How to Spot Thrush When Nursing

 Thrush is a nasty affliction that causes more problems with breastfeeding than probably anything but a poor latch.  It is characterized by burning and itching on or around the nipples, and sometimes even inside the breast (called Ductal Thrush), and the nipple usually is very pink.  The nursing woman may notice a deep shooting pain in the breast and often has pain that continues long into or throughout the entire nursing session.  A nursing mom may also notice signs of yeast infection in other parts of her or baby's body (vaginal, diaper area, neck folds, etc.)  Often thrush will transfer to or from baby’s mouth, and you may be able to see signs of it there, too (but not always, no matter what your pediatrician may tell you).  Look for white patches on the gums, inner cheeks and/or tongue. 

Usually, you will want to make sure your nursing bra is mostly cotton, to insure breathability, or make from a wicking material (as the Bella Materna bras are). A small amount of spandex for fit and comfort in a cotton nursing bra is fine but if you have problems with recurrent thrush, you will want to avoid "cotton" nursing bras with less than 90% cotton.

If your nursing bra becomes damp, change into a new one. Wet nursing bras and nursing pads create a great environment for yeast to grow. Our Lily Padz nursing pads prevent leakage, and easily sterilizable, so may be helpful with thrush. However, if the condition worsens, you'll want to switch to cotton or disposable temporarily. If you do, change your nursing pad regularly to eliminate excess moisture that may cause yeast to grow.

Nursing: How to Treat Thrush

There are various treatments for thrush.  Some are effective and some aren’t.  Some are messy and can be irritating, some aren’t.  I’ve been through literally all of them, and have been witness to hundreds of women’s testimonials on bulletin boards as to what has and hasn’t worked for them.  I discuss them below.

• Nystatin – Often a doctor will prescribe liquid Nystatin for you to rub in baby’s mouth, and maybe even mention rubbing it on your nipples, after each feeding for a few days to 2 weeks.  I have never once seen this alone have any effect on thrush, and the treatments have always had to be accelerated.
• Diflucan - Diflucan may be enough to reverse a case of thrush, if given to both mother and baby (if both are afflicted), and if given to mother for no less than 14 days.  The problem with this treatment is that doctors are often reluctant to write such a prescription and insurance companies are even more reluctant to pay for it.  If you need information to take with you to the doctor's office to back you up, print Dr. Jack Newman's article on thrush treatments.  (Dr Jack Newman is the leading medical professional in all things breastfeeding related.) 
• Gentian Violet – The next stage of attack is usually gentian violet.  This is a brilliantly purple antiseptic/astringent used for cleaning open wounds for many years before the modern-day Neosporins and the like.  It can be very irritating to the soft tissues and mucous membranes of baby’s mouth and your nipples and it is generally recommended not to use it for more than 3 days on either of you.  Rarely is thrush wiped out in 3 days, so even gentian violet is not a very effective treatment.  Beyond this, it hopelessly stains everything it touches purple. 
• Over the Counter Anti-yeast Creams – Now we are getting somewhere.  Used on your nipples, in conjunction with Nystatin in baby’s mouth, Lotrimin AF (our personal recommendation for the most effective and economical antifungal) is very effective.  Applied thinly after each feeding, meaning you will see a slight shininess on the nipples, but no actual cream, you will have absorbed enough to be harmless by the time baby feeds again.  Use until symptoms disappear.
• Sunlight and Air-Drying - Thrush is a yeast overgrowth.  Yeast thrive in warm, dark, moist places.  This is why you often find overgrowths in the vulvar area, breastfeeding nipples, and babies’ mouths.  Natural enemies of thrush are sunlight and dry places.  Do your best to air dry your nipples after every feeding, whether or not you are currently experiencing a period of thrush, and try to expose thrush nipples to some sunlight for a few minutes a day.
• Garlic and Echinacea - Both of these treatments boost your immune system, allowing your body to try to rebalance itself.  Either can be very beneficial whenever you are battling any body imbalance.
• Grapefruit Seed Extract - Grapefruit Seed Extract is a broad-spectrum antimicrobial compound extracted from the seeds and pulp of grapefruit. It is an extremely potent and effective bactericide, fungicide, antiviral and antiparasitic compound. If used diligently, it typically will clear up thrush within a couple of days. Read Dr. Jay Gordon's article here for dosing information.  (Dr Jay Gordon is a renowned attachment parent advocating pediatrician.)

What Causes Thrush When Nursing and How to Prevent It

The underlying cause of thrush, however, is what you really need to treat.  If you do not, you will likely find yourself like over half of women who have had one case of thrush, and be battling it off and on the entire time you breastfeed.

Why are you experiencing a yeast overgrowth? 

There are two causes of yeast overgrowth. 

1. Yeast "eat" sugar.  If you are eating a lot of sugar you could be encouraging them to grow and cause an imbalance in your body.  Your body ph is altered a bit when you are pregnant and nursing, so it's a lot easier for them to grow wild with just a little too much “yeast food.”
2. The thing that keeps yeast in check, keeping a good balance of things in your body, is the beneficial bacteria living within it.  This is the “microflora” in your intestines you may have heard about in the news.  These beneficial bacteria can be found anywhere in and on your body, however, and they are what keep you healthy.  They help you digest your food, help your immune system operate correctly (not be “hyperactive”, causing allergies to harmless things in your environment), and keep yeast in check, keeping your body in balance.  These are some of the living cells you pass on to your baby through breast milk, that help develop his or her immune system.

When you take antibiotics, use antibacterial soaps and cleansers, drink chlorinated tap water, etc, you are killing the good bacteria along with the bad. This is why babies often get diarrhea when they are on antibiotics, especially formula fed babies that have a deficit in this area to begin with. The good bacteria that help digest their food and help their immune systems work properly are being depleted.

The good news is you can replenish them. Lots of people tell you to eat yogurt, since the "cultures" in yogurt are the good bacteria. However, they are only 1 type (acidophilus), when your body has tens of types, and most of them are dead by the time they reach your table. Instead you should visit your local health food store and find a good multi-strain probiotic (good bacteria in powder or capsule form). You and baby should both take them every time you take antibiotics at the very least, and *should* take them all the time. You should incorporate a probiotic into your thrush treatment repertoire, in order to help re-balance your yeast/bacteria ratio.

Check out our highly recommended site, http://www.kellymom.com, for more exhaustive info on thrush.
For more info on probiotics, check out our article Probiotics - What They Are and How to Choose Them.