All Women Need Antibiotics One Hour Before Cesarean Delivery - Mothering Forums

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#1 of 30 Old 08-24-2010, 01:44 PM - Thread Starter
 
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I read this today and I dont know if I agree with this. I didnt have antibiotics with my first and I healed up beautifully. I also think this will affect the future health of the babies as they are now finding that bacteria does play a role in their immune system developing properly.

http://www.medicalnewstoday.com/articles/198701.php

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All pregnant women should be given antibiotics before having a cesarean delivery to help prevent infections, according to new recommendations issued today by The American College of Obstetricians and Gynecologists. The College says that the antibiotics should be given within one hour of the start of surgery for maximum effectiveness.

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#2 of 30 Old 08-24-2010, 01:45 PM
 
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Hm, I didn't get antibiotics with either of mine and had no problems with either.

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#3 of 30 Old 08-24-2010, 01:49 PM
 
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I was going to post the to the allergies forum. Many women suspect antibiotic use (during c-sect, for example) has contributed to problems with gut flora and that, in turn, creates problems for food intolerances.

did they look for outcomes further down the road, after the newborn stage?

DS, 10/07. Allergies: peanut, egg, wheat. We've added dairy back in. And taken it back out again. It causes sandpaper skin with itchy patches and thrashing during sleep. Due w/ #2 late April, 2012.

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#4 of 30 Old 08-24-2010, 03:43 PM
 
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Does it occur to them that antibiotic overuse is a danger in itself? It won't wipe out all infections. It might prevent a few infections from beginning but it will also play a role in resistant strains developing.
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#5 of 30 Old 08-24-2010, 06:50 PM
 
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Interesting. I didn't have any antibiotics with my cesarean and I'm healing very well, and I'm typically infection-prone.

I wonder if the need for this is dependent upon closure type, the dr's skill, and the hospital's aftercare. My doctor is highly skilled, considered one of the best ob's in the area (and also has the lowest cesarean rates). He closes with sutures, cuts and sews with the idea a vbac will be the next birth, and the aftercare is very hands-off.

Given that many cesareans aren't planned (and even my planned cesarean turned crash) there ought to be a good comparison avaliable in a few years of this implimation to see what the real outcome difference is.

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#6 of 30 Old 08-24-2010, 06:53 PM
 
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Does it occur to them that antibiotic overuse is a danger in itself? It won't wipe out all infections. It might prevent a few infections from beginning but it will also play a role in resistant strains developing.
This. MRSA is already a huge risk when you WALK INTO the hospital (add in an open wound??) I think that using MORE antibiotics will only make it worse and up the risk. I mean, if you give antibiotics and kill off the weaker bacteria (not to mention your good bacteria!) before the surgery even starts aren't you setting women up for nastier infections?

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#7 of 30 Old 08-24-2010, 08:40 PM
 
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This is a prophylactic treatment used to prevent infections from happening in the first place. It's commonly done in planned surgeries. Not that I agree with it but it probably won't leave the women open for new nastier infections like AFwife mentioned. The idea is that you have a ton of good bacteria (or should) with possibly some bad bacteria that is introduced when the surgeon doesn't wash his hands or equipment as well as he should. So you put the antibiotics in there and kill off some of your good bacteria but you also kill off the few bad bacteria quickly before they have a chance to colonize. Usually antibiotic use only leaves you open for worse infections when you've been on them a while and almost all of your good bacteria is gone.

That said I don't agree with this practice unless your talking about someone who is already sick who is going in for surgery. But for an otherwise healthy mom who needs a c-section I don't think it's necessary.

This is probably an attempt to bring down the maternal mortality rate. If I remember right infections from c-sections is a pretty common problem for women who undergo them.

I also bet that it is going to be used by doc's to push scheduled c-sections more rather then just waiting for labor to begin on it's own. After all if labor begins on it's own they won't have time to get the recommended 1 hour of antibiotics in.
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#8 of 30 Old 08-24-2010, 08:47 PM
 
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Are you all sure you didn't have any antibiotics? I just always assumed that I'd had some, since I had major abdominal surgery, yk? They can give you one injection that is effective for 7-10 days, so is it possible you got that and didn't know?

ETA: yeah, I just googled "antibiotic standard cesarean" and there is a ton of information about the standard of care being a prophylactic antibiotic during surgery.

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#9 of 30 Old 08-24-2010, 09:00 PM
 
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I would also guess that if you had a cesarean section, antibiotics were most definitely a part of your care. They're not something you need to consent to on an individual basis, just part of standard orders, especially for major abdominal surgery. Things like that are pushed right through your IV with your fluids.
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#10 of 30 Old 08-24-2010, 09:20 PM
 
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Totally 100% sure I didn't have antibiotics.

Cindy, joyful SAH mama to rainbow1284.gif William & Katherinefly-by-nursing2.gif Forever missing Amelia 7-12-09 angel3.gif  signcirc1.gifsaynovax.giflactivist.gif Ask me about my natural cesarean! 

 

 

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#11 of 30 Old 08-24-2010, 09:34 PM
 
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If you didn't have antibiotics during surgery, that's very unusual. They're a standard addition to IV fluid for surgery, emergent and non-emergent, along with the anesthesia and sedation, Zofran for nausea, Reglan for heartburn, Pepcid, etc etc. There's a whole lot of drugs that are part of standard surgical orders that patients are not asked about and rarely see the orders for. *Most* people having abdominal surgery -or any surgery- in the United States right now are going to have a cocktail of all kinds of standard drugs for surgery including prophylactic antibiotics, especially now that hospitals are concerned with MRSA and VRE and other nosocomial infections.

What's interesting about this topic is the new recommendation that they be given at least an hour ahead of time when possible, especially in light of the other news stories about the differences in bacterial colonization of infants depending on delivery route.
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#12 of 30 Old 08-24-2010, 10:09 PM - Thread Starter
 
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I am allergic to so many antibiotics and so I know they did not give me any. We didnt want to risk any more antibiotic allergies.

Me(33), Mama to a crazy DD (6), Wife to a wonderful mountain man(32) BF my babe for 2 years.
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#13 of 30 Old 08-24-2010, 10:32 PM
 
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Ah that must be why. I think generally once you say no allergies they feel free to give whatever. My first was an emergency so they hit me with them afterward. My second was planned an they gave me antibiotics before the surgery but they didn't tell me! It wasn't until I said something to a nurse that she said I'd already been given them. I wasn't happy with that at all. I think it had a hand in my ds having a yeast diaper rash. I'm not allergic but I have Crohn's and things like antibiotics and Ibuprofen reek havoc on my system. I did convince them not to give me the Ibuprofen but I couldn't convince them to let me keep my piercing in - I have 23-mainly in my ears- it took me a half hour to get them all out!
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#14 of 30 Old 08-24-2010, 10:57 PM
 
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I am pretty sure I had some during my c-section. I should check my records just to be sure.

However, the septasemia, early cardiac failure, and pneumonia 5 days post op, is where I got a whole load of them. In several varieties, and IV form (then pills later). I still don't think my gut is completely healed and any antibiotics give me bad yeast infections now (worse than before). DS has the same reaction too (but I did not nurse him during the heavy antibiotics time frame, so I wonder where that came from).

I hate antibiotics. I know they save lives, but I hate taking them and avoid at all costs.

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#15 of 30 Old 08-25-2010, 08:40 AM
 
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I had them with all 3 c-sections (one emergent, 2 planned). Like someone said, the only way that I knew I was getting them is that they double checked about allergies (I'm allergic to something related to the antibiotic they gave, but that particular antibiotic is fine). And, my babies #1 and #3 both got yeast diaper rashes, which I think was related.
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#16 of 30 Old 08-25-2010, 08:52 AM
 
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I had a planned c-section at a major university hospital and I never once got antibiotics that I was told about (I have allergies to several kinds of antibiotics, so they would have had to run it by me to let me know what one they were going to try)... (The baby ended up with thrush somehow anyhow, but all of my kids got thrush whether they were exposed to antibiotics or not. She also has food allergies. So that theory didn't work for her I guess....)

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#17 of 30 Old 08-25-2010, 10:44 AM
 
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I had abx with my section. Wasn't given an hour ahead of time--couldn't have been, my section was emergent. They already knew I didn't have allergies so I was never asked any more questions.

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#18 of 30 Old 08-25-2010, 10:49 AM
 
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I also just read the NICE guideline for CS (I gave birth in the UK) and this is what it says:

"In the UK 85% of surgeons usually administer prophylactic antibiotics, 12% do so if other factors are present and 3% rarely use them.306 [evidence level 3]"

and

"Women having a CS should be offered prophylactic antibiotics, such as a single dose of first generation cephalosporin or ampicillin, to reduce the risk of postoperative infections (such as endometritis, urinary tract and wound infection), which occurs in about 8% of women who have had a CS."

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#19 of 30 Old 08-25-2010, 10:58 AM
 
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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.
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#20 of 30 Old 08-25-2010, 12:52 PM - Thread Starter
 
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Originally Posted by *farmergirl* View Post
Ah that must be why. I think generally once you say no allergies they feel free to give whatever. My first was an emergency so they hit me with them afterward. My second was planned an they gave me antibiotics before the surgery but they didn't tell me! It wasn't until I said something to a nurse that she said I'd already been given them. I wasn't happy with that at all. I think it had a hand in my ds having a yeast diaper rash. I'm not allergic but I have Crohn's and things like antibiotics and Ibuprofen reek havoc on my system. I did convince them not to give me the Ibuprofen but I couldn't convince them to let me keep my piercing in - I have 23-mainly in my ears- it took me a half hour to get them all out!
I have crohns too and I am prone to fistulas which is why I have to have a c-section. I wish I would have said no to the advil. I think it helped bring me out of a 4 year remission. I did heal beautifully though even though I was abx free. I will decline abx when I have another baby.

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#21 of 30 Old 08-25-2010, 01:09 PM
 
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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.
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#22 of 30 Old 08-25-2010, 11:26 PM
 
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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.
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#23 of 30 Old 08-26-2010, 03:25 PM - Thread Starter
 
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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.

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#24 of 30 Old 08-30-2010, 10:15 AM
 
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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!!

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#25 of 30 Old 08-30-2010, 10:34 AM
 
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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.

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#26 of 30 Old 08-30-2010, 11:49 AM - Thread Starter
 
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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.

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#27 of 30 Old 08-30-2010, 11:57 AM
 
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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.

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#28 of 30 Old 09-01-2010, 10:16 PM
 
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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.

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#29 of 30 Old 09-01-2010, 11:19 PM - Thread Starter
 
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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.

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#30 of 30 Old 09-05-2010, 05:16 PM
 
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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.

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