Hi again. I had an interesting talk with our general surgeon about the 24
hour recommendation. I have never talked with her before, but she called me
because she has had 2 patients this week whose LCs said they could
breastfeed as soon as they feel able after surgery. My mom had an unplanned
gall bladder surgery and she was distressed about not being able to feed
her very healthy 2 month old exclusively breastfed baby for 24 hours. I
gave her info. about the current recommendation of "as soon as mom is awake
and ready" and encouraged her to discuss this with her Dr. and
anesthesiologist.

Anyway, this surgeon went on to tell me that many of these meds are
contraindicated with breastfeeding according to her sources and there is
not enough research out there to prove otherwise. She listed the PDR as a
source. A couple of the meds she listed are fentanyl and versed. She does
not want to take the risk and get sued someday. We had a friendly
conversation and I pointed out that I feel a greater risk would be baby
getting formula due to an unplanned surgery. Some are so concerned about
these minimal and sometimes non-existent risks of
breastmilk "contamination", but they don't even consider the short term and
long term risks of formula--especially if the 24 hour weaning causes
breastfeeding complications and actual weaning.

She went on to say that she does not understand what the big deal is about
giving a baby a bottle. She said we (breastfeeding counselors) make it seem
like it is a cardinal sin to give a baby a bottle. I very nicely explained
that our reasons for avoiding bottles and formula and interrupted
breastfeeding is based on biology and science, not on some "all naturale"
idea that bottles are bad.

I thanked her for calling because I believe very strongly in open
communication.  I told her that it is not my job to persuade mothers one
way or the other concerning meds. My job is to provide factual and up-to-
date information that she can share with her Dr. and make an informed
decision.  She agreed with this and has no problem with me giving the info.
to moms, but she will continue to recommend the pump and dump for 24 hours.

I do plan to give this surgeon some information about these meds.  Dr. Hale
recommends waiting 4 hours to breastfed after giving versed. Is it possible
that a mother could have a quick surgery and be ready to breastfeed sooner
than 4 hours?  If so, is the recommendation that mom can breastfeed as soon
as she is awake and ready not always accurate?

In our perfect world we would hear a doctor say, "Oh no, I could not
recommend that a mother cease breastfeeding for 24 hours and offer formula.
The short and long term health risks are too great--I don't want to get
sued!"  Just because emails can be read wrong sometimes I would like to go
on record as saying that of course there are times when it is essential to
temporarily interrupt breastfeeding.

By the way, I work at the same hospital as this surgeon so I am glad it was
a friendly conversation.  Plus, my position is newly created so I would
like to make a good impression, but I did not want to put myself down.  I
may not be a surgeon but I am an important part of the health care team and
I do know alot about one subject--breastfeeding!  :-)

Thanks for listening.

Christine Lichte  LLL Leader, CBE, 2003 IBCLC candidate

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