The Academy of Breastfeeding Medicine is a worldwide organization of physicians who support breastfeeding. They have developed protocols that address some common newborn problems that may impact breastfeeding success. Here are some examples:
Protocol #15
Anesthesia and Analgesia for the Breastfeeding Mother
Anesthesia makes the patient unaware. Drugs used for induction of general anesthesia such as propofol, midazolam, etomidate or thiopental are only in the bloodstream for minutes. The same is likely true for anesthetic gases. The transport of these drugs into breastmilk is likely low to nil.
Analgesia reduces pain. Meperidine (Demerol) is consistently associated with infant sedation. Because the body breaks meperidine down into substances that hang around for a long time, transfer into milk and infant sedation can occur up to 36 hours after the dose.
Hydrocodone and codeine have been used in millions of breastfeeding mothers. Occasional cases of neonatal sedation have been documented, but these are rare and generally related to higher doses. Breastfeeding mothers should take just what is needed to control the pain.
Although morphine does transfer to breastmilk in low levels, the infant does not absorb it well. Fentanyl has extremely low levels in breastmilk. Sufentanil and remifentanil are likely similar to fentanyl in their impacts on breastfeeding. These drugs have not been associated with infant sedation.
Nonsteroidal anti-inflammatory drugs (NSAIDS) include ibuprofen (Motrin, Advil), ketorolac (Toradol), naproxen (Naprosyn, Aleve, Anaprox), and celecoxib (Celebrex). Ibuprofen, ketorolac, and naproxen interfere with the body's ability to clot and should be avoided if there is a bleeding problem. These drugs all have low levels in breastmilk and are not associated with sedation.
It is difficult to separate epidural analgesia out from all the other factors that cause breastfeeding problems. Epidural analgesia can include non-sedating medications such as bupivicaine as well as narcotics such as fentanyl. When epidural analgesia has been used for labor, particular care to provide mothers with good breastfeeding support and close follow-up after postpartum hospitalization should be taken.
Women have differing levels of pain tolerance. Pain that exceeds a
woman’s ability to cope, or pain magnified by fear and anxiety, may
produce suffering in labor. Suffering in labor may lead to
dysfunctional labors, poorer psychologic outcomes, and increased risk
of
postpartum depression, all of which may have a negative effect on breastfeeding.
Protocol #1:
Guidelines for Glucose Monitoring and Treatment of Hypoglycemia (Low Blood Sugar) in Breastfed Babies
For babies who have no symptoms, begin breastfeeding within 30 to 60 minutes of life and continue as frequently as baby requests. Recheck blood sugar levels. Avoid forced feedings. If blood sugar level remains low despite feedings, begin giving glucose intravenously. Breastfeeding may continue during IV glucose treatment.
For babies who have symptoms of low blood sugar, start giving glucose intravenously. Do not rely on oral feedings to correct extremely low sugar levels or if it is symptomatic. Encourage frequent breastfeeding.
Keeping the infant skin-to-skin with the mother to keep baby warm is easily done with an IV and lessens the calories a baby needs to maintain it's body temperature.
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