Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk

Abstract

Brief Summary:Doctors, nurses, and midwives often inform mothers to "pump and dump" their breast milk for 24 hours after receiving anesthesia to avoid passing medications to the infant. This advice, though cautious, is probably outdated. This review highlights the more recent literature regarding common anesthesia medications, their passage into breast milk, and medication effects observed in breastfed infants. 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. Few medications can have sedating effects to the infant, but those medications are specifically outlined. For additional safety, anesthesia providers and patients may screen medications using the National Institute of Health' LactMed database. INTRODUCTIONThe positive impact of breastfeeding for both mothers and infants has been well established.1, 2 Given the difficulty of conducting randomized clinical trials in breastfeeding mothers and their infants however, there is a paucity of human data regarding the transfer of anesthesia and analgesia medications into breast milk. Available information remains limited to case studies, small sample observations, and animal studies, which may or may not accurately reflect conditions for lactating women. 3,4 This lack of knowledge may lead mothers who require medication to abandon nursing on their own accord or based on conservative advice from healthcare practitioners who are concerned about possible adverse effects in the infant. 5 In addition, physicians, hospitals, and even patients continue to rely on the information given by drug manufacturers concerning the use of drugs during breastfeeding, which is often restrictive or similarly contains contraindications for the lactation period. The lack of agreement among physicians, the FDA, and hospital policy has created different recommendations and practices regarding, 1) the interval between medication administration and breastfeeding, 2) when to "pump and dump", and most importantly, 3) which medications are safe. This review highlights the most recent medical literature concerning breastfeeding and the perioperative use of common medications by anesthesia providers during the intraoperative, intrapartum, postoperative and postpartum periods. 6 The review is focused only on opioid-naïve patients as evidence addressing recommendations in opioid-tolerant lactating mothers remain non-existent. Information presented in this review is written on the premise that data is limited and most medications administered in this patient population have not been rigorously screened by the FDA for safety and efficacy. EVIDENCEThe transfer of medications into breast milk depends on pharmacological properties including protein binding, lipid solubility, molecular weight, pKa, and maternal plasma level of the drug. 7 In general, medications that are highly lipid soluble, less protein-bound, of lower molecular weight, or wit...

Guideline on anaesthesia and sedation in breastfeeding women 2020

“…There are several publications that give guidance on the compatibility of breastfeeding following anaesthesia [4][5][6][7].…”

“…Breastfeeding is considered acceptable following single doses of fentanyl to the woman. This is also extrapolated to alfentanil [5].…”

“…Online resources include lactation specific databases such as the UK Drugs in Lactation Advisory Service (UKDILAS) [1], Drugs and Lactation Database (LactMed) [2], and Hale [3]. There are several publications that give guidance on the compatibility of breastfeeding following anaesthesia [4–7].…”

Low-Dose Ketamine as Perioperative Analgesia in Caesarean Sections in Remote Areas with Limited Medical Supplies

“…Inadequate pain management, especially during the first 24 hours will interfere with the bonding process between the baby and the mother. The use of analgesics also has to be done cautiously due to the patient's breastfeeding needs after giving birth (6,18). Thus, the administration of NSAIDs is the main choice for the management of postoperative cesarean section pain, but NSAIDs alone cannot treat moderate to severe pain.…”

Critical Care in Placenta Accreta Spectrum Disorders—A Call to Action

“…While the previous advice to "pump and dump" breast milk for 24 hours after receiving anesthesia is not based on evidence, in most cases breastfeeding can commence when the mother is awake, alert, and able to hold her infant. 35 A few notable considerations include narcotics; all opioids transfer to breast milk in varying amounts. When opioid analgesia is required, it should be used with caution and for the shortest reasonable time in breastfeeding mothers.…”