“I’m breastfeeding, but I need to have surgery. Help!”

Are you breastfeeding and have a surgery coming up? Read on for helpful information about breastfeeding after surgery.

Anesthesia and Breastfeeding

More often than not, breastfeeding and anesthesia are compatible. The common suggestion for the lactating parent to “pump and dump” for 24 hours post-surgery is not in line with current evidence. Generally, the nursing parent can resume breastfeeding once they are awake, stable, and alert after anesthesia has been given.

The American Society of Anesthesiologists published the following recommendations for nursing parents requiring surgery:

1. All anesthetic and analgesic drugs transfer to breastmilk; 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 relative infant dose or RID).
3. Because pain interferes with successful breastfeeding, lactating people should not avoid pain medicines after surgery. Despite an excellent safety record, breastfeeding people who require narcotic pain medicines should always watch the baby closely for signs of sedation: difficult to wake and/or slowed breathing.
4. When possible, spinal or epidural anesthesia consisting of local anesthetic and a long-acting narcotic, should be used for cesarean delivery to reduce overall post-operative pain medication requirements.
5. 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.”

The Association of Anaesthetists in the United Kingdom published recommendations including:

• Where possible, day surgery is preferable to avoid disrupting normal routines. A nursing parent having day surgery should have a responsible adult stay with them for the first 24 hours post surgery. The nursing parent should be cautious with bedsharing, or sleeping while feeding the infant in a chair, as they may not be as responsive as normal.
• Breastfeeding support should be accessible for lactating women undergoing surgical and medical procedures.

The following are considered compatible with breastfeeding:

Midazolam
Fentanyl (single dose IV)
Ondansetron
Dexamethasone
Metoclopramide
Propofol
Etomidate
Volatile anesthetics Succinylcholine
NMBAs Neostigmine/glycopyrrolate Lidocaine
Bupivicaine

The following should be monitored closely or avoided: 

Morphine- Monitor closely
Hydromorphone- Monitor closely
Ketamine- No Data
Meperidine- Avoid

Reference: Anesthesiology 10 2017, Vol.127, A15. doi:10.1097/ALN.0000000000001867

Resources

Anesthesia and Breastfeeding Hand Out, LLL USA

Statement on Resuming Breastfeeding after Anesthesia, American Society of Anesthesiologists

Guideline on anesthesia and sedation breastfeeding women 2020, Association of Anaesthetists UK

Breastfeeding when mom has surgery, KellyMom

Does Anesthesia Affect a New Mom’s Ability to Breastfeed?, American Association of Nurse Anesthetists

Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother— Academy of Breastfeeding Medicine

Easing the Distress of Major Surgery, LLL USA blog

My Baby Is Having Surgery, LLLI

IS YOUR CONCERN OR QUESTION NOT COVERED HERE?

Please contact a local LLL Leader with your specific questions.

Medical questions and legal questions should be directed to appropriate health care and legal professionals.

Page updated September 2020