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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