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FAITH - UK Stillborn October 23, 2015 Consistent with Prenatal-onset GBS Disease Mother's GBS Status: Not tested (testing not routine in UK) Gestational Age: 41 weeks, 2 days Age Harmed: 41 weeks, 2 days |
My precious daughter, Faith, was stillborn on 23rd October 2015, nine days after her due date. She was my 4th and last child to complete our beautiful family. I had a normally healthy pregnancy, with growth scans throughout due to my second baby born in 2010 being a small baby for me (weighing 6lb 120z). I had my last scan just 3 weeks before my baby was born and she was growing well. She was very active throughout the pregnancy and I had no cause for concern. As I live in the UK, I was not tested for group B strep.
On 21st October I had a routine 41 week sweep. On the morning of 23rd October when I awoke at 5am I was having regular contractions. By 8am I rang the hospital as the contractions were 3 minutes apart and lasting around 20-30 seconds. I was informed by the hospital to stay at home until they were lasting around 40 seconds. I waited until 10:30am and then went to the hospital. When I arrived they asked me if my movements were good, to which I replied, actually I can’t recall feeling any movements today but I felt her in the night and she was active yesterday and to be honest I’ve been in agony all morning working through my contractions I haven’t been aware. They listened in and to my horror there was no heartbeat. This was confirmed by ultrasound and minutes later I was ready to push. Within one hour of arriving at the hospital super excited to have our 4th and last child complete our family I had my dead baby in my arms.
This was a massive shock and I could not understand how this could be so, when I had a normal healthy pregnancy, and my baby had developed and grown perfectly. She weighed 7lb 14oz and looked just like her older sister, beautiful and perfect. In our state of shock we decided not to have an autopsy but have the placenta and cord sent for testing. Upon receipt of all my results my placenta was working fine for its age, but had a moderate growth of GBS, my vaginal swab showed a heavy growth of GBS, my daughters groin swab showed a heavy growth of GBS but nose swab was normal, my bloods showed a mild infection such as that of a common cough or cold. In conclusion we were told that is was an unexplained stillbirth and none of the results would have caused any harm to my unborn child. It was explained to us that GBS is only a danger to the baby upon delivery and as my baby was dead before she was born this would not in any way have caused her death. Nothing in any of my results could explain what had caused my seemingly perfect baby to die.
Upon returning from my consultation I started doing some research and indeed found that rarely GBS can enter before birth and in rare cases stillbirth. I have found the following information:
http://www.nhs.uk/conditions/Streptococcal-infections/Pages/Introduction.aspx
Strep B in pregnancy
It's estimated around one in every four pregnant women have strep B bacteria in their vagina or digestive system.
The bacteria can sometimes be passed on to the baby through the amniotic fluid (a clear liquid that surrounds and protects the unborn baby in the womb) or as the baby passes through the birth canal during labour.
Most babies exposed to strep B will be unaffected, but in around 1 in every 2,000 cases they can become infected.
A strep B infection during pregnancy can also cause miscarriage or stillbirth, but this is rare.
http://www.nhs.uk/chq/Pages/2037.aspx
What are the risks of group B streptococcus (GBS) infection during pregnancy? Extremely rarely, GBS infections during pregnancy can also cause miscarriage, early (premature) labour or stillbirth.
http://www.nhs.uk/Conditions/Stillbirth/Pages/Causes.aspx
Causes of stillbirth - Infections Around one in 10 stillbirths are caused by an infection. The most common type of infection is a bacterial infection that travels from the vagina into the womb (uterus). These bacteria include group B streptococcus,
http://gbss.org.uk/who-we-are/about-gbs/what-is-gbs/faqs/
Are membrane sweeps safe for women who carry GBS?
There is currently no good evidence that membrane sweeps are harmful in women known to carry GBS. Indeed the results of trials of membrane sweeps don’t show any increase in problems caused by GBS in women having sweeps, and it is highly likely these trials would have included many women carrying GBS at the time.
However, there remains a theoretical risk that a membrane sweep might occasionally introduce GBS into the uterus, and so our medical advisory panel advises caution in using a membrane sweep for women known to carry GBS when there are other acceptable alternatives (for example, induction of labour with prostaglandin gel introduced into the vagina)
http://www.gbss.org.uk/filepool/2012_07_13_The_Facts_4_HealthProfessionals.pdf
Pre-birth Complications & GBS 2.3.1 Stillbirth and late miscarriage - Along with many other bacteria found in the vagina, GBS can cause infection in a baby whilst still in the womb, which can cause stillbirth. GBS can live in amniotic fluid and from here can spread into the baby’s lungs and, from there, into the baby’s bloodstream where they may cause infection, which can result in the baby’s death. Bacteria will most probably have been passed from the mother to her baby before or during delivery
The 3 ways in which a baby becomes infected with GBS are: 2.5.1 Before birth There are physical and chemical barriers to keep bacteria from getting inside the baby, including the cervical canal, the mother’s immune system and the amniotic fluid. If GBS get inside the baby, they will normally be attacked by the baby’s immune system, although GBS can sometimes foil this immunological attack. In pregnant women who carry GBS, the bacteria can travel from the mother’s vagina into the baby’s bloodstream. To do this, they cross the cervix and have an enzyme, called hyaluronate lyase50, which can punch microscopic holes in apparently intact amniotic membranes, normally without causing any sign or symptom of these rupturing. Unlike many bacteria, GBS can live in amniotic fluid and from here spread into the baby’s lungs and into the baby’s bloodstream, where they may set up an infection46. At each stage of the journey, the bacteria come up against the mother’s or baby’s natural defences and, the vast majority of times, invasion is prevented. However, when infected with GBS before birth, none of these natural defences has protected the baby, who develops early onset infection. Once an infection has developed, this can lead to shock (a dangerous reduction of blood flow throughout the body tissues that, if untreated, may lead to collapse, coma and death.
http://www.obgyn.net/articles/prenatal-onset-group-b-strep-pogbs-disease
Prenatal-onset Group B Strep (POGBS) Disease
Group B strep (GBS) can definitely infect babies before birth, yet there is not an official name designated for GBS disease when it causes babies to be miscarried or stillborn. To further awareness and prevention of GBS disease in all stages of a baby’s development, Group B Strep International is giving a name to GBS disease acquired before birth: Prenatal-onset Group B Strep (POGBS) Disease.
However, a baby can definitely succumb to GBS infections long before the bacteria are transmitted during delivery. Since this is not yet a recognized disease it is unknown how many babies have been miscarried or stillborn due to GBS. Pathology testing is not mandatory and not even always suggested to the mother. At minimum, placental culturing may tell the cause of death. This is important especially since having a baby infected by GBS puts a mother at higher risk for subsequent babies being infected by GBS.
Perhaps the reason that prenatal-onset GBS disease has not been officially recognized is that the general medical opinion considers GBS-caused miscarriages and stillbirths to be rare occurrences. However, among GBS awareness groups, there are far too many parents who have had their baby’s autopsy or placental testing report cite GBS as the cause of death for prenatal-onset GBS disease to continue being regarded as rare.
GBS may be introduced to the baby during routine cervical checks and other invasive procedures such as intrauterine fetal monitoring, application of cervical ripening medications, and “membrane stripping” sometimes known as “membrane sweeping.”
Membrane stripping can introduce infection5 although there is a debate about whether or not it is directly related to a higher incidence of GBS infection. However, it has been proven via dye tests that small particles can ascend through the cervix. Case studies of dead or very sick babies at birth point to a direct correlation. Common sense alone dictates that if a gloved hand or instrument is moved through the lower third of the vagina (where GBS usually colonizes) and then up into the cervix that GBS or other bacteria can be moved closer to where the baby can be harmed. A recent legal case examines the potential for litigation regarding membrane stripping.6
http://www.groupbstrepinternational.org/what-is-group-b-strep/prenatal-onset-3/
The term, “prenatal-onset GBS disease” was presented by GBSI at the Center for Disease Control and Prevention’s GBS Guideline Re-evaluation Meeting in June 2009 and then included on page 23 of the resulting guidelines for early-onset GBS disease prevention issued in the November 19, 2010 MMWR. Previously there was no specific name given to GBS disease resulting in miscarriage or stillbirth, but pregnancy is a distinct time when unborn babies can become infected by GBS.
Although there are currently no prevention guidelines in place for prenatal-onset GBS disease, GBSI has identified three knowledge-based strategies to help prevent babies becoming infected by group B strep before birth.
GBS can cross intact membranes and invasive procedures can help transport GBS closer to the baby. Please click HERE for medical abstracts on the risk of infection due to invasive procedures.
http://www.groupbstrepinternational.org/about-gbsi/
The mission of Group B Strep International (GBSI) is to promote international awareness and prevention of Group B Strep (GBS) disease in babies before birth through early infancy.
https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg36/
Group B streptococcus (Streptococcus agalactiae) is recognised as the most frequent cause of severe early-onset (at less than 7 days of age) infection in newborn infants. However, there is still controversy about its prevention.
http://www.sciencebasedbirth.com/ObGynNews%2001a/OBN%20Cx%20manip%20leads%20infection%20Oct01.html
In a series of eight case reports, Dr. Stamm of the University of Colorado, Denver, described how cervical manipulation or membrane stripping preceded perinatal sepsis and even one instance of stillbirth caused by invasive group B streptococcus (GBS) as well as other pathogens.
If all this information is out there how can the 2 consultants who have looked at my results and an experienced midwife all believe it is not possible for my daughter to have died from GBS as it is only a danger during delivery and she was dead before she was born? The explanation they give for the placenta and her groin to have a medium growth of GBS is because it will have picked up the bacteria as it passed through my vagina at time of delivery and it cannot possibly have gotten in before.
Since researching GBS I have also found that thrush like symptoms are also an indication of GBS. I visited my antenatal day unit regarding this and was prescribed with a pessary and cream, this didn’t cure it and I suffered symptoms on and off throughout the pregnancy. I visited my GP regarding this and again was prescribed with a pessary and cream. I have since learnt that these symptoms are another sign of high levels of GBS, yet this was never mentioned or investigated.
While I accept I will never know if my daughter was infected by GBS and this was indeed the cause of her death, however I do believe it is a possibility. I think GBS entered into my amniotic fluid after my sweep which was performed on 21st October 2015 just 2 days before she saw born; she had then had GBS attacking her for more than 48 hours and eventually it killed her.
I accept that my theory can never be proven as we did not have an autopsy for our daughter. We spoke to 3 midwives and a consultant about an autopsy and while they told us the decision was ours, they advised us that having an autopsy would most likely not determine the cause of Faith's death and would give us no answers. The common theory was that these things just happen and in most cases an answer is never found. We therefore decided to only have the placenta and cord sent off for testing. It was not explained to us amidst our grief, heartbreak and shock why placental examination and autopsy are so important in understanding why a baby has died. Of course now I have the ability to think clearly that is obvious! Of course we should have had an autopsy, If any of our other healthy children died with no explanation, of course we would have an autopsy and never except the answer that these things just happen! Death does not just happen, even in an unborn baby. There is always a reason, especially when it has developed and grown healthy for 9 months and accepting that these things just happen will never lead to reducing the number of stillbirths.
I can accept that I will never receive any answers as to why my baby died. However, what I do not accept is being told it is not possible for GBS to affect an unborn baby. Also what I do not accept is that I will be treated for GBS in future pregnancies but I have had to wait for my baby to die to find out I even have this! I do not accept that women are not routinely screened for GBS at 37 weeks, even if the NHS will not pay for it we should be offered it.
These are the guidelines our NHS follows regarding awareness and prevention of GBS. You only have to read this to see there really are no prevention procedures in place in the UK!
https://www.rcog.org.uk/globalassets/documents/guidelines/gtg36_gbs.pdf
However, these are very useful links in the awareness and prevention of GBS:-
http://www.gbss.org.uk/filepool/2012_07_13_The_Facts_4_HealthProfessionals.pdf
http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf
http://www.groupbstrepinternational.org/wp-content/uploads/2012/12/GBS_Awareness_brochure_V11.pdf
I hope that in the midst of this heartbreak I can do some good, that I can somehow increase awareness and help bring about changes for the future. I will forever miss my beautiful perfect daughter and I will think of her every day. She will always be part of our special family and will be made alive every day through our conversations and few memories we have of her. I am grateful to have the knowledge as a member of The Church of Jesus Christ of Latter-Day Saints that although I miss her deeply every day, our parting is brief and one day I will receive her back in my arms and be able to be her mother forever. Until then she is safe in the arms of my Heavenly Father.
~ Kim Poulton
Faith's mother started The Faith Cause, Increasing Group B Strep Awareness
On 21st October I had a routine 41 week sweep. On the morning of 23rd October when I awoke at 5am I was having regular contractions. By 8am I rang the hospital as the contractions were 3 minutes apart and lasting around 20-30 seconds. I was informed by the hospital to stay at home until they were lasting around 40 seconds. I waited until 10:30am and then went to the hospital. When I arrived they asked me if my movements were good, to which I replied, actually I can’t recall feeling any movements today but I felt her in the night and she was active yesterday and to be honest I’ve been in agony all morning working through my contractions I haven’t been aware. They listened in and to my horror there was no heartbeat. This was confirmed by ultrasound and minutes later I was ready to push. Within one hour of arriving at the hospital super excited to have our 4th and last child complete our family I had my dead baby in my arms.
This was a massive shock and I could not understand how this could be so, when I had a normal healthy pregnancy, and my baby had developed and grown perfectly. She weighed 7lb 14oz and looked just like her older sister, beautiful and perfect. In our state of shock we decided not to have an autopsy but have the placenta and cord sent for testing. Upon receipt of all my results my placenta was working fine for its age, but had a moderate growth of GBS, my vaginal swab showed a heavy growth of GBS, my daughters groin swab showed a heavy growth of GBS but nose swab was normal, my bloods showed a mild infection such as that of a common cough or cold. In conclusion we were told that is was an unexplained stillbirth and none of the results would have caused any harm to my unborn child. It was explained to us that GBS is only a danger to the baby upon delivery and as my baby was dead before she was born this would not in any way have caused her death. Nothing in any of my results could explain what had caused my seemingly perfect baby to die.
Upon returning from my consultation I started doing some research and indeed found that rarely GBS can enter before birth and in rare cases stillbirth. I have found the following information:
http://www.nhs.uk/conditions/Streptococcal-infections/Pages/Introduction.aspx
Strep B in pregnancy
It's estimated around one in every four pregnant women have strep B bacteria in their vagina or digestive system.
The bacteria can sometimes be passed on to the baby through the amniotic fluid (a clear liquid that surrounds and protects the unborn baby in the womb) or as the baby passes through the birth canal during labour.
Most babies exposed to strep B will be unaffected, but in around 1 in every 2,000 cases they can become infected.
A strep B infection during pregnancy can also cause miscarriage or stillbirth, but this is rare.
http://www.nhs.uk/chq/Pages/2037.aspx
What are the risks of group B streptococcus (GBS) infection during pregnancy? Extremely rarely, GBS infections during pregnancy can also cause miscarriage, early (premature) labour or stillbirth.
http://www.nhs.uk/Conditions/Stillbirth/Pages/Causes.aspx
Causes of stillbirth - Infections Around one in 10 stillbirths are caused by an infection. The most common type of infection is a bacterial infection that travels from the vagina into the womb (uterus). These bacteria include group B streptococcus,
http://gbss.org.uk/who-we-are/about-gbs/what-is-gbs/faqs/
Are membrane sweeps safe for women who carry GBS?
There is currently no good evidence that membrane sweeps are harmful in women known to carry GBS. Indeed the results of trials of membrane sweeps don’t show any increase in problems caused by GBS in women having sweeps, and it is highly likely these trials would have included many women carrying GBS at the time.
However, there remains a theoretical risk that a membrane sweep might occasionally introduce GBS into the uterus, and so our medical advisory panel advises caution in using a membrane sweep for women known to carry GBS when there are other acceptable alternatives (for example, induction of labour with prostaglandin gel introduced into the vagina)
http://www.gbss.org.uk/filepool/2012_07_13_The_Facts_4_HealthProfessionals.pdf
Pre-birth Complications & GBS 2.3.1 Stillbirth and late miscarriage - Along with many other bacteria found in the vagina, GBS can cause infection in a baby whilst still in the womb, which can cause stillbirth. GBS can live in amniotic fluid and from here can spread into the baby’s lungs and, from there, into the baby’s bloodstream where they may cause infection, which can result in the baby’s death. Bacteria will most probably have been passed from the mother to her baby before or during delivery
The 3 ways in which a baby becomes infected with GBS are: 2.5.1 Before birth There are physical and chemical barriers to keep bacteria from getting inside the baby, including the cervical canal, the mother’s immune system and the amniotic fluid. If GBS get inside the baby, they will normally be attacked by the baby’s immune system, although GBS can sometimes foil this immunological attack. In pregnant women who carry GBS, the bacteria can travel from the mother’s vagina into the baby’s bloodstream. To do this, they cross the cervix and have an enzyme, called hyaluronate lyase50, which can punch microscopic holes in apparently intact amniotic membranes, normally without causing any sign or symptom of these rupturing. Unlike many bacteria, GBS can live in amniotic fluid and from here spread into the baby’s lungs and into the baby’s bloodstream, where they may set up an infection46. At each stage of the journey, the bacteria come up against the mother’s or baby’s natural defences and, the vast majority of times, invasion is prevented. However, when infected with GBS before birth, none of these natural defences has protected the baby, who develops early onset infection. Once an infection has developed, this can lead to shock (a dangerous reduction of blood flow throughout the body tissues that, if untreated, may lead to collapse, coma and death.
http://www.obgyn.net/articles/prenatal-onset-group-b-strep-pogbs-disease
Prenatal-onset Group B Strep (POGBS) Disease
Group B strep (GBS) can definitely infect babies before birth, yet there is not an official name designated for GBS disease when it causes babies to be miscarried or stillborn. To further awareness and prevention of GBS disease in all stages of a baby’s development, Group B Strep International is giving a name to GBS disease acquired before birth: Prenatal-onset Group B Strep (POGBS) Disease.
However, a baby can definitely succumb to GBS infections long before the bacteria are transmitted during delivery. Since this is not yet a recognized disease it is unknown how many babies have been miscarried or stillborn due to GBS. Pathology testing is not mandatory and not even always suggested to the mother. At minimum, placental culturing may tell the cause of death. This is important especially since having a baby infected by GBS puts a mother at higher risk for subsequent babies being infected by GBS.
Perhaps the reason that prenatal-onset GBS disease has not been officially recognized is that the general medical opinion considers GBS-caused miscarriages and stillbirths to be rare occurrences. However, among GBS awareness groups, there are far too many parents who have had their baby’s autopsy or placental testing report cite GBS as the cause of death for prenatal-onset GBS disease to continue being regarded as rare.
GBS may be introduced to the baby during routine cervical checks and other invasive procedures such as intrauterine fetal monitoring, application of cervical ripening medications, and “membrane stripping” sometimes known as “membrane sweeping.”
Membrane stripping can introduce infection5 although there is a debate about whether or not it is directly related to a higher incidence of GBS infection. However, it has been proven via dye tests that small particles can ascend through the cervix. Case studies of dead or very sick babies at birth point to a direct correlation. Common sense alone dictates that if a gloved hand or instrument is moved through the lower third of the vagina (where GBS usually colonizes) and then up into the cervix that GBS or other bacteria can be moved closer to where the baby can be harmed. A recent legal case examines the potential for litigation regarding membrane stripping.6
http://www.groupbstrepinternational.org/what-is-group-b-strep/prenatal-onset-3/
The term, “prenatal-onset GBS disease” was presented by GBSI at the Center for Disease Control and Prevention’s GBS Guideline Re-evaluation Meeting in June 2009 and then included on page 23 of the resulting guidelines for early-onset GBS disease prevention issued in the November 19, 2010 MMWR. Previously there was no specific name given to GBS disease resulting in miscarriage or stillbirth, but pregnancy is a distinct time when unborn babies can become infected by GBS.
Although there are currently no prevention guidelines in place for prenatal-onset GBS disease, GBSI has identified three knowledge-based strategies to help prevent babies becoming infected by group B strep before birth.
GBS can cross intact membranes and invasive procedures can help transport GBS closer to the baby. Please click HERE for medical abstracts on the risk of infection due to invasive procedures.
http://www.groupbstrepinternational.org/about-gbsi/
The mission of Group B Strep International (GBSI) is to promote international awareness and prevention of Group B Strep (GBS) disease in babies before birth through early infancy.
https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg36/
Group B streptococcus (Streptococcus agalactiae) is recognised as the most frequent cause of severe early-onset (at less than 7 days of age) infection in newborn infants. However, there is still controversy about its prevention.
http://www.sciencebasedbirth.com/ObGynNews%2001a/OBN%20Cx%20manip%20leads%20infection%20Oct01.html
In a series of eight case reports, Dr. Stamm of the University of Colorado, Denver, described how cervical manipulation or membrane stripping preceded perinatal sepsis and even one instance of stillbirth caused by invasive group B streptococcus (GBS) as well as other pathogens.
If all this information is out there how can the 2 consultants who have looked at my results and an experienced midwife all believe it is not possible for my daughter to have died from GBS as it is only a danger during delivery and she was dead before she was born? The explanation they give for the placenta and her groin to have a medium growth of GBS is because it will have picked up the bacteria as it passed through my vagina at time of delivery and it cannot possibly have gotten in before.
Since researching GBS I have also found that thrush like symptoms are also an indication of GBS. I visited my antenatal day unit regarding this and was prescribed with a pessary and cream, this didn’t cure it and I suffered symptoms on and off throughout the pregnancy. I visited my GP regarding this and again was prescribed with a pessary and cream. I have since learnt that these symptoms are another sign of high levels of GBS, yet this was never mentioned or investigated.
While I accept I will never know if my daughter was infected by GBS and this was indeed the cause of her death, however I do believe it is a possibility. I think GBS entered into my amniotic fluid after my sweep which was performed on 21st October 2015 just 2 days before she saw born; she had then had GBS attacking her for more than 48 hours and eventually it killed her.
I accept that my theory can never be proven as we did not have an autopsy for our daughter. We spoke to 3 midwives and a consultant about an autopsy and while they told us the decision was ours, they advised us that having an autopsy would most likely not determine the cause of Faith's death and would give us no answers. The common theory was that these things just happen and in most cases an answer is never found. We therefore decided to only have the placenta and cord sent off for testing. It was not explained to us amidst our grief, heartbreak and shock why placental examination and autopsy are so important in understanding why a baby has died. Of course now I have the ability to think clearly that is obvious! Of course we should have had an autopsy, If any of our other healthy children died with no explanation, of course we would have an autopsy and never except the answer that these things just happen! Death does not just happen, even in an unborn baby. There is always a reason, especially when it has developed and grown healthy for 9 months and accepting that these things just happen will never lead to reducing the number of stillbirths.
I can accept that I will never receive any answers as to why my baby died. However, what I do not accept is being told it is not possible for GBS to affect an unborn baby. Also what I do not accept is that I will be treated for GBS in future pregnancies but I have had to wait for my baby to die to find out I even have this! I do not accept that women are not routinely screened for GBS at 37 weeks, even if the NHS will not pay for it we should be offered it.
These are the guidelines our NHS follows regarding awareness and prevention of GBS. You only have to read this to see there really are no prevention procedures in place in the UK!
https://www.rcog.org.uk/globalassets/documents/guidelines/gtg36_gbs.pdf
However, these are very useful links in the awareness and prevention of GBS:-
http://www.gbss.org.uk/filepool/2012_07_13_The_Facts_4_HealthProfessionals.pdf
http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf
http://www.groupbstrepinternational.org/wp-content/uploads/2012/12/GBS_Awareness_brochure_V11.pdf
I hope that in the midst of this heartbreak I can do some good, that I can somehow increase awareness and help bring about changes for the future. I will forever miss my beautiful perfect daughter and I will think of her every day. She will always be part of our special family and will be made alive every day through our conversations and few memories we have of her. I am grateful to have the knowledge as a member of The Church of Jesus Christ of Latter-Day Saints that although I miss her deeply every day, our parting is brief and one day I will receive her back in my arms and be able to be her mother forever. Until then she is safe in the arms of my Heavenly Father.
~ Kim Poulton
Faith's mother started The Faith Cause, Increasing Group B Strep Awareness