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From:
Sarah Reece-Stremtan <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 30 May 2012 14:11:03 -0400
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Sorry to be a little late to respond here, but it does sound like you have a really nice opportunity to educate a group of physicians who probably don't know that they can make a considerable impact on how well breastfeeding starts.  Appeal to the idea that anesthesiologists are self-styled physiologists, striving for norms in thermoregulation and sympathetic nervous system responses, and that promoting immediate mother-baby bonding through physical contact is physiologically normal.

You have a great outline planned -- practical suggestions on EKG lead placement, drapes, (use pulse oximeter probes that fit on the ear instead of the finger!), etc to make skin-to-skin contact natural and easy right after cesarean section will be most useful.  

Almost certainly, trying to advise OB anesthesiologists on types/how's of epidural placement and management will likely not go over too well from a group of docs who spend their lives doing just that, but you can mention judicious fluid management and how that may affect edema afterwards.  Narcotics (fentanyl) typically are included in labor epidural infusions, and anesthesiologists seem to have varying ideas about much of that actually reaches the infant.  We never need to give naloxone to an infant following epidural analgesia for moms, and most babies still are born squealing, pink, and healthy -- not depressed or apneic related to narcotics.  So most anesthesiologists don't see that what is given to mom may play a role in an infant's early behavior when the babies appear fine at birth.  It still might be worth planting that idea, however, just to get them thinking.

Good luck and enjoy,
Sarah Reece-Stremtan M.D. (pediatric anesthesiologist, quite happy not to be doing any OB...)

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