Antibiotics, Labor, and Breastfeeding

I am so grateful to have had the opportunity to have breastfed all of my children for some length of time.  There are countless benefits, both emotional and physical to the nursing relationship.  I am saddened though that it appears that so often women have very real and very severe difficulties getting started and maintaining a breastfeeding relationship. 

I do believe that often this difficulty stems from our habit of intervention heavy birthing.  I talked about it a little yesterday in this post that contains many research articles pointing out the negative impact that birth interventions sometimes have on breastfeeding. 

Many women spoke up to point out that another thing that seemed to cause them difficulty with breastfeeding was antibiotic induced thrush in themselves and their newborn and the associated pain and discomfort. 

I think that this is a huge issue today in breastfeeding and maternity care, and sadly, not often talked about.  I WANT to talk about it though because all to often I hear women say that there is "no harm" in taking preventative antibiotics in labor or while breastfeeding.  

Antibiotics- Why?

First we need to talk about why women are given IV antibiotics in labor.  One of the big reasons is group B strep.  Many women test positive for it and it has become fairly standard in America for IV antibiotics to be administered. 

This link has a nice and easy to understand breakdown on the treatment and the dangers of group B strep in the birthing woman.  Clearly, antibiotic treatment does seem to greatly decrease the passage of the bacteria to the baby.  (What I am trying to say is this- don't not take antibiotics because you read this stupid blog.  This is a serious decision.)

This is not me saying "Don't take antibiotics for group B strep"  (that would be totally dumb of me and I don't want to tell you what to do either).  This is just me (a mom, nobody special) saying, "Women deserve to know what antibiotics can do to the breastfeeding relationship and also ways to prevent problems."

Antibiotics- What Is Used?

When a woman tests positive for group B strep then she is often given antibiotics in labor every four hours or so.  

The two most common antibiotics use are these: 

Penicillin G (Which you can read more about HERE)

I think it is highly advisable for people to read the package inserts of the drugs they take before they put them in their bodies.  Since we are talking about antibiotics and their impact on pregnancy and nursing, I wanted to share with you this quote from the package insert-

"Use Penicillin G Benzathine Suspension with caution in NEWBORNS; they may be more sensitive to its effects.

PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Penicillin G Benzathine Suspension while you are pregnant. Penicillin G Benzathine Suspension is found in breast milk. If you are or will be breast-feeding while you use Penicillin G Benzathine Suspension, check with your doctor. Discuss any possible risks to your baby."

They also point out that some of the common side effects of this drug are:

"Pain, swelling, or bleeding at the injection site; mild diarrhea; worsening of arthritis."

 Regarding the use during breastfeeding, they state:

"Penicillin is excreted into human milk in small amounts. Risk to the nursing infant is unlikely. The manufacturer recommends that caution be used when administering penicillin to nursing women."

The other antibiotic commonly given to women in labor with strep B is Ampicillin.  Again, from the drug information:

"An uncontrolled observation of the breastfed infants of mothers taking ampicillin noted a seeming increase in cases of diarrhea and candidiasis that was attributed to ampicillin in breastmilk. "

(Candida and thrush are the same thing.)

Though they also point out that:

"Relevant published information was not found as of the revision date."

 Let me just point out, I am not saying- Antibiotics = Thrush 100% of the time.  But I do find it ....sad that we don't know what this is doing to laboring women and their babies because we haven't bothered studying it.

Antibiotics- Known Impact?

What do antibiotics do when we take them?  Hopefully they take care of whatever "bug" we have that needs killing.  But anther thing that we don't often think about is that sometimes they kill other things (especially broad spectrum antibiotics like those listed above) and can cause thrush or yeast overgrowth in the person reciveing them.

Dr. Sears describes thrush here, and also says that:

"Antibiotics – the normal bacteria that live in the mouth usually keep the yeast from overgrowing. They compete for space. Since antibiotics kills these normal bacteria, the yeast is allowed to overgrow unchecked."

So- who cares?  Does it really matter if mom or baby gets thrush?  What does this have to do with breastfeeding?

Dr Jay Gordon, a well known doctor describes this well here.   He also points out some of the symptoms of thrush, which you can see could impact the comfort and desire to breastfeed.  They include:

"-Unusually pink or red nipples. 
-Cracked or bleeding nipples
 -Itching or burning nipples 
-A shooting pain deep within the breast
 -Pain that continues throughout a nursing session 
-White patches inside the baby’s mouth. (the inside of his cheeks is a “thrive” zone and an easy to identify location)"

 (He also has a comprehensive list of things that can be done if thrush is already a problem for you.  You can find more resources here via Kellymom and here from a lactation consultant.)

 

 What does this really matter to you?  Honestly, I don't know.  What I do know is this- women are constantly telling me of the difficulties they had with breastfeeding due to thrush- and they are often convinced that the thrush started because of IV antibiotics given them in labor. 

Am I saying not to take them?  No. 

What I am saying is that I am not sure we yet know the impact of this common intervention.  There is a possibility, given what we know about antibiotics and thrush and breastfeeding, that their administration can impact the breastfeeding relationship negatively, causing pain for mother.