Hi Jamie,

My experience with gastric by-pass is that the surgery does affect  
the quality and quantity of the milk...

I have had clients who were unable to produce enough milk after  
conceiving more than a year after the surgery
and once their weight had stabilized...

One client made enough milk by volume but the baby failed to gain  
weight...

One client had nursed two previous children for over 2 years each,  
and it was especially devastating for her that she was unable to  
breastfeed
as she had before...

Another client said she was sad that she was unable to breastfeed,
but if she had it to do over she would still have the surgery
because she felt without the surgery her marriage would have been in  
jeopardy...
this was her first baby so she did not really know enough what she  
was missing,
although I'm sure she grieved somewhat...

Of course only the mothers with problems lactating after gastric by- 
pass would be contacting me,
and you have met mothers who apparently had no problems with their  
milk supplies,
so it could be a question of which type of procedure is done whether  
or not lactation is affected in the long term...

But the idea that your client is considering any elective procedure  
while breastfeeding seems naive....

When I first started encountering mothers with breastfeeding problems  
after gastric by-passes,
there was nothing in the literature about it,
so I went to the people I knew who worked with gastric by-pass  
patients, endoscopy nurses,
and I asked them if they thought gastric by-pass could affect  
breastfeeding....

(I didn't go to the surgeons because my experience with plastic  
surgeons who do peri-areolar incisions is that they deny this poses  
any problems for breastfeeding,
and they insist their clients can and do breastfeed after surgery  
with no problems....it is hard for surgeons to be candid about  
complications because they are concerned about being sued...nurses  
don't have this self-interest so they can be honest about what they  
see...)

The endoscopy nurses said "Duh! Gastric by-pass patients are  
malnoursished for the rest of their lives!"

That may seem over the top, but that is how it was put to me by the  
women who see these patients year after year...

I think this was at a time when there was just one procedure, and  
perhaps the newer procedures hold out better hope for lactation.,
but surgeons use the tools they have in their tool box and not every  
surgeon will learn newer procedures...

Some surgeons make the pouch so small that there aren't enough  
gastric juices for the patient to be able to get B-12
from their food and they have to get B-12 injections...and what else  
are they not able to absorb?

Your client may want to research the various procedures and which  
surgeons
in her area perform which procedures, and choose one that will give  
her the largest pouch...

I would encourage a mother to consider at least putting the surgery  
off until she had finished a normal course of nursing so she can  
reflect on whether she wants to put future breastfeeding  
relationships at risk, and if she would prefer to put the surgery off  
until she has finished having her family.

My personal opinion is that she can't really know what she would be  
risking until she has experienced a normal course of nursing...
so if this is her first breastfeeding relationship she really can't  
make a fully informed decision at this time...

Jen O'Quinn IBCLC

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