Group B Streptococcus (GBS), often referred to as group B strep, is a common type of bacteria carried by many adults and often doesn’t cause any symptoms. In pregnancy, however, GBS can pose a serious risk to newborn babies if passed on during labour and birth. While most babies exposed to GBS remain healthy, some develop severe infections, including sepsis, pneumonia and meningitis. Most early-onset GBS infections can be prevented when appropriate antibiotics are given during labour.

For expectant parents, understanding when antibiotics should be offered is important. As a clinical negligence solicitor, I have seen failures to identify GBS risk factors or administer antibiotics when indicated tragically lead to devastating and avoidable injuries.

What is group B strep?

Group B Strep is a bacterium that can naturally live in the vagina, rectum or urinary tract. It is estimated that around 20-40% of women in the UK carry GBS at some point. In most cases, it causes no harm and produces no symptoms.

However, during labour and birth, GBS can be passed from mother to baby. In some cases, this can result in early-onset GBS infection, which occurs within the first week of life and can lead to life-threatening complications.

Why should antibiotics be given during labour?

The purpose of administering intravenous (IV) antibiotics during labour is to significantly reduce the risk of a baby developing early-onset GBS infection. Research and national guidance show that many cases can be prevented when antibiotics are given during labour to women whose babies are at increased risk.

In the UK, routine screening for GBS is not currently offered to all pregnant women. Instead, doctors, midwifes and healthcare professionals assess whether specific risk factors are present and whether antibiotics should be administered during labour.

When should antibiotics be offered to a pregnant woman?

According to UK guidance, IV antibiotics should generally be offered during labour in the following circumstances:

• A previous baby had a GBS infection: Women who have previously given birth to a baby affected by GBS infection should be offered antibiotics in labour during future pregnancies. This is because the risk of recurrence is increased.

• GBS is found during the current pregnancy: GBS may be detected in a urine sample during pregnancy or identified through a vaginal or rectal swab.

• Preterm labour: Babies born before 37 weeks are at increased risk of developing serious infections. For this reason, women who go into confirmed preterm labour are generally offered antibiotics that provide protection against GBS.

• Maternal fever during labour: A high temperature of 38 degrees or more during labour can indicate infection and is recognised as a significant risk factor. Broad-spectrum antibiotics that cover GBS should be administered where maternal fever is present.

• Waters breaking more than 24 hours before labour: If a woman's waters break more than 24 hours before labour starts the risk of infection may increase. Depending on the circumstances and other risk factors, antibiotics may be recommended.

When should antibiotics be started?

Timing for starting antibiotics is crucial. National guidance recommends that IV antibiotics should be administered as soon as possible once labour begins and continued at regular intervals until birth. The antibiotic most commonly used is benzylpenicillin, although alternative antibiotics can be prescribed where there is a penicillin allergy.

The goal is to ensure sufficient antibiotic coverage before the baby is delivered, reducing the likelihood of transmission and infection.

What happens if antibiotics are not given?

Most babies born to mothers carrying GBS will be healthy. However, where risk factors are present and antibiotics are not provided when clinically indicated, the consequences can be severe.

A baby who develops GBS infection may suffer:

• Sepsis

• Pneumonia

• Meningitis

• Brain injury caused by infection

• Long-term neurological disabilities

• In the most serious cases, sadly, death

Prompt recognition of risk factors and appropriate administration of antibiotics are therefore vital parts of safe maternity care.

Could failure to provide antibiotics be medical negligence?

Not every case of GBS infection results from medical negligence. However, concerns may arise where healthcare providers fail to follow accepted standards of care.

Examples could include:

• Failing to recognise known GBS risk factors

• Not communicating positive GBS test results

• Delaying or failing to administer antibiotics during labour

• Failing to act on signs of maternal infection

• Not appropriately monitoring mother or baby when GBS risk factors are present

Where these failings lead to avoidable injury, families may be entitled to compensation and may want to seek legal advice regarding a potential medical negligence claim. Experiencing complications during pregnancy, labour or birth can be overwhelming, particularly where there are concerns that opportunities to prevent harm were missed.

Group B strep support

The charity, Group B Strep Support, can provide further information and support to anyone who is worried or affected by GBS. They are currently campaigning for routine NHS screening for all pregnant women at 35 to 37 weeks. As a legal partner for the charity, I support this campaign which should ensure parents are made aware if there is a risk of their baby contracting GBS and ensuring that antibiotics can be given to those who need it, to hopefully prevent more babies contracting GBS.