Q. I am expecting my second baby at the end of March (I am currently 30 weeks pregnant) and had a pretty awful time giving birth to my first child - strep B antibiotics, induction, 2 failed epidurals, a 3rd degree tear and then a cocktail of drugs afterwards (to cut a long story short)... Obviously I am slightly nervous about giving birth for a second time. I was really hoping to have as natural birth as possible but have been told I have to go to hospital and have iv antibiotics. What are my options I regards to treatment and choice of place of birth?? Thanks

A. It is understandable to feel apprehensive about the birth of your second baby when you've had a difficult time previously. However, please be reassured that events often tend to progress more smoothly second time around; this is because your body already knows what to do - ie it knows how to labour and give birth. There also appear to have been lots of things that caused you and your baby a problem last time, and it is important that you have an understanding of the relationship of these events to their likelihood of happening again. I hope you will have already discussed this in some detail with your midwife, your GP and the obstetrician at the hospital so that they can help you put each aspect into context and discuss with you and your partner how it might or might not affect your next labour.

Maternity services are committed to supporting women in their choices, but these choices and the decisions subsequently made, should always be ‘informed' and based on accurate and reliable information. With regard to the birth of your first baby, where you have discussed this with the obstetrician at the hospital, it will mean that the people looking after you this time will be aware of the events that happened then and try to avoid a repeat occurrence. This is particularly relevant for induction of labour, the siting of the epidural, and the injury to your perineum. Where your doctor and midwife have any concerns, they will ensure that you are aware of these and should explain why, as well as discussing any benefits and/or disadvantages associated with the options/alternatives available.

However, taking the issue of group B Streptococcus (GBS), this is slightly different as the current thinking makes it very clear that giving intravenous (IV) antibiotics is very effective in reducing the potential for infection, while also recognising that it does considerably reduce your choice of location for birth.

Because of your previous history of GBS, you are considered to be at a higher risk of carrying GBS in this pregnancy. The concern in maternity care is that GBS is the most common cause of life-threatening infections in newborn and young babies, including septicaemia, pneumonia and meningitis, all of which, with the aid of antibiotics, are usually preventable. GBS infects around 700 babies each year; therefore, wherever possible your doctor and midwife will be looking to reduce any possible risk of infection being passed on to your baby. This can be done by identifying any GBS infection in pregnant women between 35-37 weeks, and by giving those testing positive IV antibiotics from the start of labour or when their waters break (membranes rupture) until their baby's birth. Where there is a pre-existing history of GBS, it is recommended that treatment is given on the likelihood of you having the infection. Therefore, your midwife and doctor are likely to recommend that you give birth in hospital where you can be offered IV antibiotics at least four hours before your baby is born. However, if you are considering remaining at home, this would need to be talked through with your doctor and midwife. In some situations, a compromise may be reached and it might be possible to go into hospital for a bolus dose of IV antibiotics and then return home to labour and give birth. However, taking any medication including IV antibiotics is not without risk and the hospital staff would want to make sure that you make an informed decision. It also very much depends on your individual obstetrician and the policy within your local maternity unit. If this is something you feel you would like to do you can discuss your preferences and any concerns with one of the Supervisors of Midwives at your local hospital, who should be able to offer additional advice and support.

This ‘preventative' approach to GBS has proved extremely effective in preventing GBS infection in newborn babies. There are, however, some occasions where labour and birth occur so rapidly, there is literally no time to give antibiotics. In these circumstances, it is strongly advised that the baby is closely monitored and treated, which means the newborn receives IV antibiotic therapy on the postnatal ward. This would also be recommended by the paediatricians where a mother declined IV therapy for herself.

So, referring back to your original question, I think you will feel I have not really given you the answer you were perhaps hoping for. However, I hope this has given you some information about what you need to talk through with your midwife and doctor, so that they can discuss your views and wishes with you and offer you the help and guidance that you require.


Further more detailed information is available from Group B Strep Support: www.gbss.org.uk Email: info@gbss.org.uk or Tel: 01444 416176.


I hope this is helpful; every best wish for your baby's birth.

Best regards

Vicky