<I have a mother who is 2 days post delivery.  This is her second baby.  She
BF her first baby for 3 months and stopped due to yeast.  She is positive
for Beta Strep.  She is terrified that the same thing is going to happen
again.  >

Sharon, it is hard to say in the first few days if the pain is due to thrush
(in addition to the pain we would expect from poor positioning), but with a
history of previous candida infection and recent antibiotics, I would be
recommending:
- one dose of antifungal orally for the baby (you could use nystatin oral
drops)
- oral nystatin caps for the mother. I know this is not widely used in the
US, but I have seen hundreds of women who felt this helped (presumably by
decreasing the amount of candida in the bowel). Most doctors don't mind
prescribing it - they often don't believe it will work, but they know it is
safe (incl pregnancy and lactation). I use 2 caps three times a day, after
food.
If she describes the nipple pain as burning / sunburnt / sandpaper / etc, I
would be suggesting a topical antifungal as well.
I'd tell her that nipple thrush doesn't always recur, and if she can work on
the positioning and do the preventive things you've suggested, feeding may
go well this time. (ie offer hope, but don't promise it).
Lisa Amir
MBBS, MMed, IBCLC in Melbourne, Australia

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