Care of the breastfeeding mother in medical-surgical areas

MedSurg Nursing, April, 2007 by Lori Wenner

As the rate of breastfeeding in the United States continues to rise, the likelihood that a medical-surgical nurse will participate in the care of a breastfeeding mother also increases (Li, Mokdad, Barker, & Grummer-Strawn, 2003). Professional organizations including the World Health Organization (WHO, 2001), the American Academy of Pediatrics (AAP, 2001), and the American Academy of Family Physicians (2001) recommend that babies be breastfed for at least 1 year, with exclusive breastfeeding for the first 6 months of life (Garner et al., 2005). However, maternal contact with the health care system during breastfeeding can lead to premature weaning or supplementation with formula. Knowledge regarding breastfeeding, maternal medications, pumping, and storage of breast milk is vital to the nurse's role as patient advocate in sustaining the breastfeeding relationship. In the author's experience, breastfeeding women have been hospitalized for varied issues, including urinary tract infection, Caesarean section wound infection, cholecystectomy, and high blood pressure.

Benefits of Breastfeeding

Documentation of breastfeeding benefits to mothers and infants is extensive and compelling (Biancuzzo, 2003; Department of Health and Human Services [DHHS], Office on Women's Health, 2000; Garner et al., 2005; Hale, 2006; Lawrence, 1997; Riordan, 2005). Infants who are breastfed are hospitalized less often, and are less likely to suffer from certain childhood cancers, gastroenteritis, ulcerative colitis and Crohn's disease, bronchitis, pneumonia, sudden infant death syndrome, juvenile diabetes, otitis media, asthma, and eczema (DHHS, 2000; Garner et al., 2005; Riordan, 2005). No formula can provide the benefits of autoimmunization, the process of antibody production in the breast milk in response to maternal and infant exposure to organisms (DHHS, 2000; Garner et al., 2005; Riordan, 2005). Maternal benefits include decreased risk of osteoporosis and hip fractures, as well as decreased risk of ovarian and breast cancer (DHHS, 2000; Garner et al., 2005; Riordan, 2005).

Care of the Hospitalized Lactating Woman

In most instances, a mother can continue to breastfeed her infant during hospitalization or outpatient procedures. The anxiety and stress of separation from a child are compounded in the breastfeeding mother who is concerned about her health and the emotional and nutritional needs of an infant who is dependent upon her. Inadequate pumping of the breasts and/or feeding may result in the pain and discomfort of engorgement. Oxytocin release during breastfeeding results in relaxation and a diminished response to stressors and pain in the mother (Riordan, 2005). Another caretaker feeding the infant may seem to enhance maternal recovery, but time spent pumping breast milk and the loss of the maternal benefits of breastfeeding make this option ill advised unless absolutely necessary (Garner et al., 2005).

If available, the assistance of a lactation consultant and/or maternal-child nursing personnel is recommended. In a facility without maternal-child services, the nurse can contact community assistance as needed (see Table 1). Rooming with the infant is the most desirable alternative, if allowed. Another adult may be required to stay with the mother to assist with infant care. The infant should be brought to the hospital to breastfeed as often as possible if not able to room in. Basics of supporting the breastfeeding mother include the following (Biancuzzo, 2003; Riordan, 2005):

* Encourage rest, good nutrition, and hydration.

* Support efforts to breastfeed and reinforce the benefits for mother and infant.

* Provide privacy as needed.

* If abdominal surgery is performed, assist mother with supporting the surgical area with pillows.

* Encourage mother to take postoperative analgesia to alleviate pain.

* Good hand washing, limited contact with the infant's face, and continued breastfeeding are the best ways to prevent transfer of infection from mother to infant.

* Reassure mother that medications and procedures have been investigated and breastfeeding will not harm the infant.

Surgical Procedures

The AAP (2001) lists the following analgesics as maternal medications usually compatible with breastfeeding: acetaminophen (Tylenol[R], Tempra[R] paracetamol), codeine (Empirin[R] #3 #4, Tylenol[R] #3 #4), fentanyl (Sublimaze[R]), ibuprofen (Advil[R], Nuprin[R], Motrin[R], Pediaprofen[R]), ketorolac (Toradol[R], Acular[R]), meperidine (Demerol[R]), methadone (Dolophine[R]), morphine (Duramorph[R], Infumorph[R]), naproxen (Anaprox[R], Naprosyn[R], Aleve[R]), and secobarbital (Seconal[R]). Other analgesics should be assessed on a case-by-case basis, but the AAP classification lists no analgesics as drugs for which the effect on nursing infants is unknown or may be of concern. Mothers who have outpatient or inpatient surgical procedures can return to breastfeeding after awaking from surgery in most cases (Hale & Berens, 2002; Riordan, 2005; Ting, 2001). Most anesthetic agents are used for brief periods and attain extremely low levels in breast milk (Hale & Berens, 2002; Riordan, 2005; Ting, 2001). Age and clinical condition of the infant should be considered when resuming breastfeeding. Care of the breastfeeding mother having surgery includes the following (Biancuzzo, 2003; Riordan, 2005):