Okay, my new job doesn't start until the eighth, I haven't busted Bessie out yet (I'd better soon but we're all sick so Kiddo keeps waking up at 4:30 to nurse), and I have no excuses... it's time. I have to write The Thrush Entry.
Let me begin by saying that my goal here is to provide some encouragement to other moms who find themselves in this predicament. Maybe also to whine a little bit. Apparently thrush nipples (and milk ducts, in my case) is pretty common, which I totally did not know before it happened to me. Bleh. And it can be really hard to get rid of, and I have had some pretty painful, frustrated moments with it. And I am so glad that I did not let it get the best of me and make me stop nursing my kiddo. I still totally love nursing him (and it's really helping him right now that we all have this nasty head cold/cough) and I would be really upset if nasty old yeast had taken that away from me. So before I dive into this narrative, I will say, PERSIST ladies! Relief is available, and it will be worth it.
So, I blame the antibiotics from the c-section, but realistically, I have been prone to yeast since puberty, so if someone was going to get boob thrush in motherhood, it was gonna be me. I don't remember the exact onset but it was pretty early on. My lactation consultant was the first professional to identify it, and I think we saw her around the two-week mark. At its worst, it felt scratchy and burny when kiddo was pulling milk through the ducts, and the pain did not go away after he was done nursing (one of the signs that it's thrush and not latch problems). I also got stabbing pains in my breasts and into my shoulders and chest cavity, which would occur at intervals seemingly unrelated to nursing. My nipples would be bright red and very tender to the touch, and hurt while nursing. Bright spot - most of these symptoms were very responsive to ibuprofen. Check with your own health care providers of course but most of them let you take this while nursing. They had me on piles of it after the c-section.
I have received varying advice for this infection. Before finding the useful stuff, I was put on nystatin by my well-meaning OB, which did squat, and also for kiddo's mouth. The yeast just laughed at it and went on its merry way. I called a well-reputed breastfeeding center at a very highly-regarded hospital near me in Pasadena. They gave me a long list of totally impractical advice, including going no-sugar, putting all sorts of bizarre crap on my nipples, and something else I can't remember now but I think it involved herbs? This just seriously bummed me out because I knew the no-sugar was not a viable alternative for me at that time (see below) and I could tell that what she was describing for smearing crap on my nipples (including the goo you can buy over the counter for vaginal yeast) was (a) unlikely to work, and (b) not really a good idea for the kid, despite this person being a supposed breastfeeding expert. I'm sure some expert will weigh in and tell me why I am wrong on this point, but it just wasn't useful advice for me in that moment. So that was a serious low point - here I am with barbed wire being sucked through my nipples, talking to a breastfeeding resource, being given crap advice, and months from being willing to even consider weaning my child (which I still have not done, thank goodness). So, mamas, if you find yourself in this boat at the moment, take heart! I got past this point and am feeling much better, and while this yeast is a bee-yatch, there are things that will help, although it will take longer than you want. And again, ibuprofen helps a lot. Do make sure you have a doctor or lactation consultant diagnose your nipples, since latch problems and bacterial infections can feel similar.
The most useful resource I can point you to is Dr. Jack Newman's breastfeeding website. (I highly recommend making a donation if you find his site helpful! Even a few bucks is a help! But of course technically it is free.) My lactation consultant has me using a hair dryer on the girls twice a day (carefully - not to burn them!) and going topless or at least braless as much as possible. To which I would add, breathable tops, preferably cotton, and breathable bras are very important.
I have been through most of Dr. Newman's Thrush Protocol at various points. It will work differently for different women, so don't view this narrative as The Ultimate Truth, but I will relate my experience. Some of the products Dr. Newman recommends are expensive and you will need to find a sort of crunchy granola pharmacy or health store to get them, but it's worth it. There's a great one in Claremont where I used to work - I'm gonna miss her! But realistically most cities have these now, and if not you can try online.
Gentian violet worked well the first couple times and eventually did not. My yeast is getting smarter - not what we want. Gentian violet makes a big mess, and (as you will read in the instructions) this includes kiddo's face. First time I tried it I freaked out that I had permanently stained my child purple, which of course I had not. There is a perennial dry spot on his lip which stayed purple longer than the rest of his face, but that went away too. So get some old/dark towels to put kiddo on when you nurse kiddo with the gentian violet, and have the baby naked or in an outfit you don't care about. Also, gentian violet is not to be found at most big chain pharmacies but little neighborhood pharmacies have it.
The topical grapefruit seed extract seemed to help a little but I found it very drying, even at the more dilute concentration, so I first tried olive oil and then gave up on it. The oral GSE didn't seem to do much. The all-purpose nipple ointment (APNO) works wonders topically but since I had deep breast yeast eventually I wound up on fluconazole (generic for diflucan).
I've probably been on too much fluconazole at this point - I started getting a few random bruises, which realistically are probably from packing and moving, not the drug, but they were sort of out of character for me, so I went off it for now. At this time I am just on the macrobiotics (which I keep forgetting to take) and the APNO, and so far so good. My nipples are still really red but they don't actually hurt. I should add the hair dryer back in.
My OB is a great guy, but he apparently hasn't seen a case of thrush like this, so after the nystatin he was sort of out. So after finding Dr. Newman's site, I printed the appropriate pages, circled the things I wanted and faxed them over with a nice little note. E.g., "please prescribe me this APNO, here is a compounding pharmacy to call it in to, please let me know if you need to see me first." I think some doctors might take offense at a patient sending them articles and instructions but my awesome OB actually thanked me for "the interesting article" and did just what I wanted. If your doctor isn't getting you what you need and isn't cooperating with your instructions then find someone who will. Persistent yeast is shockingly difficult to treat and you don't need some jerk who thinks that MD stands for "I know more than you, you silly woman" telling you that you will feel better soon when something isn't working.
I have done the no-sugar anti-yeast diet before. It is very effective in combating vaginal yeast. It is also a lot of work, and the way I was able to do it in the past was to spend all of each Sunday meal planning, shopping, and cooking. New moms are lucky if they get to spend all of Sunday asleep, thank you very much. Besides this, no matter how little sugar you eat, there will be sugar in your breast milk, because your baby needs it so your body makes it. It is of course a good idea to eat as little sugar as you can, just generally, but certainly if you are combating yeast. But the idea that a new mom who was not previously doing so is suddenly going to be able to go on a totally no sugar macrobiotic home cooked diet is pretty laughable. As a side note, at one point I tried having half a beer after kiddo's bedtime because it is a galactagogue. The yeast just LOVED that. So I stopped. Which is really fine because I don't like beer. I think the yeast really loves wine too. Alcohol works just like sugar for yeast, and of course these beverages also have yeast in them. Just tell yourself when the last of your kiddos is weaned you can go for a weekend in Vegas.
Recall that my dudelet just turned one year old. I have been combating thrush in my breasts and on my nipples for a year. It was WORTH IT. Really. I may be nuts, fine, but I'm telling you, I still totally love nursing my little guy, and I got through it, and you can too. I hope this post will be helpful to someone, and please message or comment if you have any further questions.
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