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Group B Strep – have you heard of it?

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Group B Strep SupportWell, if not, you’re not alone. Last November, a survey found that only 54% young women in the UK had heard of GBS and, of those who had, only 20% knew what it was.

Here are the key facts:

  • Around 20-25% of women carry Group B Strep (also known as GBS and Strep B) as part of their healthy vaginal and rectal bacteria, where it is normal, has no symptoms and causes no problems to the carrier.
  • GBS also causes infection though and is the most common cause of serious infection in newborn babies. Without preventative medicine, around one out of every 300 babies born to women carrying GBS will develop infections such as sepsis, pneumonia and meningitis.
  • Most babies will recover from their GBS infection, but even with the best medical care, around one in every 10 of these sick babies will die and some of the survivors will be left with long-term problems, especially when the baby has had GBS meningitis

Ok, who knew that? We’re told about spina bifida, sickle cell disease, Down’s Syndrome but not about GBS – how come? Maybe nothing can be done about it? Well, no… more facts:

  • Most GBS infections in newborn babies are preventable by giving Mums whose babies are at raised risk antibiotics (usually penicillin) in labour
  • A Mum carrying GBS who has antibiotics in labour has a less than one in 6,000 risk of her newborn developing GBS infection, compared with around a one in 300 chance if she doesn’t.
  • Key risk factors for GBS infection in newborn babies are:
    • A sibling having GBS infection
    • GBS found in the urine or from a vaginal or rectal swab during the current pregnancy
    • Labour starting or waters breaking before 37 weeks of pregnancy
    • Waters breaking more than 18 hours before birth
    • Mum having a raised temperature in labour
  • GBS infection usually shows early – normally on the first day of life. After the first week, these infections are rare and after ago 3 months very rare indeed.
  • Key signs/symptomsof GBS infection in babies include
    • Age 0-6 days: grunting; lethargy; irritability; poor feeding; very high or low heart rate; low blood pressure/ blood sugar; abnormal (high or low) temperature; and abnormal (fast or slow) breathing rates with blueness of the skin due to lack of oxygen (cyanosis)
    • Age 7-90 days: fever; poor feeding and/or vomiting; impaired consciousness; plus typical symptoms of meningitis, including any of: fever, which may include the hands and feet feeling cold, and/or diarrhoea; refusing feeds or vomiting; shrill or moaning cry or whimpering; dislike of being handled, fretful; tense or bulging fontanelle (soft spot on the head); involuntary body stiffening or jerking movements; floppy body; blank, staring or trance-like expression; abnormally drowsy, difficult to wake or withdrawn; altered breathing patterns; turns away from bright lights; and pale and/or blotchy skin.
    • If a baby shows signs consistent with GBS infection or meningitis, call your doctor immediately. If your doctor isn’t available, go straight to your nearest Paediatric Casualty Department. If a baby has GBS infection or meningitis, early diagnosis and treatment are vital: delay could be fatal.

The number of newborns with GBS infection has been rising: up nearly a third since ‘risk-based’ prevention measures were introduced in 2003. UK pregnant women aren’t offered screening for GBS, which may explain this – many western countries routinely screen pregnant women for GBS (usually at 35-37 weeks of pregnancy) and have seen their numbers fall by between 71-86%.

Some enlightened NHS trusts offer some of their pregnant women sensitive tests for GBS carriage (the tests usually used by the NHS were not designed to detect GBS carriage and give high false-negative results) and – if women want to be tested – they can obtain reliable home-testing kits for around £35. Labs listed at http://www.gbss.org.uk/test offer the sensitive ECM (Enriched Culture Medium) test, following the Health Protection Agency National Standard Method.

Somewhat unsurprisingly, when asked, young women say they want to be told about group B Strep, they want to be offered tests for GBS as a routine part of their antenatal care and, if found to be carrying it, they want to be offered antibiotics in labour.

Prevention is better than cure, particularly when we’re talking about life-threatening infections in newborn babies.

Isn’t it about time the UK caught up with other western countries on this?

During GBS Awareness Month, please help protect babies by:

From Mel at MilkChic: This is a guest post from Jane Plumb MBE, of Group B Strep Support. Please take the time to read and share this information and if you have a website, consider downloading a badge. As a Group B Strep carrier myself (routinely swabbed in pregnancy) and having been educated about the risks, I was horrified by the lack of knowledge when I moved to a new area. Preventative measures are so simple for Group B Strep – protection shouldn’t be down to luck.

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My Breastfeeding Journey: Breastfeeding a Newborn

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In honour of Breastfeeding Awareness Week (19th-25th June 2011), I am sharing my breastfeeding journey so far. I would love to hear your stories too. Please share your breastfeeding related posts in the comments feed.

Samuel

Photo: Raphael Goetter

I first fed my daughter in the recovery room after a c-section. I was still pretty dazed after my planned natural birth fell apart and utterly in awe of the tiny baby in my arms.

The midwife was old school and comfortingly practical, helping me to get my nipple into the small one’s mouth so she could feed. There was no checking of latches or anything else I had been told about at that stage, and I suspect the latch was horrendous, but it felt natural and amazing and didn’t hurt. I think the fact that my first experience of breastfeeding was positive made a massive impact over the next few days

I was in hospital for 3 days after the birth. Honestly, I don’t know how I would have coped if I had been fit to go straight home. The birth left me exhausted and at one stage, I was so tired that I nearly fell off the bed trying to feed. I was very lucky to have the support of midwives and nurses as I got to know my baby and learned how to feed her successfully.

My start to breastfeeding was overwhelmingly positive, but that’s not to say I found it easy. I needed help getting a good latch – newborns’ mouths are very tiny so it is much harder with a small baby. My daughter used to fall asleep within minutes of being on the breast and I had to stroke her cheek and undress her to keep her awake. Without the advice of the medical staff, I would have assumed she had finished feeding instead of encouraging her to feed for longer. None of these were big issues, but they seemed huge at the time and without access to immediate support, I would definitely have struggled.

I first breastfed publicly in hospital. It wasn’t a conscious choice – I had visitors, I couldn’t move from the bed, and the small one needed feeding, so I did it. I was too sleep deprived to worry about anyone else’s misplaced sensitivities. It was only at this point that it occurred to me that I was going to need different clothes if I wanted to be able to breastfeed without getting completely undressed each time. While I didn’t feel uncomfortable about breastfeeding I did feel uncomfortable with my body, which had lost the confidence of pregnancy and felt flabby and bloated. My mum had found me some lovely pyjamas with a wrap top which gave me good access and hid my tummy, but I still felt a little exposed. Having said that, if I’d worn the large t-shirt I would have probably chosen otherwise, I would have had to flash my knickers to feed, so it could have been worse!

Going home was a big step and I felt very nervous. Having only ever fed in bed or a high armchair in hospital, I encountered new issues. Our sofa made it difficult for me to stand up after a feed and I needed cushions at my back, under the small one and under my elbows just to make breastfeeding possible. Often, by the time I had found the energy to stand up, she needed feeding again, so I spent days glued to the sofa. I was constantly starving but had no time to make myself meals, supplementing leftovers from the night before’s dinner with terrifying amounts of chocolate and cake.

With hindsight, being physically unable to do much was a good thing. For many of my friends, the pressure to get out of the house to visit people or “do things” was immense and they did not get the opportunity to recuperate or to spend time getting to know their babies’ cues. By the time I was out and about, I was confident in my ability to recognise hungry from tired or uncomfortable which meant that usually when I offered milk, she was content to feed.

Most of the information you receive about breastfeeding is about benefits. There is very little about the reality. It is hard to know what is normal. Nearly every mum I know had a hiccup at some stage – mastitis, cracked nipples, pain while feeding, slow letdown, fast letdown, uncomfortable letdown, engorgement… When you hear about all these problems it sounds daunting, but no one has all of these issues. If you have access to support, they are just blips. Without it, they can be insurmountable. The best support is immediate, practical, non-judgmental and ideally face-to-face. It doesn’t necessarily come from “experts” – other mums are a great resource.

As a first time mum, it is hard to imagine how much life changes. Just being a new mum is overwhelming and you don’t have time to read all those books that you thought would be so helpful during pregnancy. For reliable information in bite-sized, readable chunks at any time of day or night, I find Kellymom brilliant.

My tips:

  • Your first feed doesn’t need to be perfect. I am grateful that my midwife prioritised the psychological benefits of success over technique. Knowing that I had already done it once made the next few feeds less overwhelming and I was more receptive to support.

  • Don’t believe people who tell you that “you’ll know what to do when the baby arrives”. It’s a lie that can leave you feeling inadequate. You don’t magically know how to drive a car just because there’s one parked outside. Breastfeeding is no different.

  • Supportive friends can make all the difference to your first feeds in public. If no-one makes a big deal of it the first time you do it, you have more confidence the second time. If you don’t feel sure of your close friends, go to a breastfeeding group where you know you’ll get a 100% positive response.

  • Be selfish. Your needs and your baby’s needs are more important than anything else in the first few weeks. Don’t expect too much of yourself. Establishing breastfeeding takes time and energy and it may be the only task you can manage at first.

  • If it doesn’t feel right, ask for help. There is no one size fits all breastfeeding technique and you may have to try a lot of things before you find your comfort zone.

  • Remember that even if you knew everything in the world about how to breastfeed, your baby would still be a novice. Give yourselves a break and take a day at a time.

The other posts in this series are My Breastfeeding Journey: Pregnancy ; My Breastfeeding Journey: Finding My Style ; Crimes of Breastfeeding

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