When faced with the possibility of surgery or hospitalization as a nursing mother, you may wonder how you can continue to breastfeed. You may have even been told you have to wean. Fortunately, however, in most cases, this is not true and breastfeeding can continue as before with just a few considerations and a little planning.

The following are questions you should ask your doctor and yourself when faced with surgery or a hospital stay during the course of breastfeeding:

• Is there an alternative to hospitalization?
• Have you received a second opinion?
• Could the surgery or hospitalization be postponed until the baby is older?
• Is it possible for the treatment or procedure to be done on an outpatient basis and/or with a local anesthetic?
• If a hospital stay is necessary, is an early discharge a possibility if nursing care were arranged in the home?

If hospitalization or surgery is recommended, inquire as to whether the hospital has a specific policy regarding breastfeeding mothers and babies. This information is probably available through the hospital's lactation consultant and/or patient liaison. Some hospital policies allow for the baby to stay with the mother night and day as long as there is a third party to care for the baby. If having the baby with you 24 hours a day is not a possibility, perhaps frequent visits will be. Some hospitals are willing to make exceptions when special requests are made. Don't be afraid to make such a request if your situation warrants it. Important questions to ask include:

• Would arranging for a room in another area of the hospital such as the pediatrics or maternity floor make it permissable for the baby to stay with you?
• If rooming-in is not possible, can the baby be brought to you for feedings and how often during the day and night?
• If the baby cannot be brought to your room, would you be allowed to nurse in another part of the hospital?

If your hospital stay will require you to miss any feedings, pumping your breasts as often as your baby would regularly be nursing will help keep you comfortable, lessen your risks for engorgement and breast infection, and maintain your supply. Preferably, you should have access to a hospital-grade electric pump that will allow for double pumping. This will lessen the time needed to pump and perhaps maintain your supply more effectively. Some questions to ask related to pumping include:

• Will the hospital provide such a pump or would you need to make arrangements for one yourself?
• If you are unable to express your milk by yourself due to pain, lack of strength, etc., will there be a nurse who is knowledgeable about how to use the pump who would be willing to help you?

Most drugs are compatible with breastfeeding. Drugs used to give general anesthesia do not remain in a mother's system or affect her milk. If you must undergo anesthesia, you can breastfeed as soon as you are alert enough to handle your baby. Pain medications can be chosen which are compatible with breastfeeding as well. If a particular drug is contraindicated during lactation, most always a suitable alternative can be found. You may have to implore or even insist that your doctor prescribe only those medications that are compatible with breastfeeding. Ask for those drugs used during and following a Cesarean section.

In most situations, fear of transmitting an illness via breastfeeding or breastmilk is unwarranted. Most likely your baby has already been exposed to the illness prior to your symptoms appearing. And antibodies which your body is continually manufacturing to help you fight off your illness will be passed onto your baby via your milk, affording the baby extra protection. Only severe illnesses in the acute stage or certain treatments may require temporary or permanent weaning. Furthermore, continuing to breastfeed may help ease your mind which will prevent added worry and allow for better rest. Uninterrupted breastfeeding will also help prevent any possible physical and emotional traumas for both you and your baby.

This risk is extremely minimal especially if you are in a private room of the hospital. And, again, any illness that you are exposed to will initiate the manufacture of antibodies which will be passed onto your baby. You also can lessen this risk by limiting the hospital staff's handling of your baby and carefully washing your hands prior to breastfeeding and holding your baby.

If your baby is less than 3-4 weeks old, it is best that he/she be fed any supplemental feedings with an alternative feeding device to the bottle. This will help prevent the risk of nipple confusion. Other such devices include: a nursing supplementer attached to the finger (SNS), a soft, flexible medicinal cup, a feeding syringe, a medicine dropper, or a spoon.

If your baby is older than 4-6 weeks of age, then a bottle may be used. Try to use a bottle with a newborn nipple which will encourage the baby to suckle vigorously.

If your baby is older than 4-6 months of age, he/she may be able to take supplemental expressed milk or formula from a cup.

If your baby is older than 4-6 months of age, supplemental feedings may be given with a cup. Following are some tips for getting the younger baby to accept a bottle:

• Choose a newborn size nipple.
• Use a silicone rather than a rubber nipple to avoid an unpleasant odor or taste.
• Warm the nipple under running water before offering the bottle to the baby.
• Make sure the milk is not too warm and not too cold. If when holding the bottle in your palm, it feels warm to the touch, it is most likely too warm. If it feels cool to the touch, it is most likely not warm enough. If you can feel no difference in the temperature of the bottle and your palm, the milk is probably at the right temperature.
• Most babies will accept expressed breastmilk more readily than formula.
• Offer the bottle while holding the baby with his back to your chest so that he is facing outward, rather than trying to cradle him.
• Move with the baby - rock, sway, bounce, walk, walk in circles, etc. as you offer the bottle.
• Place the baby in a swing, bouncy seat, infant/car seat, etc. and offer the bottle.
• Place an article of mother's clothing up near the baby while offering the bottle.
• Lightly tickle the baby's lower lip with the nipple and allow him to pull it in his mouth rather than trying to force the nipple in.
• Offer the bottle when the baby is already sleepy or just waking up (but not fully awake) or once the baby is already asleep. Many babies will instinctively suckle at these times.

Most babies will accept a bottle with time and persistence. Try not to allow feeding time to become associated with unpleasantness. Offer the bottle for no more than 10 minutes at a time. If the baby is still refusing the bottle and becoming more upset, it's best to back off and try again later. Remember that if the baby will not take supplemental feedings in this way, an alternative device may also be used (see above).

Last revision: January 7, 2000