A mother was recently told to pump and dump for 72 hours following
anesthesia.  This should be old ground in our community - I'm quite sure all
the anesthesiologists have it right  - but apparently there's still some
office staff passing out misinformation.  I'm sending a good ol boys letter
to the anesthesiologists and surgeons, alerting them to make sure the office
staff has its facts straight, and am offering these hints "that might make
sense to a non-physician for whom the idea of nursing following anesthesia
is new."  Any suggestions before I send it out?  And anyone who wants to use
it is welcome to.

Diane Wiessinger, MS, IBCLC  Ithaca, NY

Some of the reasons that breastfeeding following anesthesia is rarely a
concern:

… Milk in a breast isn't held in a sealed-off unit, but stays in constant
synchrony with the mother's blood.  As blood levels rise, milk levels rise.
As blood levels fall, milk levels fall.  Once a mother's blood level of an
anesthetic is low enough for her to be conscious, there's also very little
in her milk.  The notion of "pumping and dumping" to discard "tainted" milk
makes no physiological sense.

… Even if a mother's blood level for a given drug is high, it's still
present in very dilute form from the perspective of the breastfeeding baby.
Imagine trying to anesthetize someone by injecting not the anesthetic itself
but the blood of someone who has been anesthetized!

… Any drug in the mother's milk is *ingested* by the baby, not injected, and
must pass through his digestive system before entering his own plasma.
Drugs that can be measured in the mother's plasma and milk are often
undetectable in the baby's plasma.  And drugs that are given by injection
because they're ineffective orally are usually just as ineffective when the
baby swallows them in the milk.

… Age matters. Some drugs that might be a concern for premature infants are
not a concern for full-term babies.  Some that are a concern for newborns
are not a concern after the first month.  The older the baby, the more
mature his systems.  And any baby who is also eating solids automatically
gets less through his mother's milk.

… Whether or not a mother continues to nurse, her baby must continue to need
to eat, and the known risks of formula-feeding almost always outweigh the
theoretical risks of continuing to breastfeed.  Even short-term exposure to
formula increases a baby's risk of allergies, infections, and, in
susceptible children, diabetes.

… Disruption of breastfeeding can slow a mother's recovery and add
considerable stress to her life.  The 1997 AAP statement on breastmilk and
the use of human milk* states, "Should hospitalization of the breastfeeding
mother or infant be necessary, every effort should be made to maintain
breastfeeding, preferably directly, or by pumping the breasts and feeding
expressed breast milk, if necessary."

*American Academy of Pediatrics.  Breastfeeding and the use of human milk
(RE9729).  Pediatrics, 1997; 100(6): 1035-1039.

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