Antibiotics, Labor, and Breastfeeding

Let's talk about a subject that doesn't get covered enough- antibiotics and their impact on breastfeeding.  Do antibiotics (particularly those given a woman in labor) alter the breastfeeding relationship?  Can antibiotics administered to the mother actually HARM breastfeeding?  Can antibiotics even make breastfeeding so painful that women will quit?

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. 

Comments

BzeeMom said…
I also developed debilitating thrush due to routine antibiotics after unnecesarean. The pain was insane. I remember getting up to feed him at night, and crying in the dark because every time he sucked it killed me. It took two to three months of probiotics, blue stuff treatment, nipple shields, pumping and bottles, sterilizing EVERYTHING, and showering with a bra stuffed with washcloths, before I was better. My sweet boy wasn't allowed to feed directly from my bare nipple until he was four months old!!!
C. Beth said…
I really appreciate this article.

I tested positive for GBS early in this pregnancy, twice. (They were testing for yeast, and tested for that too.) I'm eating probiotic yogurt, hoping by 36 weeks I'll be negative.

I'm in a somewhat unique position. I won't be breastfeeding, as I'm a gestational carrier (not the baby's mother, just the carrier.) I probably will be doing some limited pumping, however, to ease engorgement (plus a bit of pumping before my milk comes in so that the baby gets colostrum too.) So I probably won't get thrush but the baby could, through the milk. I've dealt with thrush, with my son, for MONTHS...such a pain.

I'm also -cillin allergic, so this article gives me some motivation to ask the midwives at my birthing center what antibiotic they'd suggest for me if it's necessary. The baby's mother and I may want to do some research in advance.
ellie said…
I've "had" to have penicillin during labor both times because of testing GBS+ (hospital protocol.) In both of my babies the amniotic sack was ruptured less than 15 minutes before delivery. (To me that seems like VERY low risk of the baby contracting GBS.) I've always wondered how effective these antibiotics were in actally preventing GBS in my case because they were given 15 to 20 minutes before delivery with each birth. With baby #2 I was fortunate enough to avoid thrush myself, but I was sure he had it. He was also very gassy and threw up a ton. Using baby probiotics helped a lot and made all the white film go away on his tongue. I sure wish I could avoid all that this time around, but it's sure scary when you do hear a horror story of a baby that died from GBS. Not sure what I'll do yet this time.
Janie said…
I have had five babies, GBS + with all.

The first four were routine hospital births with antibiotics and later soul crushing debilitating thrush.

My fifth was at home, we treated with GBS and hibiclens...

NO THRUSH

it was a beautiful miracle and I wish more women knew about this.
Ashley said…
I had a necessary c-section and thankfully didn't get thrush from the resultant antibiotics. I'm also in the not terribly unique position of not having any good drugs for GBS. I'm severely allergic to all the -cillins and only seriously allergic to the sulfa drugs, which knocks out every single antibiotic that works on GBS. Thankfully GBS infection is rare, so I'm not too worried about it.

I just wish doctors were better educated about antibiotic allergies. I've had such a struggle avoiding -cillins over the years despite it saying in big bold letters on every chart that I'm severely allergic.
kijjet said…
I am GBS+ and after tons of research I decided not to get antibiotics during labor. Here's why... based on what I research, 1 in 200 women who are GBS+ AND give birth without antibiotics will pass GBS on to the baby. Of THOSE 1 in 200 babies, 1 in 1000 will actually get GBS (for the other 999 the bacteria will be present on their skin but will never spread inside where it can make them sick). And of THOSE 1 in 1000 babies an even SMALLER percent will have serious, life threatening sickness caused by GBS.

The other scary thing about antibiotics given during labor is it can cause antibiotic-resistant strains of other things (like E coli). One article I read said that although moms that were given antibiotics had a lesser chance of passing GBS to their child, the birth mortality rate was the SAME as moms who did not have antibiotics. One theory to this was the increase in antibiotic-resistant bacteria the antibiotics created (if the antibiotics isn't able to kill all the bacteria, say E coli, the ones left become super bacteria that are resistant to antibiotics and pose a much greater threat to the baby).

After all this research, I decided to treat my GBS naturally. I did hibiclens washes every four hours during labor and we monitored my baby super closely for the first 48 hours, checking for fever and labored breathing. And the month prior to labor, I ate raw garlic twice a day. Drank kompucha in the morning. Drank green magma with 3 scoops. And some other things that are so out there and private I won't post them publicly (but anyone interested can contact me for more info).

So yeah, I hear ya loud and clear on this one. I'm not saying either that people shouldn't take antibiotics, but people should definitely do the research first. Unfortunately you really have to go looking for the research because most doctors won't just give it to you.
mary faybik said…
First baby was an unnecesarean w/ me being GBS+ resulting in months of all of the antibiotic side effects you listed-- it was extremely painful to nurse, so much that I barely got a milk supply in and fought tooth and nail to keep it, even doing a round of Reglan, which resulted in mastitis. It's the snow ball effect- what came first? I'd have to say the interventions... Second baby I had at home, in water. I used hibiclens for 2 weeks prior and washed with it during labor. Water broke 45 min before I had him-- no GBS for baby and amazingly NO THRUSH, NO MASTITIS, etc. Seems pretty clear to me.
mary faybik said…
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I was GBS+ during my first pregnancy and my water broke early, so had to be induced. Labored with an IV containing penicillin and pitocin. I had heard about epidurals potentially causing breastfeeding problems, so turned down the epidural.... But I never thought about the potential effects of the antibiotics. Fast forward a few weeks... baby could not nurse, constant pain and bleeding from nipples. Finally got the thrush under control and established exclusive breastfeeding, and now are dealing with allergies and leaky gut issues. We're trying to heal her gut using elimination diet (for me) and probiotics. Just want others to be aware of potential long-term gut issues from antibiotics during labor.
Jessica said…
I'm also trying to make this decision. I'm currently 20 weeks pregnant with my 3rd, and my 2nd baby developed GBS in utero and almost died. The GBS was able to penetrate my cervix (at around 36 weeks - even though I tested negative 3 days before I went into labor) and I went into early labor. She was resuscitated at birth and spent over a week in the NICU. Horrifying experience.

This time around my Dr (who I ADORE) wants me to get antibiotics for my whole labor. I'm nervous on two fronts - how this will effect my vaginal micro biome and it's lifetime protective effects to the baby, and also the possibility of thrush (although I've breastfeed 2 babies for over 2 years each and never had thrush).

I'd love to see some studies that give numbers as to the risk of developing thrush. How many cases of thrush in women who get IV antibiotics vs. those who don't?

Such a hard decision. Ugh.
Sara said…
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Can u please give me your contact so i can contact you and ask you abot your reasearch as i am tested +ve too n this is my first baby i have no clue what to do but im really scared to take antibiotics during labour and i seriously want my baby to breastfeed
Thanks a lot i would really appreciate this :)
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Ryan Melody said…
The vagina always contains small amounts of yeast. When you’re healthy, that yeast (technically, a fungus known as Candida albicans) exists in harmony with your immune system and your other normal vaginal microorganisms. But when something disrupts this balance, the yeast can grow quickly, becoming dense enough to cause the symptoms of a full-blown infection.
How To Treat Yeast Infection In Women
Emma Sara said…
I've tested positive for GBS and am trying to kill it naturally before labor. I'm 36w4d at the moment. I had the worst case of thrush at about 22 weeks and think that's why I have this now. I got rid of the thrush naturally after succumbing to Monistat as I couldn't walk but had a terrible reaction to it EVIL STUFF. I took 2x turmeric capsules, 4x garlic capsules, 1000mg vitamin c, 1x 5 billion pro-biotics and made a paste of 4tbsp yoghurt, tsp turmeric, 2 garlic capsules, 1tbsp neem oil, 1tbsp Apple cider vinegar and 10 drops of tea tree. I applied externally and left for about 30 mins and internally for a few hours. I'm now doing the same but taking 4 drops of colloidal silver x3 day, consuming 3tsp of raw Apple cider vinegar in water and will be getting some astragalus to take. I also consumed lots of kombucha, keffir and natural yoghurt. All organic and sugar free if possible. I'm confident I can get rid of it naturally first. My dr said even if I test negative I should have the iv drip which I don't understand and have found no evidence to suggest baby would get it still if I was negative. I did see a 1 in 4000 chance somewhere which does not weigh up to me. I'll keep you posted.
dixiefiddler said…
It was hellish afterwards, two trips to emergency room, increased auto immune disorders...three rounds of antifungals, liver got toxic from detox....i have spent four years recovering from systemic candida. Found Plexus triplex and am finally better but the increased inflammatory pain is still there...And my baby girl suffers lots from exzema and tummy troubles with food allergies. This is no way to live and it destroyed my quality of life. Just say no!