Is childbed fever history?

by Jane Bartlett

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Thanks be to Dr Semmelweiz
Pregnant women today need to thank the Hungarian doctor Ignaz Semmelweiz for their health. The role of bacteria in infection wasn't recognised until the end of the 19th century, but in the 1840s Dr Semmelweiz observed that childbed fever was carried on the hands of birth attendants. Although his theory was hugely controversial, he insisted that they scrub their hands in chloride of lime. The death rate plummeted as a result.

Doctors of this generation would rarely have encountered a case of puerperal sepsis - the deadly phase of the disease - but Dr Downey reassures us that they have been sufficiently trained to cope. Early administration of antibiotics is the recommended treatment.

Do we need screening?
However, Dr Downey does believe that we might not be sufficiently screening pregnant women for group B streptococcus. 'Nobody knows what is the best thing to do,' she says. 'Should we take a swab from every pregnant woman, and if we do, how often, and what should we do as a result of it?'

In her own hospital, Dr Downey screens all women who have had a problem in the past with group B strep on a monthly basis. Antibiotics are administered during labour as a precautionary measure. Although there are currently no national guidelines on screening for group B strep, the Public Health Laboratory Service GBS Working Group has issued "interim good practice recommendations for the prevention of early-onset GBS infection in the UK" click here to download their factsheet.

Are you vulnerable?
Are some women more prone to puerperal fever? Those who are run down and anaemic or have endured a long labour may be more vulnerable, as are those who are HIV positive or have other conditions or drug treatments that compromise their immune system. Women who have Caesareans may get localised wound infections but, Dr Downey says, they are no more likely get puerperal sepsis.

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Is childbed fever history?