All Women Need Antibiotics One Hour Before Cesarean Delivery - Page 2

[LizD]

Originally Posted by harli

This is not talking about giving antibiotics during c-section or after. This new guideline is talking about giving antibiotics within the hour before delivery. Before most of the c-section Mama's probably did have antibiotics but now c-section Mama's will get them before delivery. Just wanted to point that out.

Yes, that's what has some uncomfortable implications. We already restrict eating and drinking for women in plain old ordinary labor because of the possibility of surgery; do we now start some abx in the requisite IV on the same grounds? Do we use this "need" for antibiotics as another reason women "need" an IV?

FYI for those with allergies: if your known drug allergies are listed you will not necessarily be asked about individual antibiotics; I work in SICU and docs regularly skim the list of allergies and choose antibiotics based on cross-allergy. The patients/families aren't informed. Only once have I seen docs ask a patient about specific antibiotics because the list of allergies took up many pages, and even then my guess is they were only asking her because she had had an episode of anaphylaxis during that hospital stay. If it had been a prior admission she'd have been given whatever they wanted to try and observed for a reaction.

If you're allergic to penicillin or macrolides or something common like that, you're getting a stronger one like vancomycin. The point is if you don't want a specific drug during surgery you need to be very, very specific in the consents you sign, but will probably still be given antibiotics even if you specifically refuse.

[EmTheWife]

I just wanted to claify that the recommendation is within the hour prior to surgery, which in practice can be anywhere from the moment before the incision is made to 60 minutes before the incision is made. If you keep this in mind, you won't have to worry about the potential for the administration of abx for a woman in labor on the off chance she would need a c/s. Furthermore, if the abx are given 61 minutes prior to the time of incision, they don't count as prophylactic for that surgery. IME, the abx are usually given as the woman is moved to the OR, immediately before anesthesia is given, so 5-20 minutes before incision. It's done this way so that the abx are effective, even if the surgeon is slightly delayed.

[MountainMamaGC]

My OB and I discussed the abx and together decided not to. We decided not to so I could prevent another allergy from happening. It seems with me, the more often I use a specific antibiotic, the more likely I am to be allergic. So we try not to use them at all. He said he only liked to use them if the mother had an underlying condtion like crohns or asthma. In my case he did want to use them but decided not to because of my history. I know 100% I did not have abx.

[owlgirl]

I know at my hospital the OBs started doing this 2g of Ancef 60 minutes prior to the C/S. I think it may have to do with infection rates and an attempt to decrease them if a particular group has a higher than desired infection rate? All the FPs don't do this. ALL WOMEN get abx during the c/s administered by the anethesitist. Usually unbeknowest (sp?) to them.

I am not an advocate of abx. I haven't had them in my adult life, I think the last time was as a child and I am 34. BUT, with that said, we are talking about major abdominal surgery in a hospital environment. There is a time and place for abx. I am not sure what the new recommendations are with the 1 hour prior, seems like overkill to me. I wouldn't consent to that, but I'd surely want some during surgery!!

[Maine Mama Doula]

It makes sense to me that as a general rule antibiotics would be used prophylactically prior to any major surgery. Of course, doctors are tasked with considering each individual patient. If I had to have a c-section, I would want antibiotics and pain medications. I think that's all just part of the surgery and comfort afterward. I would not want to take the 8% risk of post-operative infection because it would take away from my baby during the postpartum period. I'm trying to decide whether I think it should be a "choice" in that it is brought up during prenatals, but I am on the fence there.

[MountainMamaGC]

If the antibiotic can prevent the infection then those same antibiotics can be used to treat the infection should one arise. So i think its ok for women to decline antibiotics if they see fit. Maybe some women prefer to go with the 92% chance they wont need them at all.

[pumpkinhead]

If you had IV fluids with your c/s then you probably had abx whether you were informed of this or not. Unless you expressly asked your surgeon not to give you abx, you probably would have recieved them regardless. It would be highly unorthodox to not have abx during major abdominal surgery unless there were special, extenuating circumstances.

Normal flora can't help you when you're being cut open. The peritoneal cavity is sterile and even introduction of normal skin flora can cause a serious infection.

[Llyra]

I had them, with my c-section. Even that one dose kicked off a flare of my ulcerative colitis that took almost a year to bring back into complete remission. I nearly died. This s, me, because nobody even asked me-- they didn't tell me until they'd already started putting them in the IV. I'm not going to say they shouldn't be used at-- I don't know enough to say that with certainty. I can say that I believe in INFORMED consent, and anything that becomes "standard procedure" almost inevitably starts to be done without any attempt at informing patients of options.

[MountainMamaGC]

Originally Posted by Llyra

I had them, with my c-section. Even that one dose kicked off a flare of my ulcerative colitis that took almost a year to bring back into complete remission. I nearly died. This s, me, because nobody even asked me-- they didn't tell me until they'd already started putting them in the IV. I'm not going to say they shouldn't be used at-- I don't know enough to say that with certainty. I can say that I believe in INFORMED consent, and anything that becomes "standard procedure" almost inevitably starts to be done without any attempt at informing patients of options.

Llyra, that would have bugged me too. I have crohns, and I know how devistating antibiotics can be. For the record I did not have them and I healed perfectly. Anecdotal, but something to think about if you get into the same situation someday.

[Storm Bride]

I've only been told I was getting antibiotics once (not a planned section - long story, but I was in L&D, and a section was possible, but I already had an infection of some kind). I'm 99.99% sure I got them with all five, though (haven't looked at my records recently).

My first ("emergency") and second (scheduled, no labour) were both totally infection free. My incision got infected after both my third (scheduled, some labour), and fourth (the above...long labour beforehand, and existing infection - I received a megadose of antibiotics prior to the call for surgery, but I was pretty out of it, and I don't know how long before...I'd guess about 20-30 minutes). The infection was minor, and treated with a prescription topical antibiotic cream the first time around...and was a nasty one requiring fairly high doses of Keflex the second time around - I had the megadose before the surgery, was on IV antibiotics in the hospital, went home with a prescription for more antibiotics and got a new prescription for more antibiotics when the staples were removed a week post-op.

DD2...it was only last summer, and I honestly can't remember for sure, but I think I was clearn of infection this time. I was open the longest ever (four previous c/s, so lots of scar tissue, some of which she excised, plus I had a tubal, plus she closes with lovely sutures, instead of the torture staples). but everything went great.

I know antibiotics are routine with surgery, but I'm pretty nervous about them, and always have been. The antibiotics are one more reason why I hate getting surgery. Fortunately, I'm not prone to yeast infections, but I do wonder what effect all those abx have had on my kids.