Breastfeeding and Anaesthesia

SJH Theatres and Anaesthetics
NHS Lothian

Pre op 

  • Reassure that breastfeeding can continue perioperatively
  • Allergies (mother and baby)
  • Does mother wish to breastfeed or express and store milk
  • Use opioid sparing techniques/aim for day case anaesthesia/regional techniques where possible 
  • Aim to minimise disruption to breastfeeding and fasting time 
  • Breast pump may be required to avoid engorgement and mastitis 

 

Anaesthetic drugs used perioperatively 

  • Intravenous anaesthetic agents:  Propofol , Thiopentone, Etomidate safe to use.
  • Volatiles
  • Benzodiazepines: Midazolam safe, Diazepam - single dose.
  • Local anaesthetics: safe
  • NMB:
  • Reversal: Neostigmine & Sugammadex both safe.
  • Antiemetics: all safe. : Metoclopramide and Domperidone may increase milk supply.
  • CVS drugs: Ephedrine and phenylephrine both safe. Glycopyrrolate safe, atropine can inhibit lactation but compatible with breast feeding.
  • Analgesics:  Should be individualized & lowest effective dose where possible.

Paracetamol,  ibuprofen, diclofenac, naproxen, celecoxib, ketorolac, parecoxib, morphine dihydrocodeine, pethidine, remifentanil, fentanyl and alfentanil all considered safe. 

 

Caution

  • Oxycodone - Avoid repeated dosing
  • Tramadol Use with caution.
  • Ketamine - Use other induction agents if possible.

 

AVOID 

  • Aspirin – not in analgesic doses. 
  • Codeine - If a dose of codeine has been taken by a breastfeeding woman, then discard breast milk for 15 hours to allow full clearance from maternal plasma and minimal transfer to breast milk thereafter. 

 

Post op 

  • Aim for early recovery from anaesthesia to allow breastfeeding to resume ASAP 
  • Mother will need responsible adult present for 24 hours post operatively
  • Advise to avoid co-sleeping/feeding in a chair for 24 hours