerned that women screening positive for group B strep would be given intrapartum antibiotics as routine without being given the risks associated with the treatment, so that they could make an informed decision. I fear that they would simply be told to have antibiotics or else risk their babies lives, and that this would also affect their choices as to where and how they can give birth. GBSS can be very severe and I want to express how sorry I am that mothers have lost babies through this illness. But research shows that things aren't simple when it comes to treating GBSS. The article "the war on Group B strep" by Midwife Berverley Beech highlight the issues very well (see aims.org.uk/Journal/Vol15No... . The latest Cochrane database review shows that the use of intrapartum antibiotics is not supported by research evidence (see summaries.cochrane.org/CD00.... There are risks to babies receiving intrapartum antibiotics-in particular antibiotics treated babies are more at risks to suffer from an antibiotics resistant E coli infection. It isn't easy to make the right decision, but the decision should be made by the parents nevertheless-not by the health professionals, and parents should not be coerced into making a decision.

I was group B strep positive with my son and had intrapartum antibiotics. I believe that this played a strong role in the development of the severe eczema he has suffered from birth (because the antiobiotics prevented the normal colonisation of his digestive system by healthy bacteria). I am a research scientist in a large genome research centre and more and more research shows how important the normal colonisation of the gut is for health.

I would hope that if GBSS screening was introduced, it would be offered alongside informed choice leaflets, so that families could make the right choice for them and their babies.

[WorriedNanny in reply to smessager]

I have had a look at the two links given. A quote from the Sara Wickham's, 2003 article (not Beverly Beech?) actually states

'it depends on whether you are happy to be gathered together with all of the other Ms General Publics and told what is best for your health (and that of your children)'.

How condescending is that? Such a statement has no place in an article that the author expects anyone to take seriously as a clinical, evidence-based article. When you have had a baby born with strep B and are concerned about your next child I would hardly believe anyone could dismiss your concerns in such a manner. I hope she no longer practices.

The cochrane summary states that the research comes from 3 trials conducted 20 years ago? I am a nurse and understand concerns about the overuse of antibiotics and exacerbating the problems of penicillin resistant infections, however, my main priority is to never see my daughter go through the stress and heartache we endured during our grand-daughters first weeks of life again. Or experience the post natal depression resulting from that time which destroyed her confidence in her ability to care for her own child.

She will be having penicillin during her labour this time and as an informed personal choice not as a 'MS General Public' who has been 'told what to do'.

[JaneEliz Group B Strep Support Volunteer]

Hi smessager, thanks so much for posting. We completely agree that pregnant women who test positive for group B Strep should be able to make an informed decision based on accurate information on the pros and cons of both having intravenous antibiotics in labour and not.

It is very important to tell women of all relevant risks, both of GBS causing infection in their babies and of the risks associated with the antibiotics they may be offered. We have a section on the potential side effects of antibiotics on the FAQ page of our website (gbss.org.uk/content.php?sec....

Clearly group B Strep being found during the current pregnancy would mean the mother should be offered intravenous antibiotics in labour against GBS infection developing in her newborn baby. And it is true that this could, in some circumstances, restrict where she could give birth – unfortunately many midwives aren’t qualified (or insured) to give IV antibiotics at home. In the past, many midwife led units have taken the same stance although anecdotal evidence suggests that is changing, particularly when the midwife led unit is alongside a maternity hospital. As to how they give birth, if they’re having IV antibiotics in labour, it really shouldn’t change their birth plan too much – the drugs are usually given by slow injection/drip over perhaps 25 minutes every 4 hours in labour and, although slightly inconvenient for that time, this shouldn’t preclude most activities during the labour.

Sara Wickham’s article did, if I remember rightly, create a bit of a stir when it was published in 2003, however there have been many papers published since then. Studies have repeatedly shown that screening reduces the incidence of early onset GBS infections massively, and that the rates stay low. On the other hand, the UK incidence has risen since the introduction of the Royal College of Obstetricians & Gynaecologists risk-based guidelines in 2003, despite the expectation that they could potentially halve the number of cases (incidence data hpa.org.uk/web/HPAweb&Page&.... Also publicly funded studies have found screening to be more cost-effective than risk factors.

In terms of some of the fears of the negative effects of intrapartum antibiotics, the experiences in other countries have largely allayed these – antibiotic resistance studies in the US (see cdc.gov/mmwr/preview/mmwrht... and ncbi.nlm.nih.gov/pubmed/215... have not shown an increase in antibiotic resistance in response to using antibiotics for early onset GBS prophylaxis except in very low birth weight babies and, in the latter, the incidence of resistant E.coli infection was identified in babies whose mothers were given amoxicillin as intrapartum antibiotic prophylaxis, not the preferred benzylpenicillin (see ncbi.nlm.nih.gov/pubmed/159... and ncbi.nlm.nih.gov/pubmed/121....

Systematic Cochrane Reviews are great and are widely recognised and revered for being “Independent high-quality evidence for health care decision making”, as their strapline states. However, their review on Intrapartum antibiotics for known maternal GBS colonisation onlinelibrary.wiley.com/doi... is not one of their best. Quite simply, the review was inadequately powered to say anything very much based on the studies it reviewed (more on this at scienceandsensibility.org/?..., although they did find “a statistically significant reduction in early GBS neonatal infection.” Whilst we would agree that “Ideally the effectiveness of intrapartum antibiotics to GBS colonized women to reduce neonatal GBS infections should be studied in adequately sized double blind controlled trials. The opportunities to conduct such trials have likely been lost”, the reality is that there is evidence from other studies, including population studies, which show very clearly that screening is more effective at reducing early onset GBS infections than the use of risk factors alone (Schrag et al, 2002 is one example).

There is increasing evidence that should provoke caution in the widespread use of broad spectrum antibiotics in perinatal care but the situation is much simpler for GBS disease. As stated at bmj.com/content/344/bmj.e28..., “ the situation is much simpler for group B streptococcal (GBS) disease. The balance of risks clearly favours administration of a narrow-spectrum antibiotic to which GBS is highly sensitive. Intrapartum antibiotic prophylaxis with benzyl penicillin allows effective eradication of this common and frequently lethal neonatal infection, with a much lesser likelihood of long term impact upon perinatal imprinting events mediated by the normal flora.”

We also hope that if antenatal GBS screening were introduced, a major education exercise for families and health professionals involved in maternity care would accompany it, to enable each family to make the decision which is best for them and their baby. Anything less would be appalling.

[WorriedNanny in reply to JaneEliz]

Many thanks for your response to this. It is very helpful and there are some very useful facts given. My daughter does not want a hospital birth after the last (pretty horrendous) one. She is seeing a consultant next week (after I put in a complaint about her 'care' so far this time), and will be asking why she cannot have IV antibiotics at home. As I used to give them on a regular basis as a community nurse, the possibility that midwives may not be insured to give them hadn't occurred to me. A useful thought to possibly bring into the discussion at that appointment. Thanks again for all your help and info at GBSS!

[JaneEliz Group B Strep Support Volunteer in reply to WorriedNanny]

Glad you found the comments useful. One other possibility is that not all midwives who support women giving birth at home are trained in giving IV antibiotics - something else to consider perhaps? Best of luck with the meeting and do give us a call on 01444 416176 or email us [e-mail] if we can help in any way

[llawrence]

This has taken to long to come to light in this country. The sooner we can get this as routine screening the better maybe if this had been in place sooner we may not have lost our baby boy at 23 weeks on 13/09/2012

[NatalieFrost]

I take it this is after all the screaming & tears of joy?! This is the day we are waiting for, the decision we have been fighting for and dreaming of... The day we and so many others will hopefully find some justice & some peace again in this mad old world...

Our daughter Ella Alma Frost died minutes before her birth at 41 weeks & 2 days on the 10/07/11, with no symptoms and no warnings. We had never even heard of it before. Screening will save babies lives, what better reason is there?!

[WorriedNanny]

I would say 'it's about time!!!' We nearly lost our grand-daughter due to Strep B. The doctors and midwives we repeatedly told that she was not well dismissed us repeatedly. At 6 days old she was finally admitted to hospital and it was another 5 days before they would say 'yes, she will make it'. A horrendous time and all being brought back into sharp focus now my daughter is having her second child. The care she has received so far isn't inspiring any more confidence this time. With a number of countries now showing good reduction rates after introducing screening how much more evidence does this government want before they take action to stop this heartbreak? It's all down to finances. Nye Bevin must be turning in his grave!

[kirstens]

It seems to me that the risks of not giving antibiotics far outweigh the risks of giving them. I would rather have a child born free of Strep B than risk the development of meningitis and subsequent brain injury. If you are not given intra partum anti biotics then the baby can be symptom free after birth, with late onset symptoms, by which time it's usually too late to reverse the damage done. The choice should absolutely lie with the parents, on an informed decision basis- but a lot of hospitals still don't even give the option on the basis of statisical chance of complications- I wouldn't want to take the chance of being that minor statistic whose child suffers appallingly as a result of this awful infection.

[Lasiuke]

I wouldn't mind the screening too much, my fear is that it might create a hostile birth environment for those women who are GBS positive and still make an informed choice not to receive the antibiotics. As it is medical community is very pushy when it comes to interventions (even if some aren't evidence based) so this might be just another "dead baby" card to throw around. Otherwise, if women are fully informed in all statistics, risks, benefits (both for GBS and antibiotic use) and their choice is fully respected - I'm all for it.

[mrsemgthomas]

Cant understand why it isn't already! could save lives!!!

[JJREYNOLDS]

If gbs screening was introduced and its about time it were!! i would actually cry with happyness that alot more babies won't be dying and suffering with the lasting effects that GBS can leave, we lost our little boy jake to gbs on mothers day 2011 this has changed our lives forever, i live in hope that this day will come soon xxx

[FayeBee]

My boy was born with GBS...I had the perfect pregnancy, with no signs of being a GBS carrier...I had to watch my little boy fight for his life for 14 days. I couldn't hold him for 2 days. I now have to wait to see if my boy has any development delays, this has made me an over protective mum who should be enjoying watching my son develop. Not worrying about what he should and shouldn't be doing. Knowing all this could of been prevented by a simple swab test makes me sick to the core. I would of quite happily of paid for the test myself...I thought Id researched everything about being pregnant, I never once heard about GBS...not enough information about it, its as if they don't want you to know about it. My boy could of died...Im so blessed to have him. How many parents don't have the chance to say that because they have lost a child to GBS...