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The Lactating Patient

The Lactating Patient. What her nurse needs to know. 1. Objectives. Participants can state at least one reference to check compatibility of medications used by a breastfeeding patient. Participants can state three benefits of breastfeeding and three risks of formula feeding.

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The Lactating Patient

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  1. The Lactating Patient • What her nurse needs to know. 1

  2. Objectives • Participants can state at least one reference to check compatibility of medications used by a breastfeeding patient. • Participants can state three benefits of breastfeeding and three risks of formula feeding.

  3. Jane Doe’s Story • 27 year old first time mom. Her labor was complicated by PIH. She delivered her healthy full term infant girl vaginally. As a result of her low platelet count she had a severe postpartum hemorrhage. • She was admitted to ICU after initial stabilization in maternity.

  4. A Holistic Approach • The insightful ICU nurse, in addition to caring for the immediate needs of her patient, understood the need to protect the patient’s ability to breastfeed her baby after her recovery. In doing this she was meeting the needs of both mother and baby.

  5. Appropriate actions by this nurse • She assessed the patient’s desire to breastfeed through consulting with the family as the patient was unable to participate. • The nurse ordered a pump motor and double electric kit through SPD. • The nurse understood the importance of early stimulation to establish a milk supply. Therefore the plan was to double pump the mom every three hours. • She also knew that this early pumping may only produce a drop or two.

  6. Symphony pump and double kit

  7. Patient and Family Education • She taught the family how to assist with this pumping goal. • The father was sent to maternity to obtain storage containers and labels, so he could transport the milk to the baby in the nursery. • The milk is good at room temperature for four hours. • On ice it is good for 24 hours. • In the refrigerator in the nursery it is good for 5-7 days. • Due to the nurses proactive care this mom was able to pump ½ - 1 ounce by day two.

  8. Initial actions created long term success! • Mom was stabilized and transferred back to maternity where she was reunited with her baby. • She went on to develop a full milk supply and had a successful breastfeeding relationship with her baby.

  9. Vulnerable moms • All moms need our support. • Simply being admitted to the hospital is a stress on their bodies. • Other stressors may include: blood loss, infections, surgery… • With your great support, the breast milk supply can be protected and these moms can return to successful breast feeding after the acute episode.

  10. Medications and Mother’s Milk • Mother of a one month old breastfeeding baby admitted through the ER for abdominal pain. Assessment revealed appendicitis. She then had an emergency appendectomy under general anesthesia. • In recovery she received pain medication and antibiotics. • Pumping was initiated. Her nurse called maternity concerned about the infant’s exposure to all the medications she had received. Should she dump her milk?

  11. General Principles • Generally, almost all medications are compatible with breastfeeding if the exposure to the medication is short term. • Medication is at highest concentration in milk when it is at its peak in the mother’s body. One can minimize the infant’s exposure by breastfeeding or pumping prior to the next dose.

  12. General Anesthesia • General anesthesia leaves the body quickly. When the mother is fully awake and alert it is fine to breastfeed. • The meds are poorly transported into the breast milk and are poorly absorbed by the baby’s gut. • Have the mother pump prior to leaving for surgery. This milk can be stored for baby.

  13. Antibiotics • Generally safe but look them up in Hale or Micromedex • If approved for use in pediatrics it is safe with breastfeeding. Only a very small fraction goes to the infant through the milk anyway

  14. Pain Medications • The following medications are safely used in Family Maternity with no ill effects to baby: • Oxycodone/Oxycontin • Dilaudid • Fentanyl • Percoset • Vicodin • Morphine • Toradol • Ibuprofin/Tylenol

  15. Tests and Contrast Dyes • See hand out on radio-contrast agents • Only Teslascan not compatible with immediate breastfeeding-requires pumping and dumping for four hours • Have mom save milk before Teslascan to provide for one or two feedings

  16. Resources • Pharmacy – Make sure it is noted in orders to pharmacy that patient is breastfeeding and meds will be checked. • On line resources • Go to Providence home page • Click on departments, go to nursing • Click on References and Resources • Click Micromedex • Enter medication name • Click on subcategory “Breast Feeding”

  17. Resources cont. • Medications and Mother’s Milk by Thomas Hale. • This book is updated every two years. • Each department should have their 2012 copy. • Hale Publishing L.P. • Call: 806-376-9900 • Sales 800-378-1317 • Fax 806-376-9901 • On line web orders: • www.ibreastfeeding.com

  18. Hale’s Pregnancy and Lactation Categories

  19. Lactation Categories continued

  20. L1 Safest Rating

  21. L3 No controlled studies Text

  22. Benefits of Breastfeeding • Benefits to Mom • Reduces risk of breast and ovarian cancer • Reduces risk of obesity, metabolic syndrome, diabetes • Saves money: infant sick less often, less time lost at work and breast feeding is free. • Benefits to Baby • Breast milk transfers to mothers protective antibodies specific to their environment. • Reduces SIDS, diabetes, respiratory infections, ear infections, chronic and acute gastrointestinal disease. • Enhanced nutrition: benefits cognitive development. Breast milk has over 200 identified nutritional components that change to keep pace with infant’s growth and nutritional needs.

  23. Risks of formula feeding • Baby more vulnerable to infections of all kinds. • Higher risk to obesity in both mom and infant. • Higher risk of diabetes and allergy in infant. • Higher cost to family, society and the environment. • Cost of formula alone for one year is approximately $1700 or greater.

  24. Employee Benefits • Employee nursing mother’s room available • On 3G. Includes sink, refrigerator, and bathroom • Lactation Clinic and store located at 2705 E. Burnside suite 100. Monday-Friday 9-5 • 10% employee discount at the store • Pump rental and sales, bras and supplies • Breastfeeding support by an IBCLC. Medically indicated visits are covered by insurance including OHP • If indicated have your patients call for follow up support after discharge (503)215-6255

  25. Questions??

  26. References • American Academy of Pediatrics, Breastfeeding and the Use of Human Milk Pediatrics: originally published online 2/27/12 DOI 10.1542/peds.2011-35521 • American College of Radiology, Committee on Drugs and Contrast Media. Administration of Contrast Media • to Breastfeeding Mothers, ACR Manual on Contrast Media, Version 7, 2010 • Hale,Thomas, Medications and Mothers’ Milk; Fourteenth Edition 2010 • Walker, Marsha, Just One Bottle Won’t Hurt- or Will It? http://www.health-e-learning.com

  27. Thanks!!

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