Dear Teresa,

You wrote about working with a mother in her second trimester who has 
ankylosing spondolytis and fears medication and possible C section will interfere 
with breastfeeding her baby.  First of all how fortunate for her that she has you 
working with her to help her overcome any obstacles to initiation and 
continuance of breastfeeding.  Providing her with plans for each possible scenario 
will be most helpful.

Informing her of the benefits of skin-to-skin contact after birth, involving 
her partner or helper in the process so that he/she can learn how to place 
baby on her chest and even position and hold baby there to initiate 
breastfeeding, and knowing that baby may indeed be sleepy and less responsive due to 
medication so will need continuing skin-to-skin and that touch and keeping baby with 
her or in partner's arms (or skin-to-skin) will be helpful.  She has the 
benefit of time and pre planning, so ecourage her to discuss with her OB what meds 
she might receive, avoiding ones, like meperidine, with known adverse affects 
on infant.  (She might explore alternative methods of pain control, such as 
acupuncture, or hypnosis; it isn't written in stone that medication is her only 
solution.  Use of these and other alternative methods of pain control could 
even be useful now.)  Help her to create a birth and post partum plan to 
present to her OB and baby's pedi.  Prenatal expression of colostrum might be 
considered so there is something to give baby should she be unable to breastfeed 
soon enough.  I'd teach her manual expression and have her make sure a pump is 
available to her as soon as possible.  Let her know how just a few drops of 
colostrum can elevate blood sugar of infant, and this is more readily obtained 
with hand expression. Most importantly, reassure her that many mothers breastfeed 
post section, overcome obstacles to breastfeeding, and armed with information 
and support, she, too, can do it. Best of luck with her.

Barbara Latterner, BSN, RN, IBCLC



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