Anesthesia in the News
  • Resuming Breastfeeding After Anesthesia

    Breastfeeding mothers may receive conflicting information about when to resume breastfeeding following surgery. A team of nursing students and nurse anesthetists at Naval Hospital Jacksonville in Jacksonville, Florida, set out to standardize the information that these surgical patients receive at their facility.

    The researchers developed evidence-based practice guidelines that were first published online in the Journal of PeriAnesthesia Nursing in May 2021.

    Their project led to an evidence-based tool that resulted in significant increase in provider knowledge about the safety of resuming breastfeeding. Also, perianesthesia staff reported increased confidence in delivering postoperative breastfeeding recommendations to patients.

    Literature search and baseline surveys

    To inform their recommendations, the researchers performed a search for the most recent evidence related to the transference of commonly used anesthetic medications into mother’s milk using PubMed, CINAHL, and Embase. It was found that when medications are given in usual doses for anesthesia, transfer into breastmilk is negligible.

    The team also conducted interviews with hospital staff and administrators to determine how post-operative breastfeeding instructions were delivered to patients. Naval Hospital Jacksonville is a military hospital performing up to 6000 surgical cases annually, many of whom are mothers of childbearing age.

    Recommendations and patient education

    The researchers developed three practice recommendations:

    • Support the mother in breastfeeding as soon as she has recovered from the immediate effects of anesthesia
    • Empower the mother to make an informed choice about when to breastfeed her infant after surgery
    • Consult the LactMed database for medications, conditions, or situations not otherwise addressed.

    A patient information brochure for mothers was designed that included a space for the patient to record the medications she received, a list of online resources, information on the benefits of breastfeeding, and reassurance that, in most cases, it is safe for a mother to resume breastfeeding soon after recovering from anesthesia.

    Sustaining change

    Ten hospital staff members in the anesthesia department and postoperative care unit (MDs, CRNAs, and RNs) received training on the newly developed breastfeeding policies in 2017. Assessment then and in 2019 revealed that, although knowledge improved immediately following training, it was not well retained over a two-year period. The researchers noted that, due to the nature of military staff turnover, there is no way to follow and repeatedly reassess knowledge and practice habits for specific providers year-to-year. Approximately two-thirds of military staff transfer every two years, so a repeated measures analysis on the same participants was not possible.

    However, the researchers noted that their project showed that providers are willing to change their practice and alter their recommendations if the evidence is presented in a manner that promotes change.

    Read the full study at Moore CB, Bond JD, Bundoc EG, et al. Resuming Breastfeeding After Surgery: Influencing Practice Recommendations. Journal of PeriAnesthesia Nursing. https://doi.org/10.1016/j.jopan.2020.12.010