Antibiotics During Labour

The use of antibiotics during labour is very common.

However, the decision to take these powerful medications shouldn’t be made lightly.

There are different circumstances when antibiotics may be completely necessary for the safety of you or your baby.

In these cases, the benefit of use is likely to outweigh the potential risks.

However, there is a growing body of evidence suggesting these powerful medications are causing problems for the future health of babies worldwide.

It’s important for your care provider to take into consideration all factors when considering prescribing antibiotics for you during labour. You can also take an active role in your care by learning about why they are used, and the benefits and risks in different situations.

Why Might I Be Offered Antibiotics During Labour?

Antibiotics are used to fight infection. They either kill bacteria or prevent it from reproducing and growing. Used properly, antibiotics can save lives and improve the health of both mothers and babies.

Group B Strep (GBS): Most women are tested for GBS around 36 weeks of pregnancy. If you receive a positive test you will be advised to have intravenous antibiotics during labour to reduce the chance your baby is infected with GBS.
Preterm Labour: Preterm labour can be caused by infection, therefore antibiotics may be given to stop your labour or help clear up the infection. Research has shown that while infection in the mother was improved, using antibiotics when the membranes had not ruptured did not improve outcomes for babies. Instead, it increased risks associated with use of antibiotics in children.
Ruptured Membranes: Hospitals usually have a policy to administer antibiotics to women if their membranes rupture, in order to prevent infection of the uterus or amniotic sac (chorioamnionitis), especially if GBS status is unknown. The time frame allowable differs from hospital to hospital, however most hospitals will prefer to give antibiotics around 24 hours after your waters have broken, and if there is no sign of labour.
Maternal Health: If you have a temperature during labour, it’s likely you will be advised to have antibiotics, even if it’s unknown why you have a fever. This is to try and prevent transmission of whatever you might have to your baby.
Just In Case (Prophylactic): In some situations you may be given antibiotics just in case, such as preparing for a c-section. This is in the hope the antibiotics will reduce your risk of infection after the surgery.

Are There Side Effects of Antibiotics?

Antibiotics are such a commonly used intervention, so we often don’t question the use of them. In most cases, we’re told that not taking antibiotics poses a risk to our baby or our health. Around 10% of women given antibiotics experience a mild reaction such as a rash. One in 10,000 women experience anaphylaxis during labour, which is a life threatening allergic reaction to penicillin used for the treatment of GBS.

Giving antibiotics during labour affects the bacterial colonisation of the newborn baby. This bacteria is fundamental to your baby’s maturing immune system. Disrupting this process so early is believed to increase the risk of your baby suffering a number of diseases in the future. Babies are also more likely to be colonised with unfriendly bacteria as a result of being in hospital and in contact with hospital staff. This is one of the many reasons why some women choose to give birth at home.

One of the more serious health issues we’re facing today is bacteria becoming resistant to the antibiotics that were used to treat them. Resistant bacteria are able to survive and multiply even when antibiotics are used. Antibiotic resistance is now considered an important public health issue and health authorities believe it can be prevented by not overprescribing antibiotics.

Staphylococcus aureus, also known as MRSA, staph or golden staph, has become a big issue for health authorities. Women who may need antibiotics are at risk of creating antibiotic-resistant bacteria in themselves and their newborn babies. Antibiotics during labour may delay the colonisation of beneficial bacteria in your baby’s intestinal tract. This allows antibiotic-resistant bacteria to become established instead. Babies in neonatal intensive care units (NICU) are particularly vulnerable to being infected by hospital acquired infections. MRSA is one of the most common types of bacteria in hospital settings.

A five year study looked at causes of newborn blood infections and found the occurrence of infections caused by GBS decreased during this time. However, they found that infection caused by other bacteria, especially E. coli, actually increased. During this time period, antibiotic use during labour increased from less than 10% to almost 17%. The researchers concluded that increased use of antibiotics during labour was the likely cause of increased newborn blood infections with bacteria other than GBS.

Other side effects of antibiotics are thrush and other yeast infections in newborn babies. While this may seem like a mild side effect, if babies have thrush in the mouth they can transfer the infection to their mother’s nipple. The impact of nipple thrush on breastfeeding can be significant. Nipple thrush can cause cracked and bleeding nipples, shooting pain deep in the breast area, and constant pain during nursing. These symptoms can often lead to babies feeding poorly and experiencing low weight gain, or mothers switching to formula and bottles despite wanting to breastfeed.

I Need Antibiotics – What Now?

If there’s a chance you will require antibiotics during labour, there are some ways you can help yourself and your baby:

Consume a pre- and probiotic rich diet during pregnancy and after birth to promote a healthy gut. Prebiotics are found in asparagus, leeks, onions, beans, chickpeas, lentils, psyllium husk, and slippery elm. Foods that contain probiotics include yoghurt, miso, sauerkraut, kefir, tempeh and kimchi.
Vitamin C to help your immune system fight any potential infection. We don’t make Vitamin C in our bodies, it needs to be consumed from our diet. Sources such as kiwi fruit, strawberries, citrus fruits, watermelon and other berries have good quantities of Vitamin C but a supplement may also be necessary.
Garlic is known to have anti bacterial effects, so don’t be shy about adding it to your food. Raw is best or capsules if you can’t tolerate it raw.
Prepare a vaginal swab before antibiotics to seed your baby with good bacteria. Read BellyBelly’s article on seeding here.
Ensure you have skin to skin contact immediately after birth to further enhance the positive benefits of transferring good bacteria.
If possible, request no one touches your baby so your baby doesn’t acquire bacteria. Being at home as soon as possible after birth may limit your baby’s risk of hospital acquired bacteria.
Breastfeeding transfers more beneficial bacteria to your baby. Breastmilk also provides your baby with a prebiotic that will help good bacteria to flourish in your baby’s gut.
After the birth of your baby, limit contact with anyone who is sick and give yourself time to recover and heal. If you’re exposed to everyday germs you may be more susceptible to other infections.

Having antibiotics during labour should not be a decision that is made for you by your care provider. This option needs to be weighed carefully in light of your individual situation. If it’s possible to avoid antibiotics or take a wait and see approach that may be the right choice for you. Women who need antibiotics during labour can take certain steps to minimise the effects on their health and their baby’s wellbeing.