This article contains posts and extracts from the UK Midwives and Consumers email list, a discussion group for people interested in midwifery in the UK. Open to midwives, students, mothers, and anyone interested in improving maternity services in UK. Posts in these archives express the views of the individual authors, and not those of the Association of Radical Midwives. Unless otherwise stated, the comments are personal experiences rather than evidence-based research.

Group B Strep and other bacterial infections

Group B Streptococcus

I am a midwife from the USA. I was hoping that some of the European midwives on this list could share their Strep B protocols with me so I could share it with other USA midwives. Your own protocal and your local standard of care protocals would be appreciated.

Midwife, USA

Like most UK independent midwives, we work without set protocols. Each woman’s care is tailored to her individual circumstances, and also to her own wishes regarding care. We give her the information, she makes the decisions, we then give appropriate support.

In a case like strep B, so much depends on when the woman books in pregnancy, whether or not she is symptomatic for strep B, how she is choosing to treat the condition, and so on. One woman we looked after, who had a vaginal colonisation of strep B, but who was asymptomatic, chose not to use antibiotics, but went the homeopathic route. When she gave birth, the baby was born wrapped in the membranes, which I had to puncture when the head was delivering. The baby was fine, and the mother remained asymptomatic. The baby took care of the problem herself!

You’ll have gathered that we manage conservatively, and largely follow the ‘wait and see’ principle. Of course we were monitoring both mother and baby carefully for any symptoms, and if either had become sick would have suggested antibiotic treatment (which the woman would probably have accepted). In the event, it wasn’t needed.

Comments from consultant bacteriologist

The consultant bacteriologist I consulted during the pregnancy about the woman’s situation made the following general comments, which I reproduce here as they may prove useful:

  1. The fact that a high vaginal swab sample may test positive for strep B does not necessarily reflect vaginal infection, but is more likely to be relatively benign colonisation. This should be assumed unless there is positive evidence of disease, such as cellulitis, vulval inflammation, or Bartolin’s abcess.
  2. It is unlikely that a woman with a vaginal colonisation of strep B, even if levels are raised, would carry a blood-borne infection of the same organism.
  3. This being the case, it is most unlikely that such a woman’s baby would be born with congenital strep B infection.
  4. There is no conclusive evidence to suggest one approach more beneficial than another in treating women and babies at higher risk of strep B infection at or after birth. There is not enough evidence to support giving I/V antibiotics to the woman during labour and the baby post-delivery. Oral amoxycillin given to the woman in labour, and one dose of oral (or I/M) antibiotic given to the baby post-delivery is probably as effective.
  5. Most infection of mother and baby in the early postnatal period with strep B is relatively benign, and may be adequately treated with oral antibiotics when symptoms appear. The most reasonable approach is to manage these babies expectantly – waiting to see whether or not symptoms appear.
  6. In the case of pre-labour rupture of membranes, there will be an increased risk of amnionitis and intra-uterine infection, increasing with the length of time between PROM and delivery. Although this situation also may be managed expectantly, and no one strategy has been shown to be superior to any other, it could be argued that it is advisable for the woman to be admitted to hospital in this case.


In the hospital where I work it is policy not to give IV antibiotic unless:

  • Under 37 weeks
  • Previous baby had gpB strep
  • Membranes ruptured for over 18 hours

It is also possible to have a water birth.

Unfortunately the other hospitals in the area have policies which give IV antibiotic 4-hourly in labour


I was at a lovely waterbirth with a woman who had a GpB strep infection in pregnancy with no adverse effects, especially as there was only 5 mins between rupture of membranes and time of birth.

What are midwives out there recommending to women who test positive for Group B Strep antenatally? I assume that most cases are found incidentally as there’s little organized screening in the UK at the mo?

I’ve frequently had queries from women who had tested positive for GBS and were told they ‘couldn’t’ have home births as they would ‘need’ intrapartum antibiotics. Heard from one NHS midwife who said her team had offered to give intrapartum antibiotics at home, but nobody had taken them up yet.

What I’m interested in is the situation where a woman has tested positive for GBS but has no specific risk factors for her baby having GBS disease, ie, by the RCOG’s definition (see below):

  • Previous baby affected by GBS
  • GBS found in urine in current pregnancy
  • Preterm labour
  • Prolonged rupture of membranes
  • Fever in labour

I’ve just been looking at the RCOG’s Clinical Guideline no 36 (November 2003) – Prevention of Early Onset Neonatal Group B Streptococcal Disease. This document is available online at . It says:

9.2 Should women receive intrapartum antibiotic prophylaxis, if GBS detected incidentally?

(answer) Intrapartum antibiotic prophylaxis should be considered if GBS is detected incidentally.

Goes on to say that risk of GBS disease in a woman who tested positive at 35-37 weeks can be regarded as 1 in 500. It seems significant to me that, in the case of a woman who tests positive for GBS but has no other risk factors, antibiotics in labour should only be ‘considered’. This recommendation is only Grade C, ie based on ‘expert opinion’ but ‘Indicates and absence of directly applicable clinical studies of good quality’.

Mortality of early-onset GBS disease is said to be 5.7% in babies born at or after 37 weeks’ gestation. Therefore a woman who tests positive for GBS in late pregnancy, and who goes into labour after 37 weeks, without any other risk factors, could work on the stats that she has a 1 in 500 chance of her baby being affected by GBS if she does not take intrapartum antibiotics, ie 0.2%, and the chance of her baby dying from GBS is 5.7% of that – ie 0.0114% – just over 1 in 10,000.

Given those odds, it would be understandable if a woman decided that intrapartum antibiotics offered more risks than benefits.

What I would like to know is how such a case would be treated in your units, ie would it be difficult for you to support a woman in this situation? I know a woman who tested positive incidentally for GBS in her first pregnancy and had intrapartum antibiotics in her first labour. Now she is expecting her second and is being told that she can’t have a waterbirth etc, etc, as she will ‘have’ to have the antibiotics again. She is not hugely militant, but is clearly sad to see her opportunities being restricted. Any thoughts?

Angela Horn

If she is low risk and wishes ABs then she could have a venflon sited and have the IV ABs then get into the bath/pool once they’re through, no need for continuous IVI.

We no longer constantly monitor women with GBS (success!) and treat them as low risk in every way except they get the ABs if wanted. Also no ARM unless absolutely indicated and only after covered with ABs (2-4hrs). However the MW Led units send their women with GBS to us (cons unit), so not sure if that will change in line with our guidelines (those mws working in those units do not cannulate or prepare IVs unfortunately)


I had an incidental positive GBS result. The midwives agreed to give me antibiotics if I had any risk factors at home, but I declined ABs without risk factors. Had a home water birth and no ABs (and healthy baby).


One local mw unit tests the urine for GBS and, if this is clear, they treat the woman as low risk (GBS in urine seems to be associated with high rates of infection in the baby). She is then able to give birth in the isolated Mw led unit. My isolated mw unit, however, would not be happy for her to labour there unless she had discussed it with a consultant, but women are able to birth at home without anyone’s approval (as approval is not required to birth at home).


I’m pregnant with my third baby and have just been informed that I have Haemolytic B streptococci.

I was desperately hoping for another wonderful homebirth and was about to talk to indie midwives because of an NHS staff shortage in my area when this news breaks! I’m told I have to go to the main hospital for intravenous antibiotics; either as soon as labour starts or if my waters break (in which case I would be induced).

Oh my God – I have been in floods of tears (what a wimp – very weakly lol) as all my plans go awry. I know the baby is my priority but I wanted to welcome it into the world so beautifully with his or her brothers (3 years and 22 months) there in the room.

So any info that you wise women can share will be so greatly appreciated.

I was so excited about another divine birth in water at home and now I don’t want to go into labour or hospital – a bit late for that though and I’m not suure the baby would agree to stay in there forever.

I know I’m being pathetic and I’m sorry for being silly. What a shock – I never saw this one coming!!


Oh my goodness, the world has gone mad over GBS!

1 in 6 women NATURALLY are carriers of GBS in their vaginal and or rectum, 1 in 200 babies that are born to women that are POSITVE and DO NOT recieve antibiotics in labor will become infected with GBS which can lead to menigitis, pneumonia, sepsis, and subsequently death within hours of birth. However, of the 0.5% of babies who do get it, 6% of those will die, meaning 1 out of 10,000 babies will die whom are born to infected mothers who DO NOT recieve antibiotics in labor.

1 in 4000 babies that are born of POSITIVE women who DO recieve antibiobics in labor will contract GBS, but studies show that the use of antibiotics in labor fails to prevent up to 30% of GBS infection. However, there is a 1 in 100,000 chance that the mother will die from anaphylactic shock from the antibiotics herself.

Regardless, a home birth, a water birth – all of this should not be a problem. Your midwife should be able to give you a little IV in your hand for 10 min every six hours, should you CHOOSE to have the antibiotic. You should still have the birth of your dreams. There are several alternative therapies as well to treating the GBS, instead of antibiotic, should you be interested.

Good luck, don’t cry, it is really no big deal, and I am sorry someone made you feel like it was.


Ref for anaphylactic shock stats:

RCOG clinical guidance paper on GBS ( says that 1 in 10,000 women treated with penicillin in labour will have a severe anaphylactic reaction, and 1 in 100,000 women treated will be expected to die. The source given for this is :

Weiss ME, Adkinson NF.
Immediate hypersensitivity reactions to penicillin and related antibiotics.
Clin Allergy. 1988 Nov;18(6):515-40. Review. No abstract available.
PMID: 2977302 [PubMed – indexed for MEDLINE]

The Home Birth Reference Site has a new page on GBS and Home Birth (

I was also GBS positive for my 2nd pregnancy and denied anything other than the “big” hospital birth. You do have choices though and personally I would be vigilant and not have the antibiotics if I were ever likely to have another child.

Anyway, I found the UK Group B Strep Support site really useful and they have a helpline number as well (

Anna – student midwife

I tested positive during my fourth pregnancy and continued to have a homebirth, uncomplicated and without event. Granted this was waaaay back in 1993 and I wasn’t even really told I needed antibiotics, I was just told what to watch for in the baby postnatally and what GBS could do to the baby. I chose to not be tested again (should I confess I’ve never had a smear since?) and have obviously had many more births without it effecting anything.

Everyone has GBS in varying levels at different times. It’s more the baby’s ability to cope with it that is the problem and you can’t tell that beforehand. I don’t think anyone has really figured out why some babies are more susceptible to step than others.


Having a conversation with my mentor today about the aggresive policy for dealing with “prolonged rupture of membranes” in this area, i.e massive doses of antibiotics. We spoke about testing, I was told that even if a swab proves negative (eg at 37/38 weeks) she could still have Group B when she goes into labour at any time over the next few weeks. Help and advice gratefully received!


The US Center for Disease Control (CDC) 2002 guidelines on GBS say that women with negative vaginal and rectal cultures within 5 weeks of delivery do not require intrapartum antibiotics, even if a risk factor develops. Source for this is listed below.

Also worth having a look at RCOG’s clinical guidance paper on GBS ( Doesn’t address this question exactly, but does consider a woman who has had GBS in a previous pregnancy:

9.3 Should women receive intrapartum antibiotic prophylaxis if GBS was detected in a previous pregnancy?

There is no good evidence to support the administration of intrapartum antibiotic prophylaxis to women in whom GBS carriage was detected in a previous pregnancy.

Section 7 of the paper mentions potential risks of antibiotic prophylaxis, including severe anaphylaxis in the mother (1 in 10,000 cases, with death expected in 1 in 10 of those affected, an effects on the baby unknown), infection of the baby by antibiotic-resistant organisms, and possible disruption of the development of normal neonatal gut flora, with subsequent impact on the immune system and later allergy.

Here is something from the US Center for Disease Control’s guidelines on GBS. Bear in mind that the attitude to GBS in the states is more aggressive than here, eg they recommend screening all women for it whereas the RCOG explicitly do not recommend this. Here’s an extract from a Medscape report on the new CDC guidelines:

Field Notes in Obstetrics and Maternal-Fetal Medicine
An Update on Perinatal Group B Streptococcal Disease
from Medscape Ob/Gyn & Women’s Health
Posted 11/14/2002
David Cole, MD, and Peter S. Bernstein, MD, MPH

Early-onset neonatal group B streptococcal (GBS) sepsis remains a significant source of morbidity in perinatal care. The Centers for Disease Control and Prevention (CDC) recently released revised guidelines for GBS perinatal disease that will have a significant impact on all obstetricians and pediatricians. These new guidelines replace those issued in 1996.

What Should the Healthcare Provider Do if a Patient Delivers Postdate?

The 2002 recommendations say that women with negative vaginal and rectal cultures within 5 weeks of delivery do not require intrapartum antibiotics, even if a risk factor develops. However, if a culture is done at 35 weeks’ gestation and is negative for GBS, then the guidelines do not address what to do at 40 weeks’ gestation, if undelivered. The obstetrician had 2 choices: (1) repeat the culture at 40 weeks’ gestation or 5 weeks after first negative culture, or (2) treat in labor for rupture of membranes over 18 hours or temperature over 100.4º F (38º C).[3]


Finally, I would strongly recommend Sara Wickham’s excellent article about GBS from the AIMS Winter 2003 journal.

Angela Horn
Home Birth Reference Site (

Early-Onset Group B Streptococcal Disease — United States, 1998–1999

Medscape article:

Discusses a screening approach versus a risk-based approach. A ‘screening approach’ means prophylactic antibiotics if mother tests positive for GBS in pregnancy, while a ‘risk-based’ approach means giving them only if there are signs of risk, such as fever, prolonged rupture of the membranes, or preterm delivery).

The study is retrospective, so they look at cases of babies who had GBS and then discuss whether different management might have prevented it. This sort of study always seems to come out in favour of more intervention, probably because it has no means of quantifying overall outcomes or any disadvantages to intervention. The editor’s comment does discuss antibiotic resistance; in 15- 20% of cases, erythromycin and clindamycin resistance was documented.

My friend was having her first baby in a US hospital. Because Strep B infections are so much more common there than in the UK, she was screened for infection during pregnancy and pronounced clear. I believe she had two further checks shortly before being induced (no pressing reason for the induction – she’d just reached or shortly passed EDD), and again all were clear. Her membranes were ruptured, monitors attached, pitocin, etc….

During the labour the baby went into severe distress and had to be delivered by emergency C/S. Baby was suffering from Strep B. Baby nearly died and spent a week in intensive care – as a 6 year old, still has scars on her arms from IVs. Subsequent tests on mother found that she STILL tested negative for Strep B, and only explanation was that baby picked it up during labour from infection in the hospital after membranes were ruptured. Her subsequent two children were born by planned c/s too; I get the impression she wasn’t even aware there was an alternative.


Don’t assume that anything occurs more frequently in the US than it does in the UK. Do assume that American doctors just make a much bigger deal about it to justify their control over the whole process of pregnancy and birth and to justify all their interventions. And it justifies their presence there in the first place instead of a midwife.

Melody – US Midwife

Is GBS that much more common in the US than in the UK? It was my understanding, and I may well be wrong, that the reason for all the hubbub in North America has been litigation and a powerful consumer movement for universal testing and prophylactic IV antibiotics… Any info on the incidents on infection by region would be welcome.


Southern Norway: lots of Group B strep infections, not just in newborns. Some very virulent (“meat-eating bacteria” as the tabloids have named them). The virulence of strep and other bacteria undergoes cyclical changes and always has. When I was a child, strep throat was common. I hardly heard of them as a young adult. Now the streptococci are back. Nothing necessarily sinister or doomsday about that.

I don’t have our hospital protocol here at home, sorry. From memory: ROM (rupture of membranes) preterm– we take high vaginal swabs for cultures and follow FHT’s, amniotic fluid appearance and odor, mother’s temp and C-reactive protein daily. Await spontaneous labour unless signs of infection, in which case it is induced.

In very premature ROM (before week 32) mother is kept on strict bed rest until as close to week 32 as possible, and given steroids IM (intra-muscular injection) initially and then weekly boosters until week 34. We have had numerous babies born over two months after ROM and they do amazingly well.

In acute infections C-section may be used, while starting IV antibiotics. After birth, if baby’s condition is normal, mother and baby are monitored daily for signs/symptoms of infection (CRP, temp, and HR and RR in baby) and treated as needed.

ROM at term is handled much the same way minus culture, if I remember correctly.

If mother has positive GBS culture in pregnancy, which is not routinely checked, nothing is done unless a previous child has been infected and needed treatment. We simply observe mother and baby post-partum and treat as needed.

Midwife, Norway

I don’t have a reference, but was under the impression that GBS can be missed unless a rectal swab is also taken? Does anyone know where this comes from?


I am currently doing some research on GBS and the general understanding is that GBS bacteria naturally colonises the body, the primary reservoir being the gastrointestinal tract with approximately 30% of the population carrying the organism at any one time. So this would fit with fact that a rectovaginal swab should isolate the bacteria if present.


Can all you intelligent people out there who work in the hospital setting inform me of your policy for treatment of women with positive Group B Strep on HVS AND previous pregnancy with Group B Strep also?

Ours is:commence IV antibiotics 4 hourly in labour. Do not treat the baby following delivery, but obtain an ear swab and 6 hourly temps and resps for 48 hours.

Here’s my questions:-

1) How long does it take for the first dose of antibiotics to take or have any effect? (I’ve always presumed 4 hours)

2) What happens in the event that a woman arrives and births her baby too rapidly for any antibiotics to be administered? ie Does the baby automatically receive antibiotics or would a septic-screen be obtained?

We do not have mandatory testing. Most practitioners only commence antibiotics if there has been rom +24hours. As the antibiotics should not be started until labour is established, there is rarely time enough for the minimium required two doses in most labours. If you only have a partial dose, or one dose, you risk masking symptoms, while leaving the strep untreated.

Time for antibiotics to take effect – depends on the antibiotic – can be four or six hours (pen g is 6)

If a woman’s labour is too quick for the administration, the baby is monitored. If a woman has unknown status, the baby is monitored (usually in the home). With physicians there is little discussion re GBS. Some test routinely, some do not mention it – I have yet to hear of one who teaches the parents to monitor the newborn.

The shorter the duration of labour, the less likely the chance of infection!

Toxic Bacteria – Group A Streptococcus

I want to respond to the statements about virulent strep infections. Having had a loved one die of Toxic Strep A after childbirth I have researched it better than most doctors, along with my husband.

Southern Norway: lots of Group B strep infections, not just in newborns. Some very virulent (‘meat-eating bacteria’ as the tabloids have named them). The virulence of strep and other bacteria undergoes cyclical changes and always has

The virulent strains that have made the news are various types of Strep A that have mutated to become what is termed “toxic”. These strep bacteria figured out how to release a “toxin” each time the bacteria “divides” and multiplies. The toxins and cell membrane coating that these bacteria produce make them an extremely poor target for antibiotics. The more virulent strains are almost entirely resistant to antibiotics. When the toxins are released they travel quickly in the blood stream to destroy internal organs and kill. Toxic strep can kill in a matter of hours from the first sign of illness, unlike the Strep B bacteria that causes the majority of Uterine infections.

Now the flesh-eating bacteria have a different action, a little less deadly as their first target is to multiply within the tissue and destroy tissue rapidly. It is when Toxic Strep goes systemic that the organs are attacked, and even if the infection can be stopped the internal damage to organs can be so great as to cause death at a later date from internal damage, to the organs, liver, heart, kidneys….

Strep A has been broken down into different strains. Some known to be more virulent than others M-1 and M-2 Strep A are the most deadly strains and then there are strains T-1 to T-4 which are not so “toxic” and are more treatable.

My family member died of an M-1 toxic strep A. She was talking and laughing on her way to the hospital to be checked out 50 hours after birth; she had no fever. She died before nightfall.

My husband had a postpartum mother come into the ER. She had come into the ER earlier that day with nausea and not ‘feeling well’. The doc on call sent her home with an anti-nausea medication. She called later than night and spoke to Lewis, he sent an ambulance out to her home as she had no ride to the hospital. She came to the ER laughing and talking; she died 65 minutes later.

Both had died of heart failure-due to the rapid damage to the heart tissue.

Toxic bacteria are still very rare but it is a good idea for us to understand them so as to accurately describe them to our clients should they read of them or be concerned about them.

The development of Toxic strep has been blamed on the overuse of antibiotics – the bacteria have created the mutant toxins to survive. The medical community has tried to play down the significance/real dangers of this happening but there has been ‘some’ response to try to limit unnecessary antibiotic use.

The reason that Strep B has become more actively treated in the US is not due to Strep B developing the toxic strains. If anyone can verify for me the development of a Toxic Strep B I very much want to know.

I do not think that bacterial deaths from Strep B have become more common at births; they remain steady. This aggressive treatment is an attempt to take action on something that we have little control of, the rare occurrence of a baby becoming systemic with Step B, which otherwise would not affect the child. No-one knows why one baby will become that ‘one’ out of many exposed vaginally to Strep B who becomes systemically affected and who also fails to have the proper antibody response to fight it off. Perhaps it is related to something allopathic medicine has yet to find much of an answer for, like auto-immunity. It is a very rare baby exposed who becomes systemically affected.

Routine antibiotic treatment has not been shown effective in bringing down the damage (mortality/morbidity) of Strep B. But of course we know that this is not the determining factor in the US when instituting a standard or care. This is why I am asking about the routine treatment of Strep B in Europe. It was my understanding that testing and antibiotic use was not routine intervention. Where as in the US there is pressure on homebirth midwives to treat positive cultures with antibiotics in labor at home.

Midwife, USA

Hospital-Acquired Infections

My friend was having her first baby in a US hospital. Because Strep B infections are so much more common there than in the UK, she was screened for infection during pregnancy and pronounced clear. I believe she had two further checks shortly before being induced (no pressing reason for the induction – she’d just reached or shortly passed EDD), and again all were clear. Her membranes were ruptured, monitors attached, pitocin, etc….

During the labour the baby went into severe distress and had to be delivered by emergency C/S. Baby was suffering from Strep B. Baby nearly died and spent a week in intensive care – as a 6 year old, still has scars on her arms from IVs. Subsequent tests on mother found that she STILL tested negative for Strep B, and only explanation was that baby picked it up during labour from infection in the hospital after membranes were ruptured. Of course, this being the US, her subsequent two children were born by planned c/s too; I get the impression she wasn’t even aware there was an alternative.

Another friend whose baby was born in the UK last year was induced at 8-10 days past dates. She was planning a home birth but a consultant put the frighteners on her over post-dates risks, and told her her cervix was so ripe, induction would be really easy. After 24 hours of hard induced labour she was still only dilated to 2 or 3 cm and the baby went into distress, so emergency c/s was performed. Baby taken to SCBU for observation, released after a day or so, during which time mum had to fight to stop staff giving formula.

Mum is a nurse, and was convinced a day or so later that baby was not quite right. Hospital staff dismissed her fears. Mum took baby home, only to have to rush back as baby developed roaring temperature and turned blue. Turns out baby had septicaemia, and had to spend several days in intensive care, also on IV antibiotics. Fortunately he recovered well. Mum is convinced that the most likely place for her baby to have contracted his infection was SCBU, where of course he was subjected to numerous blood tests etc. in the name of ‘observation’.

The first person I knew who had a home birth was a microbiologist who decided, after contracting a nasty postnatal infection following her first hospital birth, that the risk of hospital birth was just too great if there were no complicating factors. She went on to have a 9 1/2 lb baby girl at home; the baby was a full face presentation. Mum wishes that an epidural had been available, but is still glad that she did not go into hospital; her career has left her adamant that she is not going into hospital in future unless she is dying!

Of course, half the time when you mention home birth, people start on the ‘But what if something goes wrong…. ‘ routine. I am tempted to ask the same when those people tell me they’re planning a hospital birth!

Angela Horn
Home Birth Reference Site

Links to other sources of information:

Homebirth and GBS, from

US Midwife Archives pages on GBS


US Center for Disease Control page on GBS:

Women’s Health Website (by UK obstetrician Danny Tucker):

UK Group B Strep Support Group:

AH updated 30 September 2004

1 Comment

  1. anna

    My beautiful little girl imogen passed away on the 2nd of June this year at just one week old she contracted GBS which caused her meningitis and sepsis we where in hospital for 3 days and sent home as this wasn’t detected in the hospital 7 hours after being discharged we rushed our baby girl to a and e and she was rushed straight to intensive care and then transferred ro picu in Newcastle and can I just add what a absolutely fantastic hospital it is they done everything in there power to save our daughter unfortunately this raging infection was just too much for our angel to endure ,, I am currently fighting my hospital for it to become part of antenatal care weather we pay for the test or not we pay thousands of pounds on our children to give them the best opportunity in life I was never even aware gbs existed perhaps I did I would have payed privately for a test and I would have known of the symptoms leading to meningitis and septicaemia the health professionals of the hospita didn’t pick up on how can this be justified its a midwives job to know the signs of a sick baby my instincts my daughter was ill but noone would listen ,, my body is my body and if I want a test done to protect my child then that should be MY decision not the nhs


Submit a Comment

Your email address will not be published. Required fields are marked *

Pin It on Pinterest

Share This