Antibiotics in Labour
What antibiotics in labour means for you and your baby
You have been given this information because we have started giving you antibiotics in labour. There are two reasons this may happen:
Known risk of an infection
Antibiotics in labour will be recommended if there is an increased risk of infection to the baby by a bacteria called Group B Streptococcus (GBS). This could be indicated in labour if a) results in your current or previous pregnancy have detected GBS in vaginal or urine testing and b) labour starts prior to 37 weeks and is associated with rupture of membranes prior to the onset of labour.
The team will check your allergies and available results to determine which antibiotics to give you until your baby is born. When antibiotics are administered for this indication only, you will be able to walk around in labour.
Signs of a possible infection
Infection in labour may be suspected based on symptoms like fever, or signs like a higher than expected heart rate in you or baby in the womb.
Infection can occur in any part of your body. If we can’t identify where the infection is, we work on the assumption that it could be in the womb, and this may be difficult to confirm until at least a few days later.
Untreated infection can sometimes spread to the blood and if not treated it may have serious consequences. Given the risk that an infection may pose, the medical team will undertake a detailed assessment of you and your baby. They will conduct a range of tests on you to help establish the type of infection. This will include blood tests, urine tests and vaginal swabs. The tests include Full blood count, C-reactive protein, blood/urinary/vaginal culture and sensitivity. The team will recommend starting antibiotics through a cannula (a very fine, flexible plastic tube) directly into your vein.
You will need to be monitored closely and this will involve continuous monitoring of you and the baby, which may limit you from walking around in labour. We will continue to support your birth preferences as best as possible and discuss all options and recommendations so that you can make informed choices about your care. We will help you adopt positions that are comfortable for you and that are known to support vaginal births.
Some of the blood results will be available within a few hours and some tests (microbiological cultures and sensitivity) may take up to 3 days.
Your team will continue to monitor you and your baby closely through your labour and will keep you informed of their findings and recommendations. You are encouraged to ask any questions or share concerns you may have.
What will happen after the birth?
Known risk of an infection
If you received antibiotics in labour only because of the known risk of GBS infection, this will be stopped at the time of the birth. For 12-24 hours after the birth, your team will monitor you and the baby for anything concerning, including signs of infection. The monitoring aims to identify early warning symptoms and signs. For the baby, this will include overall assessment and regular measurement of heart rate, respiratory rate, color, temperature and feeding. The baby will stay with their mothers on the postnatal ward.
Signs of a possible infection
Your care
Your antibiotics will be continued through the cannula until your temperature has been normal for at least 24 hours after the birth, you feel well and the infection results indicate an improvement.
Based on your recovery and test results, you may need to continue the antibiotic course as tablets. The total duration of antibiotics can vary but they will be safe to take if you are breastfeeding.
If you have a urinary infection, you will need to repeat a urine test (culture and sensitivity) a week after you complete your antibiotics course to make sure the infection has been treated fully.
Your baby’s care
At birth, a doctor who works in the neonatal unit will review your baby’s risk of infection based on factors including your own signs infection, the course of your labour and an assessment of your baby. Your baby will be observed closely and have regular measurement of heart rate, respiratory rate, colour, temperature and feeding for at least 12 hours.
Depending on the risk of infection, your baby may need to have some blood tests to look for infection and be started on antibiotics. In this case, the neonatal doctors will put a tiny cannula in your baby’s hand or foot so that they can take some blood to test and give the antibiotics directly into a vein (intravenous).
If antibiotics are required, your baby will receive these twice a day through the cannula and the ward staff will continue to monitor your baby closely as before. Your baby can stay with you on the postnatal ward during this time. Should there be further concerns your baby may need to be admitted to the neonatal unit to enable close monitoring, further tests and necessary treatment. You’ll be able to visit your baby in the neonatal unit.
Why does my baby need antibiotics?
Antibiotics are started in babies assessed as being at significantly increased risk of infection. This is because infection in babies can be very serious if left untreated and even if your baby looks very well, they can become sick very quickly. The good news is that antibiotics can help keep your baby well.
The antibiotics must be given directly into their blood stream as babies are not able to absorb sufficient amount of antibiotics from their gut. You will be able to breastfeed your baby and the ward staff will support your feeding choices.
While you will have to be careful with the cannula when holding your baby, you will be able to do skin to skin and breast feed your baby.
We want you to know that there are normally no side effects or allergic reactions with use of antibiotics in newborn babies. If you are unsure why your baby needs antibiotics, please ask the medical team to explain this to you.
What tests will my baby have?
If your baby requires investigation for infection, a number of blood tests will be performed, including:
- CRP (C-reactive protein), which is produced by our bodies in response to an infection or inflammation. A high CRP can indicate the presence of an infection in the body.
- Blood cultures to identify if any bacteria are growing in the blood. This result may be available within 36-48 hours of the test.
- After 18–24 hours from birth, the CRP test will be repeated by collecting a small amount of blood from a heel prick.
- Heel prick test allows us to compare the previous CRP result to see if the level is increasing or decreasing.
If at any stage your baby’s health or any of the results are a concern, they may need more tests like a chest X-ray and/or a lumbar puncture to work out the site of infection and will require a longer course of antibiotics. The neonatal doctors will discuss this with you.
How long will my baby need antibiotics?
The length of time your baby needs antibiotics will depend on how your baby is doing and what the results show.
If your baby remains well, the CRP is not high and the blood cultures do not grow any bacteria, the antibiotics can be stopped after 36-48 hours. A longer course of antibiotics will be indicated should there be any concerns.
When can we go home?
At the time of birth, it is difficult to know when you and your baby will be able to go home. After 36–48 hours, the doctors will have a better idea of the duration of treatment required. Your team will continue to review you and your baby on the ward daily until they feel sure that you are both well enough to go home.
On discharge from the hospital, you will receive written information about the medical treatment delivered on the ward. You can share this with your community midwife and health visitor. Your GP will be sent this information.
Guidance for future pregnancy if you or your baby was identified to have GBS-If you become pregnant again, please inform the maternity care team looking after you that about the positive GBS result, so that they can offer antibiotics in labour to reduce the risk of early onset GBS infection in the baby.
Where can I get further information?
Please refer to the Mum & Baby app for information about symptoms or signs of infection that you should look out for and seek help for. The app also contains useful information to support your recovery with advice on diet, wound care, bleeding concerns, bowel and bladder care tips.
What should I do if I have any worries?
Ongoing maternity care is provided by community midwife, who are local to where you will be based after discharge from the hospital. The community midwife will make contact with you within 24-48 hours of being at home. They will support you and your baby’s care.
Should you have any urgent concerns regarding the health of you or your baby, please seek medical advice from your GP, NHS 111, 999 or attend your local Accident and Emergency department.
For baby, these concerns may include baby showing abnormal behavior (for example, inconsolable crying or listlessness), being unusually floppy, has an abnormal temperature unexplained by environmental factors (lower than 36 or higher than 38 Degree centigrade), abnormal breathing (rapid breathing, difficulty in breathing or grunting) or change in skin colour (for example baby becomes very pale, blue/grey or dark yellow) or has developed new difficulties with feeding.
Further information
If you have a question about your care or any of the contents in this leaflet, please discuss this with a doctor or midwife.
How parents were involved in the creation of this information
Three mothers from Chelwest Maternity Voices Partnership (MVP) helped the hospital team by identifying parent concerns and perspectives, which are included here. A MVP represents a group of women and their families working together with health care providers to enhance local maternity care. If you are interested in finding out more or would like to be involved, please email ChelWest.MVP@gmail.com
Chelsea and Westminster
T: 020 3315 6000 Option 1
West Middlesex
T: 020 8321 5839
- Call 999 if you are having difficulty breathing or your symptoms are life threatening.
- If you have any questions or concerns about you or your baby’s health you should seek medical advice as early as possible.
- Your maternity team is there for you and you will receive safe, personalised, and respectful care