|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.|
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.
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.
Cindy, joyful SAH mama to William & Katherine Forever missing Amelia 7-12-09 Ask me about my natural cesarean!
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.
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.
Fledgling midwife on hiatus, Wife to B, mama to C (c/s 12/04) and S (12/07), m/c (3/12) and expecting another bean 6/13 .
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.
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.
DD 01/2007, DS 09/2011
"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]"
"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."
DD 01/2007, DS 09/2011
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!
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.
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.
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!!
Mama to DD1-4y DS-3y DD2-21m
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.
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.
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.
Lisa, lucky mama of Kelly (3/93) , Emma (5/03) , Evan (7/05) , & Jenna (6/09)
Loving my amazing dh, James & forever missing Aaron Ambrose (11/07)