breast feeding post op

[Joy.Moores]

Hi Dr. Hale,

I was wondering if you could clarify something for me. Are there general guidelines we can give mothers who are undergoing surgery but want to breastfeed afterwards? I am still running into a lot of resistance from anesth. who states moms need to pump and dump anywhere up to 48hrs. post op. (even after a lap-chole) The rationale I am being given is "the inter-operative loading dose of narcotics was 'high'....If mom is awake and alert enough to care for her baby is the narcotic load still that high? and what is defined as high....I tried to find the article you referenced at the Vancouver conference but have been unable to find it. I just returned to day from another pharm. talk on breastfeeding and they would not answer the question - said it was up to anesth. to decide...

[admin]

Joy:

Most of us say, that as soon as mom is awake and unsedated, that it is probably fine to breastfeed. Read the ABM protocol attached.

Tom Hale PH.D.


http://www.bfmed.org/Media/Files/Protocols/Protocol_15.pdf

[dflohr]

I have a question about regional anesthetic. I read ABM's 2006 protocol for Analgesia and Anesthesia for the breastfeeding mother. They mention a mother undergoing plastic surgery with large doses of local anesthetics to pump and discard for 12 hours before resuming breastfeeding. If orthopedic surgery lasts for over 3 hours using regional local anesthetic (20mls .5% Marcaine & 20 mls. 2% lidocaine with epinephrine for instance) along with "twilight" sleep how do we counsel mother? The anesthetic effect will last for hours. What is considered a large dose? Thank you.

[admin]

dflohr:

With these larger doses of "local" anesthetics, you might have the mom wait 12 hours or more to breastfeed. Usually, with most surgeries, we worry about the opioids, the benzodiazepines, and propofol early after the procedure. But with larger doses of local's, you might want to wait longer.

To be honest, we don't really know how long. Other than the fact that lidocaine and marcaine don't attain very high levels in milk. In the above procedures, they probably just "leak" out of the bone and surrounding tissues over a prolonged period, and never would attain clinically relevant levels in milk.

Tom Hale Ph.D.