From:   shirley phillips[SMTP:[log in to unmask]]
Sent:   Monday, March 24, 1997 7:08 PM
Subject:        abnormal PAP and breastfeeding

A mother of a three month old, fully breastfed infant called today about
the
chances of resuming breastfeeding after a complete break of two weeks.
Apparently a PAP smear done very early in or just before this last
pregnancy
revealed some abnormal cervical cells.  The mother was referred to a
specialist after her baby was born and the specialist is recommending laser
sugery.  The physician has told the mother that she must stop nursing for
one week prior to and one week following surgery as the hormones of
lactation cause the cervix to be too vascular - that mother risks serious
bleeding if she is still nursing when the surgery is done.
What is the fancy laser for anyway? The big advantage of the laser is that
it controls bleeding so well.
  Her surgery is scheduled for the end of April.  She has been pumping and
freezing so that
she will have as much breastmilk as possible for the two weeks without
breastfeeding.  She had her husband try giving the baby a bottle of her
milk
yesterday and both mom and baby were miserable.  Does anyone have any
experience with this type of situation? Yes, Some with the problem and some
with BF mothers but none with this combination.
 Do hormone levels drop that quickly to make such a difference in
vascularity of the cervix? No.
 Isn't laser regularly used to cauterize blood vessels in other surgery?
Yes
 In order to avoid severe engorgement, and possible mastitis or abscess,
mom would have
to start gradually cutting back now - something she really doesn't want to
do - or she would have to pump to relieve fullness during the week before
surgery and that would defeat the purpose of temporary weaning.  I have to
be away from Lactnet for a couple of weeks so would appreciate any
responses
emailed to me directly.  Many thanks in advance for your help!


Shirley Phillips, RN, IBCLC
[log in to unmask]

I would ask the doctor these questions:

How many lactating women with this problem have you personally treated with
this problem?

What published reference can you provide to me that weaning is necessary
for this situation?

How often do you or other doctors treat this problem as an office surgical
procedure, done with local anesthetic in the office?

Just how abnormal was her pap smear?  What was the pathological diagnosis?
 Just what is the term of the procedure that they are planning to do?  Is
this planned surgery going to be done in the office or in the hospital?
  It sounds to me like this woman hasn't even had a colposcopy done yet to
exactly define the level of the abnormality of the pap smear.  Certainly
this is something you do not want to ignore, but it doesn't sound to me
like she needs laser surgery now.  She should have a colposcopic exam and
some tiny biopsies (the size of a grain of rice) first.  I have treated
scores of women for their abnormal pap smears and OFTEN this can be treated
in the OFFICE using techniques that are termed LEEP  (Loop Electrocautery
Excision Procedure)  or LEETZ (Loop Electrocautery Excision of the
Transformation Zone)  sometimes called a CONE BIOPSY.  The other OPTION is
that if the cells are not that severely abnormal is that she could have
CRYOTHERAPY done to the cervix which rarely results in any bleeding.

Yes sometimes the cervix will bleed ALOT, (we say "like a stuck <butchered>
hog") but this is what the laser or electrocautery is for.  Depending on
the severity of her pathology report and how extensive of an excision that
they are planning to do, it may well be possible for this to be done in an
office setting with local anesthesia.  Some doctors don't want to do it in
the office though because: 1)  If bleeding occurs they may have better
(more expensive) equipment in the hospital than at the office.  2) Lasers
are fancy and powerful pieces of equipment but they are expensive too, t
here fore they might more likely be in the hospital than in the doctor's
office.
3) The doctors most certainly charge more to do the procedure in the
hospital than in the office.  Doing anything in the hospital makes it sound
much more "serious" so that the patients really believe that this is a
serious complicated medical problem the the omnipotent doctor must treat in
the hospital.  This same line of thinking is now applied to
"medicallization of pregnancy and childbirth", but that is another topic.

If this woman's procedure is being scheduled for late April, she certainly
has enough time to get answers to the above questions and also consider
getting a second opinion about the unnecessary recommendations to wean.
 Like Dr. Jack Newman says, "Breastfeeding is often sacrificed on the alter
of ignorance." Perhaps the doctor want the mother to wean because he feels
so uncomfortable with his lack of breastfeeding expertise that he wants to
avoid dealing with any engorgement problems/medication issues during the
time of the procedure.
 I could never recommend this but certainly the mother realizes that she
has the right to not follow the doctor's advice and then tell a white lie
about it.  For example:
Dr., "Have you weaned"?  Mother: "Yes."--While thinking, I did wean for one
feeding just don't ask me if I have weaned completely."

If you would like to email me back with further questions I would be glad
to try and answer them.

Jon Ahrendsen MD FAAFP
LLLI Medical Associate
Clarion, Iowa, USA