Hi Jeanine,
We've had a couple incidents where mothers were given pretty poor
information on drugs and breastfeeding, or misinterpreted the information
they were given. So, we are currently working to change that. There've
been a lot of steps in this path, some of them exploratory or dead ends,
but some recent ones are:
--Providing the radiologist with up to date info about radiology procedures
and their effects on breastfeeding; she is currently updating the
department's policies and procedures, so the newest facts will be incorporated.
--I got the pharmacist to make me up a list of the most commonly used
anesthetic/analgesic/sedative drugs and then I looked them all up in Hale
and Briggs et al. Not all were there, but now I have a quick-reference
list that will make it much easier to figure out whether a mother having
minor surgery needs to avoid breastfeeding after she wakes up.
--Something I hope to do soon is make up a handout (or several, for
different circumstances) for the mothers to take home with them. A nurse
anesthetist pointed out to me that a mother who's had all this explained to
her and then is given those mind-boggling drugs often can't remember
afterwards what she was told, and it's important to give them something in
writing and check in with them later to see if all is well. One possible
handout would be a list of drugs the mother has been given and the Hale
info for each of them, though I'm trying to figure out a way to make that
practical. At the very least she should leave the hospital with a sheet of
paper that says whether breastfeeding has to be restricted at all, and if
so, why, for how long, and with info on pumping etc. This part is just in
the beginning planning stages.
--Talking to the head of nursing and the head nurses of the ER and the OR
to expand their existing pregnancy triage. They already send patients who
are more than 20 weeks pregnant to the Birthing Center for evaluation. Now
I've written up a policy revision that specifies they need to do the same,
or at least notify the Birthing Center, if a postpartum mother (less than 8
weeks), or a breastfeeding mother (any age baby/child) or a breastfeeding
baby or child is to be treated. Hopefully they will let us know in a
timely fashion, so that in case of planned prolonged interruption of
breastfeeding we can get the mom pumping enough milk ahead of time to avoid
having to give the baby formula.
--The storyboard for this month is "Protecting and Supporting Breastfeeding
throughout the Hospital" and has quotes from the Dept of HHS Blueprint for
Action on Breastfeeding, the CDC's NIS statistics, the AAP's policy
statement, and various other calls to arms for health care
providers. Visually it's a bit crowded as I was trying to squeeze in an
awful lot of material :-) but it's divided into three main sections:
"Breastfeeding is Best Practice" (with a bunch of supporting material about
how breastfeeding supports the mother's and baby's health, plus specific
sections on the importance of exclusivity and duration, to try and get
people away from the idea that a couple days of formula makes no
difference); "Breastfeeding is Challenged...In the United States / In
Hospitals" (CDC stats, Healthy People goals, typical hospital scenarios
that pose a barrier to continued exclusive breastfeeding, etc.); and "How
can the Hospital Support Breastfeeding?" (Involve the Birthing Center and
the Lactation Consultant, Understand Reasons for Pumping, Know Your
Resources and Where to Find them...)
The week after I started to really go on the warpath about this, the
Birthing Center was notified of two mothers of 9 month old babies: one
coming in for scheduled minor surgery w/general anesthesia, and the other
admitted for ulcerative colitis. (Previous post.) So, this is having some
effect. The Birthing Center nurses are fine with the plan to help these
moms with pumping etc., though what they're going to do if they have two
mothers in labor and one of these situations comes up, I don't quite know yet.
It's just a small hospital, but I think it's going to pull together a
pretty good program to make this work, in the end. I hope. I have to
leave, permanently, in a month, so I'm crossing my fingers that there's
enough momentum and good will to keep this going.
So, if this mother wants to use any of this information to nudge her
hospital, she's welcome to contact me.
Elise M-G
LLLL, IBCLC
New Hampshire
At 05:42 PM 6/1/2005, you wrote:
>I called patient's nurse on 8th day to stress getting the patient a hospital
>grade pump and what the complications would be if she didn't. It came within
>two hours. Previously patient was using a hand pump. Lactation consultant
>came once. No other support has been given. This is the 5th day of
>hospitalization. Patient briefly saw baby two days ago. Now she is
>experiencing a great
>deal of depression and crying all day. Finally seen by a new pulmonologist
>who is very grudgingly sending mom home tomorrow with directions to come in
>every day for lab tests. He told her he dosen't want to see her develop
>postpartum depression.
>
>My question concerns hospitals making accommodations for such mothers and
>babies. Are there any institutions that do treat such mothers with
>knowledge of
>the total patient and make accommodations accordingly. She would like the
>information to hopefully educate the staff and help such patients in the
>future.
>
>Thanks
>
>Jeanine Barsamian in NJ
>RN, IBCLC, LLLL
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