Alicia:  I have to say that in the rainy Pacific NW, yeast is exceptionally
prevalent among our c/sec moms (all of whom have had antibiotics and usually
a long history of poor diet, OCs and more antibiotics).  My practice is at
around 40% yeast cases because I get the "tough" cases that have been
referred to me for this purpose (including long distance).  It becomes a
catch 22 for me.  I'm a sucker for the phrase "you are my last resort before
I wean."  I tend to give and give and then give some more to help these moms
achieve their bf goals (I know it's probably an ego thing).

Another issue is the moms who are repeatedly treated for bacterial mastitis
when in fact they have yeast.  With many of our docs, any breast
pain=bacterial mastitis, yet patients only get worse with diclox tx.  These
were moms with no fever, no red hot spots, no constitutional symptoms, and
no other bacterial signs.   The antibiotics then wipe out the beneficial
intestinal bacteria and shazam, you've got an even bigger yeast problem.   I
also see many moms who have actually had bacterial mastitis secondary to
yeast because the yeast actually backs up the ducts with long strands of
colonies.  After the milk stasis is around for awhile, plus some unhealing
cracks inhabited by yeasts, the bacterial mastitis becomes horrible.  Then
they are sick as dogs with flu symptoms, fever, etc.  Then we have to treat
both.

I have authored several papers on breast yeast treatment--especially focused
on nonpharmacologic treatment for the moms who don't have access to MDs who
are educated on the perils of breast yeast or for those who wish to avoid
prescribed meds.   It is not the cases where an MD will prescribe the 21 day
regimine  of Diflucan that I have to pull out all stops, but those who have
been  habitually undertreated by 1-10 day treatments.  Usually the moms have
recurrent yeast with each round resulting in stronger, more resistant yeast
strains.  Almost invariably these moms have not had anyone tell them about
rebuilding their beneficial bacteria in their intestines after or
concurrently with treatment.  I could go on and on, but you get the idea.
  
If you need more elaboration, please say the word.
Warmly,
Chris
--Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC    [log in to unmask]
€€€INFANT CUISINE AND MOTHER CARE: LACTATION CONSULTING & PERINATAL CARE€€€

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