Gallstone surgery while still nursing?
November 19, 2010 12:48 AM   Subscribe

Has anyone been through gallbladder surgery while breastfeeding a newborn?

I'm the happy mother of a 2.5-old daughter and a 20-month old son, and I'm pretty sure I have gallstones or some kind of gallbladder issues. I get a lot of pain under my ribs on the upper right side, and it radiates around to my back. Lately all food seems to hurt, and I've been trying to stay away from anything fatty or greasy. I was about 95% vegan (I'd occasionally have a little cheese or Greek yogurt), so I don't eat a lot of junk, but I've been avoiding oil, nuts, tahini, etc. (along with pretty much everything but dry toast/fruit/crackers/rice).

Anyway, my midwife said that I needed to see a GI specialist, and I have an appointment in two weeks. It seems like it's pretty likely that there could be surgery, and that's fine. I'm over this and ready for it not to hurt anymore! I have two questions:

1. Has anyone been through this surgery while breastfeeding? I'm still nursing pretty much around the clock. I'm prepared to pump and stock up beforehand if necessary, but I'd like to limit use of bottles (she hasn't had one yet) and nurse as much before and after as I can. I'm eager to any advice on this or would just appreciate hearing about your experience.

2. Does anyone have advice for managing the discomfort until I see the doctor? Most of the time it is strong and steady, but dull, if that makes sense. I'm not having a lot of nausea or vomiting, but the pain seems pretty constant over the past two weeks or so, with some short periods (a day or so) where I don't seem to notice it much, and other days where I feel truly lousy.

Thank you!
posted by nonsenseprecious to Health & Fitness (16 answers total)
Gallstone surgery while still nursing?

Hand the baby to someone else first.

And expect the best (a day or two in the hospital before returning to normal) but plan for the worst (up to a week on drugs and maybe still in the hospital?). Have lots of your milk (or substitute) stocked up at home, or at least have a plan for switching to bottles fast.

After the operation, even if you're on painkillers and shouldn't be feeding the kid, remember to keep pumping and disposing of milk so you stay comfortable and lactating even though you're not actually nursing the kid.
posted by pracowity at 1:57 AM on November 19, 2010

Perhaps get the baby used to bottles now, rather than when you're unable to feed her any other way. If you don't need to use them, then no harm done. If you do need to use them, though, teaching her while she's hungry probably wont go down well.
posted by Solomon at 2:10 AM on November 19, 2010

Well, first you nead a clear diagnosis. Your symptoms may well be gallstones. My gallstone symptoms were quite different: days or weeks with no pain at all, punctuated with 8-hour spells of cursing, sweating, curled-up agony. But the symptoms vary.

You'll probably end up getting an ultrasound scan. Mine showed up a lot of smaller stones and sludge in my gallbladder. Surgery for gallbladder removal was recommended and scheduled for a couple of months later, and in the meantime I was prescribed codeine/paracetamol (acetaminophen if you're in the US) tablets - I think in the US they'd be Tylenol #1 or something. Initially I took a 8/500 dose, but because my symptoms were so painful I ended up on a 30/500 dose (equivalent to Tylenol #3), two tablets of which was enough to make the attacks bearable.

For surgery I was in at 9am, on the table by ten, and being driven home by lunch. Laparoscopic surgery rules. I was given the same medication, plus some antiinflammatories that I didn't use, to manage the pain during recovery, which took a couple of weeks (plus a few extra weeks with no lifting). It definitely worked for me, although I know some people get unpleasant side-effects such a nausea from codeine. I did try other basic over-the-counter painkillers, but nothing other than a strong dose of codeine did anything for me, and I think that's quite a common experience with gallstones.

I haven't breast-fed (obviously, given that I'm male). But I believe codeine-containing drugs are considered reasonably safe during breastfeeding. You'd need to verify this with a doctor, though, or at the very least a pharmacist.

As for what to do after the op, you're going to be totally unable to lift a child for several weeks. I can't imagine that, even with someone to hold your son for you, you'll be able to feed him easily for a couple of weeks. If you're not a die-hard bottle-feeder (and I have no agenda either way) then I'd personally say that you've done an outstanding job in reaching the 20-month mark, and you might want to consider whether you really need to struggle with it post-surgery.
posted by le morte de bea arthur at 2:32 AM on November 19, 2010

bottle-feeder breast-feeder. Sorry, that made no sense,
posted by le morte de bea arthur at 2:34 AM on November 19, 2010

Oops. Sorry. 2.5 months! In which case, scrub my last sentence anyway. I had the wrong end of the stick completely.
posted by le morte de bea arthur at 2:36 AM on November 19, 2010

I had mine out (with bonus extra emergency surgery!!) when Toddler Anachronism was wee baby anachronism. She was exclusively breastfed at that point.

The basic deal went like this: pregnant and had my first 'oh god I'm going to die' attack which landed me in the maternity ward at 2am on a Friday night while 32 weeks pregnant with blood pressure issues. They diagnosed indigestion which neither my ob. nor I particularly felt was the case but it didn't happen again until after I had my daughter. She was a few weeks old when I had my next attack which landed me in ER at 2am AGAIN, pissing myself every time I vomited. Which was a lot. So, smelling of pee, vomit and sour milk they finally diagnosed me.

At which point I nearly slapped myself since my mother, my grandmother and my great-grandmother no longer have gallbladders so you'd think that'd be on my radar.

Once they did a tentative diagnosis I did the rounds of ultrasounds and surgical consults. I got a surgeon with some snarky issues about fat but who swears diet doesn't impact the frequency of attacks. I swear differently, but that was his take. Another few weeks go by, with occasional attacks if I do something stupid like eat Mint Slices, or pizza. I pump madly to build up a freezer stash and we work on the bottle thing again. After stopping the bottle thing because she finally 'got' breastfeeding.

I ran into some issues with the hospital and breastfeeding - they were mostly dealing with the elderly so they had no support whatsoever. No pumps, no steriliser that they'd use for my pump, no willingness to support me. Even though I pointed out that if surgery goes too long, they'd be dealing with mastitis as well. In any case I'd talked to our local medication and lactation guru as well as my anaesthetist and both said that there were no issues with me feeding immediately after surgery under general anaesthetic. They said to pump and dump if it made me feel better but reckon I could feed while out and at most it'd make the baby sleepy.

Day of the surgery, the baby and the Other Anachronism came in with me. She fed just before I went in and then they waited around for me afterwards. Surgery went well - laparascopy under a general. After the surgery I was too yuck to feed so they went home and she had bottled EBM overnight and I pumped through the night. The next day the surgeon came to see me, pronounced me all good and said I could choose to stay another day or go home. I went home and fed the kid (I'd dumped the milk I'd pumped overnight since the pump couldn't be washed/sterilised properly between feeds and the milk sat in a shitty hospital fridge).

I had my little brother come stay to give me a hand for the few days after surgery and it really helped. He lifted and carried her around, did the changing and helped me with food and whatnot.

About three days after I came home I had another 'oh god I'm going to die' attack. Except it didn't stop. I can remember telling my brother to call my husband to tell him someone had to look after the baby even though my brother was there for that precise purpose. I could not stop throwing up and the pain was incredibly excruciating. Exponentially worse than labour. The ambulance got there and loaded me up with the whistle thingo for pain at which point I could finally talk and make some sense. They took me to the ER and my brother stayed home with the baby and the other anachronism. In the ER they loaded me with morphine and maxilon since I was not stopping the whole agonising show. After several hours they transferred me over to my surgeon's hospital who diagnosed a stone stuck in the remnants of the duct. Three days of fasting and testing later I finally got an 'emergency' endoscopy to remove the stone. For those three days baby anachronism and my brother hung out in the hospital room with me - her breastfeeding, him eating all the delicious smelling food they insisted on bringing to my room. I think I ate a sandwich, a small bowl of cereal and some juice over the three days and they ended up putting me on a drip. The Other Anachronism would drop in after work, hang out, go home for tea then just before bed come back and take Baby Anachronism home and hang out with her overnight, bottle feeding her. I would pump through the night and they'd take the pump home and wash it for me during the day.

Once I'd had the endoscopy, I stayed one more night, finally ate, then went home in the morning. Baby Anachronism fed immediately after surgery, while I was drugged up and still kinda out of it. If I'd been able to have someone stay the night with me, she would have stayed with me overnight too and fed through the night (and not had bottles).

So, to answer the questions: look at alternative methods of feeding, cup, syringe etc. and make sure you have the best information about when you can feed safely. Here in Australia we call a guy at Monash University to specialises in medication while lactating who okayed the anaesthetic/painkiller feeds. As for the perpetual discomfort, I would be super super worried - extensive pain tends to mean inflammation/infection and that's when you're looking at open surgery rather than laparascopy. It is still doable but a much longer recovery time. So I'd hit up the specialist sooner rather than later.

After all that pumping and worrying, I didn't even go through the stash of milk in the freezer! The kid just doesn't dig EBM.

Memail me if you want!
posted by geek anachronism at 3:11 AM on November 19, 2010 [1 favorite]

Do not let the first answer worry you; there are not a lot of drugs that are off-limits to nursing mothers. Better resources for that: LactMed -- (note phone numbers; I have called and rec'd extremely detailed {peaks in X hours, X% actually ends up in milk, gone in X hrs; considered safe because} advice, and they advise health care professionals too so you can boot a doctor off there if s/he is not up to date) -- Infant Risk Center. Beware of 'first Google hit' sorts of 'information' on a particular drug and nursing; go to the linked sites first.

A friend who was hospitalised with a life-threatening postpartum problem managed to do it with her infant daughter in a bassinet by her side, with a forward-looking hospital who were very helpful. FW that's W. The option is out there and supported by at least one hospital.

If you are in enough pain that the thought of surgery is a pleasant one, I would call your GP and ask for something strong. (Speaking as somebody now nursing on narcotics. Speak to a knowledgeable doctor or pharmacist...)
posted by kmennie at 4:08 AM on November 19, 2010 [1 favorite]

I haven't breast-fed (obviously, given that I'm male). But I believe codeine-containing drugs are considered reasonably safe during breastfeeding. You'd need to verify this with a doctor, though, or at the very least a pharmacist.

I recently read a scientific paper where a nursing mother was taking codeine and the baby developed fatal toxicity as a result of it passing in to breast milk. I would strongly advise against using it during breastfeeding. In fact I would strongly recommend not breastfeeding or giving your children any expressed breast milk until you have finished taking all painkillers etc.

NB Here is what the authority says about use of codeine during lactation:

Narcotic Agonist Analgesic, Respiratory Drug (Antitussive)
Fetal Risk Recommendation: Human Data Suggest Risk
Breast Feeding Recommendation: Limited Human Data – Potential Toxicity

I would also strongly advise not listening to any medical advice given by random strangers on the internet, including me.
posted by ruperto at 8:33 AM on November 19, 2010

I just had my gallbladder out. You'll be fine. Some people are put under general for emergency c-sections, so obviously it's OK for baby.

You WILL need painkillers, though.* You can go home from the hospital the next day, or even the same day if you're feeling perky (I went home same day), but it's not exactly a walk in the park.

I would actually recommend doing this as soon as possible unless you want to wait until you're done BFing. You won't be able to pick up anything heavy for 10-14 days after the surgery--this includes kids! I'd do it while your little one is still really little.

(Also, yes, talk to your doctor or a lac consultant about narcotic painkillers, but I had sciatica while pregnant and a C-section to give birth... my daughter has been exposed to a lot of narcotics while in utero and breastfeeding, and no fatal toxicity. Or even non-fatal toxicity. In fact, she's happy, smart, and perfectly normal.)

* I'm sure there are people out there who don't. Some people just never seem to need them.
posted by amberwb at 9:09 AM on November 19, 2010 [1 favorite]

I had an emergency appendectomy under general anesthesia while breastfeeding then 2 week old Baby bardophile. Continued to breastfeed him pretty much the whole time (barring the time I was actually in surgery or in the recovery room, so about 24-36 hours total).

For about a month after the surgery, a supplementary bottle was necessary. After that, Baby bardophile refused the bottle, and continued exclusively breastfed.

The first week or three after the surgery were really hard. I was tired all the time, I felt totally inadequate for not being able to nourish my baby sufficiently. But we survived it. And I'm very glad that I made the choice to continue breastfeeding.

note: we talked to the doctors about the fact that I was breastfeeding, and they chose medications accordingly.
posted by bardophile at 9:40 AM on November 19, 2010 [1 favorite]

ruperto: In fact I would strongly recommend not breastfeeding or giving your children any expressed breast milk until you have finished taking all painkillers etc.

That's highly over-reactive given both the study you are referencing AND general guidelines on treating pain in lactating mothers. The study gives a genetic basis to the biotransformation responsible for neonatal death and recommends careful use - not more than 4 days continuously and using NSAIDs where possible.

Particularly in light of practitioners and specialists in the area not agreeing with such a blanket statement.
posted by geek anachronism at 6:26 PM on November 19, 2010 [1 favorite]

I agree geek anachronism that my comment was pretty strong - but my subjective personal opinion is that breastfeeding would probably be best avoided in this situation. I stand by my opinion based on the balance of risks; switching the baby to bottle feeding for a couple of weeks is essentially no risk to a 20 month old, but continuing to breastfeed whilst on narcotics (esp codeine) could potentially cause some serious problems. Therefore on balance it would seem most logical to avoid it altogether.

Just wanted to present the other side of the argument and highlight that breastfeeding while taking narcotics does have some risk associated with it. Ultimately the choice is between the OP and her doctor, hopefully she can make a better informed choice as a result of all our comments and opinions! :-)
posted by ruperto at 1:27 AM on November 20, 2010

The OP mentions a newborn, 2.5 months old. At which point there are risks to weaning, and it is obviously important to the OP.
posted by geek anachronism at 2:43 AM on November 20, 2010 [1 favorite]

Here, FWIW, is Dr Jack Newman, probably non-arguably the world's foremost expert on breastfeeding:

Does the addition of a small amount of medication to the mother’s milk make breastfeeding more hazardous than formula feeding? The answer is almost never. Breastfeeding with a little drug in the milk is almost always safer. In other words, being careful means continuing breastfeeding, not stopping.
posted by kmennie at 6:17 AM on November 20, 2010 [1 favorite]

I concede your point! I mistook the OP to mean a 2.5 year old. I guess that shifts the balance of risks quite a bit - still a decision which needs careful thought though.
posted by ruperto at 9:32 AM on November 20, 2010

Seeing this thread a bit late, but if it still helps, I can give you a different view. I had my gall bladder out and was fine in two or three days. Outpatient laparoscopy and I barely took any of the pain meds. (They never seem to have any effect on me anyway.) I wasn't breastfeeding at the time (my kids were around 4 and 2 then), but I did once have minor surgery under sedation, not General Anesthesia, when my oldest was only a few months old and she didn't have any trouble taking a bottle for a while and then going back to the breast. So, hopefully you'll only be out of commission for a few days. Good luck!

I'm not saying I wanted to go for a jog, but it was pretty uncomfortable for a day and then kinda uncomfortable for a few more.
posted by artychoke at 8:41 AM on November 25, 2010

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