Dear Amy,

Thanks for the helpful note.  I agree whole-heartedly that almost every
anesthetic drug is safe during lactation, and also that regional anesthesia
is preferable.

An important prerequisite is that the hospital have policies that are
breastfeeding friendly, not just on the obstetric units but also on surgical
units (and in any other area where lactation might occur).

Lactating mothers admitted for routine surgery should be appropriately
counselled and reassured about the safety of perioperative breastfeeding.
If staff are unable to care for the infant (usually because of cost) a crib
and an extra bed should be provided in the room for a designated adult to
provide the infant with care and supervision.  A breast pump should be made
available prior to surgery so that unforseen circumstances (eg prolonged
surgery or recovery) can be dealt with.  Patient-controlled analgesia will
give the mother better control of her pain, so she can diminish any
discomfort that might occur during the process of putting the infant to the
breast.

These are not unattainable ideals:  they existed in the last institution I
had the pleasure of working in.  My wife and I also enjoyed the benefit of
an enlightened policy when she required major surgery.

Khalid

Khalid Aziz
Memorial University of Newfoundland