Dear All,
At Cottage Hospital we are trying to coordinate care so that all
breastfeeding mothers or babies (children) admitted to the hospital for
inpatient or outpatient procedures will get routed to the Birthing Center
as early as possible for information and support in maintaining
breastfeeding (or preserving their milk supply, if weaning is in fact
indicated for a while).
Anyway, what are some suggestions for things that might reasonably and
usefully be included in a patient handout meant to cover situations where
the breastfeeding mother or baby might be hospitalized, operated on,
sedated, and/or otherwise medicated? (I think I'll need to route this past
all the family physicians and pediatricians once I've drafted it. Maybe
full Medical Staff, with the FP and Peds blessing. I'm still trying to get
a handle on the finer points of hospital hierarchy.)
I'll probably make separate ones for mother situations and baby
situations. I feel as if the baby one is simpler, because the principal
challenges to breastfeeding that I can think of are separation (which is
not an issue at Cottage), NPO orders before anesthesia (for which I have
the Am. Soc. Anes. model hospital policy saying 2 hours), and orofacial
surgery (for which I have Lawrence saying breastfeeding is fine after cleft
surgery). But this reminds me of a weird thing. If you look up the
American Society of Anesthesiologist (or whatever they're called) they have
two relevant places on their website.
One is a model JCAHO policy for hospitals to use, and it says "Small
amounts of clear liquids or human milk are acceptable up to 2 hours before
sedation and
analgesia." http://www.asahq.org/clinical/toolkit/sedmodelfinal.htm
The other one is
Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic
Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy
Patients Undergoing Elective
Procedures. http://www.asahq.org/publicationsAndServices/npoguide.html
This one says:
"There is insufficient published evidence to evaluate the relationship of
the timing of breast milk intake before procedures to the incidence of
emesis/reflux or pulmonary aspiration. The Consultants and Task Force
support a fasting period for breast milk of 4 hours for both neonates and
infants.
Recommendations:
It is appropriate to fast from intake of breast milk for 4 or more hours
before procedures requiring general anesthesia, regional anesthesia, or
sedation/analgesia (i.e., monitored anesthesia care)
[<http://www.asahq.org/publicationsAndServices/#gen0>Table 1]
IV. Preoperative fasting status (infant formulae)
There is insufficient published evidence to address the safety of any
preoperative fasting period for infant formulae. For infants and children,
the Consultants and Task Force support a fasting period of 6 hours. For
neonates, the Consultants support a fasting period of 4 hours, and the Task
Force supports a fasting period of 6 hours.
Recommendations:
It is appropriate to fast from intake of infant formula for 6 or more hours
before elective procedures requiring general anesthesia, regional
anesthesia, or sedation/analgesia (e.g., monitored anesthesia care)
[<http://www.asahq.org/publicationsAndServices/#gen2>Table 1]."
Now that is really, really different from the model policy.
I kind of don't want to write to them and point it out for fear of losing
the model policy version!
Also, I know which one I'd rather quote to hospital staff...but I don't
want to hide things, either.
Any anesthetists or anesthesiologists out there who want to comment on this
discrepancy?
--Elise
(the New Hampshire one--for now)
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