Re: << I am a CLE, CLC, working towards my IBCLC. I would like to learn from your knowledge base regarding a client. She is scheduled for a
hysterectomy this week and is breast-feeding exclusively a one month old
baby. She had a suspicious pap smear 2 years ago after her last
delivery. >>

There's got to be more to this -- more recent testing/diagnostic info. I'm wondering why the docs or this mother suddenly seem to feel a need to do a hysterectomy based on 2 year old info? A "suspicious" pap could mean several different things from mild to critical. Surely, someone has followed up since 2 years ago to determine that it is crucial to now do major surgery on someone having a baby that is only one month old? If not crucial, why do it now vs. when baby is a bit older? (And if crucial, too bad someone didn't suggest timing it with a c-section for birth.)


<< The anesthesiologist plans on using Tramadol and is not
willing to use any other medication and has suggested she stop
breast-feeding. Her gynecologist is also not supportive. >>

I've never heard of the anesthesiologist writing the orders for post-op meds. Here the surgeon would write them. In any case, Hale cites info that demonstrated "cumulative secretion in breastmilk within 16 hours" as 0.1% of maternal dose of a single IV 100mg (p.806-807, 2004 ed.). Most post-op patients need more analgesia during the 1st 24-36 hours after surgery than they do after that. Would think she'd likely be on lower dose by the time she heads home.

In the years I've worked with mothers on this kind of situation, I've found most docs find a way to work with the mother if she's assertive and lets the doc know that weaning from the breast is not an option! And at this point she couldn't turn lactation off fast enough anyway for surgery this week, so failing to provide her with a means to remove milk pre- and post-op could complicate her recovery.


<< I am also concerned regarding her milk supply after surgery. I realize
the pituitary gland is more responsible for making milk then the ovaries
and uterus but I need your comments and suggestions of how to best help
her. >>


Unless more is going on than included, she'll probably keep her ovaries. Still, frequent milk removal via breastfeeding or milk expression (via pump or other) is the most important thing for maintaining production. In most of the moms I've worked with having such surgeries, they've noticed a decrease in production for several days post-op -- even with fairly good pumping routines. (Perhaps the insult to the body, "redirection" of fluids, etc. for healing and other factors play a role.) In all I can think of milk production bounced back again with frequent breastfeeding by the end of a week or less.

Hope all is well for her...

Karen

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