The breastfeeding surgical patient: 1.8 ce

AORN Journal,  April, 2008  by Deborah Dumphy

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If the patient is unable to express breast milk herself intraoperatively, the circulating nurse will apply the sterile, breast-pump kit flange centrally to the surgical patient's breasts simultaneously and maintain a suction seal of the flanges to each breast. The nurse will hold the pump kit with the collection bottle vertical on the ventral-dorsal side of the patient for gravity flow of the expressed breast milk so that the milk will not leak from the flanges and potentially contaminate the surgical field. This is a difficult challenge intraoperatively so the perioperative team must weigh these risks against the benefits and risks of waiting to express breast milk postoperatively.

The plan of care should be developed with the patient and perioperative team members before the circulating nurse transfers the patient to the OR. The circulating nurse should ensure that the postanesthesia care unit (PACU) nurse is aware of the patient's breastfeeding status before the patient arrives in the PACU.

POSTOPERATIVE NURSING CONSIDERATIONS

As soon as possible after settling the patient in the PACU (eg, after obtaining initial vital signs, managing the airway, and managing postoperative pain), the PACU nurse should offer the postoperative patient the opportunity to breastfeed. (10) If breastfeeding is not an option, the PACU nurse should assist the patient in using the electric breast pump to express milk, adhering to standards for collection and storage of breast milk.

The PACU nurse should explain to the patient that postoperative pain can suppress lactation and should encourage pain management with medications identified as compatible with breastfeeding. (10) The nurse should inform the patient of any possible adverse medication effects for the infant and should ensure that the patient is aware of what infant behaviors to observe and report. When an inpatient stay is required, nursing staff members should ensure that continued rooming-in is allowed. An adult care giver should remain with the patient to provide primary care for the infant and to support the surgical patient with continued breastfeeding. (10)

MEDICATION SAFETY FOR THE BREASTFEEDING PATIENT AND HER INFANT

When caring for a breastfeeding surgical patient, perioperative nurses have a unique opportunity to support the maternal commitment to breastfeeding and the mother's goal to provide optimal nutrition and health benefits for her infant. As with most obliged responsibilities, this requires time and dedication to achieve the best outcome. The perioperative team plays a vital role in supporting maternal and infant safety. The nuances of medication safety with a breastfeeding surgical patient may be unfamiliar territory for perioperative nurses; however, evidence does not indicate that a breastfeeding patient must discontinue breastfeeding when undergoing surgery. Preparing a plan of care and obtaining necessary breast pump equipment and supplies in advance can help ensure positive outcomes for both the breastfeeding surgical patient and her infant.