Jan asks for suggestions in dealing with medicos who take the "easy" way out
(IMO) by telling mom she cannot breastfeed due to xyz meds and/or treatments.
We must empower moms that physicians, nurse practitioners, etc (myself
included) give ADVICE, not MANDATES!!! She must gather enough INFORMATION
(different from advice, and I usually point out that this is what I am
providing to her) to make the decision herself.
Case in point: this week, I came in to see a mom on Fri who had been told on
Wed (after my partner had done rounds -- no one was there on Thurs,
unfortunately) that she would NEVER be able to nurse her 2nd baby due to the
fact that she had been identified as having pulmonary thrombosis/embolism.
She had several scans on Wed and was put on Heparin, and would be going home
on coumadin (warfarin) for 6 months. Needless to say, mom was devastated when
I saw her, as she had such a positive experience with nursing her firstborn.
I first addressed the nurse who told me mom could not nurse with heparin, by
telling her that heparin molecules are too big to get into the milk (I
managed to tell several other nurses and docs this fact as well) and that
coumadin was recommended by AAP as compatible with breastfeeding. This done,
the mom was reassured that she would not have to consider the 6 months on
coumadin as no go.
Secondly, I had to find out what tests she had, and what type of contrasts
were used. The pulmonologist I spoke to told me that no radioactive
substances had been used. He felt no problem with breastfeeding, but that he
could not make the decision, I should speak to the mom's doc.....I suggested
the pedi instead, since it was the baby we were concerned with. I called and
spoke to the pedi, who said fine to breastfeed with all of the above info
conveyed, but that it should be cleared with the mom's docs in case they had
any problems with nipple trauma causing her to bleed (now we are talking
about a newly postpartum mom here.....anyone ever see nipples bleed more than
lochia flow????) So, I also spoke with the ob docs and gave them all of the
above info, to which they had no problems, so long as the pedi agreed (do I
sense a bit of CYA here????) (CYA=Cover your a##)
However, the patient felt uncomfortable breastfeeding as she was sure she saw
Radioactive labeling on the drugs used for her scan. After further
investigation, we found that she was right, while the pulmonologist was
wrong. However, it was now more than 48 hours since the scan....so I
explained about half life, etc. She was still more comf pumping and dumping
for a couple more days, (HER decision based on all of the information and/or
misinformation given to her). She was thrilled to learn that at least she
would not have to totally give up breastfeeding for the 6 months of anticoag
treatments.
All in all, I spoke to about 5 nurses, one pedi, two obs, and the
pulmonologist. My one mistake was in not calling the radiologist (which I
have done in the past) b/c I trusted that the pulmonologist would know what
meds had been used, and he had assured me that none were radioactive!! The
poor patient was given so much conflicting advice that she was not sure what
info to choose in making her decisions. I supported her decision to P&D for a
couple more days as I felt she was not trusting of any info at that point.
Our goal was to preserve the breastfeeding for her.
Of course, everyone else had accepted the "mandates" that mom could never
nurse, and so had not even started her with pumping until I came in on
Friday. This mom would have gone home not pumping and thinking that her 2nd
baby was missing out on the important relationship she had enjoyed with her
first, all due to misinformation and people not wanting to take control of a
decision.
Several hospitals in our area have gotten rid of their lactation consultants,
putting in place that breastfeeding certificate program that they are sending
their nurses to.....if this patient had been in one of those hospitals, there
would have been no one there to advocate for breastfeeding or for the
patient's desires.....
I believe that the moral of this long story (thanks for letting me vent here
) is to EMPOWER moms in your classes prenatally and afterwards, that there
are very few reasons that she cannot breastfeed if she really wants to, and
to gather info and contact a Lactation Consultant (IBCLC credentials are
important as you can see from what I have said is happening in our area) to
help her make an informed decision.
I did convince several nurses and physicians that it would be OK for mom to
breastfeed as long as the radioactive substances had dissipated. They are
learning at our hospital to "call Kathy & Joanne" with any questions of this
sort. But if we are not there for even one day, you see what happens!!!
Sorry to be so long-winded today....not my usual.....
Kathy Rubin in NJ
IBCLC, RN, BC (Maternal/Infant), APN, C (Family Nurse Practitioner)
PhD student hopng to study lactation issues someday
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