New Thinking on C-section Antibiotics

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In order to minimize the risk of infection in mothers, women giving birth to babies by caesarean section should routinely receive antibiotics an hour before the surgery, according to a new recommendation issued Monday by a national doctor group.

Currently, women who undergo caesareans often receive antibiotics as a precaution against infection to the abdomen and uterus—but usually only after the delivery, when the umbilical cord is clamped, because of concern for the baby's safety.

Some pediatricians worry that antibiotics administered to the mother will reach the newborn and suppress the baby's blood bacterial count, potentially masking a serious infection in the baby unrelated to the caesarean section.

The American Congress of Obstetricians and Gynecologists examined several large, recent studies that administered antibiotics to mothers before and after caesarean deliveries. The group concluded there was no evidence of greater risk to the babies when mothers received antibiotics before surgery. Yet there was an increased benefit for the mothers in receiving the antibiotics before surgery.

... Some 8% to 10% of women who have a scheduled caesarean will acquire an infection, as will about 30% of women who have a caesarean delivery after labor has begun, because of greater exposure of the inside of the uterus to bacteria from the vagina ...

In newborns, the prevalence rates for sepsis ... is estimated at less than 1% of live births.

While the maternal antibiotic appears to neither help nor hinder a newborn's chances of getting sepsis, doctors have worried that in babies who have the bacterial infection, antibiotics administered to the mother before the c-section will suppress bacteria in the babies' blood test, resulting in a failure to detect the sepsis infection.

Some doctors, however, question whether the existing research adequately addresses the question of harm to the baby.

Concerns about masking babies' infections are largely theoretical ... While the antibiotic does cross over from the mother to the baby through the placenta, and while it could mask the blood culture, there are usually other clinical signs that a baby is sick ...

But while such a change in practice could make caesarean deliveries safer, it "comes nowhere close to eliminating all the risks of a c-section," ... vaginal delivery is still the safest for mom and baby."

Melissa Maimann, Essential Birth Consulting 0400 418 448