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Refusing antibiotics due to breastfeeding. What will happen?(33 Posts)
I need the professional opinion of people in the medical profession about what will happen if I choose not to treat a soft tissue infection in my wound, just leave the wound open (with packing) and keep daily dressing changes and wait for the infection to clear.
DD will be 6 weeks on Friday, she was born by emergency C-Section and straight after birth I developed a soft tissue wound infection... that just has not gone away. It is now considered a chronic infection.
I spent 5 days re-admitted onto post-natal ward with IV antibiotics. Discharged with oral antibiotics which I took for 14 days. 1 week break and infection not cleared so another 10 day oral antibiotic.
Daily dressing changes at doctors. Wound still smelly, lots of discharge, one open hole and the rest of the wound keeps re-opening in small sections(sorry TMI). They think my body is rejecting dissolvable stitches and is pushing the stitches to the surface of my skin (also issues with ingrown hairs), causing skin to break and infection.
So the dilemma. I have been asked to attend a review on Monday with the doctor. The antibiotic I am taking is not working (penicillin). But I am breastfeeding. The antibiotic I need cannot be used when breastfeeding. But breastfeeding is going so well and I don't want to give up! [cry]
My options are
* to be readmitted for IV. No guarantees this will work since it didn't last time. Also makes family life difficult since I am SAHM to three older children. If it's unlikely to work then is it worth the hassle?
* To take the antibiotic I need and stop breastfeeding for the duration of the course. I can express and dump to keep up supply. But my supply will no doubt be affected. I also don't have enough stored milk for any length of time and I am quite evangelical about DD not having formula milk.
* to refuse further treatment (since I and DD are both well in ourselves) and continue with dressing changes, keep wound open, hope it clears up on its own in time.
I am stuck between a rock and a hard place and I don't know what to do
I am most inclined to go with the last option. What will happen if we don't treat the infection?
What is the antibiotic you need? I took Metronidazole while breastfeeding to clear a chronically infected section wound. Worked like a dream.
I have no idea about what will happen if you refuse treatment, but... is the antibiotic you need really contra-indicated in breastfeeding? Sometimes they say that but it's not based on evidence of it causing harm, just no evidence of it being safe because it's not ethical to do studies IYSWIM. There is a breastfeeding network pharmaceuticals information line - they might have some ideas...
Here is their leaflet on antibiotics and breastfeeding:
Interested to see what responses you get, I'm allergic to penecillin and similarly hoping to avoid antibiotics as ebf, the infection I've got is being tested, meanwhile I'm bathing with tea tree oil and lavender (mine are infected tears not a c section though). It sounds as though you've really been through the mill with all these antibiotics...
Have they swabbed and cultured from the wound? Really worst case scenario depends on the bacteria involved.
They have done several swabs. Initially it was non specific, just 'skin infection. The last one (done Thursday, results Monday) was specific to a bacteria and I was told the doc now knows exactly which antibiotic I need but I can't have it while breastfeeding.
What I'm annoyed about is that I didn't ask what the infection was. Will ask when I have my dressing change tomorrow and refer to the leaflet Pheonix gave (thanks!)
I've been taking co-amoxiclav (which is a penicillin) oral tables. They make the wound smell a little less but are basically ineffective.
Drs default position tends to be you can't have this whilst bfeeding. I would find out what the medication is and then do some research with the bfeeding network and there is a specific helpline you can get in touch with or email and they will find out for you. I forget the details but am sure someone will remember though.
Ring the BFN rugs helpline, Drs often say you can't take things while BF that you actually can. The durgs helpline are fab.
Have you tried medical grade sterile honey on the wound? Truly amazing stuff and widely used in the NHS these days.
That lady is bfn and pharmacist and offers advice. Also lactmed? Is another place for help online.
No idea what will happen if you dont' get this bacteria out of your wound but I doubt it's anything good
I personally in your situation would take an antibiotic with 'no evidence of safety in breastfeeding' and only avoid any that have 'evidence of harm in breastfeeding'. So it may be you don't need to avoid the anti-b OR stop bf.
Why not wait till you know the exact name of the prescribed anti-b and call the bfn pharmacists or check with kellymom and they'll let you know if it's actually harmful in bfing or just 'not proven to be safe for bfing'?
Just wanted to offer some hope in case you do have to stop briefly and pump and dump - I also had to stop for 10 days for medical reasons with DS in week 7 and was also devastated. The good thing was that after the time of pumping (and dumping, which HURT, throwing all that milk down the drain!!!), he took right back up with exclusive bfing and never took a drop of formula since.
For me the key was being incredibly rigorous about pumping just under every 4 hours and doing it properly, my LC said that it's totally possible to keep supply and the reason most women say it drops is because they start going longer between pumps/shorter times etx. I realise this is easier with a first child than a 4th, though! The best thing I had was hiring a double pump for 2 weeks, it is so much faster and with a pumping bra could be hands free so I gave DS a bottle (sniff) at the same time to boost my supply while I looked down at his little feeding face.
It might have been overkill, but I also asked for him to have Elecare as DH's family have a history of cows milk issues and I didn't want him to have increased risk of CMPI, and took lots of probiotics myself to boost good bacteria.
I can't give a medical issue online, but would say that is sounds like your team have been patient and thorough and tried lots of approaches - and chronic infections that aren't healing after a lot of time don't tend to mysteriously go away later. They can be way overprescribed by some doctors for colds and the like, but they also have a really important place - the reason that the end of antibiotics is terrifying, and it's because so many people would die from even minor injuries let alone post childbirth and surgery before antibiotics arrived. Whatever outcome, I really hope that your health improves soon, and that you will be feeding for a long time to come!
Thank you everyone for replying. I am going to find out tomorrow exactly what the infection is then start googling.
I've arranged for DH to come to the review appointment at the doctors with me on Monday. I don't want to be bullied into anything affecting breastfeeding unless absolutely necessary and unavoidable. But equally I need a non-emotional sounding-board there to make sure I don't take too many health risks here.
Please do ask them which antibiotics they want you to take. Then you can research it and make an informed choice.
Very few drugs are actually definitely risky during breastfeeding. But few have adequate research to prove their safety, and this isn't likely to change.
The BFN is a fab resource and you can email for detailed info about less common drugs if they aren't featured on the fact sheets.
Do consider the risk of not treating vs potential risk of treating during bf and the risks of not breastfeeding, both to you and the baby. Also many antibiotics are licensed for/given to even very young babies.
Expressing would be a possibility but unlikely to be needed and is hugely inconvenient. LACTMED is also a good resource but not always easy to use for non medical professionals IME ( I'm an HCP and a bf support person IYKWIM)
Sorry to hear you've had a rough time.
I think you need to get the infection out of the wound, so it can heal, and to prevent possible transfer into your blood.
However, I'd find out what antibiotics are possible, and then talk to the breastfeeding network, as linked to above. Drs often say no to drugs and bf, but actually there is no evidence of harm, which is usually as good as it gets as testing drugs on lactating or pregnant women isn't seen to be ethical.
If the bfn says no, I think you may have to think hard about how long you can sustain an open, rotting, sore on your body.
But the bfn may well have an alternative which would be suitable.
If it is a short course of AB's, you may be able to pump and dump, and then go back to bf once your healed.
Hope you and your Baby are Ok soon.
My first option would be to double check check the antibiotic options and their dafety to breastfed babies. If the best option really is harmful, then I would appeal for donor milk either from a friend or through HM4HB.
Speaking on behalf of the medical profession, in a very general sense, we really don't know a whole lot about breastfeeding and will often wheel out the "not safe on this medication" line without properly looking into it.
Since starting to BF I am now much more
obsessed with interested in medication safety and tbh as PPs have said many many medications are safe to use while BFing. I use lactmed as a guide- it's available as an app for iPhone.
Knowing what exactly was cultured on your swabs would be very helpful as there are sometimes a number of options for treating a given bacteria.
I would think in your situation it would really not be a good idea to forgo antibiotics, even if it did mean having to pump and formula feed for the duration of treatment. And I say that as someone who was also a bit "nooooo!" at the idea of formula, but even then recognised that the whole point of formula should be that it's a reasonable alternative to breastmilk if medically necessary (with apologies to those who FF by choice- it's not an opinion I usually voice).
Hope you get some clarity on this and get well soon OP .
I had to have some after I was sterilised and the stitches got infected so expressed and dumped mixed with the odd bottle (dc3 was 8 months and just starting to have one as I had gone back to work) and I carried on until he was one. I'd had 5 eye ops under local when i was pregnant with him (very very stressful and painful and no pain relief after as I was pregnant ) and I was told at the time that though there are certain things known to pass through to the baby/breast milk, it would be totally unethical to undertake any studies on pregnant and breast feeding women and after all who would volunteer?!
Much as I am a breast feeding supporter you need to get yourself well or you will not be able to feed your beautiful baby so please think of yourself in the equation too.
I got a print out of the swab results. I have "moderate growth of Coliform organism" in the surgical wound.
Suggested treatments are:
- Co-amoxyclav(Augmentin) R
- Piperacillin/Tazobactam S
- Gentamicin S
I'm taking Co-amoxyclav.
NHS website says Gentamicin cannot be used when breastfeeding and it isn't given on the BFN antibiotics factsheet.
NHS website says Piperacillin/Tazobactam can be given to BF mothers only if doctor considers it necessary. So maybe Dr just wants to discuss risks of this one with me when I see her on Monday?
Here's hoping anyway. I am feeling more confident that there should be treatments available that mean I can breastfeed using. Also Dr is a young woman and supportive of breastfeeding. So hopefully all will be well.
Info from Wendy Jones breastfeeding and medication book - Gentamicin is poorly tolerated orally. So the baby would get little and it states it is compatible with feeding for
short courses. (However because it is poorly absorbed orally it's usually given while you are an inpatient and administered by injection)
I would still contact the bfn helpline (I think you can email? I'm sure I did) and get their views.
the piperacillin/taz is also given by iv. There is some info here http://www.medicines.org.uk/emcmobile/medicine/21655/spc#INDICATIONS there is little known about it in bf acc to the leaflet but equally it does not flag up known problems/reactions. It isn't in the book, I would definitely recommend emailing the Breastfeeding Network for more information
Lactmed says that gentamicin "poorly excreted" into milk so your baby would absorb only small amounts
And says "piperacillin is acceptable to use during breastfeeding" - that's as good as it gets! Hope this gets sorted for you soon.
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