18 December 2014

Breastfeeding Through Medical Procedures

Breastfeeding through various medical procedures is very important to me. When my first born was three weeks old, I sat on the floor in the middle of the night after a 20 minute pumping session and sobbed over two empty bottles that should have been full of breast milk. The hurt that followed over the next few months was something I vowed I would avoid in the future. With Eleanor, it became a top priority and I went to great lengths to set myself up for success before she was born and sought patience and resources in the first few weeks home. (Remember that time I got mastitis? Twice?) Since her birth, I've had a couple of medical procedures and some ongoing care (most, but not all, due to kidney issues), and I also have a seven-month-old, exclusively breastfed baby.

In my experience, doctors and nurses who fully support my desire to breastfeed are few and far between. "Just pump and dump!" is a favorite expression I heard as my desires are written off. The same people who eagerly offered pain meds for levels one and two pain, fetched ice chips refills after a breathing tube removal, and unhooked all my tubes and wires again so I could go to the bathroom, looked annoyed and advised pumping and dumping my precious breast milk when I asked follow-up questions about the drugs in the IV.

I'm very open with everyone I come into contact with from the moment something gets discussed: the nurse scheduling the appointment, the pre-op nurse: "Jacqueline ______, 10/06/86, kidney stone removal surgery, left side, I'm breastfeeding." Everyone who inputs data to my chart gets the rundown. More than half of these people advise that I'm going to have to "pump and dump for 24 hours!" I always follow up with, "Okay, what medications will I be receiving?" Most of these people don't even know. Whenever I can get a specific drug name (Some nurses are polite enough to ask the doctor and call me back or have anesthesia give me a call. Honestly, I get the most accurate specifics right before the procedure), I research the snot out of it. If I can't get a name, I'll Google what types of medications are typical and research those.

Whenever I'm headed into a procedure, it is my MO to breastfeed Eleanor about 30 minutes beforehand. Get her nice and full to hold her off until I get out of recovery. And I've never had to do more than ask. (At this stage, even the stodgiest White Coats are conducive to my requests.) As the OR nurses, doctor, and anesthesiologist report to the bedside for the standard pre-procedure interview, I get a list of what I'm likely to receive, and I jot them down. In my experience, there are times when you can request different meds to accommodate breastfeeding, but rarely is that the case during surgery. In my experience, anesthesiologists are the most open and willing to discuss drugs, side-effects, and breastfeeding. In my experience, anesthesiologists also offer the most conservative (and liability ass-covering) directions. It feels to me and Matt like they're working with studies from the 1950s that have never been updated. And lots of drugs have never really been tested, so I often get a "pump and dump" because it's "better to be safe than sorry."

Post-op is when I have the most flexibility in requesting new drugs. Whenever the nurse approaches my bedside with a little plastic cup of pills, an injection for the IV, or an Rx from the doctor, I a-l-w-a-y-s ask: "Can I take this while breastfeeding?" and if the answer is anything but "yes," I ask inquire about different options. Honest [paraphrased] summary of a conversation I've had with a nurse:
"Here's your medication?"
"Can I breastfeed through this?"
"Nope, pump and dump for the full 7 days you'll be on it."
"Can I take something else that I can breastfeed with?"
"I don't know."
Always permit the awkward silence to work on your behalf.
"I'll check." A few minutes later. "Here is something that's safe to take while breastfeeding."

Sometimes these conversations suck! I hate confronting authority - inside I'm always, "Oh my gosh, I totally don't want this!" But outside, I'm like, "Yes, sir, of course, sir." It's hard for me to stand up like that, but as hard as it is in the moment, it's always worth it when I'm back at home in bed nursing Eleanor at 3:00 in the morning. I also really helps that I have support: a husband by my side who doesn't mind questioning a doctor.

The BEST advice I can give anyone going through a medical procedure is to ALWAYS ask if there is another breastfeeding-friendly option. Sometimes there is not. When that is the case, the BEST advice I can give is to get a second opinion.

The doctor's advice that you can't breastfeed after general anesthesia is his opinion, based on studies and a desire to avoid malpractice law suits. Sometimes it means s/he'll sacrifice your breastfeeding. In my experience, most doctors do not keep up with the latest "drugs in breast milk" studies, and some of those studies show that drugs that previously required a 24-hour pump and dump is not necessary.

So when a doctor doesn't give me an answer I like, I get a second opinion. Often with an online search after the doctor has closed the curtain and walked away. I recommend finding websites with specific facts and researchable citations. I personally trust the La Leche League, Dr. Sears, and the website Drugs.com (They are huge fans of data and citations. Check out this example on fentanyl). I also give more weight to websites ending in ".gov" and board's websites (the American Academy of Pediatrics, for example). Matt usually reads those articles too and backs me in my decision, sometimes to the doctor's face, sometimes when we privately make a decision without informing the doctor.

And once you have all that data, you can make an informed decision. Sometimes I choose to breastfeed Eleanor when my doctor says, "nope," but the La Lecha League says, "yup." Sometimes the second opinion backs the doctor and I do pump and dump. After my kidney surgery, I pumped and dumped for 12 hours because I was on a lot of stuff and I felt all the little risks were adding up too fast. I'm confident of those decisions because they were made after much research and honest discussion. They're what we felt were best for us. And so far, they've proven to be: I have an exclusively breastfed seven-month-old who passes her wellness visits with the pediatrician with flying colors.

1 comment:

Anonymous said...

Wow. This was a great post. Thanks be to God, I haven't had any medical procedures, but your words are an excellent reminder that we, as patients, should research, question, and make decisions throughout all the steps of medical care, rather than just downing the drugs in the paper cup. TB