Thrush during pregnancy and breastfeeding

What is thrush?

Thrush is an infection caused by a yeast called candida. It often affects the vagina and vulva. If you’re breastfeeding, it can affect your breasts or nipples and your baby’s mouth or bottom.

What are the symptoms of thrush?

If you have vaginal thrush, you may have itching or pain in your vagina or vulva. The area may look red and swollen. It might hurt when you pass urine or have sex. You might notice white discharge that looks a little like cottage cheese.

With nipple thrush, your nipple may be painful, itchy and sensitive even to the lightest touch. Pain doesn't only happen with breastfeeds. It doesn't go away if you reattach your baby to your breast. Your nipple might look pink and shiny, with a dry, red areola.

With breast thrush, you may have shooting pain deep in your breast after feeding. You might feel pain in your back or arm. Your breast will probably look normal.

If you have breast or nipple thrush, your baby will probably have thrush too. They may have a white coating on their tongue or inside their cheeks and a red nappy rash surrounded by small dots.

What causes thrush?

It’s normal to have candida in your vagina. If you have too much, it can cause symptoms of thrush. There are a few things that cause candida to multiply.

A type of bacterium called lactobacillus also lives in your vagina. It stops candida from multiplying. If you don’t have enough lactobacillus, it can’t control yeast growth and you can get thrush. This might happen after you take antibiotics, which destroy bacteria.

High levels of oestrogen can also help candida to multiply. Oestrogen naturally raises the sugar level in your vagina, which helps yeast grow.

Candida can also live on your skin. It grows in warm, damp conditions, such as your nipple area if you’re breastfeeding. If there are cracks in your nipple, the yeast can get inside and cause thrush. You’re also more likely to get nipple thrush if you have recently taken antibiotics, or if you’ve had vaginal thrush. However, often there isn’t an obvious cause.

Am I more likely to get thrush during pregnancy?

Yes. If you’re pregnant, you are twice as likely to get vaginal thrush, because you have higher oestrogen levels.

What treatment will I need for thrush when I’m pregnant?

You can use antifungal vaginal creams or pessaries (tablets that you insert in your vagina) containing the medicines clotrimazole or nystatin. These are safe in pregnancy.

A 6-day course of treatment is better than shorter courses. If you’re using pessaries, it’s best not to use the applicator.

Even though these medicines are available without a prescription, it’s best to see your doctor first, to make sure there’s nothing else causing your symptoms.

Don’t use the single dose oral tablet for thrush during pregnancy unless your doctor tells you to.

Will having vaginal thrush affect my baby?

Vaginal thrush during pregnancy will not harm your baby. If you have thrush during labour and birth, there’s a chance your baby could catch it from you during birth. In the unlikely event that this does occur, it is easy to treat.

What treatment will I need for thrush while I’m breastfeeding?

Vaginal thrush

If you have vaginal thrush when you’re breastfeeding, you can use antifungal vaginal creams or pessaries containing clotrimazole, miconazole or nystatin. You can also use the single dose oral tablet containing fluconazole — a small amount will get into your breastmilk, but it won’t harm your baby.

It’s best to see your doctor before starting treatment.

Nipple thrush

If you have nipple thrush, you and your baby will need to have treatment at the same time, so you don’t keep transferring the infection to each other.

Your baby will usually be prescribed miconazole oral gel. After feeds, wash your hands and rub a small amount of gel onto your baby’s tongue and on the inside of their cheeks. Ask your doctor or pharmacist how to use the gel safely. Alternatively, you can give your baby nystatin drops, but this is less effective. Your baby might also need an antifungal cream if they have a nappy rash.

You can treat your nipples with miconazole oral gel or nystatin cream. Apply a thin layer to both nipples after feeds. You don’t need to wipe it off before the next feed. Your doctor may also prescribe oral antifungal tablets for you.

Ask your doctor how long to use each treatment.

It’s important to:

• sterilise bottle teats and dummies every day
• change your breast pads often
• wash your bras and towels in hot water and hang them out to dry

If your pain doesn’t improve, see your doctor. You might need a different medicine, or it might not be thrush.

Can I keep breastfeeding my baby?

Yes. With both vaginal and nipple thrush, it’s safe to breastfeed. You don’t need to throw out expressed breastmilk.

What can I do to prevent thrush?

• Wear cotton underwear and loose clothing.
• Wipe from front to back and wash your hands when you go to the toilet.
• Don’t use soap or scented products in your vulval area.
• Wash your hands after changing nappies.

Taking probiotics or changing your diet won’t prevent thrush.