New Breastfeeding Network Thrush FAQ leaflet: why the changes?

(28 Posts)
OhBuggerandArse Sat 10-Mar-12 16:31:00

Both the new leaflet and the old one (which I thought was very useful) are available here.

The recent guidance has some stuff in which I think is odd, and which might discourage people with genuine infections from seeking treatment - most notably for me the idea that a thrush infection will always be felt equally in both breasts, and that the nipple will always present as red and shiny in genuine thrush cases. Neither of these things was true for me; I'd be interested to hear what other people's experience has been?

I can understand the need to rule out positioning issues which might cause ongoing problems, but feel that the material presented here is likely to shake women's confidence in requesting treatment, which is often difficult enough, given how sceptical some GPs still are about the problem.

Does anyone have any knowledge of how and why this new guidance was put together?

Enraha Sat 10-Mar-12 16:42:18

Watching with interest, as I suspect I have thrush, but am failing to get diagnosis/treatment as only one breast affected, DS not showing obvious visible signs (nor me on nipple) and I'm getting a lot of thrush-type symptoms, as per old leaflet, following a course of anti-b's.

At a loss at what to do, having a painful weekend of it, as expressing even more painful and less effective at draining than feeding.

MigGril Sat 10-Mar-12 16:43:22

I belive the reasion for the change is that to many new mums are being overdiagnosed with Thrush and that other things like possitioning and attachment have not been adressed as a possible cause first.

I can understand your concern, but consider the other possiblity that a new mum does have a possitioning problem and not thrush and has just been told it's thrush and medicated which then woun't solve the problem.

The information is put together by the BfN's specilits pharmacit, who is also a trained BfN supporter.

crikeybadger Sat 10-Mar-12 16:51:31

Why not email Wendy, the pharmacist that MigGril referred to?

She may be able to answer the questions on here.

OhBuggerandArse Sat 10-Mar-12 16:52:57

I'm amazed that you think that there is over diagnosis of thrush. In my experience, including anecdotal evidence from a wide number of friends, it's been incredibly difficult to get a diagnosis and even more difficult to get treatment, and delay in both is the direct cause of more of these people unwillingly giving up breastfeeding than any other factor.

I can't see why treating thrush should prevent anyone from also exploring positioning issues. Just as a comparative example, in neonatal wards ANY baby who has received antibiotics is given thrush treatment routinely, just because they know that it's so important to prevent it from setting in and becoming systemic.

I'm concerned that the leaflet as presently formulated will become yet another reason for doctors to delay treatment, leading to worse infections and increased pain for sufferers, with all the knock on effects on BF maintenance rates that are an obvious consequence. It's also, as far as my own experience of thrush symptoms goes, factually incorrect.

OhBuggerandArse Sat 10-Mar-12 17:50:06

crikeybadger, I've just been looking on the BFN website and am not clear which email I should use to get in touch with Wendy - you sounded like you might know?

crikeybadger Sat 10-Mar-12 18:00:06

Oh OK- you could try this one. It's from her own website which she has not long launched.

OhBuggerandArse Sat 10-Mar-12 18:07:58

Thanks!

TruthSweet Sat 10-Mar-12 19:47:17

I believe there was concerns over mothers being given repeated prescriptions for ever increasing doses of Fluconazole without ever checking that the baby was feeding well in the first place.

Also, as fluconazole can build up in newborns bodies (they can't clear it out like an older baby can) so the babies could end up getting huge doses of fluc. for no reason as there was no thrush in the first place just poor postioning/attachment or other feeding difficulty that could be resolved without drugs if given the correct support.

Thrush has been a bit 'Emperor's New Clothes' in recent years and in some areas been the go to 'diagnosis' when a mother was experiencing pain during bfing rather than actually addressing the real cause of the pain.

That is not to say thrush doesn't exist (I have had it and fluc. treated it easily) or that mothers haven't had pain while bfing just that there are reasons why fluc. and thrush diagnosis in general needs to be a bit circumspect.

Interestingly, a study done in Australia found that of the mums in the 'diagnosed with thrush' group none had thrush - they all had a staph. infection but some of the mums in the 'no pain during bfing' control group were colonised with Candida Albicans (the organism that causes thrush) and they had with no symptoms....

OhBuggerandArse Mon 12-Mar-12 12:34:40

Have heard back from Wendy who says that she'll try and post some answers or maybe come onto the thread on Wednesday evening. So ask away, guys!

TheGreatHunt Mon 12-Mar-12 21:23:33

My baby is windy (bum wind) - ridiculously so, her farts are mental and disturb her day and night. She doesn't like feeding - flips about like a seal, twists her head which folds my nipple back, slides to the end etc. I thought maybe thrush as ruled out other things and I've had two courses of antibiotics so far (she's 14 weeks). But my GP won't swab for thrush.

Is there anything I can do to rule out thrush - I'm surviving on 90 mins of sleep plus snatches of 20 mins through the night and it's killing me. I've seen bf counsellors, lactation consultants and the GP and so far she's had a tie snipped plus reflux meds plus advice on positioning but getting nowhere.

OhBuggerandArse Wed 14-Mar-12 09:56:56

Bumping in case there's anyone who wants to get a question in if Wendy comes on tonight.

breastfeedingandmedication Wed 14-Mar-12 20:46:54

Hi everyone, sorry I havent been able to join you before in this discussion.
From what I can see your questions revolve around
a) why cant you just have thrush on/in one breast?
b) use of medication
c) why did I post the new FAQ sheet

so I'll start with that and see where we get

breastfeedingandmedication Wed 14-Mar-12 20:53:22

Why was new information sheet necessary?

I get many calls each week on the drugs in breastmilk helpline. Often the mums have had several courses of treatment of various types but symptoms havent improved and mums are at their wits end. OR they want more information to take to the GP.

My big concern centres around what I feel is over diagnosis of thrush. When we first wrote the leaflet (originally about 1998) we were thinking about a small number of mums who developed pain after a pain free period with no obvious reason. These days it seems to be the first thing hcp think of if they havent been able to see what is wrong.

Seeing can mean that no-one has watched a full feed - how the baby goes to the breast, during the feed and the shape of the nipple afterwards.

In the vast majority of cases mums describe one sided pain, mi shapen nipples, never having had pain free feeds and no one is helping them with positioning and attachment

So we have 2 problems - using medication when it isnt necessary and a mum not getting help with basic bf support

breastfeedingandmedication Wed 14-Mar-12 20:58:57

If we over diagnose thrush and coerce GPs to prescribe - but it doesnt work, they are much more reluctant to prescribe next time.

Thrush pain is very specific and if diagnosed correctly by a bf expert responds really quickly to treatment.

As has already been discussed the potential build up of fluconazole in small babies is frightening - I've already had one baby about to be hospitalised and operated on as no one realised how long the drug was in the system and why the baby was still getting side effects.

I'm not quite sure where the link with smelly wind is coming from - it doesnt appear in any of the research papers I can think of. Candida is killed by lactoferrin in the gut and the gut bacterial balance restored by breastmilk - how can this therefore be linked with wind. IMHO opinio it is more likely to be linked with lots of "fore milk"and higher lactose produced by less than perfect p and a and braest drainage.

breastfeedingandmedication Wed 14-Mar-12 21:00:25

Enraha, can you describe your symptoms and what makes you convinced you have thrush? Have you had pain free feeding?

and sorry I havent said I'm Wendy !!!

nannyl Wed 14-Mar-12 21:15:16

breastfeeding and mediction
sorry to hi-jack, but are there any anti-emetics i can safely take if i have another HG pregnancy while still breastfeeding?

My Dr says no but others have said there are

i took cyclizine last time

crikeybadger Wed 14-Mar-12 21:19:09

Hi Wendy,
thanks for popping along to answer questions. smile

Could you clear up the confusion about thrush being in both breasts... some other posters seem to strongly disagree with this but I have heard that it can only be thrush if it is both breasts.

LadyWidmerpool Wed 14-Mar-12 21:23:15

I told a midwife I thought I had thrush and she told me how to treat it and what to ask the GP for. The GP then prescribed the medication. Neither examined me! Now I strongly suspect I never had thrush at all but it stopped me from freezing any EBM and now I think I may have problems expressing enough when I go back to work on Monday.

I attended our local BF clinic for about six weeks and over and over again I heard women being given advice on treating for thrush. I can definitely believe that it's being over diagnosed, perhaps in some areas and not others.

breastfeedingandmedication Wed 14-Mar-12 21:37:32

nannyl, cyclizine is probably fine. If you find it makes your toddler drowsy we could try something else. You can always message me through my website www.braestfeeding-and-medication.co.uk

hope it doesnt happen next time

breastfeedingandmedication Wed 14-Mar-12 21:42:29

Crikybadger

if we think about how contagious thrush is - both breasts makes much more sense. Hence leaflets say if mum or baby has thrush (and I'd ideally confirm by mouth swabbing baby) treat both. Sorry to be basic but if you have vaginal thrush you can pass it to your sexual partener but he may not show symptoms. However if you have oral sex you can rapidly develop oral symptoms

So if you have it on one breast, you will pass it to the baby who will inevitably pass it to other breast.

I'm sure we all have one breast its easier to get a good attachment on, so its also easy to get one where there is squashing of the nipple and cutting off blood supply temporarily during feeds which still gives an agonising pain after feeds. Or you can have a tongue tie where the baby can get a good mouthful on one side but not the other.

Does that make sense?

breastfeedingandmedication Wed 14-Mar-12 21:45:03

LadyWidmerpool, you hit the nail on the head, how could they be sure without watching a full feed? they couldnt and therefore they missed an opportunity to help you.

Try expressing frequently but for short periods over next few days to boost supply before you go back to wor but be aware then that you need to be able to express at work whilst you are apart.

Good luck!

crikeybadger Wed 14-Mar-12 21:58:53

Yes, thanks Wendy.

You're saying that because thrush is so contagious, there is no chance that it could only affect one breast.

But, maybe women who have pain in one breast (and get pain after a feed) are wrongly thinking they have thrush when in fact it is poor positioning and attachment. Perhaps the fact that the pain clears up once medication is taken is purely coincidental and it is something else that has changed that has sorted out the pain.

Have I got that about right?

breastfeedingandmedication Wed 14-Mar-12 22:13:57

sounds about right to me . Sometimes I think time helps - another 10 days and feeding has got easier and baby better at attaching. Cynically I could say its the great placebo effect but I dont think so

OR maybe we just dont have the right name for the group of symptoms and the drugs work in a way we dont understand

But with most bf problems what mums need is an expert pair of eyes and hands as well as a good listening ear cos it isnt always easy. And I take my hat off to those of you who keep going despite the terrible painsmile

TruthSweet Wed 14-Mar-12 22:17:29

Wendy - what do you think of the study I posted up-thread from Australia where none of the mothers diagnosed with thrush actually having thrush but a staph. infection instead?

Is it GP mis-information, an overlap in the symptoms, a one off statistical anomally or a mis-attribution of symptoms to thrush that are actually staph symptoms? Or something else altogether?

TruthSweet Wed 14-Mar-12 22:18:00

Oh and thank you for coming on to this thread - very much appreciate it.

OhBuggerandArse Wed 14-Mar-12 22:28:21

Thanks again for coming on, Wendy. Can I ask a couple of questions?

I totally get the need for caution, but I think you might be underestimating the ease of getting fluconazole prescribed at all - I found it a real struggle, and I do know of many people who never managed to and eventually gave up breastfeeding. How can you (as information providers) balance the need to not get it prescribed in excess or error with the very real needs of women for whom access to it would make it possible to maintain a breastfeeding relationship?

And the other one is about the one breast thing - I have absolutely no doubts that my thrush was correctly diagnosed and treated: I had no positioning or supply problems, and it responded very quickly to treatment. But the pain I felt was overwhelmingly on one side. Is it really possible to use this as a diagnostic criterion?

breastfeedingandmedication Wed 14-Mar-12 22:48:16

I do think that the Australian study has a very valid point which is why i have no gone back to thinking we need to swab baby's mouths and mum's nipples to be sure of diagnosis. Tom Hae did a study in US and proved he couod grow candida in breastmilk and do it readily even in presence of lactoferrin, but didnt grow any from mums diagnosed as having thrush.

so he concluded thrush in the breast didnt exist.

Not sure I'd go that far but I do think it is far less frequent than diagnosed in some areas and by some people.

Signing off tonight but happy to return tomorrow in case there are more questions. Wendy

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