Date of Award

Spring 4-30-2023

Document Type


Degree Name

Doctor of Nursing Practice (DNP)




Kacy Ballard


Lactation, Anesthesia, Guidelines, Safety, Breastfeeding, Post-Surgical

Subject Categories

Nursing | Perioperative, Operating Room and Surgical Nursing


Postoperative breastfeeding recommendations for lactating mothers by anesthesia providers are inconsistent and often inaccurate. Inappropriate recommendations have led to withholding of breastmilk to the infant, unnecessary disposal of breastmilk, surgical delay, exposure of an infant to high levels of drugs in breastmilk, and early cessation of breastfeeding. The purpose of the scholarly project was to develop a set of evidenced-based practice guideline recommendations and a proposed implementation plan for anesthesia providers to use in support of breastfeeding mothers who recover from surgery. Many studies in the literature indicate that there are inconsistencies in postoperative breastfeeding recommendations by anesthesia providers. When postoperative breastfeeding guidelines were implemented, anesthesia staff were more likely to recommend breastfeeding in the immediate postoperative period and feel more confident in their recommendation. In addition, there were fewer preventable delays in breastfeeding resumption and fewer neonatal safety events. Tools from the Johns Hopkins Nursing Evidence-Based Practice model were used to guide a systematic literature review, synthesize evidence, and develop an implementation plan. The literature review included the safety of commonly used perioperative medications in the lactating mother. Overall, almost all medications used in the perioperative period are safe to use in lactating mothers, except for codeine, meperidine, tramadol, diazepam, and hydromorphone. As part of this project, a guideline implementation plan for future use by anesthesia providers was developed and proposed to occur over 11 months. Additionally, a ten-question knowledge and confidence assessment regarding breastfeeding recommendations was proposed to be distributed to all anesthesia providers (e.g., Anesthesiologists and Certified Registered Nurse Anesthetist [CRNAs]) prior to guideline implementation, one month after implementation, and six months after implementation. The anticipated statistical analysis plan for knowledge and confidence outcome data is recommended to utilize the one-way analysis of variance (ANOVA) test. The clinical importance of this scholarly project is that the project’s proposed clinical practice guidelines may help to increase anesthesia provider knowledge and confidence in providing effective postoperative education concerning the safety and compatibility of certain anesthesia medications and continued practices of breastfeeding patients following surgery.

Licensing Permission

Copyright, some rights reserved. Attribution – Noncommercial – Share Alike



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