Transcript: Breastfeeding After Surgery and Anesthesia

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The Boob Group
Breastfeeding After Surgery and Anesthesia

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Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

SUNNY GAULT: This episode of The Boob Group is brought to you by Rumina Nursingwear. Hands-free pumping and nursing tanks and bras to support your breastfeeding goals. Visit www.pumpandnurse.com and save 20% with promo code BOOBGROUP20.

[Theme Music]

LEILANI WILDE: Are you a breastfeeding mom facing surgery with anesthesia? Have you been told that you need to pump and dump before resuming breastfeeding again? Maybe you are postponing your surgery because you do not want to interrupt your breastfeeding relationship with your child? We are here with Dr. Capetanakis, an obstetrician with a private practice in San Diego. Today, we’re talking about: “Breastfeeding after surgery.” This is the Boob Group.

[Intro/Theme Music]

LEILANI WILDE: Welcome to The Boob Group, broadcasting from the Birth Education Center of San Diego. The Boob Group is your online, on the go support group for all things related to breastfeeding. I'm your host, Leilani Wilde; I'm also an IBCLC and owner of Leilani’s Lactation and Doula Services.

If this is your first time listening to The Boob Group, welcome. If you’re a regular listener, thanks so much for your continued support. If you’d like to listen to Boob Group on-the-go then please check out our New Mommy Media Network App where you can listen to all the podcast on our network including The Boob Group. If you’d like to be notified of our new episodes released each week then head to our website at www.NewMommyMedia.com and subscribe to our newsletter. There are lots of fun ways to get involve with The Boob Group. Here’s Sunny with more information.

SUNNY GAULT: All right, hey everybody and thanks for listening to The Boob Group today. We love hearing from our listeners. So if you are a listener of this podcast, we would love to get some feedback from you and how we are doing. If you love the show, tell us that. If there’s something you think the show needs, tell us that too. We’ll read your comments on the show.

Also, we have some fun segments you may want to participate in. We have an: “Ask the Expert” segment which actually our expert Dr. Cap is part off. If you guys have breastfeeding questions that you want some answers too or could be really about anything and parenting, go ahead. You can contact us through the contact link on our website. That’s a great way to e-mail us.

Also, we have a voice mail line at 619-866-4775 that you can call and leave us a message. We have a fun segment that I like a lot. It’s called: “Boob Oops” and it’s where we share our funny, breastfeeding and pumping stories that have happened to us in the past that we all like to laugh at after the fact not during the fact usually. But it’s fun to kind of reflect on that kind of stuff. If you have anything like that-that you can submit again through the website or contact us via voice mail.

Throughout our recording today, I’m going to be posting pictures on Instagram – some of the behind the scene stuff from our show. So if you ever wonder what I look like or Leilani’s look like, go ahead and check that out. It’s the New Mommy Media profile on instagram.

LEILANI WILDE: Today on our studio, we have two panelists. Welcome. You may introduce yourself.

CHARLOTTE JERVIS: My name is Charlotte Jervis. I’m 35 years old.

LEILANI WILDE: Right.

AMANDA ELMORE: I am Amanda. I’m 34. I’m a civil engineer and I have one son who’s 12 months old.

LEILANI WILDE: Welcome.

[Theme Music]

SUNNY GAULT: Okay. So before we get started with today’s show, we have an app that we want to talk about. This app is produced by a company called Iodine. It’s called Start and it is free on iPhone and iPad and it was just released. This app is designed to let you know if your medication is working by tracking the results that you’re entering into the app.

So for example, when you first login to the app, it will ask you about the type of anti-depressant that you are currently taking. It will ask you about the dosage and it will ask you some simple questions about what you’re trying to accomplish with this medicine. Are you feeling depressed about this? You’re not wanting people to touch you. What exactly is your situation?

Then it will basically remind you every couple of days and it will ask you some of these questions: “How are you feeling about this?” Rate this one to five. It will go through a series like that. It tracks all of the results and then after six weeks, this app is design to help you, try to figure out if this medication is working for you or not. If you go back and talk about it with your doctor perhaps adjust the dosage a little bit.

So it’s a way to gauge on a regular basis whether or not you think this medication is working for you. So I wanted to get some feedback from the ladies here on the studio. What do you think about something like this whether or not you had to use any kind of medication for post partum depression, what do you think? Charlotte, let’s start with you.

CHARLOTTE JERVIS: It’s definitely worth a try. I was fortunate enough to not really have any issues on my third child. My second child though, I had pretty bad postpartum depression and I did get put on Prozac. I remained on it for about six months and just kind of wean myself off because I felt better.

SUNNY GAULT: Okay.

CHARLOTTE JERVIS: But really, you start to wonder: “Is it a placebo effect? Do I really need it?”

SUNNY GAULT: Right.

CHARLOTTE JERVIS: Who knows? I’ll never know but it seemed to work and I was able to look at myself off of meds. But it’s definitely something that I think it’s maybe working. It might help out a little bit.

SUNNY GAULT: Right.

CHARLOTTE JERVIS: So it’s like: “Well, I think right now, there is a little playing on.”

SUNNY GAULT: Sure. Okay, great. Amanda, what do you think?

AMANDA ELMORE: I never had any issues with depression. So I would say that: “I don’t really have much experience with taking out anti depressants.” But since I’m the type of person that has a tend to take medications, it would be nice to actually track it and see if it’s actually beneficial or something I really shouldn’t be taking.

SUNNY GAULT: Yes, Leilani?

LEILANI WILDE: I also think that it could be a really good option for a lot of moms. I do work in the postpartum field with moms dealing with the day-to-day stress and the hormones. A lot of moms are sleep deprived and they’re functioning on different levels. So a reminder app like this would be super helpful. I think it would be great.

SUNNY GAULT: Okay, well we’re going to put some more information on our website as well as a link to download it for free and check it out.

[Theme Music]

LEILANI WILDE: Today on The Boob Group, we’re discussing breastfeeding after surgery. Our expert Dr. Capetanakis is with us today. He’s an OBGYN in San Diego, California. Thank you for joining us Dr. Cap and welcome to the show.

NICK CAPETANAKIS: Thank you very much for having me.

LEILANI WILDE: So Dr. Cap, is breastfeeding after anesthesia and surgery safe?

NICK CAPETANAKIS: It’s a great question. It’s a topic of discussion that we always have with the anesthesiologist especially when a patient needs something emergent. If we’re talking about something elective that can be postponed till after breastfeeding is done, it’s probably always safer to not take the risk. However if there is some emergency situation where something needs to be performed and mom is still breastfeeding then we always have that discussion with the mom about the medications used.

The medication that we always try to use during situation where a mom is breastfeeding are the older medications that have been around for a while that we feel more safe using. There are two different kinds of medications. The first one that we usually use to start the procedure, the medication called: “Propofol.” Propofol is an injectible medicine with a very short half life. So the medication comes off very quickly when you turn off the Propofol adrift patients can be awake within a few minutes and that’s how quickly the body processes it.

So there isn’t a big concern with Propofol as far as breastfeeding is concerned. It really is in a big concern with the inhaled anesthetic. So if you need a longer procedure and you need to go to sleep for a longer time and you need what we call: “gas” to be use to keep you asleep, those medications also come up very quickly. So when we’ve had discussions with the anesthesiologist, within an hour or two, most of those anesthetic medicines are gone.

So the CUR recommendation from the anesthesiologist that I have talked with is that: “Usually, they would ask the patient to pump and dump that first time after they’ve woken up. But from then on out, they are okay to see because all the medications has been processed.” Even that first one because of medications comes off very quickly, some people are even recommended that you don’t even need to dump that first time after-after feedings because the medications comes off extremely quick.

The concern for medication is really when it comes to pain medicine because a pain medicine is usually something that we want to last a little bit longer. So there’s a little bit of concern about that getting into the breast milk. But all of the studies have shown that it’s still safe to use and if there is anything, it’s very negligible as far as how much it gets to the breast milk.

LEILANI WILDE: You know that a lot of moms are being to seize breastfeeding for 24 hours and a couple of our panelists in here have had surgery. Amanda, can you tell us what kind of surgery you had while you’re breastfeeding?

AMANDA ELMORE: Sure. I had the craniotomy where I had an osteoma removed from my skull. That was kind of a long surgery probably about four to six hours and then I had to spent the night in the ICU.

LEILANI WILDE: Okay. Were you told to pump and dump for any length of time? I’ve got a lot of different advice from doctors, nurses and anesthesiologist. Doctors didn’t really tell me much. They wanted to defer the other people. The nurses were a little bit more conservative or tell me to pump and dump up to several days. Then, I think I’ve got the best info from anesthesiologist to actually told me: “He thought that it would be completely safe from me to use the milk after surgery that I wouldn’t have to dump.” I could if I want to be conservative but he said: “He didn’t think it was necessary.”

NICK CAPETANAKIS: There’s definitely length of procedure with make an intuitive sense that if you’re under for a longer time and you’re exposed to more of the inhaled anesthetics does that accumulates – we don’t think so kind of what the anesthesiologist had said that: “Maybe that comes off quickly and you don’t necessarily need to wait 24 hours.” They are concerns for cumulative effects.

Remember the procedure of that nature. You’ll probably getting antibiotics. You’ll probably getting the Propofol. You’re getting inhaled the anesthetics. You’re getting pain medications. You may be getting some Versed or some Valium which further kind of have a central nervous system effect which may stay on a little bit longer. All these medications though are not necessarily going to accumulate in fat soluble matter of the breast milk to large quantities.

So I think when people say: “Hey. You should take 24 hours.” That’s really ultra conservative from all of the anesthesiologist and the papers that I have read. I think currently The Society of Anesthesiologist that they don’t really have a recommendation as far as breastfeeding is concerned that I’m aware of. So as a whole group, The Society of Anesthesia really doesn’t have a stand.

So you can understand have varied the recommendations were behind when your own somewhat governing body hasn’t really come out with a paper that has said: “Hey tell patients it’s two hours. Tell patients it’s three hours” because it’s so very non procedures and what are the medications you get. I think they are a little bit gun-shy to say anything. It’s more of a blanket statement.

LEILANI WILDE: how about you Char, what was your experience? What kind of surgery did you face?

CHARLOTTE JERVIS: I have my appendix remove when my son was three months old. They had initially told me 24 hours after the CAT Scan that I would need to pump and dump. Once we found out exactly what was going on and my appendix have actually ruptured at that point, they were telling me 48 hours that I would have to pump and dump. So that was pretty devastating.

LEILANI WILDE: Okay. When we come back, we will discuss with Dr. Cap what we need to know about how anesthesia passes through breast milk and if we need to pump and dump. We would be right back.

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[Theme Music]

LEILANI WILDE: Welcome back to the show. We are here with Dr. Cap an OBGYN discussing: “Breastfeeding After Surgery.” Dr. Cap, can you tell us more about how anesthesia passes through the breast milk?

NICK CAPETANAKIS: Sure. There are various types of anesthetics. There are anesthetics that are through the IV and metabolize quickly through the liver. One of the major ones that we use is again a medicine called: “Propofol” the half life is several minutes. So if you do get a dose, you will process it very quickly. It is not for my understanding of fat-soluble medication so it should not accumulate in the breast milk. Because it comes down quickly, it also leaves the body quickly. So from a breastfeeding concern where it feel a little bit more comfortable with patients starting breastfeeding, earlier than a 24 hour mark that has kind of been out there and have been told the patients.

The other medications are: “The inhaled anesthetics or the gasses.” Those are processed in the lungs and those are also blowing off pretty quickly. Whenever we turn off the anesthetics, patients wake up very quickly. So they’re metabolize in the lungs and should not have effect or accumulation in the breast milk especially in cases that are shorter if you need your appendix removed or gallbladder or something of that nature.

There are some theories that maybe over the longer procedures that it can accumulate more. However the anesthesiologist that I’ve talked with feel that because it comes out so quickly that it’s really not going to metabolize or have the time to enter into the breast milk to the levels that would be a substantial concern.

LEILANI WILDE: Does it matter how old the baby is when the mom has surgery?

NICK CAPATANAKIS: Yes, that’s a great question. You know there are some spots that babies are exclusively breastfed. If they’re younger maybe they would then have a harder time to process some of the medications that are given or may have more of an effect. The thought is with some of the pain medications that are needed after surgery that they are probably trace amounts I get through the breast milk and then may pass on to the newborn.

It makes intuitive sense that if a baby was smaller, that maybe it would affect them more than a baby that was larger in size or older. I can’t say that I had seen a lot of papers. I think it’s more intuitive but there are some concerns from some of the anesthesiologist if you are exclusively breastfeeding a one-month old that maybe the pain medication may have more of effect than a 12 month old.

LEILANI WILDE: Well, what about the babies that are actually going under procedure themselves and they have anesthesia? I mean right? That’s in their body and their breastfeeding. I know it’s not transfer to but it’s still in their system. To me, when I think about that I wonder how moms are or doctors or anesthesiologist are actually applying that kind of information when it’s considered – there’s a minimal amount that passes through breast milk versus if a baby was directly receiving anesthesia itself. Does it make sense? Do you know what I’m saying?

NICK CAPETANAKIS: It doesn’t really make sense that you’re always worried about exposure. So you’re worried about: “Do we need to do the procedure? How long is the procedure?” If the baby obviously needs surgery, you’re going to do whatever’s needed for that baby. You’re not doing it cosmetic-wise. You’re doing it for an emergency basis. So all bets are off to see at that point because you’re just really thinking about solely the patient.

So that changes the situation a little bit but maybe they do need surgery obviously are getting anesthetics. Then they are a breastfeeding afterwards because mom hasn’t been exposed to anything. So you’re right. If there was truly a major concern I think then that concern will be brought up in pediatric surgery and I’m not too aware of anything from that standpoint.

LEILANI WILDE: Char, I know your experience, you had a little bit of a battle in regards to being able to breastfed, they had recommended originally that you needed to wait 24 hours with after having the CAT Scan, is that right?

CHARLOTTE JERVIS: Yes. 24 hours and then it got extended to 48 hours once they found out the appendix have actually ruptured.

LEILANI WILDE: What did you actually end up doing?

CHARLOTTE JERVIS: I chose to not listen to them. I did my own research. I ask around that a lot. I just decided. My husband and I decided for ourselves that: “For us, we were comfortable with me just to presume nursing as soon as I woke up – just pumping the entire time that I was in the hospital for three days.” He would just pick up the milk and my son never – I mean the only other option for us was the formula.

That to me was more devastating than pumping and dumping. I felt comfortable nursing right away from all the research that I had done personally.

LEILANI WILDE: Did you have any conflict with the staff at the hospital in regards to that?

CHARLOTTE JERVIS: The emergency room definitely I think kind of try to persuade me to not nurse him right after. But when all was said and done, the doctor that I had was absolutely amazing and he prognosis is up to me. It was my choice and if that’s what I decided. He got me the pump. He got me everything I needed for the three days that I was there. He was pretty much on board.

LEILANI WILDE: Did you have any problems getting your baby to take a bottle if you’ve been breastfeeding?

CHARLOTTE JERVIS: No, I actually kind of the reverse on that. My son took a bottle from day one. We would nurse and then of course, I would pump so my husband could feed him. The three days spent in the hospital – of course, he took a bottle because he was my husband the whole time for the most part. Then as soon as I got home, he as of now has never taken another one. So I think traumatized him honestly but he still likes breastfeeding. He loves to nurse even almost two years later.

LEILANI WILDE: Well good. That’s good. Well, how about you Amanda? What did you do have to deal with?

AMANDA ELMORE: Well, I knew that I was going to have the surgery for a while. So I started pumping beforehand so I have a stock of milk because I wasn’t sure how many days I was going to be away and I found out that I wouldn’t be able to bring baby into the hospital at all. So I couldn’t bring him in to nurse or visit or anything.

I think the hardest part of me was that the nurses and people working there was just weren’t used to seeing anybody breastfeeding. So it would be open the curtain and pumping. You would be very freaked out about it which I thought was bizarre. I’m sure they see worst things than that. So that was a little bit of an issue and then flagging somebody down to bring in the ice so my milk would be able to be stored properly until somebody could take it home.

Those were kind of my biggest issues there. Nobody was really questioning what I was doing with the milk or wondering.

LEILANI WILDE: Did you feel like you couldn’t tell them that you are going to be giving that to your baby?

AMANDA ELMORE: I think they assume that I was because of the packaging it up because if I’m going to dump it, why pour it to a bag and label it and do all of these things that I was doing. Nobody really question that much and I thought: “They don’t care. That’s none of their business.” But I didn’t get a lot of advice like I said unless I would specifically ask somebody. Like you I did my own research and I felt really comfortable of giving baby milk right away and much more comfortable of giving the formula.

LEILANI WILDE: Didn’t give him the formula.

AMANDA ELMORE: Correct, right. I was at ease with my decision for sure.

LEILANI WILDE: Good. Then, how about for your baby taking a bottle, was that an issue for you guys?

AMANDA ELMORE: I was very worried about that because he would never take a bottle. I thought he was going to starve to death while I’m gone. Of course when I’m gone, he isn’t sucking them bottles like a champ. I actually had to tell my sister to calm down. There’s only so much milk and teach her a little bit about paced feeding.

But when I’m in the room, he won’t have anything to do with a bottle but I guess if I’m not there, it’s the next best thing. So he did great.

LEILANI WILDE: Wonderful.

AMANDA ELMORE: Yes.

LEILANI WILDE: Dr. Cap, when is it necessary to pump and dump after surgery?

NICK CAPETANAKIS: Again, it all depends on the medications that you get. There are some medications that probably have a little bit of the longer half life. So some anesthesiologists will tell you to: “Pump and dump whatever several half life’s are that hopefully that-that medications all the way out of your system.” But again, most anesthesiologists now especially in my hospital are telling patients that: “Once you’ve woken up with an hour or so, all the inhaled anesthetics should be off.”

So if you wake up and then pump that first one and then feed after that, they feel comfortable that-that the medications that they had used have all left the system. But again, it’s all anesthesia-dependent what’s given and things of that major. So there is some variation to different cocktails that anesthesiologist use to help keep patients anesthetized if you will.

So it always depends on that conversation with your anesthesiologist. But most that I have spoken with again say: “Either within a couple of hours maybe just pump and dump that first one and then you should be fine from that perspective.”

LEILANI WILDE: Okay. Can you explain to our audience what half life means for those that don’t understand that?

NICK CAPETANAKIS: Sure. Every medication takes a certain amount of time to be metabolized in the system. They are medications that take minutes. So we use a terminology of half life. There is a curve that corresponds to every medication that basically tells you half that medication is out of your system. Let’s say five minutes. So in five minutes, half of the medication is gone and then another five minutes, another half is gone. It quickly dissipates let’s say from your body.

So depending on what medications are given. Every medication whether it’s Tylenols or Motrin or pain medication, they all are metabolized in different rate and by different organs in the body. Some of them are metabolize much quicker than others which means: “Your body will process them and they will be out of your system quicker than other medications.” Most of the anesthetic medications come on quickly. You go to sleep fast and then you also wake up fast – which means that your body is very capable of processing in a very, very fast rate. Meaning that the half life is probably several minutes on it, it’s not something that’s going to stay around for hours per say.

LEILANI WILDE: You mention metabolizing as far as the BMI of the patient, does it make a difference in regards to that as far as metabolizing or is it just a case-by-case on the medication itself not necessarily the BMI?

NICK CAPETANAKIS: Yes, it’s usually case-by-case but I would say that BMI does have some effect in an equation but because this falls on a more of an anesthesiologist question, I’m not really 100% sure on which medications have more of an effect if the BMI is higher or lower and will take more time to process it. I guess I would be a medication-by-medication basis.

LEILANI WILDE: Most doctors or anesthesiologist choose their medication or their anesthesia according to whether or not mom’s breastfeeding or is it kind of a standard across the board medication that everything is the same whether you’re breastfeeding or not?

NICK CAPETANAKIS: Yes, whenever somebody is breastfeeding, they do try to stay away from medications that are going to stay in the system longer sometimes you were said Valium, some of those medications will stay a little bit longer than other medications. So breastfeeding does play a factor as far as what the anesthesiologist feels comfortable with.

Most anesthesiologists have their favorites as far as what medications they were trained with and feel more comfortable with. Any time you have anesthesia, it’s always good to have that discussion with your anesthesiologist. I mean we’ve done several procedures on moms who have been breastfeeding and have used very little anesthetic in between the comfort level of your surgeon and the comfort level of being anesthesiologist. Keeping you asleep for just enough time versus trying to get you to sleep earlier and then do procedures or things that it could be done while you’re still awake if that make some any sense, trying to minimize the exposure if you will.

LEILANI WILDE: Good. Amanda, can you tell us if you felt like your doctors or surgeons or even the anesthesiologist had any information ahead of time before your surgery or did you really feel that you’ve had to this all on your own?

AMANDA ELMORE: Mostly on my own, nurses especially were not aware that I was breastfeeding. The doctors knew but I’m not sure that-that was a big concern for them. They didn’t talk about it much or give me much advice. I believe that the anesthesiologist knew ahead of time which was nice. I think the doctor really adapt to them. But no, because I had to keep bringing it up and reminding people that I needed to be accommodated or I would like people be aware of the fact that I was breastfeeding and didn’t want the extra medications or treatments that weren’t absolutely necessary.

LEILANI WILDE: Okay. How about your family? Your husband, was he really supportive in the fact that you wanted to nurse as soon as you could, as soon as you woke up from the surgery or was that something that you had to kind of convince him?

AMANDA ELMORE: He needed a little convincing but he knows I’m the type to really research the heck of kind of anything and everything. So he was comfortable once I had kind of showed him a little bit of the research that I had done and told him what the anesthesiologist and I had talked about. He became more comfortable with me giving baby the milk after surgery.

LEILANI WILDE: Okay, good. How about you Charlotte?

CHARLOTTE JERVIS: Kind of the same. The doctors and nurses never really brought – I mean they never brought it out to much other than when I would make it a point to: “Hey. What I’m supposed to do now?” Of course, I’m clueless. It all happened very quickly. As soon as I had the CAT Scan – that’s when they kind of put the brakes on and we’re just like: “Wait. You can’t nurse your baby yet.” I was just like: “Why can’t I?” They explain to me 24 hours pump and dump.

That’s when I kind of backed off and I was like: “Well, we know it’s my appendix. Let’s just forget about it right now. I’ll deal with the pain whatever.” But then it had ruptured so I kind of didn’t have an option at that point. But, I think they kind of fought me a little bit more on that emergency room. I’m not sure if it was more-or-less they just wanted. They didn’t want the complex. They were like: “This is what we’re telling you. This is just what you need to follow.”

But once I’ve got out of the emergency room, it was a lot easier. They just pretty much: “Well, what do you want to do? What do you need from us?” It seemed like they are a lot more educated as far as what I was able to do and not just doing what I was told to do. So it made a huge difference.

LEILANI WILDE: That’s good. What about your husband, did you feel he was onboard from the beginning?

CHARLOTTE JERVIS: He was like me. We were very clueless. Once we started researching it and actually called you, once we were told: “You’re fine.” When you wake up, just nurse your baby. You’re completely fine. Do not dump that milk.” He was like: “Okay. We’re fine. If Leilani said it then we’re good. We’re good with this.” I think that was really the only reassurance he needed. Well, good.

LEILANI WILDE: Well, good. I’m glad that I could be of help.

AMANDA ELMORE: I had follow-up comment too. I had a second surgery six weeks ago at the follow-up surgery and that was an outpatient. So I didn’t spend the night and my doctor sent me home with the prescriptions. So I went to fill them and it was an antibiotic and a steroid. The pharmacist told me that: “Both of those – I should not be breastfeeding if I took them.” They were like couple of weeks long.

So instead of just taking them or I talk to my doctor the next day and I said: “How necessary is this because you know I was breastfeeding.” He’s like: “They’re just preemptive in case you get infection or to help you heal quicker.” So I kind of talked him out of having me take those medications. Sometimes it’s really good to question all of these extra medications that might be associated with the surgery. I didn’t have any complications.

LEILANI WILDE: Excellent. Being an advocate as a mom and a new parent in general or a parent anyways, it’s important to stand-up for what you believe and what you think and following your instincts and doing your own research you are your best advocate, right? You want to do what’s best for you and your baby. Yes.

Thank you so much Dr. Cap and the panelists for sharing your knowledge and experience with us after surgery. For our Boob Group Club members, our conversation will continue after the end of the show as Dr. Cap will give us tips on how we should use pain medication after surgery. For more information of our Boob Group Club, please visit our website at www.NewMommyMedia.com.

[Theme Music]

SUNNY GAULT: Okay, it’s time for our fun segment on the show called: “Mama Hacks” and it’s where you guys are able to share your hacks that you have discovered in breastfeeding and pumping for your babies. So we posted some stuff on Facebook and we got some responses and I thought some of these are really good so I thought Leilani and I could kind of just chit-chat about them a little bit.

This first one comes from Veronica King and Veronica writes:

“Her hack is to keep a nipple shield from falling off wear sports bra with holes cut around the nipples and put the nipple shield on under it and then you can do the same for a make-shift pumping bra.”

So Leilani, what do you think about that hack that she discovered?

LEILANI WILDE: Well, actually in regards to the pumping bra, actually I tell my clients to that a lot because if they don’t have a hands-free bra – I always say: “Do you have an old sports bra?” Because let’s cover and I’ll do it right there on the spot so they have free access to double pumping when they need to.

SUNNY GAULT: Okay.

LEILANI WILDE: As a nipple shield, I’ve actually never thought about that.

SUNNY GAULT: Yes, I know.

LEILANI WILDE: Do you know what? I think too because when people use a nipple shield, they should be using it to get the nipple to come through to the nipple shield closer to the end and not just set it on right there and that’s what some people think that’s how it’s used. Just set it there and it will do its job.

SUNNY GAULT: Right.

LEILANI WILDE: I don’t know if that would work in necessarily for the nipple shield but what an interesting idea.

SUNNY GAULT: I could try it and see it if it works. So Veronica thanks so much for sending this in.

[Theme Music]

LEILANI WILDE: That wraps up our show for today. We appreciate you listening to The Boob Group.
Don’t forget to check out our sister shows:
• Preggie Pals for expecting parents
• Newbies for postpartum moms during baby’s first year
• Parent Savers for moms and dads with newborns, infants and toddlers
• Twin Talks, for our show with parents of multiples.

Thanks for listening to The Boob Group: “Your judgment-free breastfeeding resource.”

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This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

SUNNY GAULT: New Mommy Media is expanding our line up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or organization interested in joining our network of shows through a co-branded podcast, visit www.NewMommyMedia.com.

[00:35:03]

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Episode Transcript

The Boob Group
Breastfeeding After Surgery and Anesthesia

[00:00:00]

Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

SUNNY GAULT: This episode of The Boob Group is brought to you by Rumina Nursingwear. Hands-free pumping and nursing tanks and bras to support your breastfeeding goals. Visit www.pumpandnurse.com and save 20% with promo code BOOBGROUP20.

[Theme Music]

LEILANI WILDE: Are you a breastfeeding mom facing surgery with anesthesia? Have you been told that you need to pump and dump before resuming breastfeeding again? Maybe you are postponing your surgery because you do not want to interrupt your breastfeeding relationship with your child? We are here with Dr. Capetanakis, an obstetrician with a private practice in San Diego. Today, we’re talking about: “Breastfeeding after surgery.” This is the Boob Group.

[Intro/Theme Music]

LEILANI WILDE: Welcome to The Boob Group, broadcasting from the Birth Education Center of San Diego. The Boob Group is your online, on the go support group for all things related to breastfeeding. I'm your host, Leilani Wilde; I'm also an IBCLC and owner of Leilani’s Lactation and Doula Services.

If this is your first time listening to The Boob Group, welcome. If you’re a regular listener, thanks so much for your continued support. If you’d like to listen to Boob Group on-the-go then please check out our New Mommy Media Network App where you can listen to all the podcast on our network including The Boob Group. If you’d like to be notified of our new episodes released each week then head to our website at www.NewMommyMedia.com and subscribe to our newsletter. There are lots of fun ways to get involve with The Boob Group. Here’s Sunny with more information.

SUNNY GAULT: All right, hey everybody and thanks for listening to The Boob Group today. We love hearing from our listeners. So if you are a listener of this podcast, we would love to get some feedback from you and how we are doing. If you love the show, tell us that. If there’s something you think the show needs, tell us that too. We’ll read your comments on the show.

Also, we have some fun segments you may want to participate in. We have an: “Ask the Expert” segment which actually our expert Dr. Cap is part off. If you guys have breastfeeding questions that you want some answers too or could be really about anything and parenting, go ahead. You can contact us through the contact link on our website. That’s a great way to e-mail us.

Also, we have a voice mail line at 619-866-4775 that you can call and leave us a message. We have a fun segment that I like a lot. It’s called: “Boob Oops” and it’s where we share our funny, breastfeeding and pumping stories that have happened to us in the past that we all like to laugh at after the fact not during the fact usually. But it’s fun to kind of reflect on that kind of stuff. If you have anything like that-that you can submit again through the website or contact us via voice mail.

Throughout our recording today, I’m going to be posting pictures on Instagram – some of the behind the scene stuff from our show. So if you ever wonder what I look like or Leilani’s look like, go ahead and check that out. It’s the New Mommy Media profile on instagram.

LEILANI WILDE: Today on our studio, we have two panelists. Welcome. You may introduce yourself.

CHARLOTTE JERVIS: My name is Charlotte Jervis. I’m 35 years old.

LEILANI WILDE: Right.

AMANDA ELMORE: I am Amanda. I’m 34. I’m a civil engineer and I have one son who’s 12 months old.

LEILANI WILDE: Welcome.

[Theme Music]

SUNNY GAULT: Okay. So before we get started with today’s show, we have an app that we want to talk about. This app is produced by a company called Iodine. It’s called Start and it is free on iPhone and iPad and it was just released. This app is designed to let you know if your medication is working by tracking the results that you’re entering into the app.

So for example, when you first login to the app, it will ask you about the type of anti-depressant that you are currently taking. It will ask you about the dosage and it will ask you some simple questions about what you’re trying to accomplish with this medicine. Are you feeling depressed about this? You’re not wanting people to touch you. What exactly is your situation?

Then it will basically remind you every couple of days and it will ask you some of these questions: “How are you feeling about this?” Rate this one to five. It will go through a series like that. It tracks all of the results and then after six weeks, this app is design to help you, try to figure out if this medication is working for you or not. If you go back and talk about it with your doctor perhaps adjust the dosage a little bit.

So it’s a way to gauge on a regular basis whether or not you think this medication is working for you. So I wanted to get some feedback from the ladies here on the studio. What do you think about something like this whether or not you had to use any kind of medication for post partum depression, what do you think? Charlotte, let’s start with you.

CHARLOTTE JERVIS: It’s definitely worth a try. I was fortunate enough to not really have any issues on my third child. My second child though, I had pretty bad postpartum depression and I did get put on Prozac. I remained on it for about six months and just kind of wean myself off because I felt better.

SUNNY GAULT: Okay.

CHARLOTTE JERVIS: But really, you start to wonder: “Is it a placebo effect? Do I really need it?”

SUNNY GAULT: Right.

CHARLOTTE JERVIS: Who knows? I’ll never know but it seemed to work and I was able to look at myself off of meds. But it’s definitely something that I think it’s maybe working. It might help out a little bit.

SUNNY GAULT: Right.

CHARLOTTE JERVIS: So it’s like: “Well, I think right now, there is a little playing on.”

SUNNY GAULT: Sure. Okay, great. Amanda, what do you think?

AMANDA ELMORE: I never had any issues with depression. So I would say that: “I don’t really have much experience with taking out anti depressants.” But since I’m the type of person that has a tend to take medications, it would be nice to actually track it and see if it’s actually beneficial or something I really shouldn’t be taking.

SUNNY GAULT: Yes, Leilani?

LEILANI WILDE: I also think that it could be a really good option for a lot of moms. I do work in the postpartum field with moms dealing with the day-to-day stress and the hormones. A lot of moms are sleep deprived and they’re functioning on different levels. So a reminder app like this would be super helpful. I think it would be great.

SUNNY GAULT: Okay, well we’re going to put some more information on our website as well as a link to download it for free and check it out.

[Theme Music]

LEILANI WILDE: Today on The Boob Group, we’re discussing breastfeeding after surgery. Our expert Dr. Capetanakis is with us today. He’s an OBGYN in San Diego, California. Thank you for joining us Dr. Cap and welcome to the show.

NICK CAPETANAKIS: Thank you very much for having me.

LEILANI WILDE: So Dr. Cap, is breastfeeding after anesthesia and surgery safe?

NICK CAPETANAKIS: It’s a great question. It’s a topic of discussion that we always have with the anesthesiologist especially when a patient needs something emergent. If we’re talking about something elective that can be postponed till after breastfeeding is done, it’s probably always safer to not take the risk. However if there is some emergency situation where something needs to be performed and mom is still breastfeeding then we always have that discussion with the mom about the medications used.

The medication that we always try to use during situation where a mom is breastfeeding are the older medications that have been around for a while that we feel more safe using. There are two different kinds of medications. The first one that we usually use to start the procedure, the medication called: “Propofol.” Propofol is an injectible medicine with a very short half life. So the medication comes off very quickly when you turn off the Propofol adrift patients can be awake within a few minutes and that’s how quickly the body processes it.

So there isn’t a big concern with Propofol as far as breastfeeding is concerned. It really is in a big concern with the inhaled anesthetic. So if you need a longer procedure and you need to go to sleep for a longer time and you need what we call: “gas” to be use to keep you asleep, those medications also come up very quickly. So when we’ve had discussions with the anesthesiologist, within an hour or two, most of those anesthetic medicines are gone.

So the CUR recommendation from the anesthesiologist that I have talked with is that: “Usually, they would ask the patient to pump and dump that first time after they’ve woken up. But from then on out, they are okay to see because all the medications has been processed.” Even that first one because of medications comes off very quickly, some people are even recommended that you don’t even need to dump that first time after-after feedings because the medications comes off extremely quick.

The concern for medication is really when it comes to pain medicine because a pain medicine is usually something that we want to last a little bit longer. So there’s a little bit of concern about that getting into the breast milk. But all of the studies have shown that it’s still safe to use and if there is anything, it’s very negligible as far as how much it gets to the breast milk.

LEILANI WILDE: You know that a lot of moms are being to seize breastfeeding for 24 hours and a couple of our panelists in here have had surgery. Amanda, can you tell us what kind of surgery you had while you’re breastfeeding?

AMANDA ELMORE: Sure. I had the craniotomy where I had an osteoma removed from my skull. That was kind of a long surgery probably about four to six hours and then I had to spent the night in the ICU.

LEILANI WILDE: Okay. Were you told to pump and dump for any length of time? I’ve got a lot of different advice from doctors, nurses and anesthesiologist. Doctors didn’t really tell me much. They wanted to defer the other people. The nurses were a little bit more conservative or tell me to pump and dump up to several days. Then, I think I’ve got the best info from anesthesiologist to actually told me: “He thought that it would be completely safe from me to use the milk after surgery that I wouldn’t have to dump.” I could if I want to be conservative but he said: “He didn’t think it was necessary.”

NICK CAPETANAKIS: There’s definitely length of procedure with make an intuitive sense that if you’re under for a longer time and you’re exposed to more of the inhaled anesthetics does that accumulates – we don’t think so kind of what the anesthesiologist had said that: “Maybe that comes off quickly and you don’t necessarily need to wait 24 hours.” They are concerns for cumulative effects.

Remember the procedure of that nature. You’ll probably getting antibiotics. You’ll probably getting the Propofol. You’re getting inhaled the anesthetics. You’re getting pain medications. You may be getting some Versed or some Valium which further kind of have a central nervous system effect which may stay on a little bit longer. All these medications though are not necessarily going to accumulate in fat soluble matter of the breast milk to large quantities.

So I think when people say: “Hey. You should take 24 hours.” That’s really ultra conservative from all of the anesthesiologist and the papers that I have read. I think currently The Society of Anesthesiologist that they don’t really have a recommendation as far as breastfeeding is concerned that I’m aware of. So as a whole group, The Society of Anesthesia really doesn’t have a stand.

So you can understand have varied the recommendations were behind when your own somewhat governing body hasn’t really come out with a paper that has said: “Hey tell patients it’s two hours. Tell patients it’s three hours” because it’s so very non procedures and what are the medications you get. I think they are a little bit gun-shy to say anything. It’s more of a blanket statement.

LEILANI WILDE: how about you Char, what was your experience? What kind of surgery did you face?

CHARLOTTE JERVIS: I have my appendix remove when my son was three months old. They had initially told me 24 hours after the CAT Scan that I would need to pump and dump. Once we found out exactly what was going on and my appendix have actually ruptured at that point, they were telling me 48 hours that I would have to pump and dump. So that was pretty devastating.

LEILANI WILDE: Okay. When we come back, we will discuss with Dr. Cap what we need to know about how anesthesia passes through breast milk and if we need to pump and dump. We would be right back.

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[Theme Music]

LEILANI WILDE: Welcome back to the show. We are here with Dr. Cap an OBGYN discussing: “Breastfeeding After Surgery.” Dr. Cap, can you tell us more about how anesthesia passes through the breast milk?

NICK CAPETANAKIS: Sure. There are various types of anesthetics. There are anesthetics that are through the IV and metabolize quickly through the liver. One of the major ones that we use is again a medicine called: “Propofol” the half life is several minutes. So if you do get a dose, you will process it very quickly. It is not for my understanding of fat-soluble medication so it should not accumulate in the breast milk. Because it comes down quickly, it also leaves the body quickly. So from a breastfeeding concern where it feel a little bit more comfortable with patients starting breastfeeding, earlier than a 24 hour mark that has kind of been out there and have been told the patients.

The other medications are: “The inhaled anesthetics or the gasses.” Those are processed in the lungs and those are also blowing off pretty quickly. Whenever we turn off the anesthetics, patients wake up very quickly. So they’re metabolize in the lungs and should not have effect or accumulation in the breast milk especially in cases that are shorter if you need your appendix removed or gallbladder or something of that nature.

There are some theories that maybe over the longer procedures that it can accumulate more. However the anesthesiologist that I’ve talked with feel that because it comes out so quickly that it’s really not going to metabolize or have the time to enter into the breast milk to the levels that would be a substantial concern.

LEILANI WILDE: Does it matter how old the baby is when the mom has surgery?

NICK CAPATANAKIS: Yes, that’s a great question. You know there are some spots that babies are exclusively breastfed. If they’re younger maybe they would then have a harder time to process some of the medications that are given or may have more of an effect. The thought is with some of the pain medications that are needed after surgery that they are probably trace amounts I get through the breast milk and then may pass on to the newborn.

It makes intuitive sense that if a baby was smaller, that maybe it would affect them more than a baby that was larger in size or older. I can’t say that I had seen a lot of papers. I think it’s more intuitive but there are some concerns from some of the anesthesiologist if you are exclusively breastfeeding a one-month old that maybe the pain medication may have more of effect than a 12 month old.

LEILANI WILDE: Well, what about the babies that are actually going under procedure themselves and they have anesthesia? I mean right? That’s in their body and their breastfeeding. I know it’s not transfer to but it’s still in their system. To me, when I think about that I wonder how moms are or doctors or anesthesiologist are actually applying that kind of information when it’s considered – there’s a minimal amount that passes through breast milk versus if a baby was directly receiving anesthesia itself. Does it make sense? Do you know what I’m saying?

NICK CAPETANAKIS: It doesn’t really make sense that you’re always worried about exposure. So you’re worried about: “Do we need to do the procedure? How long is the procedure?” If the baby obviously needs surgery, you’re going to do whatever’s needed for that baby. You’re not doing it cosmetic-wise. You’re doing it for an emergency basis. So all bets are off to see at that point because you’re just really thinking about solely the patient.

So that changes the situation a little bit but maybe they do need surgery obviously are getting anesthetics. Then they are a breastfeeding afterwards because mom hasn’t been exposed to anything. So you’re right. If there was truly a major concern I think then that concern will be brought up in pediatric surgery and I’m not too aware of anything from that standpoint.

LEILANI WILDE: Char, I know your experience, you had a little bit of a battle in regards to being able to breastfed, they had recommended originally that you needed to wait 24 hours with after having the CAT Scan, is that right?

CHARLOTTE JERVIS: Yes. 24 hours and then it got extended to 48 hours once they found out the appendix have actually ruptured.

LEILANI WILDE: What did you actually end up doing?

CHARLOTTE JERVIS: I chose to not listen to them. I did my own research. I ask around that a lot. I just decided. My husband and I decided for ourselves that: “For us, we were comfortable with me just to presume nursing as soon as I woke up – just pumping the entire time that I was in the hospital for three days.” He would just pick up the milk and my son never – I mean the only other option for us was the formula.

That to me was more devastating than pumping and dumping. I felt comfortable nursing right away from all the research that I had done personally.

LEILANI WILDE: Did you have any conflict with the staff at the hospital in regards to that?

CHARLOTTE JERVIS: The emergency room definitely I think kind of try to persuade me to not nurse him right after. But when all was said and done, the doctor that I had was absolutely amazing and he prognosis is up to me. It was my choice and if that’s what I decided. He got me the pump. He got me everything I needed for the three days that I was there. He was pretty much on board.

LEILANI WILDE: Did you have any problems getting your baby to take a bottle if you’ve been breastfeeding?

CHARLOTTE JERVIS: No, I actually kind of the reverse on that. My son took a bottle from day one. We would nurse and then of course, I would pump so my husband could feed him. The three days spent in the hospital – of course, he took a bottle because he was my husband the whole time for the most part. Then as soon as I got home, he as of now has never taken another one. So I think traumatized him honestly but he still likes breastfeeding. He loves to nurse even almost two years later.

LEILANI WILDE: Well good. That’s good. Well, how about you Amanda? What did you do have to deal with?

AMANDA ELMORE: Well, I knew that I was going to have the surgery for a while. So I started pumping beforehand so I have a stock of milk because I wasn’t sure how many days I was going to be away and I found out that I wouldn’t be able to bring baby into the hospital at all. So I couldn’t bring him in to nurse or visit or anything.

I think the hardest part of me was that the nurses and people working there was just weren’t used to seeing anybody breastfeeding. So it would be open the curtain and pumping. You would be very freaked out about it which I thought was bizarre. I’m sure they see worst things than that. So that was a little bit of an issue and then flagging somebody down to bring in the ice so my milk would be able to be stored properly until somebody could take it home.

Those were kind of my biggest issues there. Nobody was really questioning what I was doing with the milk or wondering.

LEILANI WILDE: Did you feel like you couldn’t tell them that you are going to be giving that to your baby?

AMANDA ELMORE: I think they assume that I was because of the packaging it up because if I’m going to dump it, why pour it to a bag and label it and do all of these things that I was doing. Nobody really question that much and I thought: “They don’t care. That’s none of their business.” But I didn’t get a lot of advice like I said unless I would specifically ask somebody. Like you I did my own research and I felt really comfortable of giving baby milk right away and much more comfortable of giving the formula.

LEILANI WILDE: Didn’t give him the formula.

AMANDA ELMORE: Correct, right. I was at ease with my decision for sure.

LEILANI WILDE: Good. Then, how about for your baby taking a bottle, was that an issue for you guys?

AMANDA ELMORE: I was very worried about that because he would never take a bottle. I thought he was going to starve to death while I’m gone. Of course when I’m gone, he isn’t sucking them bottles like a champ. I actually had to tell my sister to calm down. There’s only so much milk and teach her a little bit about paced feeding.

But when I’m in the room, he won’t have anything to do with a bottle but I guess if I’m not there, it’s the next best thing. So he did great.

LEILANI WILDE: Wonderful.

AMANDA ELMORE: Yes.

LEILANI WILDE: Dr. Cap, when is it necessary to pump and dump after surgery?

NICK CAPETANAKIS: Again, it all depends on the medications that you get. There are some medications that probably have a little bit of the longer half life. So some anesthesiologists will tell you to: “Pump and dump whatever several half life’s are that hopefully that-that medications all the way out of your system.” But again, most anesthesiologists now especially in my hospital are telling patients that: “Once you’ve woken up with an hour or so, all the inhaled anesthetics should be off.”

So if you wake up and then pump that first one and then feed after that, they feel comfortable that-that the medications that they had used have all left the system. But again, it’s all anesthesia-dependent what’s given and things of that major. So there is some variation to different cocktails that anesthesiologist use to help keep patients anesthetized if you will.

So it always depends on that conversation with your anesthesiologist. But most that I have spoken with again say: “Either within a couple of hours maybe just pump and dump that first one and then you should be fine from that perspective.”

LEILANI WILDE: Okay. Can you explain to our audience what half life means for those that don’t understand that?

NICK CAPETANAKIS: Sure. Every medication takes a certain amount of time to be metabolized in the system. They are medications that take minutes. So we use a terminology of half life. There is a curve that corresponds to every medication that basically tells you half that medication is out of your system. Let’s say five minutes. So in five minutes, half of the medication is gone and then another five minutes, another half is gone. It quickly dissipates let’s say from your body.

So depending on what medications are given. Every medication whether it’s Tylenols or Motrin or pain medication, they all are metabolized in different rate and by different organs in the body. Some of them are metabolize much quicker than others which means: “Your body will process them and they will be out of your system quicker than other medications.” Most of the anesthetic medications come on quickly. You go to sleep fast and then you also wake up fast – which means that your body is very capable of processing in a very, very fast rate. Meaning that the half life is probably several minutes on it, it’s not something that’s going to stay around for hours per say.

LEILANI WILDE: You mention metabolizing as far as the BMI of the patient, does it make a difference in regards to that as far as metabolizing or is it just a case-by-case on the medication itself not necessarily the BMI?

NICK CAPETANAKIS: Yes, it’s usually case-by-case but I would say that BMI does have some effect in an equation but because this falls on a more of an anesthesiologist question, I’m not really 100% sure on which medications have more of an effect if the BMI is higher or lower and will take more time to process it. I guess I would be a medication-by-medication basis.

LEILANI WILDE: Most doctors or anesthesiologist choose their medication or their anesthesia according to whether or not mom’s breastfeeding or is it kind of a standard across the board medication that everything is the same whether you’re breastfeeding or not?

NICK CAPETANAKIS: Yes, whenever somebody is breastfeeding, they do try to stay away from medications that are going to stay in the system longer sometimes you were said Valium, some of those medications will stay a little bit longer than other medications. So breastfeeding does play a factor as far as what the anesthesiologist feels comfortable with.

Most anesthesiologists have their favorites as far as what medications they were trained with and feel more comfortable with. Any time you have anesthesia, it’s always good to have that discussion with your anesthesiologist. I mean we’ve done several procedures on moms who have been breastfeeding and have used very little anesthetic in between the comfort level of your surgeon and the comfort level of being anesthesiologist. Keeping you asleep for just enough time versus trying to get you to sleep earlier and then do procedures or things that it could be done while you’re still awake if that make some any sense, trying to minimize the exposure if you will.

LEILANI WILDE: Good. Amanda, can you tell us if you felt like your doctors or surgeons or even the anesthesiologist had any information ahead of time before your surgery or did you really feel that you’ve had to this all on your own?

AMANDA ELMORE: Mostly on my own, nurses especially were not aware that I was breastfeeding. The doctors knew but I’m not sure that-that was a big concern for them. They didn’t talk about it much or give me much advice. I believe that the anesthesiologist knew ahead of time which was nice. I think the doctor really adapt to them. But no, because I had to keep bringing it up and reminding people that I needed to be accommodated or I would like people be aware of the fact that I was breastfeeding and didn’t want the extra medications or treatments that weren’t absolutely necessary.

LEILANI WILDE: Okay. How about your family? Your husband, was he really supportive in the fact that you wanted to nurse as soon as you could, as soon as you woke up from the surgery or was that something that you had to kind of convince him?

AMANDA ELMORE: He needed a little convincing but he knows I’m the type to really research the heck of kind of anything and everything. So he was comfortable once I had kind of showed him a little bit of the research that I had done and told him what the anesthesiologist and I had talked about. He became more comfortable with me giving baby the milk after surgery.

LEILANI WILDE: Okay, good. How about you Charlotte?

CHARLOTTE JERVIS: Kind of the same. The doctors and nurses never really brought – I mean they never brought it out to much other than when I would make it a point to: “Hey. What I’m supposed to do now?” Of course, I’m clueless. It all happened very quickly. As soon as I had the CAT Scan – that’s when they kind of put the brakes on and we’re just like: “Wait. You can’t nurse your baby yet.” I was just like: “Why can’t I?” They explain to me 24 hours pump and dump.

That’s when I kind of backed off and I was like: “Well, we know it’s my appendix. Let’s just forget about it right now. I’ll deal with the pain whatever.” But then it had ruptured so I kind of didn’t have an option at that point. But, I think they kind of fought me a little bit more on that emergency room. I’m not sure if it was more-or-less they just wanted. They didn’t want the complex. They were like: “This is what we’re telling you. This is just what you need to follow.”

But once I’ve got out of the emergency room, it was a lot easier. They just pretty much: “Well, what do you want to do? What do you need from us?” It seemed like they are a lot more educated as far as what I was able to do and not just doing what I was told to do. So it made a huge difference.

LEILANI WILDE: That’s good. What about your husband, did you feel he was onboard from the beginning?

CHARLOTTE JERVIS: He was like me. We were very clueless. Once we started researching it and actually called you, once we were told: “You’re fine.” When you wake up, just nurse your baby. You’re completely fine. Do not dump that milk.” He was like: “Okay. We’re fine. If Leilani said it then we’re good. We’re good with this.” I think that was really the only reassurance he needed. Well, good.

LEILANI WILDE: Well, good. I’m glad that I could be of help.

AMANDA ELMORE: I had follow-up comment too. I had a second surgery six weeks ago at the follow-up surgery and that was an outpatient. So I didn’t spend the night and my doctor sent me home with the prescriptions. So I went to fill them and it was an antibiotic and a steroid. The pharmacist told me that: “Both of those – I should not be breastfeeding if I took them.” They were like couple of weeks long.

So instead of just taking them or I talk to my doctor the next day and I said: “How necessary is this because you know I was breastfeeding.” He’s like: “They’re just preemptive in case you get infection or to help you heal quicker.” So I kind of talked him out of having me take those medications. Sometimes it’s really good to question all of these extra medications that might be associated with the surgery. I didn’t have any complications.

LEILANI WILDE: Excellent. Being an advocate as a mom and a new parent in general or a parent anyways, it’s important to stand-up for what you believe and what you think and following your instincts and doing your own research you are your best advocate, right? You want to do what’s best for you and your baby. Yes.

Thank you so much Dr. Cap and the panelists for sharing your knowledge and experience with us after surgery. For our Boob Group Club members, our conversation will continue after the end of the show as Dr. Cap will give us tips on how we should use pain medication after surgery. For more information of our Boob Group Club, please visit our website at www.NewMommyMedia.com.

[Theme Music]

SUNNY GAULT: Okay, it’s time for our fun segment on the show called: “Mama Hacks” and it’s where you guys are able to share your hacks that you have discovered in breastfeeding and pumping for your babies. So we posted some stuff on Facebook and we got some responses and I thought some of these are really good so I thought Leilani and I could kind of just chit-chat about them a little bit.

This first one comes from Veronica King and Veronica writes:

“Her hack is to keep a nipple shield from falling off wear sports bra with holes cut around the nipples and put the nipple shield on under it and then you can do the same for a make-shift pumping bra.”

So Leilani, what do you think about that hack that she discovered?

LEILANI WILDE: Well, actually in regards to the pumping bra, actually I tell my clients to that a lot because if they don’t have a hands-free bra – I always say: “Do you have an old sports bra?” Because let’s cover and I’ll do it right there on the spot so they have free access to double pumping when they need to.

SUNNY GAULT: Okay.

LEILANI WILDE: As a nipple shield, I’ve actually never thought about that.

SUNNY GAULT: Yes, I know.

LEILANI WILDE: Do you know what? I think too because when people use a nipple shield, they should be using it to get the nipple to come through to the nipple shield closer to the end and not just set it on right there and that’s what some people think that’s how it’s used. Just set it there and it will do its job.

SUNNY GAULT: Right.

LEILANI WILDE: I don’t know if that would work in necessarily for the nipple shield but what an interesting idea.

SUNNY GAULT: I could try it and see it if it works. So Veronica thanks so much for sending this in.

[Theme Music]

LEILANI WILDE: That wraps up our show for today. We appreciate you listening to The Boob Group.
Don’t forget to check out our sister shows:
• Preggie Pals for expecting parents
• Newbies for postpartum moms during baby’s first year
• Parent Savers for moms and dads with newborns, infants and toddlers
• Twin Talks, for our show with parents of multiples.

Thanks for listening to The Boob Group: “Your judgment-free breastfeeding resource.”

[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

SUNNY GAULT: New Mommy Media is expanding our line up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or organization interested in joining our network of shows through a co-branded podcast, visit www.NewMommyMedia.com.

[00:35:03]

[End of Audio]

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