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Breastfeeding and Anesthesia

(Originally posted 31 July 2001 on About Anesthesiology)

There are many good reasons for a mother to want to breastfeed her infant. In addition to psychological factors associated with bonding, etc. there are known medical benefits for the baby, including a nutritionally complete food source and benefits to the immune system. The American Academy of Pediatrics recommends that, whenever possible, breast milk be the only milk that infants receive for the first year of life. For mothers committed to breastfeeding, the need to have surgery and anesthesia often presents a dilemma. Can breastfeeding continue? Is it safe? Is it practical?

Many women are simply told to stop breastfeeding when they need surgery and anesthesia. In addition to the logistical difficulty of allowing breastfeeding when a patient is admitted to the hospital, there are concerns about the medications used in anesthesia, pain medications and any antibiotics that might be necessary. Many physicians are unfamiliar with whether medications that are commonly used in fact pass into breast milk. In fact, if you read the product inserts of most medications, the drug companies themselves often discourage breastfeeding while a mother is using their medications. This is true even for medications that have been found to be safe.

The conservative recommendations about breastfeeding when taking medications comes from a concern about possible lawsuits should problems occur. They are not usually based on sound scientific studies of the specific medication and its appearance in breast milk. In fact, most studies that have been done on this issue have shown that the majority of drugs are very safe for use in nursing mothers.

While the instruction to stop breastfeeding is certainly safe, it may be a bit too conservative. For a mother that is motivated, breastfeeding certainly can occur during the time period surrounding anesthesia and surgery. Many studies have found that the use of general anesthesia and most commonly used medications for pain relief are safe and should not interfere with breastfeeding. Mothers that have anesthesia or pain relief during labor and delivery are encouraged to breastfeed almost immediately - and it should be no different for mothers breastfeeding their infants. A nursing mother should be allowed to breastfeed as soon as she is awake and aware after general anesthesia.

Here are some facts about breastfeeding and anesthesia:

  • Medications used in general anesthesia do not remain in the mother's system and do not affect her milk.
  • Nearly all pain medications are safe for the nursing mother. Acetaminophen (Tylenol) and Ibuprofen are safe. Narcotic analgesics should be used with greater caution - but in general only trace amounts appear in breast milk. Morphine has been shown to have the least effect of all the narcotics on infants. Codeine should be used with caution, but is easily substituted with another medication. Demerol may cause some drowsiness in the infant, but again is generally considered safe.
  • Pain suppresses lactation. The proper relief of pain will help lactation to continue.
  • Always consult your physician about specifics - there are exceptions to every rule and there may be other considerations. Every decision is about weighing both the risks and the benefits.

Next page ---> Specific Patient Recommendations... Page 1, 2, 3


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