Preparing for a general anaesthetic - how to BF when I can't drink anything?

[BreastmilkDoesAFabLatte]

I'm tandem feeding a 9 month old and a toddler plus expressing whilst at work, and both BF and expressing make me extremely thirsty - I can drink literally 8-10 litres a day or more. But I've got surgery under general anaesthetic in a few weeks, and am planning to express to maintain supply throughout the hospital stay, but am aware I'll not be able to drink for howevermany hours prior to the surgery.

Does anyone have any advice/experience of how to cope with this? Does anyone have any tricks for handling thirst whilst BF when they can't drink?

Not got any tips as I can live on less than a litre a day even when tandeming (which I am currently doing as I have liquid aversions during pg and just can't force the stuff down - I know it's not good really!) so when I have been nil by mouth I am usually fine. Will you have a drip hung before surgery? They may also give you a few ice chips to suck to wet your mouth but in my experience they won't just in case you snarf the whole cupful .

However, 8-10 litres of water is an immense amount of fluid a day (15 litres is about the top limit for your kidneys to process in a day before you get water intoxication).

Probably speaking out of turn (when don't I?) but have you had a diabetes check as diabetes can cause a raging thirst? Apparently zinc deficiency can also cause excessive thirst too so might be worth mentioning how much you drink to your GP and see what they suggest. It may well be completely normal but it wouldn't hurt to talk to your GP just to rule out anything.

Raise this during your pre op assessment. They can then check with the anaesthetist who might be happy for you to have clear fluids and if not then they can sort out an iv drip for you.

I will talk to the anaesthetist about an IV. But the GP and the consultant generally operate along the lines of haven't-you-breastfed-for-long-enough-already-Breastmilk and roll their eyes .

Really, though, I suspect my thirst is more of an anxiety thing than anything physiological... but it's a fair point about diabetes and I've had lots of inconclusive blood suage and other test results for various similar disorders. I didn't know that about the zinc, though. Wonder if supplements would help.

TS - you are tandeming through pregnancy? Wow. Admiration

Ignore their attitudes. Lactation is a physiological state and the anaesthetist and surgical team will just have to accommodate for it. 8 L sounds like a lot though, so I don't think they will give you quite that much fluids.

I have just had ga and was bf. they can accommodate you at pre op- its not just the fluids but the type of ga and also painkillers they give you after can be varied to make it easier (am assuming the less time you have to pump and dump the better). Be aware though that ga can affect supply.

you can drink clear fluids (water, black tea/coffee) until 2hrs preop, by which time I imagine you'd be in the hospital anyway. (ex anaesthetic trainee)

If they do get funny with them you can ask them if they will cathaterise you if you are unable to go to the bathroom following the op? If so, they can make adjustments for another of your physiological needs......

On a personal note - I was tandem nursing a 6m & 2y (6m not on solids by Drs orders) when I had pancreatitis in 2009, I was only allowed/helped to express twice a day because you don't need to express more than that with a 6m Funnily enough I developed mastitis with in a day and needed IV antibiotics as I had a raging fever, rock hard breasts that were bright red and GREEN milk. Totally Dr induced mastitis as there is no way I would have developed mastitis so quickly if I had been able/helped to express 8-12 times a day. It really did not help my recovery as I was then fighting infection on two fronts not just one and I was in hospital for a week getting over this - plus it had a bit of a knock on effect on my supply and I struggled to express afterwards (i struggle anyway but still!).

It's my 2nd pg I have tandemed through but this one is far easier as my nurslings are much older this time (2y & 4y as opposed to 1y & 3y).

Poor you . If all goes to plan with the surgery, I should be well enough to express without needing any help to do so. And if not, I will be in ICU on mega doses of antibiotics anyway so presumably oblivious (or dead, but let's not be melodramatic...)

So what do you do when you're already tandeming and the third baby arrives? I mean, given that most of us only have two nipples...

You can drink clear fluids (water, black tea or coffee, clear fruit juice) up to 2 hours before the anaesthetic. So in theory if your op is scheduled for 9am you can drink up to 7am. However, it's often not possible to be precise about when your anaesthetic will done because they won't know the order of the operating list when you are given your fasting instructions, so you could be on a morning list which starts at 9am but you may not be done until 11.30 or later so you'll have been fasting for fasting for longer than 2 hours. I would speak to the surgeon and anaesthetist prior to the op and explain your situation and ask if you could be scheduled first so that you can minimise the time when you won't be able to drink anything. You could also ask that you have an IV set up prior to going to surgery so you can be given fluids.

Whilst you're anaesthetised you will be given IV fluids which aim to replace the fluid that you've missed out on through fasting and being anaesthetised. As others have said however, they are very unlikely to give you as much as you would normally drink as 8-10 litres of fluid a day is very, very high. You shouldn't need that much to maintain breastfeeding, so other than being possibly uncomfortable for you, it's unlikely to cause problems with breastfeeding.

When you get out of surgery, however much you want to, don't start guzzling water the second you can sit up as it may make you vomit. Try and restrict yourself to small sips - you'll probably have fluids for an hour or two after surgery anyway.

HTH.

Thanks... again, very helpful. Last time I had a GA I was kept NBM from midnight the previous night, but that wasn't in the UK. The surgeon knows how nervous I am, and has said that they'll do all they can to avoid me having to wait. Obviously I understand that emergencies take precedence and that there can be all sorts of unexpected and unavoidable delays... but yes, I'll ask about timing on the list.

I had a LLETZ under GA last year and they stuck me at the top of the list as I was bfing and they wanted me to not go too long without fluids/pumping (very nice of them it was too but as a LLETZ is a OB-GYN op I think the surgeon understood the needs of a nursing mother better than a general surgeon).

Is the hospital you are having the op at a Baby Friendly hospital/aiming for BFI? If they are, you might be able to get the BFI co-ordinator to interject on your behalf with the surgeon and explain the physiological needs of a bfing mother.

On your hijack - I don't forsee a problem with triandem nursing as currently DD2 only feeds once or twice a week and then it's under a minute, DD3 feeds two or three times a day so I think I'll be okay - that's assuming they are both still bfing when baby arrives.

Good luck with the op and I hope you recover very quickly.

I've just been told that the surgery is schedulaed for 2pm and that I cannot drink ANYTHING after 8am.

HELP!!!!!!!!!

Was it the anaesthetist that told you this or the nurse at the pre assessment clinic? If you definitely can't drink then they have to sort you out a drip but most anaesthetist will be happy with clear fluids until much later I would think.

It was the pre-assessment clinic.

I can't now speak to anyone until I get there tomorrow, by which time I will be possibly delirious with thirst.

Without speaking to the anaesthetist directly, and I can't, I daren't go until 12 noon drinking water... I'm terrified of them cancelling/postponing th whole thing and I've been on the waiting list forever :(

Have sent you a PM

Thanks. I've replied. Reassuring of you. I appreciate your help...

Another five hours to go and I'm so thirsty I could scream. Can't speak to anyone at the hospital until 1pm.

But honestly, it's the least of my worries. Dropped kids off 10 minutes ago [cry]

I can't understand why they have you completely nil by mouth for so long. We usually allow at least free water until 2 hours pre-op.

Thinking of you. Hope all goes well.

I'm back. Thanks for all your support. I was without water from 8am until 6pm but I survived... and given that I woke up in such pain, being so deydrated as to not require the toilet may have been a bit of a blessing.

Given that such a proportion of the world's population live without santitation or access to safe drinking water... and given that such areas tend to have higher breastfeeding rates than the UK... well, it's a salutory lesson.

I've updated more on the health support thread.

For those who queried the 6 hour policy - yes, there was a bit of miscommunication between cardiology and anaesthetics on the issue. But by the time the anaesthetist confirmed that I could have drunk water until 12 noon, it was already half 1.

Thank you so much for this post- been researching it myself. Glad it went well for you. Have you been able to feed your baby yet?

I'm glad you've got through it OK. Can I please suggest that when you feel better that you complain about the misinformation in being told that you were not allowed to drink for 6 hours prior to the op. As you know, this is incorrect and they should know better. In addition to the discomfort of going without fluids for 6 hours, long periods without fluids are associated with an increased risk of post-operative nausea and vomiting. Whoever gave you that information needs to acquaint themselves with the AAGBI guidelines!