General anaesthetic and breast feeding

[owainsmum]

My DD is 7 months and ebf (also on solid foods now), and I need to have a minor operation in a few weeks. Saw the registrar yesterday and he said I may have to pump and dump my milk for a couple of days afterwArds because of the general anaesthetic. He did say to check with the anaesthetist though because he wasn't sure. I really don't want to have to do this, it would also mean building up a stash of expressed milk and I'm not sure I can get enough for 2-3 days in the time I have. The last thing I want to do is have to give DD formula and possibly affect my supply. Can anyone advise, will I be able to bf after the surgery?

If you look on the breastfeeding network site, there is a factsheet (evidence based) on bf and general aneasthetic. My understanding is that it is incorrect to assume you need to pump and dump. Once you are conscious, the anaesthetic has been reduced to virtually nil in your system (otherwise you'd still be 'under') and if it is not in your system, it is not in your milk. It does not have after effects, hanging about in the milk....and if you think about it, women have a GA with a section and feed immediately on coming round :)

Pumping and dumping makes no sense - the body deals with the drug easily and quickly.

It's not just the hassle of expressing -and you are right, 2-3 days is a huge amount to stash - but the upset and distress of your daughter not being able to breastfeed from you.

I am not a doctor or HCP, so this is not me saying this, but you can easily check for yourself and share your findings with the doctor. Sounds like the doc would benefit from this, and so will future patients :)

I had to undergo minor surgery 2 months ago, and if I had refused to pump and dump they wouldn't do it. I had not to feed for 48 hours. I did have a supply luckily just made it but unfortunately I was told it was the only option due to anaesthetic and the pain killers required!

www.breastfeedingnetwork.org.uk/wp-content/dibm/anaesthetics%20-oct-14.doc.pdf

Mrsc, maybe you had a special and unusual combination that led them to be so strongly against it....who knows? But they still have no right to insist on you pumping and dumping...you were the patient, not your baby, and you are the one who make decisions about what you do about bf :(

I had general anaesthetics and breast fed afterwards as by that time I was awake and the drug was no longer an issue.

Some painkillers can be a problem I think but it sound be pretty easy to take different ones (assuming you don't have a complicated allergy history or something).

I would talk to the anaesthetist armed with the document above printed out.

Thanks for the replies, so hopefully I'll be able to carry on feeding straight afterwards. I know DD would get very upset if she couldn't have the comfort of me feeding her, especially at night. She also won't take a bottle so would have to have the expressed milk in a sippy cup. I'll double check with the doctors before hand and build up as much of a stash of milk as I can though just in case.

I bf after a general also. Had no advice to the contrary and I was having a very specific ante -natal operation that I've always had in pregnancy (so I was pregnant at the time also). Dd must have been about 15 months old, but still feeding a lot back then!

Have you spoken to the Infant Feeding Specialist at the hospital. It is her job to support Breastfeeding women in the hospital from birth onwards. The maternity department will have her number.

As a doctor myself, it really annoys me seeing doctors give out incorrect information about breastfeeding.

By the time you are conscious enough to be breastfeeding, sufficient amounts of the anaesthetic will have left your system. We don't, of course, stop women breastfeeding their newborns after a GA section, as tiktok says, and the risks with a 7 month old are far, far less.

Dino, what's the best way to inform doctors about this?

In this particular instance - GA and bf - a doctor telling a mother she cannot breastfeed is a common query on mumsnet. Why would they say this? Do they really, really think the anaesthesia hangs about in the breasts for two days sufficient to affect a baby of 7 mths???

No - I don't think they do think that, but they are covering their backsides for some reason!

Just to confirm experience from a patient's point of view - I had a crash CS under GA, was under for about 50 min, and breastfed my newborn as soon as I came round.

tiktok, I'm not an anaesthetist but I think these messages about pumping and dumping just get passed on as received wisdom so anyone who doesn't spend (the admittedly whole three seconds on the internet - it's not hard to find the info) the time looking at the actual evidence will just say something to be 'safe rather than sorry'.

Looking at the BNF [the book of all the drugs we can prescribe], loads of drugs are labelled as "avoid in pregnancy and breastfeeding", when, of course, we use plenty of those drugs in pregnancy and breastfeeding but the studies haven't understandably been done in pregnant and breastfeeding mothers, so if you just use that, then you'd advise against breastfeeding.

Sadly there is also a section of doctors who don't see BFing as important so might not see finding out this information as relevant or important. 'Why carry on BFing if you need to take medicine if you can just FF?' Questions about BFing problems are answered with, "Well, you're not a cow. It is just the breastfeeding advocates making you feel bad."

I'm now always recommending the BFN drug information sheets and LactMed to my colleagues.

I also had an EMCS under GA and fed within 30 minutes of coming around.

You could email Dr. Jack Newman- I can't link his contact details on phone but if you Google him you'll find them - he's very vocal on this subject.

Wendy Jones at the Breastfeeding Network or the LactMed database should inform you about the effects of the painkillers you'll be taking.

"Pumping and dumping" (hate that phrase!) is regularly requested but very often not actually required.

Good luck with your op.

Thing is, its not just the anaesthetic is it? Some patients will have 5-6 drugs given under anaesthesia including muscle relaxants, reversal, antibiotics, analgesia, antiemetic, induction agent and the anaesthetic gas itself. So you do really need to check with the anaesthetist what they plan to give you.

Thanks, Dino - that's all a bit depressing :(

It's good you share good resources with your colleagues.

So it's a combination of passing on received 'wisdom' and not even thinking to challenge it because the mother's wish to bf is not seen as important. We need mothers to just ask the question 'are you sure about that?' I think. My experience is that doctors vary quite a lot in their support and knowledge of breastfeeding. Most think it is a 'good thing' but of course that's not enough :(

Wildfire, you're right - checking with the anaesthetist is important.

The surgeon/GP/nurse discussing the op with the mother should be enabling this, and not just telling the mother not to breastfeed, and in this case, not to breastfeed for two days!

Wow, just looked at this again after being out all day, thanks for all the info and replies. I had thought that it must be ok to bf but the gynae doctor I saw yesterday said maybe not. He did admit that he wasn't sure though. Good point above about other drugs they may give me which may cause problems though so I'll still check. I think my biggest problem will be getting expressed milk into DD while I'm in hospital, she won't take a bottle and DH tried giving her some in a sippy cup today while I was out and she didn't have much of that either. At least she's on solids now though so won't starve if she doesn't have much milk for a day.
It does seem that there is a worrying lack of knowledge among doctors regarding breast feeding, from what others have said above, and if they are advising mothers that they can't bf when actually they can, that's pretty bad.

I had surgery under GA when dd was 3 days old and bf her as soon as I came round.