Thrush...Mastitis and think I'm going to give up BFing

[KirstyDaisyBBandFifi]

I have been back to the GP today as DD3 has horrific thrush.. I have thrush in the breast and have just been prescribed a two week course of fluconazole.... DD3 has been really ill as a result of the anti-biotics i was given for mastitis... GP has said that i shouldn't feed her whilst on fluconazole... am gutted but also slightly relieved as my breasts are so sore and i am so tired with expressing for 12 times a day.....

Poor you, it sounds like you've had a really hard time of it.

I am very lucky in that I have had numerous courses of anitbiotics for mastitis and not had thrush, but I don't think I am prone to it as I've never had thrush. I do know people who have had it though and they have said it was absolutely horrendously painful and I know mastitis is bad enough, so I really do feel for you.

I am not sure how old your DD is, but you can usually feed when taking fluconazole, even though it's not licensed for use in BF women and GP's aren't always best informed regarding drugs and BF. You can get further advice on this from the breastfeeding network drugs in breastmilk helpline though if you want to and they may also be able to advise on an alternative antibiotic for future use if you do need them again that will be less likely to affect your DD.

Obviously you will either need to express or feed your DD as if you do decide to stop suddenly then you may get the mastitis again and AFAIK, not feeding or expressing during mastitis increases the chances of a breast abcess. Not great when you already feel dreaful, I know. Perhaps you can also get advice from the BFN or one of the other helplines about this, or maybe there is a local BF counsellor or lactation consultant that can help?

Whatever you decide to do, I hope you feel better soon.

thanks for the message.. DD is 5 weeks... i think i need to stop as i cant cuddle her... or my olther two beautiful girls.... i will continue to express... everytime i have to start on meds she has reaction 24 hrs later.... when i have been med free ... she is such a lovely baby and i really want to enjoy her as this is my last baby....

Thrush is horribly horrible. However, the great news is that fluc will shift it really quickly. You should start to feel much better in a day or so. Have you also been given Daktarin gel for your baby and cream for you?

You can continue to BF while taking Fluc but with care with an under 6 week old. Read this for info: www.breastfeedingnetwork.org.uk/pdfs/dibm/FAQs_Thrush__and_Breastfeeding_Jan-2012.pdf

How certain are you it's thrush and not a latch problem? The antibugs you've taken certainly make it more likely but if you've already had mastitis there could well be an underlying attachment issue which needs addressing. It could be a combination of attachment and thrush of course.

I really, truly feel for you (very personally, having gone through the same thing with a raging thrush infection at 6 weeks) and totally understand the horrendous pain. But honestly, it does get better but really it's important to check if anything else is going on. It's really rare to get mastitis, then thrush like this without there being an underlying attachment problem so if you can possibly get a qualified breastfeeding counsellor to take a look, check for tongue tie and so on, this might really help you in the longer term.

Good luck :)

Thanks carrotcake... However it can't be a latch problem becuase DD is bottle fed with EBM... I express twelve times a day to get enough milk for her... I know it is thrush as I have had it before - however I now think that they mis-diagnosed mastitis - as there is still a lump in my breast (it is not painful) and GP thinks it is glandular or homronal in origin..... I then think I got a blocked duct and therefore got a temperature.... Now it is cleared but as the doctors diagnosed mastitis they told me I needed anti-b and these have had an awful effect on DD3 .. Need to express now... write more later

Hmm, I see, ok.

Could it be that the breast shell isn't the right size? Some pumps offer them in different sizes. This might make everything more efficient and less painful, therefore less prone to problems. I understand once you've had thrush it's easy to self-diagnose (oooh) but I'm looking beyond that at causes.

Could you hand express instead? May be more gentle.

Have you worked on expressing the lump away? If there is a lump and it's not a blocked duct then I presume they're investigating? You can have an ultrasound while breastfeeding/lactating.

Sorry if I'm teaching you to suck eggs... :)

You certainly aren't teaching me to suck eggs - I think the more information and that people talk about these things the easier it is to understand them... You have actually covered most of the points that I have just about gone through... I have ordered the smaller size breast shield and supposedly that will help... However.. I ordered it last week and there have been delays with delivery - it turned up today when we were at the doctors... I've tried hand expressing and I couldn't get it to work for me... I use it at the end of each expression to check that I have drained fully and use a tissue to mop it up... I can't figure how you can ever catch the drips...

As for the lump - my mum is very prone to these lumps - she has had about ten over the years.... The doctor thinks that it is something hormonal and I tend to agree - It appeared four weeks to the day of birth of DD3..... I am due to go back next week and I will discuss ultrasound then.

Today I have started taking acidophillis from Holland and Barratt and am hoping that with a healthy diet and some relaxation I will get better quickly... Currently I am continuing to pump and dump as I want to return to giving DD3 my milk. I also have a massive history with thrush and had anti-biotics the week before she was born, for a throat infection. I hate to think that anything I have done will cause her grief and her tummy problems will soon be behind us.... I am expressing as DD3 had tonue tie and was unable to suck enough milk out regardless of latch etc... When you had thrush what treatment did you try? and how did you finally get rid of it?

OK, grapefruit seed extract is worth a go. You can get tablets, or you can get a liquid which is better. Must contain citricidal. Some people use the liquid (VERY DILUTED!!!) on the nips after feeds but it's very drying. I took the tablets as I couldn't bear the taste of the liquid (also VVV diluted). You can take it at the same time as everything else. Acidoph is a biggy for sure. You can open the capsules and wipe a bit onto your baby's tongue, too. There are diets for candida overgrowth such as yeast free (so risen bread, wine, beer, etc etc) but I've not followed them as I've been able to clear it without it. Might be worth a Google if you need to.

Gentian violet will come up on your Googling. It's not readily available here as there are concerns that it's mildly carcenogenic. In my research I don't think this is a huuuuge issue, but still, getting it in the UK is nigh on impossible. Plus there are lots of other things to try first such as the citricidal.

Catching the drips- LOL yes. Um, wibbling your boobs over a big bowl or jug may do the job! Don't worry about sterilising it as long as it's clean.

Are you getting enough milk with the 12 expressions?

And you have the daktarin?

OH, worth getting the TT checked to make sure it's still clear. They can re-grow or sometimes they're not completely released. Classic for these symptoms.

And - please don't think you've "done" something which has upset her tummy. Breastmilk is the single most important way to care for a baby's tummy, as you know, otherwise you wouldn't be expressed for half your day. These teething problems will pass, I promise.

Sorry, I mean I understand what you mean about thing that have happened that have upset her tummy. I totally understand that and it's a hard thing to have happened but it was all necessary :(

Thanks for the ideas and messages.... I have sent another message about how I am frustrated by all of the things that seem to go wrong and how I feel that I am constantly being sent down blind alleys by doctors etc..... I will try the grapefruit seed extract...

To be honest i'm not sure that I am all that bothered by her TT as I am finding the expressing ok now and it works for me (I got PND as a result of BF problems with DD1 - and was on suicide watch(Scary as I am a really positive and determined person normally!) for three weeks. PND lasted 18 months and has affected every part of my life... This way I feel I can feed her without having to remember the pain I experienced from DD1

Oh crikey, how awful :(

Well, I've supported people who exclusively express, and Truthsweet has more experience than me (I've supported 2 in the last 6 months but she's helped a lot more). It can work beautifully although it may take more commitment than EBF when there are no problems. One mum started expressing every 2 hours like you are and has a fantastic milk supply. She's down to just 3-4 times a day AND she's getting more milk than she needs from that (donates the rest to the milk bank). So there's a good chance it can work really well if you get through the next few weeks with V frequent expressing. If you are getting enough milk then you can start to reduce expression frequency in a few weeks. Theoretically around 6 weeks but I'd get well past the 6 week growth spurt, first.

Also there's research to show that playing music you like, to help you relax, can help with let down. I've also seen that Natal Hypnobirthing has a breastfeeding CD. I have a copy to listen to to see if it would be useful for mums EE for their prems but haven't had a chance to, yet. But it's all about relaxing for maximum milk production.

I feel so much for you. I remember sitting on the bed when DS2 was about 8 weeks old with the same awful thrush pain and sobbing to my DH that I now knew why people didn't do this (dream of a time with DS1 on the whole). It was very useful to me to go through that, as a BFing supporter, but I wish none of us had to.

Have to pump now but will write back in 20 minutes after this ordeal!!!! (Am ok really!)

God I hated thrush. My DS had it from 3 weeks and gave it to me. I have never felt anything like it - the pain was madness. Anyhow I continued feeding DS through it even when on fluconozole. However despite a lot of daktarin use his thrush refused to clear up. After about 3 weeks of religiously smearing his tongue to no avail I started adding probiotic powder to his EBM. Just 1/2 teaspoon once a day and that sorted him out. I also kept getting blocked ducts on one side so started taking lecithin and that sorted them out too. Good luck!

Kirsty - it sounds like you are having a really tough time at the moment BUT it still sounds like things are on your side (you still have milk, you are still willing to express and you still have support to continue to EP [although it sounds like the medical side could be more joined up!]).

This link has info on relaxation tapes to help with increasing yield/milk removal (the more effectively you can remove milk the less often you will have to express which will mean when supply is stable you may be able to cut out some of the expressing sessions).

Also, a hands free pumping bra/top (or make your own out - try googling for tips/'how to's) would probably help make pumping easier - at least then you could MN or read a book in the evenings while pumping or even give baby her feeds while pumping (at least while she is still small and not grabby and moving about!).

I found hand expressing into the breast shields with a bottle on (after decanting the milk I'd just pumped!) worked well for me - I used to hold the shield horizontal in the opposite hand and express with the same hand (i.e. hold pump with right and express left breast with left hand).

You could also try adding a little of your ebm into some of the bottles so not all of it is dumped (i.e. if you give a 3oz bottle of formula making 1/2oz of that ebm) you could see if she tolerates that and work up from there - just a suggestion of course and you don't have to take it, I won't mind I promise!

Hope you have a better day tomorrow.

Back again.... I have been getting about 600ml a day - although this reduced after blocked duct thingy.... now am back up to 550 - and increasing every day again.... However I am still noticing that the left side is getting loads more than the right (this is the side with the funny lump etc.) Before last weekend they both got similiar amounts... I hope that as it repairs it will increase again... Fluconazole seems to be a blessing and a curse... I wonder if I could not take the prescription for the next two weeks but could treat the condition purely with natural products to minimise the time without breastmilk for DD. I am really confused how to apply Daktarin to DD? Also is there something I can put on my nipples to attack it from there? DD has has cream for her bottom.... Poor love I really feel for her....

I hope this makes sense - Also thanks for the info about lecithin - think I will try it.

Just to add I am so excited as my hands free bra arrives tomorrow morning! I am living the dream!!

I can't believe that I am still contemplating this but I still really want to succeed..

Truthsweet - thanks for the idea - I have been trying to give her half and half feeds - but the poor darling has been so screamy and colicky and vomitty that I think she needs a bit of space to calm her system down before I try again.... I like the idea of 1/2 an ounce to start with and definitely think that this is how I will start again.

I am still keeping going for now...

It's normal to have one side that doesn't make as much as the other and to have fluctuations in how much you make each day but most women don't know as they can't see how much their baby is taking or from which side.

You may find when your sized shield comes that yield increases too - I am a rubbish pumper (though I did 12 sessions a day for 8 weeks with DD1 and plenty of pumping with DD3 as either she or I were in hospital in her first year!) and I found once I found a better fitting shield I did actually get more, if only they made a even smaller size I might get even more out!

There are different forms of daktarin. An oral gel which is to be used on their tongue and a white cream which is to be used on skin as in nipples and bottoms. I found that the thrush fed off the oral gel (it likes sugar) which was why it never fully cleared until we stopped using the gel and started giving him probiotics instead. He would have been no older than 6 weeks when we started doing this and within a week it was all gone. I also took them, both powders and tablets (higher nature brand) and also ate lots of live plain no sugar yoghurt. Whilst on fluconozole I also continued to breast feed and all was fine.

Incapinka is absolutely right about the two different forms of Daktarin for infant and mother thrush treatment and you do need both. However, Daktarin gel is sugar free so should not feed the thrush. I wonder, Incapinka, whether you were given a version with sugar in by mistake? I've not seen one but there may be such a version. Nystatin drops are sometimes given instead of Daktarin Gel but this is not so effective, partly because it DOES contain sugar, and partly because it's a liquid so doesn't stay around so long in the mouth as a gel, and is therefore less effective.

So the topical treatment is Daktarin gel, for your baby's mouth and cream for your nipples. Gel isn't licensed for the under 4 months because they are concerned about choking, so what you do is apply a tiny smear to each part of the mouth, bit by bit so there is no single "lump" of gel left.

Thanks for the advice - I have just received my hands free bra and smaller shield - the shield is so much more comfy!! and hands free - wow my life is transformed. I am still combining all of the treatment and also bizarrely today the lump in my breast has disappeared - that seems to relate more to the hormonal theory and that I did not need antibiotics for mastitis .... so now I just have to get rid of thrush for her and for me.... I have been putting the daktarin gel on DDs lips morning and night - I haven't been given any cream for me.. She has got clotrimazole cream for her bottom..

Yesterday I did not express as often because I was sad and thought I would give up- I missed two slots!! However today I am back with a vengeance and determined to keep going through this one... I need to get my body back in balance so that I can stop the fluco as soon as possible.... am taking 50mg (small dose) daily for two weeks but think that if I get things under control sooner I will be ablet o use more natural products. Also I wanted to ask about using acidophillis powder on DD - where do you get the powder? Is is safe with 5 week old or should I wait for a couple of weeks for her?

I am still persevering....

Great news about the new shield and bra :)

The Daktarin needs to go inside all of her mouth I'm afraid. Put a small smear on a clean finger and wipe it around her bottom left hand gum. Then another for the bottom right. Repeat top left and right, over and under tongue and on top palate. Small smear, not a lump so there's no risk of choking. 4 times a day.

Daktarin (Miconazole) cream is definately needed for your nipples, 4 times daily. Clotimazole is fine for her bottom. You can use clotrimazole on your nipples but it's more likely to cause a skin reaction such as eczema than miconazole, but if you do a skin test and it's ok you could just use that.

Can I buy Daktarin cream over the counter? That way I can get some for myself... Do I need to remove it before expressing every time...

Thanks for the advice about DD - I will try it after the next feed.

Am feeling very chuffed as I am typing and pumping all at the same time.

Also I have learned how to hand express the end of my milk using shield of the pump...

Speak soon as my in-laws are visiting for the day and I need to be sociable...

Yay! All sounds good. YOu sound a lot more positive.

I think you can, yes, and free on prescription. No you don't need to remove it (aren't you throwing away the milk anyway?). Just a thin smear is enough.

Thanks for the info... I will get some cream from GP on Monday... UNtil then I will continue with the pain... Had a go at gel in DDs mouth - she was not very impressed. I guess like most things I will get better at it with practice..

I am pumping again - this is so easy with hands free... fed up of thrush pain though... Although I know it is a lot less painful than feeding would be.... Do you know how long it takes before it clears up?