anesthesiaWonderful as usual, Diane. May I steal your finished letter?
Lisa
  -----Original Message-----
  From: Diane Wiessinger <[log in to unmask]>
  To: lactnet <[log in to unmask]>
  Cc: stew <[log in to unmask]>; nat <[log in to unmask]>; ruth <[log in to unmask]>; pohl <[log in to unmask]>; pat <[log in to unmask]>; arnetta <[log in to unmask]>; lisa <[log in to unmask]>
  Date: Friday, December 01, 2000 12:32 PM
  Subject: anesthesia


  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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