Happy CRNA Week- How to have a happy breastfeeding and pumping CRNA

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First of all, happy CRNA Week. Today I’d like to talk about how to have a happy pumping CRNA.

Before I became a first time mom, I really had no idea what breastfeeding and pumping entailed. It’s not really talked about anywhere online especially regarding those working in healthcare and how they managed to work and pump. Now that’s been more than 8 months, I’d like to share my experience to encourage new moms to continue their breastfeeding journey once they return to work.

It’s good to share than the American Academy of Pediatrics reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Personally, I set my breastfeeding goals to the first month, then 3 months, and then every 3 months to one year.

What I’ve discovered that the breast pump represents freedom from the baby and the ability to still provide the best and complete nutrition for your baby. You don’t need to have your baby attached to your hip to be a good breastfeeding mom. The breast pump gives you freedom to express milk whenever you want and it is not dependent on when the baby is ready to eat or if the baby has trouble latching. Also in the beginning, nipples take a beating (boo… I highly recommend Motherlove Nipple Cream and Lansinoh Hot/cold pack and Ameda gel pads especially for the first week or two) from breastfeeding so pumping gives your nipples a break.

Ever since I got back to work, I’ve had the support of my colleagues and family and the opportunity to continue feeding my baby breast milk. I have to be thankful for the positive nursing culture and a built-in system in the surgical department. That really is key!

It is super helpful to have supportive CRNA leadership, especially from someone who’s done it before. It’s also helpful to have an understanding from all the other CRNAs who can give me a little extra time to pump (getting a 20 minutes break instead of the usual 15 minute breaks).

For me, I take 10 minutes to pump. 5 minutes to clean my pump parts and use the bathroom. 5 minutes for walking to and from the pump room and getting my cooler bag. However, some moms may take more time to pump, usually up to 20 minutes.

My cooler bag from RTIC includes:

In addition, I just wear my nursing/pumping bra to reduce the time that I have to put on and take off a specific pumping bra. I love the one from Kindred Bravely.

When I get to work every morning, I write down my pumping times on the assignment board so that someone can get my pump break at those times. Breastfeeding is a matter of supply and demand and requires you to pump at least every 4 hours to maintain your supply throughout the day. It is extremely helpful to try to maintain this. It is ok to seldomly miss it but not on a regular basis. Otherwise your supply will take a hit.

Anyways, I try to pump at 5am, 9am, 1pm, 5pm, 9pm. However I do adjust my schedule and move it one hour earlier to accommodate the OR schedule. For example, at 5am (at home), 8am, 12pm, 4pm, 8pm. Many moms will try to pump around the same time she would feed her baby.

Having a dedicated private pump room that is close by to the OR is extremely helpful. When the pump room is far away, it takes so much more time to walk there and back, which cuts into the pump time (and every minute counts!). Also, when there are more than 2 pumping moms in the same unit, it is extremely helpful to have additional pump rooms available nearby. The reason is that frequently, pumping moms will have a similar pump schedule. Our unit has multiple pumping moms. We started with one room when I returned to work 5 months ago. Now we have 4 private pumping rooms near the OR. This will ensure timely pump times.

Here are “must haves” to a private pump room:

  • A lock to lock the room or curtains to separate the space in a large pump area
  • Private room with no windows or a screen if the room has indoor windows so no one can peek in
  • A table large enough to put all the pump bag and supplies (for example, a bedside table typically found in hospitals)
  • Chair where your feet touches the ground
  • Trash (housekeeping should empty this daily)
  • A whiteboard and a dry erase marker for the outside of the door when there’s more than one pumping mom to indicate the estimated “out” of the door time so the next pumping mom knows when the room will be available. It’ll help her decide to either wait for the room or try to find another room.

Here are “nice to haves” (but you can have workarounds):

  • Sink to wash parts
  • Paper towel to dry parts, clean off sink and pump area
    • Workaround: Use the wipes from above
  • Mini-fridge to keep the milk/breast pump parts cold
    • Workaround: get a cooler bag and place an ice pack in there. Or put the whole pump bag or just the milk bottles into your work refrigerator (but it may take more space)
  • Nice ambiance conducive to a relaxing environment. Stress decreases milk production so thinking or looking at pictures of videos of the baby helps
  • Extra pumping supplies. If the hospital already has a mother/baby unit that has a hospital grade breast pump, having this extra set is extremely helpful when something breaks (your own breast pump, parts) or is missing (you forgot to pack it!).
    • I always keep a manual breast pump (the hospital gave it to me after giving birth before I left for home) in my locker for those “just in case” times. I’ve used it several times and I could actually empty one breast in 5 minutes but it definitely requires using one hand to pump and the other to manually pressing the breast towards the nipple to empty the milk ducts.
  • Snacks such as lactation cookies- breastfeeding requires an additional 500 calories a day. Moms are feeding for two!

Whenever possible when I’m home, I’ll directly nurse the baby. Once you get the hang of breastfeeding, I find it to be easier than exclusively pumping. However, there are definitely pros and cons to both.

In conclusion, having a happy pumping mom at work is so vital to prevent burnout and help moms do great work and feed her little one. Having a private pump room close to the OR and a respected pump break time helps immensely.

If you’re a potential or current pumping mom, what would or has made your pumping journey easier?

If you’re in management, what can do you to implement a better pumping culture to reduce burnout for new pumping moms?

My First Labor and Delivery

I can’t believe it’s been twelve weeks since I had my baby. My entire life has completely changed in so many ways. I’ve become a first-time Asian American mother during a pandemic as a CRNA. Because it has completely changed my mind and body, I’d like to share my labor and delivery story, and later on, I’d like to share some products that made my life easier as a first-time mom.

As a first-time mom throughout the entire third trimester, the body is getting ready for labor by widening the hips. About 1.5 weeks before I went into labor, I lost my mucous plug. For me, it was a yellowish sticky blob.

First Stage

Early Labor

I was exactly 38 weeks along and wished my baby would come that weekend due to my work situation. On an early Saturday morning, my water broke while I was sleeping 3:20 am. A sudden wet gush woke me up! The water breaks before labor in about 15% of women. I called the midwife to let her know. We agreed that since my water was clear and GBS was negative, I could stay at home during my early labor. FYI, a GBS test checks if you have this common bacteria. If you are positive for GBS, you will get an antibiotic through an IV at the hospital during labor.

My goal was to rest and relax as much as possible. I went for a walk, ate breakfast, lunch, and dinner, watched a movie, and took a nap. Around 6:10 pm, my contractions became more regular, and by 8:15 pm, my contractions were 2-4 minutes apart, 45 sec to 1:15 min long, for at least an hour. They wanted me to go to the hospital when it’s about 4-1-1 (4 minutes apart, 1 min long, for an hour) so that they know you’re in active labor. 

Active Labor 

Triage

I got to the hospital around 9:15 pm and went to the OB triage with my husband (I could only have one support person, so I trained my husband to be there for me!). My primary midwife happened to be on that night, which was awesome!! They checked fetal heart tones (FHT) and external contraction pressure. Normally, I think they would do a cervical exam in the triage area, but I asked to have it done once I was admitted to a room, and my midwife made that happen. 

Hospital Admission

They used a soft belly band to hold the two monitors in place and drew a CBC and type and screen (they draw blood just in case you need a blood transfusion). They asked if I wanted an IV, and I agreed to it since I know it sometimes may be more difficult to place one later. 

My midwife did a cervical exam and found that I was already 5 cm dilated, 100% effaced, and -1 station. 

Later on, my nurse Emily was able to find wireless monitors, so I didn’t have to be attached to the wall. Since I already had regular contractions, and my baby had accelerations during the contractions throughout the admission time, my midwife was comfortable with just periodic checks every 30 minutes. I was monitor free for a few hours and free to move around the room.

For the next 4-5 hours, I used a birthing ball and bounced on it. I breathed through my contractions, mindfully thinking about the pressure I felt.  I tried out different positions: “slow danced” with my husband, had my husband pull up on my belly from behind (or I called it a penguin pull). I even got into the water tub. The water distracted and dulled the immense contraction pressure. But at 3 am, I couldn’t take it anymore and asked for an epidural. As a first-time mother, I wanted to labor as long as possible without an epidural, because once an epidural is in, the laboring process slows down.

A Combined Spinal and Epidural (CSE)

I got out of the tub, and my midwife did another cervical exam and found I had dilated to 8cm. There was only another 2 cm left, but I knew that the transition phase was coming, and through my readings, I learned that the transition phase is the most painful part, and I just couldn’t take it anymore. Also, I had attended the AANA Annual Congress last year. I learned that the latest literature indicated that a combined spinal and epidural was a great anesthetic choice for a laboring mother. I couldn’t wait to get relief.

At 3:30 am, the anesthesia resident got the CSE quickly, and I immediately felt relief through the spinal. In case you don’t know, a spinal numbs you quickly, and an epidural keeps you numb. They used a 0.1% bupivacaine with 3 mcg fentanyl concentration solution, and I loved that it was a bolus every 30 minutes rather than a continuous infusion. I felt little light pins from my chest down and slight itchiness from the fentanyl. But it was much easier to tolerate a little itchiness all over than the pain, especially as it neared the transition phase. Once the epidural was in, I did have to be on continuous monitoring, but I had to be in bed anyway. The nurse placed a foley catheter, which drains the urine. Shortly after pain relief, I fell asleep for a few hours until the morning.

Second Stage

In the morning, the nursing staff helped me move into different positions in the bed. Moving into different positions encourages the baby to move down into the canal on his own. At 11 am, the midwife broke the forebag, which prevented the baby from moving into the canal. My body continued contractions, but with the epidural, I didn’t feel any of them. The nursing staff continued to monitor the baby’s heart rate. The baby had accelerations with every contraction that came every 2-3 minutes. The accelerations indicate that the baby was tolerating the contractions perfectly. Finally, after I felt rectal pressure, the midwife came to assist with the delivery. I pushed for about 1 hour lying on my side, and he was born at 3:46 pm!

Third Stage

My baby immediately went on my chest for an hour of skin to skin time. He looked healthy (a APGAR score of 9 at 1 minute and 9 at 5 minutes. The APGAR score was created in 1952 by Dr. Virginia Apgar MD, an obstetrical anesthesiologist, to determine how well the newborn tolerated birth in the first minute and five minutes of his life). so they were happy to wait to do the height, weight, and give 3 medications. He was calm and quiet, having gone through such a traumatic experience! The midwife delayed the cord clamping until it stopped pulsating so that majority of the blood went back to the baby. My husband then clamped the cord. Shortly after, I delivered the placenta as well.

Placenta and Umbilical Cord Blood Donation

The midwife and nurse then gathered the placenta and umbilical cord tissue to prepare it for donation. I decided to donate the cord blood and placental tissue to research and some went to storage to help others cure diseases. I picked Cellsure because it was free to donate the tissue that would’ve otherwise went in the trash. I also checked my hospital to see if they routinely donated tissue but they did not. Around 28 weeks, I spoke to my midwife about donating my tissue. I found Cellsure online that accepted donations. About a month before my due date, I filled out an online questionnaire to qualify. Once I was done, Cellsure sent me a box for me to bring to the hospital when I was in active labor (4-1-1). I let my midwife and nurse know about the donation and they took care of everything. After delivering the baby, the nurse did draw one more set of blood for the Cellsure. They called Cellsure and someone came around 4 hours after the baby’s birth.

During the first hour, my baby tried to nurse but was just figuring out how to latch on. Latching is probably the most important part about breastfeeding!

The next day, I was super sore all over. I had the first-degree tear, so the midwife didn’t think I needed stitches. For pain relief, I used lidocaine spray and cooled witch hazel pads provided at the hospital. When I ran out, I used benzocaine spray.  I took ibuprofen and acetaminophen whenever offered (every 6 hours in the hospital, and I slowly cut back over the following two weeks). I also took Miralax once a day for the first four days after birth to help with bowel movements. My first few poops were all nice and soft so, I was happy about that. 🙂