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The breastfeeding surgical patient: 1.8 ce

AORN Journal, April, 2008 by Deborah Dumphy

In the United States, more than 10 million women are either pregnant or breastfeeding at any given time. (1) Of the women currently pregnant, over 70% will initially choose to breastfeed. (2) The breastfeeding surgical patient may present a unique situation for members of the perioperative team. All members of the surgical health care team should be informed when a surgical patient is breastfeeding.

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In American culture, the ethical and social issue of breastfeeding often can trigger value-laden conflict among staff members. Perioperative nurses must become self-aware of any potential biases that they may have toward patients who are breastfeeding. Identifying personal beliefs about breastfeeding before the breastfeeding surgical patient arrives in the care setting requires professionalism. The goal of evaluating self biases is to ensure that the breastfeeding surgical patient and her infant both receive a comfortable environment of care that safely meets their needs.

The beliefs and knowledge surrounding breastfeeding are highly variable. Common myths associated with breastfeeding include that

* breastfeeding needs to cease for 24 hours to seven days after a surgical procedure,

* breast milk can be replaced with formula feedings without ill effect on the breastfed infant,

* breastfeeding can be resumed without difficulty after the mother has ceased breastfeeding for a considerable amount of time, and

* breast milk is one of two equally nutritive infant feedings.

The focus of this article is to enhance awareness of breastfeeding issues by dispelling the myths related to breastfeeding and surgical patients and ensuring that perioperative nurses have the resources to provide appropriate evidenced-based care.

PRACTICE IMPLICATIONS

The most prevalent concern regarding breastfeeding and surgery is the potential transfer of anesthesia-related medications, postoperative pain medications, and antibiotics into the breast milk and, subsequently, to the nursing infant. Often, medical staff members who are uninformed of current evidence to the contrary inaccurately instruct the breastfeeding patient to discontinue breastfeeding for a long period of time after the surgical procedure. (3-7) Disruption in breastfeeding can result in deterioration of the milk supply and, ultimately, may result in permanent discontinuation of breastfeeding. (4,5,8)

The American Academy of Pediatrics (AAP) policy statement on breastfeeding recommends that "human milk ... as species-specific ... be the only milk infants receive ... for the first year of life and beyond for as long as mutually desired." (9(p499) The AAP Committee on Drugs reports that a common reason for the discontinuation of breastfeeding is physician advice to stop breastfeeding when the patient is taking a medication, but this advice may not be warranted. (3) Most medications are presumed "safe" with limited bioavailability to the breastfed infant. (3-5,10) According to Hale, "Most drugs are quite safe in breastfeeding mothers ... [while the] risks of not breastfeeding and instead using infant formulas are much higher for the infant." (5(p9)) The identified risks of feeding an infant artificial milk rather than breast milk are supported and documented in medical and nursing research databases. (5,9,11) The risks include increased rates of acute diseases, such as

* bacteremia;

* diarrheal illness, including rotavirus gastroenteritis;

* meningitis;

* otitis media; and

* respiratory infections.

Other risks for artificially fed infants compared to breastfed infants include immune system disorders such as Crohn's disease, ulcerative colitis, childhood onset diabetes, lymphoma, and possible impairment of antibody response to oral and parenteral vaccines. (5,9,11) Artificial milk also increases an infant's ingestion of lead, aluminum, manganese, iodine, and other heavy metals up to 80 times compared to breast milk. (9,11)

Careful attention to medications that are not considered safe is imperative for the safety of the breastfed infant (Table 1). In determining medication uses for a patient who is breastfeeding, pertinent considerations include the age and condition of the infant and the medication's

* half-life,

* lipodensity,

* molecular weight,

* oral bioavailability,

* dosing frequency, and

* cumulative effects with other medications. (4,5,8,11)

The age and condition of the infant are deemed the most important criteria. (5) Preterm infants; infants with a history of bradycardia or apnea; neonates (ie, newborn infants or infants in their first 28 days (12)); and low-birth-weight infants may be more sensitive to maternal medication use. (5,11) In these instances, all maternal medications should be reviewed by the neonatologist or pediatric specialist caring for the infant before any medication is used. (11)

With the exception of a few medications, the shorter the half-life, the faster the medication will exit from the breast milk. (5,11) Additionally, the higher the lipodensity and the smaller the molecular weight of the medication, the greater the chance of transfer from maternal plasma to breast milk. (5,11) Medications that are low in protein binding transfer more readily into breast milk. (5,11)

Health Care Industry

The breastfeeding surgical patient: 1.8 ce

AORN Journal, April, 2008 by Deborah Dumphy

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