Breastfeeding and Maternal Surgery

By Barbara Wilson-Clay, BS, IBCLC
 
It is seldom necessary to wean a baby because the mother needs surgery. These days, most hospitalizations are brief. The mother may need to plan for only a short separation from her baby. Many resources exist to reassure  both physicians and families about the effects of drugs on the nursing infant.  For example, most types of anesthesia and post-operative pain relief are considered to be compatible with breastfeeding.
 
What can women do in advance if they know that they will be having surgery? Let the doctors involved know that breastfeeding will ideally continue. Ask the baby’s doctor to research the effects of drugs on the infant if this is a concern. Enlist the aid of family members before and after surgery. 
 
Breast pumping in advance provides a stash of milk during any period of mother-baby separation. Some hospitals allow the baby to stay in the room with the mother following surgery if other family members are present to provide care. Nurses or LCs can demonstrate methods of positioning the baby that avoid stressing incisions. Learning to breastfeed in the side-lying position may be especially useful. If the baby cannot be present or the mother is unable to breastfeed, pumping can maintain lactation. Mothers can bring their own pump to the hospital, or use a hospital pump. Family members can carry milk home in a cooler.
 
Each case is different. Some mothers may be too ill or injured to continue breastfeeding. In such instances, family members should remind hospital staff to relieve breast engorgement with a pump as part of the woman’s post-operative care. In some cases, certain radiopharmaceutical agents or powerful chemotherapies require weaning. These women should be provided with appropriate emergency weaning advice.
 
Some types of maternal surgery directly affect breastfeeding. For example, gastric by-pass surgery may lower Vitamin B12 levels in breast milk. Breast surgery may reduce milk supply or create latch problems if an incision is located near the nipple. An IBCLC can advise in such cases. It is important to remember that the advantages of breastfeeding to both mother and baby usually outweigh risks associated with maternal surgery.
 
 
References:
 
Gardiner SJ, Begg EJ. Breastfeeding during tacrolimus therapy. Obstet Gynecol 2006; 107(2 Pt2):453-5.
 
Hale T, Berens P. Clinical Therapy in Breastfeeding Patients, Pharmasoft Publishing, Amarillo, Tx. 2002.
 
Stefanski J. Breastfeeding after bariatric surgery. Today’s Dietitian 2006; 8(1):47.
http://www.todaysdietitian.com/newarchives/jan2006pg47.shtml
 
Schaefer K. Breastfeeding in chronic illness: the voices of women with fibromyalgia. MCN Am J Matern Child Nurs 2004; 29(4):248-53.
 
Wardinsky TD, Montes, RG, et al. Vitamin B12 deficiency associated with low breast-milk vitamin B12 concentration in an infant following maternal gastric bypass surgery. Arch Pediatr Adolesc Med. 1995;149:1281-1284.
 
Wittels B, Glosten B, Faure E, et al. Postcesarean analgesia with both epidural morphine and intravenous patient-controlled analgesia: neurobehavioral outcomes among nursing neonates. Anesth Analg 1997; 85(3):600-6.