What potential impact do surgeons have on breastfeeding?

23 Aug 2018

By Nikki Mills

In celebration and recognition of breastfeeding awareness month, I decided to write an article for the Association of Women Surgeons weekly blog. Some female surgeons have first hand experience in breastfeeding, and many have stories about their own personal challenges and experience. For those that rely only on the education they received on the topic during their medical training, their knowledge may be quite limited.

On the positive side, awareness is increasing on the broad-ranging benefits of breastfeeding for both Mum & Baby. Research in this area has increased exponentially in the last decade, and the wonders and complexities of breastmilk composition are continuing to unfold. Antenatal education for mums is improving, and the motivation and intention to breastfeed is at an all-time high. Unfortunately, for a proportion of Mums, the breastfeeding journey does not progress as expected. When difficulties occur with breastfeeding, it can be a huge emotional and physical challenge for the dyad.

In the last decade there has been wonderful research that has completely revolutionised our understanding of biomechanics of sucking during breastfeeding. They have shown that babies extract milk from the breast by vacuum (NOT positive pressure) and that there is no anterior tongue peristalsis. This is quite different than the biomechanics of babies drinking from a bottle, upon which all previous biomechanics of breastfeeding was presumed. My PhD research (recently presented at the Academy of Breastfeeding Medicine Conference, Gold Coast, Australia) has shown (using flexible endoscopy during breastfeeding) that gravity (latching position) can be used to improve an infant’s ability to protect their airway during swallowing. We have been successful assisting breastfeeding babies with a variety of pathologies to be positioned at the breast for feeding in a manner that keeps them fully orally feeding when traditionally they would have been made nil by mouth because of aspiration risk.

There is probably only a very small number of surgeons that would see infants with breastfeeding problems as their presenting problem, so the understanding of breastfeeding sucking and swallowing may be outside of the area of interest for most of you. However, when our patient happens to be a breastfeeding Mum or Baby – we as surgeons have a potential impact, even if the nature of our surgical procedure may seem unrelated. Failure to consider our potential disruption to the breastfeeding relationship may inadvertently cause unplanned weaning, or may lead to failure for a Mum with a newborn to ever establish breastfeeding.

If you are going to operate on Mum or Baby, create an individualized plan and an environment that actively supports their breastfeeding relationship. If a breastfed baby is nil by mouth for surgery, ensure the Mum has access to an appropriate space and equipment for expressing milk, and that there is a location for storing expressed milk. Arrange for suitable chairs for breastfeeding in the recovery room. Make sure that there is lactation consultant support if there is likely to be a longer period without feeding at the breast, to help the Mum know how best to maintain her milk supply. If the Mum is the patient, ensure that any information given about not being able to breastfeed postoperatively because of medications is up to date and specific. Make a plan with the Mum about how to maintain milk supply if separated from her baby. Advocate for “rooming in” of baby with family support wherever possible. If breastfeeding is difficult for the Mum and/or baby, arrange “in house” lactation consultant support – and if you don’t have access to one, think about how this might be possible.

I encourage you to make asking about breastfeeding part of your patient history taking in this cohort. Make it your workplace culture to actively support breastfeeding, as a passive approach is unlikely to contribute to breastfeeding success. Talk to your colleagues and management to get others on board. Challenge historical constructs around when breastfeeding is not recommended or is told to mothers it is unlikely to succeed – to ensure that we are not using outdated information to come to this conclusion or recommendation. Understand that as surgeons we have an impact on breastfeeding – let’s do our best to make sure it is positive.

 Nikki is a Paediatric Otolaryngologist from “Down Under”. She completed her training in New Zealand and subspecialty Fellowship in at Great Ormond Street Hospital in London. Nikki has subspecialised in airway & swallowing disorders, with a passion for helping Mums and babies who are having difficulty with breastfeeding. She is currently undertaking a PhD on “The functional anatomy of sucking and swallowing in a breastfeeding infant”.



Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

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