Uterine infection after childbirth, medically termed endometritis, does not interfere with breast-feeding your baby, Dr. Drew Keister reports in the July 2008 "American Family Physician." Between 1 and 3 percent of women develop endometritis after vaginal delivery, with 5 to 20 percent developing endometritis after Cesarean section, according to The Merck Manuals. Your doctor can prescribe medications to treat the infection that won't have a harmful effect on your nursing infant.
Determining the Best Treatment
When determining the best treatment for endometritis while breast-feeding, your doctor has to take into account the type of infection you have, the types of antibiotics affective against the bacteria and any potential effects on your baby. Most cases of endometritis involve between two and three different bacteria, with gram-positive cocci such as Staphylococcus and Streptococcus, particularly streptococcus B, gram-negative bacteria such as E. coli, Klebsiella, Proteus, Enterobacter and Neiserria common causes. Studies show that breast-feeding mothers often don't take medications as prescribed for fear of hurting their babies, so doctors must stress the importance of taking medicines and reassure nursing moms as to their safety, Keister states.
The antibiotics most effective when given intravenously in combination to treat endometritis are gentamicin and clindamycin, according to The Merck Manuals. Both drugs are considered safe for use in breast-feeding mothers by the American Academy of Pediatrics, lactation consultant Kelly Bonyata reports on her website, KellyMom. Gentamicin has a lactation rating of L2 assigned by breast-feeding author and expert Thomas W. Hale, Ph.D., meaning the drug has been studied in a limited number of studies without an increased risk of adverse effects in the baby. Clindamycin is rated as L3, meaning the drug is considered moderately safe for a nursing infant, with no controlled studies available or with only minimal, non-threatening adverse effects seen. Aminoglycosides, penicillin and cephalosporins are also considered safe for use.
Antibiotics to Avoid
Your doctor may not want to prescribe certain antibiotics because of their risk to your baby unless the benefit to you outweighs the risk. Potentially harmful antibiotics for a nursing infant include metronidazole, which has potential cancer-causing effects in the laboratory, and erythromycin, which may increase the risk of pyloric stenosis in your baby, a disorder that affects the muscle between the stomach and small intestine that requires surgical repair. Sulfa drugs during the first month of life may elevate bilirubin levels, causing jaundice. Prolonged use of tetracycline could cause tooth staining in the baby.
Risks of Infection for the Baby
If you have an infection, you may worry about passing it to your baby through the breast milk. This won't happen if you have a uterine infection. However, you should take care to keep any clothing stained with infected drainage from the uterus away from your baby and wash your hands thoroughly before handling the baby, especially after changing sanitary pads or toileting.
- The Merck Manual: Puerperal Endometritis
- Patient.co.uk: Endometritis
- "Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family; Adele Pillitteri; 2009
- KellyMom; Selected List of Medications Approved by the AAP for Use in Breastfeeding Mothers; Kelly Bonyata
- KellyMom: Lactation Risk Categories
- "American Family Physician"; Strategies for Breastfeeding Success; Drew Keister, M.D., et al.; July 2008