I am so very tired of breastfeeding mothers who need colonoscopies and endoscopies being told that they need to interrupt breastfeeding. I am currently trying to engage with the national body to update national guidelines. Interestingly it is the same old story – we dont see breastfeeding women needing these examinations. So how come I do?
This is the evidence that I have put together and am desperate to share with clinicians.
This week I posted a link to a recently published paper which concluded that poor pain relief after a C section affected breastfeeding. https://consultqd.clevelandclinic.org/following-cesarean-delivery-postoperative-pain-affects-likelihood-of-in-hospital-breastfeeding/
I was saddened that we even had to think that pain would not be managed well for any mother, let alone when she was trying to initiate breastfeeding. It isn’t always easy to life a baby from a cot side crib when you have had surgery, let alone try to position a baby to achieve the perfect latch.
What surprised and horrified me was the mother’s who replied that they hadnt been given good pain relief when in hospital. They mentioned:
- not being told that more than paracetamol was available
- being offered only paracetamol and ibuprofen even when they needed more
- being forgotten on medication rounds,
- being discharged without sufficient pain relief.
This just isnt good enough and I would hope that everyone to whom this applies contacts the ward directly or through PALS that pain management plans are essential.
Pain relief which should be given to a breastfeeding mum in my opinion:
- In theatre a non steroidal anti inflammatory eg diclofenac as a suppository
- On the ward there should be available oramorph (subject to extensive first pass metabolism so little in milk)
- Regular use of an NSAID – ibuprofen, diclofenac or naproxen (low levels in milk) plus paracetamol
- Codeine is no longer recommended but dihydrocodeine can be offered https://breastfeeding-and-medication.co.uk/thoughts/breastfeeding-and-codeine
- Discharge packs should include the NSAID offered in hospital plus limited number of dihydrocodeine and if necessary oramorph. This may challenge the formulary in the hospital but can be overcome simply with care and thought for the patient.
NO WOMAN SHOULD BE LEFT IN PAIN BECAUSE SHE IS BREASTFEEDING
I have been working with a small team of anaesthetists for some time to develop guidelines so that breastfeeding mothers can have surgery, pain relief etc and continue to breastfeed as normal. The guideline also recommends support for the mother in terms of pumps, information and her baby nearby – not necessarily in that order.
World Breastfeeding Week 2020 I was proud to share this guideline and infographic
Guideline on anaesthesia and sedation in breastfeeding mothers is available in full at https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.15179