Dear Judi,
       My goodness, how scary for you and your daughter that she needs brain
surgery!  One of the things I tell moms who are lactating and undergoing
surgery is that they need to make sure *someone* who knows how is available to pump
the breasts for them.  Often after major surgery, the patient is "out of it"
for several hours (sometimes longer) and the surgery itself may also have
taken quite some time.  Then add in the pre-op time, and you've got the setting
for some major engorgement.  I myself have always thought that this should fall
under "caring for the patient" and the nurses on the floor should do this for
the patient.  I figure if a patient needed insulin, they would be sure she got
it; if she needed an ostomy bag tended to, they would do it if the patient
couldn't.  (Wouldn't they?)  But apparently not everyone agrees with me because
I have had moms ask ahead of surgery if the floor nurses will be sure to pump
her breasts if she is unable, so she doesn't get mastitis on top of everything
else, and the moms are frequently told NO.  So I always suggest that her
husband, mother, someone she trusts, practice pumping her breasts for her.  The
mom must explain how, but then must lay absolutely still and say nothing, as she
would if not conscious after surgery, and let her helper practice ahead of
time.  Pumping an unconscious body is not the same as doing it yourself!  Then
the floor nurses must be made aware of what will be happening, and the helper
has to watch the clock and know when pumping should be done.  Even though your
daughter's supply is not what it usually is, the milk could still add up
significantly if there are many hours from pre-op to her being fully awake, and
able to use both hands.  (Sometimes there are so many IVs, monitors, etc., mom
can't manage to pump by herself even though she is awake.)
       Since she is uncertain about whether or not she wants to continue
breastfeeding after the surgery, she might want to make plans as though she will
continue, and then she can skip them if she decides not to.  She will want to
know ahead of time if the medications she might receive during surgery and
after will require pumping and dumping.  She can contact the anesthesiologist and
ask what meds s/he is likely to use.  They can't tell you *exactly* what they
will use, because any given patient might not respond to their preferred
anesthesia, so they might have to use different ones.  But they can usually give a
list of what they might use.  Then your daughter can find out if it is
necessary to pump and dump for any of them, and how long, and then after surgery she
can find out what was actually used, check her list, and know what she will
need to do as far as keeping or disposing the milk she pumps while away from her
baby.
       Your daughter may be torn between feeling like she needs to take care
of herself, so any help from others in taking care of the children would give
her a break, and feeling like taking care of her children after the surgery
will help her feel more normal.  Being able to nurse her baby might make her
feel like she still has an important job she is able to do when so many other
things have to be done by others.  Taking time to nurse the baby might give her
very pleasant moments in the midst of a possibly difficult recovery.  You might
want to try to help her weigh the pros and cons, or just help her figure out
what the pros and cons are so she can weigh them for herself, if you think she
might feel pressured to choose a particular path if you help too much.
       I hope the surgery goes well for your daughter.
       Dee

Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA

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