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Beyond Pump and Dump: A study on provider knowledge and practice regarding anesthesia care of the lactating patient
Abstract Number: S5A-2
Abstract Type: Original Research
Breastfeeding is widely accepted to have a positive impact on maternal and infant well-being, and multiple public health interventions have been initiated to promote successful breastfeeding (1). When lactating patients are encountered in the perioperative setting, they often receive conflicting advice regarding the safety of anesthesia and breastfeeding (2). Our study assessed provider knowledge and practices regarding anesthesia and lactation, including formal education, the need to “pump and dump”, postoperative analgesia, and safety of common anesthetic medications. We surveyed all perioperative providers at a large university, tertiary care hospital. Our institution has an obstetric anesthesia fellowship and performs about 6,000 deliveries annually, though labor and delivery is physically remote from the main operating room. Of 207 respondents, the demographics include: 37% Male, 63% Female, 3% primary OB anesthesia, 52 physician anesthesiologists (25%), 28 resident anesthesiologists (14%), 55 CRNAs (27%), 7 SRNAs (3%), 14 general surgeons (7%), 17 resident surgeons (8%), 28 perioperative nurses (13%), and 5 preoperative assessment providers (2%). In regard to prior education about the lactating surgical patient, 47.3% of respondents had never received formal instruction on care of the breastfeeding patient. The average overall score on the knowledge portion of our survey was 74%. When asked if breastfeeding was contraindicated for up to 24 hours after general anesthesia, 75% of respondents correctly identified this as a false statement. When asked if breastfeeding patients should “pump and dump” after general anesthesia, only 57% of respondents correctly identified this as a false statement. Notably, only 35% of attending surgeons and 39% of perioperative nurses correctly answered this question. These results suggest that despite evidence that breastfeeding after general anesthesia is safe (3), many health care professionals still believe and potentially advise that breastfeeding mothers should express and dispose of breastmilk after a general anesthetic. We plan to use this information to institute educational interventions regarding the safety of breastfeeding after anesthesia, to enhance the quality of care for lactating patient, and reduce unnecessary interruptions to the breastfeeding dyad.
1. Victora CG, Bahl R, Barros AJD, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet. 2016;387(10017):475-490. doi:10.1016/s0140-6736(15)01024-7.
2. Cobb B, Liu R, Valentine E, Onuoha O. Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk. Translational perioperative and pain medicine. 2015;1(2):1-7.
3. Reece-Stremtan S, Campos M, Kokajko L, Medici TAOB. ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeeding Medicine. 2017;12(9):500-506. doi:10.1089/bfm.2017.29054.srt.