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Read the recent research about medication and breastmilk HERE
Read the statement from the ASA about medication and breast milk HERE
Read a pamphlet about preparing for surgery and guidance for anesthesia and pain medication with breast milk HERE
Listen to episode 2 about questions you should ask your OB
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Listen to episode 11 about my birth experience
Listen to episode 23 about protecting your rights in the delivery room
There have been a few common themes in my content recently – advocating for your health, using nutrition as a first defense for illness, and alternative therapies for healing the body – and when I was thinking of a new topic for a solo episode, I realized that all of those topics apply to my recent hernia surgery, so I thought “why not talk about all of those things using me as a case study?”
In other words, I practice what I preach and I put all my advice to the test these last few months and I’m really excited to share with you what the results were!
So in today’s episode I’ll give you the low down on what my hernia situation has been for the last two years, how I prepared for my recent hernia surgery (including what I did with breastfeeding Hannah), how I recovered from surgery, and then we’ll compare and contrast my first hernia repair with this most recent one.
Please know that this has been my personal experience and if you find yourself in a similar situation, it’s important that you find a personalized approach to your health and recovery. I share my experience to help you know other options and possibilities out there, not tell you exactly what you should do for you.
That being said, I do believe many of the principles I’ll share are both important and relevant to you, so I hope you learn something from my experience and feel more empowered in your own health journey, no matter what you’re struggling with!
One thing I want to point out before we get started is that I’m going to put a focus on how I had conversations with my doctors throughout the entire process to advocate for my health and speak up about what was important to me without being rude or condescending. If that’s something that’s important to you, you’re gonna wanna listen all the way through and head to the show notes to find links for two other episodes that give you similar advice.
I want you to hear my story so you can see the impact that conversing with your doctor has on the final outcome of your health, whether it’s a small, one time thing or a big, important event. My story is the perfect example of what can happen when you DON’T talk to your doctor but also what’s possible when you do.
Lastly, even though today’s conversation is through the lens of my recent hernia surgery, all of the principles I’ll talk about are applicable to preparing for birth, especially if it’s a C section, communicating with your healthcare provider, or preparing for any surgery, especially if you have a baby at home.
I realized I should probably clarify what a hernia is before we jump into my story. If you were sitting there wondering what was wrong with me, you’re not the only one. I’ve had multiple people stop me and say, “wait what’s a hernia exactly?” so let me quick sum it up:
Per the Cleveland Clinic, “a hernia occurs when part of your insides bulges through an opening or weakness in the muscle or tissue that contains it. Most hernias involve one of your abdominal organs pushing through one of the walls of your abdominal cavity.”
In my case, I had an umbilical hernia, which means I had a hole in my linea alba (the tissue that divides your 6 pack in half vertically) behind my belly button and my intestines were poking through.
I don’t know if this happened during the pushing phase of labor with my first baby, but I do know that I had diastasis recti after pregnancy and I remember the exact day I got (or discovered) my hernia. At the time, we lived in an apartment but you had to walk down three stairs to get to our front door. Since we didn’t have a garage, we stored our umbrella stroller just inside the front door, which meant that I had to bring it down the stairs to get it in our apartment.
Tyler was at basic training at the time (boot camp for the military) and during basic, you can’t talk to your family at all. Anyway, I took Hyrum, who was 7 months old, on a walk, and when we got home, he was sleeping in the stroller and I didn’t want to wake him up. I decided to just carry him in the stroller down the stairs and let him finish his nap in the stroller inside the house.
Just like I’d done a million times before, I braced my core properly to lift him in the stroller, exhaling as I picked him up, but in that moment I instantly felt an extreme, concentrated amount of pressure in my stomach and it hurt so back I almost dropped the stroller with Hyrum in it. I remember thinking to myself, “wow that hurt really bad, I probably shouldn’t carry him in the stroller anymore.” And that was that.
Well, a few hours go by and my stomach still hurts pretty bad. It hurt to lift Hyrum at all and I was a little out of breath. I decided to quick look in the mirror and see if anything was visibly weird.
Um, it was haha. My belly button went from being an innie to a large outie and it was very purple. I immediately called my dad, who was an ER physician, and said, “what the heck is going on.” He told me I had a hernia and he wasn’t sure if it was emergent or not.
Basically with a hernia there’s a possibility that it could become life threatening where if you don’t get emergency surgery within 8 hours of the occurrence you could die. To give you perspective, I was at the 4.5 hour mark and I was a solo mom of a 7 month old baby with one bag of milk in the freezer. I was panicking.
Long story short, it wasn’t the life-threatening kind and after spending some time in the ER, I was discharged with a referral for a surgeon.
That was in April of 2o22. I ended up moving in July and had surgery in September of 2022. That first surgery wasn’t as bad as I anticipated, but there were many things I would’ve done different.
First of all, I only saw one surgeon. If I could go back, I would’ve gotten more than one opinion on how to fix my hernia. Because I only had one opinion, I thought there was only one way to fix my hernia. What we ended up doing was sewing a small piece of mesh over the hole and in my opinion this was just a bandaid. It didn’t actually solve the problem, it just made it less of an immediate problem.
In fact, I think this is why I had problems during my second pregnancy and ended up needing this second surgery. But we’ll get into that in a second.
Back to the first surgery, another reason I think the mesh was a bad idea was because it was a foreign material that was sewn to my body and I think it made my autoimmune stuff worse. I’ve since learned about “mesh implant illness” and wish I’d known about it before agreeing to getting mesh.
Lastly, it made exercise harder because I still had diastasis recti but now I had a hole in that weakened tissue so I couldn’t control my intra-abdominal pressure and my pelvic floor took lots of extra weight to compensate for that.
Something else I would’ve done different with that first surgery was actually recover. I just stayed in bed for a few days, slowly went on walks around the neighborhood, and didn’t lift Hyrum for a few weeks, then I jumped back into the gym.
In other words, I didn’t do anything to heal, I just avoided things that would prolong my perceived recovery.
Something else I want to clarify is that I did ask the surgeon if the mesh was going to be a problem with consecutive pregnancies. I was worried that it would rip off as my belly grew and it would endanger me and baby and I was worried that having the surgery at all would prevent me from having more kids. He assured me everything would be ok and I could have more kids without complications.
Yet here we are.
I will say though, I do think the first surgeon was telling the truth - that I had nothing to worry about - but because my belly grows SO big during pregnancy and I’m such a small person AND I had preexisting complications, my subsequent complications were inevitable. So I don’t blame that first surgeon for what I’ve endured this last year, but I do wish we had had more of a conversation and more options to talk about.
Ok, now onto what happened during my second pregnancy. Flash forward to [I think] August of last year (2023) I was feeling a lot of localized pain where my mesh was and it was uncomfortable to have anything touch it. Then, I looked down one day and saw some red specks on my clothes and thought “there’s no way that’s blood.”
Well, sure enough it was. Turns out that my mesh had not only separated from the hernia hole, but it had floated to the surface and gotten stuck to the underside of my skin and was now poking out through my belly button from the inside out. Hence, the small drops of blood!
At this point I was 33 weeks pregnant and still had some growing to do, so I started to worry that now I was a high risk pregnancy. I shared my concerns with my OB and he said, “I don’t think this should be a problem but I’m not a surgeon so I’ll get you a referral ASAP.”
That surgeon he referred me to was booked out for 6 months, so I ended up seeing another surgeon. He. Was. Awful. I left my appointment with him in tears.
He told me that the mesh had relocated and was now in the worst place possible. Thankfully, it didn’t make me high risk and I didn’t need to worry during pregnancy, but I was going to need surgery pretty soon after giving birth. Here’s what made me cry: he said that I would have to give up breastfeeding entirely to have the surgery.
Not just for a few days, not for a week or two, altogether.
He also said I would need plastic surgery afterwards because everything would look really funny but because plastic surgery is considered elective, I’d have to pay out of pocket for it.
I literally came home and told Tyler that I’d rather be broken and continue breastfeeding Hannah for a year than have the surgery, be fixed, and have to stop breastfeeding. However, after all the tears and all the big feelings, we sat down and realized it seemed a little…drastic. There had to be another way.
And if there’s anything we’d learned from the first time, it was that we needed to have more than one opinion.
So, at my next OB appointment, I told my doctor what the surgeon said and he laughed. “Brooke, that’s ridiculous. If that’s honestly what he told you, I will write you a referral for another surgeon. You will not have to give up breastfeeding or have plastic surgery.”
I’ve never been so relieved in my entire life. I was so grateful I’d asked a second opinion.
But, now I had two completely different answers. As much as I wanted to just go with the answer that I liked better, I knew that the most important thing was what was right, not just what I wanted to hear. So now I set out to get a third opinion from another surgeon. This time, it would be out of state.
I figured if I was going to have surgery while Tyler was deployed, I’d better have 24/7 help so I don’t screw things up during recovery. I decided to look for a surgeon in Phoenix where my mom lives.
And I’m so glad I did. Not only did I get confirmation that there was another way, a better way in fact, but I found the most incredible surgeon. He looked me in the eye, he shook my hand, he spent more than 2 minutes with me, he answered every question I had, and he actually listened to my concerns.
At this point, I’d had three opinions and two of them matched. On top of that, I had a surgeon who helped come up with a personalized plan for ME, based on my needs and concerns, not just the typical procedure plan that he was taught in medical school.
Now we’ve gotten to the part that I really want to talk about today and it entails two things: one, how I advocated for myself with the anesthesiologist; and two, what I did differently during recovery. This is the part of the episode that hopefully will be more interesting to you and also more informative.
Flash forward to February of this year, it was time to have surgery. At this point, I still wasn’t sure what was going to happen with breastfeeding after surgery. But this time, instead of worrying I wouldn’t get to breastfeed at all, it was just a matter of how soon after surgery I could breastfeed. I’d asked my surgeon, my OB, my sister-in-law who is a mom-baby nurse, my dad who is an ER physician, multiple nurses on social media, and even Dr. Google.
Every single medical professional gave me a different opinion about how soon I could give my baby breastmilk after surgery. Some said right away, my surgeon said I’d have to pump and dump for 36-48 hours, and Google said I’d have to wait only 12 hours. (And don’t forget the first guy who said I’d have to stop completely). Basically there weren’t two health care providers that said the same thing.
So I decided to do my own research. The biggest concern was the concentration of anesthesia and narcotics that were going to be in my breast milk post-op. There wasn’t a ton of conclusive research because it’s unethical to experiment with heavy medication on breastfeeding moms and their babies, so it was kind of just a guessing game.
What I did find was two things: an article on the American Society of Anesthesiologists website and a research article from the National Library of Medicine (PMC4582419). Here’s what they said:
[From the ASA] “The following recommendations are suggested for lactating women requiring surgery:
1. All anesthetic and analgesic drugs transfer to breast milk; however, only small amounts are present and in very low concentrations considered clinically insignificant.
2. Narcotics and/or their metabolites may transfer in slightly higher levels into breastmilk; therefore, steps should be taken to lower narcotic requirements by adding other analgesics when appropriate and avoiding drugs that are more likely to transfer (i.e., have a higher RID).
3. Because pain interferes with successful breastfeeding, women should not avoid pain medicines after surgery. Despite an excellent safety record, breastfeeding women who require narcotic pain medicines should always watch the baby closely for signs of sedation: difficult to wake and/or slowed breathing.
4. Patients should resume breastfeeding as soon as possible after surgery because anesthetic drugs appear in such low levels in breastmilk. It is not recommended that patients “pump and dump.”
In addition to those statements, the ASA article also provided a table of all the possible pain medications with the RID value (relative infant dose) and their recommendations on if/when that drug was a safe option for a breastfeeding mom.
[From the NIH] “We suggest continuing breastfeeding after anesthesia when the mother is awake, alert, and able to hold her infant. We recommend multiple types of medications for pain relief while minimizing sedating medications.”
I printed both of these articles out, highlighted what I’d found, and packed them in my hospital bag when I went in for surgery. Once I got an opportunity to speak with the anesthesiologist, I brought out my papers, took a breath, and went for it. This is how the conversation went:
“I wanted to ask you about the medications you’ll be using for my surgery. I know that medicines transfer into my breast milk and it’s really important to me that my baby continues to drink my breast milk instead of formula. I’ve heard lots of conflicting opinions about what is safe for nursing moms. What’s your opinion?”
She then said that in her honest opinion, she didn’t have a set answer because the information continues to change, but to be safe, she recommended pumping and dumping for at least 24 hours to make sure all the medication has left my system.
I then said, “thanks for sharing that with me. I’d love to know if there’s a different way we can do things today to keep me safe AND let me breastfeed or pump as soon as possible. I found some research last night that might help us decide. Can I share what I found with you?”
She smiled and said “of course!”
I then showed her the article from the ASA (her people) and the corresponding table of medications as well as the statement from the research article. Then I said, “something else I wanted to mention is that I’d really love to avoid narcotics and opioids if at all possible. My body doesn’t respond well to them and I know those are definitely more concerning than other medications. Do you have any options for anesthesia and pain management that don’t involve narcotics?”
She thought for a moment, then mentioned Ketamine. I scanned through the provided table and read the statement next to ketamine: “unknown; recommended only if medically necessary.” I then asked, “do you have any other options you can think of?” She paused again, then said, “what about a nerve block for pain? That’s what we do for our c-section moms so they can breastfeed immediately after surgery with minimal pain. We can also do a smaller dose of the IV anesthesia to minimize its effects.”
“That sounds like exactly what I need. I just don’t know much about nerve blocks. Can you tell me more?” She then explained where the medication was going, how it was being administered, and for how long. After listening to her explanation, I decided that was the best choice for me and asked if we could do that instead.
She smiled and said, “I’ll have to write up an order and get a signature from my supervisor, but that shouldn’t be a problem. I’ll be right back.”
She came back 5 minutes later and said, “it’s approved! We’re ready when you are.”
How amazing is that? I know this isn’t everyone’s experience and I know not every doctor will be as kind or cooperative as mine were, but what I want you to realize is that there are options. And there are options because there are opinions. If there truly was only one way to do things, every doctor would give you the same answer and there would be no opinions. So next time you’re worried about conflicting information, know that that means there’s room for you to find a solution that’s best for you.
Another thing I want you to understand is that the original choice in my situation wasn’t dangerous or bad, it just wasn’t the best option for me. On top of that, asking to do something different doesn’t mean you don’t trust your doctor or that you think you know more than they do, it’s reminding your doctor that you are a unique person with unique needs and concerns and what works for someone else might not work for you. And that’s how it should be!
So I hope you take some courage from my experience this last time and see that there’s a polite way to have a conversation and it’s possible to do things differently.
Just to put it in perspective, imagine if I’d listened to the first doctor that I talked to? I wouldn’t be breastfeeding Hannah right now. But not only am I still breastfeeding, I got to breastfeed immediately after surgery with no delay. That’s only possible because I was determined to have a conversation and stand up for what I thought was right for me and my health.
Now let’s get to the last section of this episode about recovering from surgery. As I mentioned before, I didn’t do much after my first surgery other than not doing much. In other words, I wasn’t doing anything to progress me forward, just things that would prevent me from moving slower or even backwards.
I really wanted to do better this time because I knew better and I deserved better. And let me tell you, it made all the difference.
First, I adjusted my diet to my nutritional recovery protocol to heal quickly and completely. This is the exact protocol I share inside of my brand new postpartum recovery cookbook that’s launching soon. I developed 6 weeks of recipes that are written specifically for healing from childbirth and surgery, and these recipes follow a flexible meal plan format to give you the best results possible. If you want to be the first to hear about when pre-orders are available, you can sign up for the waitlist in the shownotes.
These dietary adjustments focus on simple, warm, and nourishing foods that contain all the essential nutrients for healing like iron, zinc, collagen, vitamin K, and vitamin C. I also minimized my gluten and dairy intake for the first week just to protect my gut lining and keep inflammation down to only what my body was naturally producing.
Some of the recipes I had were baked oatmeal, zuppa toscana soup, pumpkin chicken curry, orange glazed salmon, and chili con carne, all of which are in my new cookbook.
Another important focus of my nutrition after surgery was minerals. Minerals power your body at a cellular level and enable hormones to be created, transported, and received effectively, and I really needed all of those things to heal well from surgery. In addition, I needed extra minerals to keep my milk supply up while I was on pain medication and trying to repair my physical wounds.
Each day, I had two electrolyte drinks and one serving of my probiotic complex from Just Ingredients. This probiotic complex was a non-negotiable for me because my gut needed tons of support after having antibiotics and removing a foreign body (my mesh), and I chose the one from Just Ingredients because it’s made with real, whole food ingredients and it has pre/pro/postbiotics all in one. If you want to check out my electrolytes and probiotic complex, they are both linked in the shownotes.
The last thing I focused on with my nutrition was increasing my protein intake. Protein is made up of amino acids, which are the building blocks of your hormones, tissues, and muscles, and it’s also essential for a strong metabolism and milk supply. I made sure to have protein every time I ate food, and I switched my cold protein shakes for protein hot chocolate to make sure my liquids were warm.
I also added in a serving of collagen every day for two weeks to facilitate strong skin, tissue, and muscle regrowth, as well as lots of bone broth for the electrolytes, amino acids, collagen, and protein.
I want to pause and recognize that 1) this recovery protocol probably sounds really overwhelming and 2) I am very blessed to have all the resources and help from family that I did during recovery. I know lots of moms who don’t have access to high quality food, supplements, or even help around the house, and that can make the situation feel even more daunting and difficult.
If you find yourself in either of those situations, please know that the most important thing is doing what you can. I don’t share all of this to gloat about how privileged I am or shame you for doing less, I share so that you can see all that’s possible so you can decide what’s possible for you.
You can’t have the best outcome if you don’t know all the options available to you. This information is here to educate and empower you to say “wow I didn’t know that would help” or “ok I can do that!” and adjust your plan accordingly so you come out better on the other side.
Okay, now that we’ve covered what I did nutritionally to recover from surgery, let’s quick chat about what I did physically.
First, I rested A TON and really didn’t do much for myself other than walk, sit down, or lay down. If I needed anything heavier than a dinner plate or stainless steel water bottle, I asked for help. This means I was not picking up my children and when I was breastfeeding Hannah, I had her stacked on pillows so I wasn’t using any strength to hold her up.
I also spent the first 48 hours resting and only walking around the house. By day 3, I was actually surprised at how good I was feeling physically, but I didn’t want to push my luck, so I very very slowly walked around the backyard while Hyrum was playing outside. By day 5, I’d seen noticeable improvements in my strength and stability, so I opted for a very short, gentle walk down the street and back in the afternoon sun.
On day 2, I also began physical therapy just like I did after birth. I focused on reconnecting my core muscles to my breath and pelvic floor muscles and doing 360 breathing exercises to keep blood flow and mind-muscle connection strong. After day 7, I progressed my physical therapy to include gentle core exercises. Since I’d been doing these since I gave birth back in November, I was quite familiar with the progression and things moved a lot faster.
Lastly, I did two naturopathic remedies for healing the actual wound and scar. After I could remove the bandages, I started red light therapy around the incision site to help with inflammation, cell regeneration, and mitochondrial energy. I also applied some of my breast milk directly on the scar. There isn’t much science behind that one, but I figured if you can use breast milk for bug bites, diaper rash, and baby acne, why could I try it on a scar? Also breast milk is magical so….
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