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Anaesthesia and sedation for breastfeeding parents

It is quite common for a parent to need surgery at some point while they are breastfeeding. Parents often feel concerned about the safety of continuing to breastfeed afterwards. This page is to help breastfeeding parents understand the safety and risks involved in coming in for an operation or procedure, while they are breastfeeding.

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    Mother breastfeeding baby

    Anaesthesia is very safe. It allows a patient to be comfortable during their surgery. Anaesthetists are specialist doctors who are highly trained to deliver anaesthesia and help look after you before, during, and after your surgery.

    This information is meant as a general guide only. It does not replace individual medical advice given by your healthcare providers. You should always ask your healthcare team If there is anything you’re unsure about.

    Most people can continue to breastfeed following sedation or anaesthesia.

    Expressing and disposing of the expressed breast milk or ‘pumping and dumping’ is hardly ever required.

    Please let your healthcare team looking after you know that you are breastfeeding so they can discuss this with you and support you around the time of your operation.

    If you have any concerns about your health, or the health of your baby, let the team caring for you know.

    Before your surgery or procedure

    • Let your surgeon/proceduralist and anaesthetist know that you are breastfeeding.
    • You can consider delaying non-urgent surgery until after you have finished breastfeeding (although this is usually not possible or required).
    • Keep well hydrated – continue eating and drinking until the time you have been told to stop. If you are waiting a long time for your surgery or procedure while nil by mouth (not eating/drinking) ask if you can have some intravenous fluids or continue drinking clear fluids.
    • Breastfeed as close as possible to the start of your surgery or procedure.
    • If you are having a long operation or major surgery it may be useful to express and store milk before the day of surgery so that someone can feed your baby while you are in surgery. You may also find it helpful to be seen by a lactation consultant if possible.
    • If your baby was born prematurely or has a history of apnoeas (pauses in breathing) discuss this with your doctor. Expressing before surgery for these babies may be useful.
    • Ensure someone is available to care for your baby or child while you are in surgery and to help afterwards.
    • Some surgeries or procedures may be able to be done under regional anaesthesia, which might allow you to return to eating, drinking, and breastfeeding as quickly as possible after your surgery. You can discuss this with your anaesthetist.

    After your surgery or procedure

    • The general rule is that: if you are awake enough to hold your breastfed child you are awake enough to breastfeed.
    • Try and have someone bring your baby to you as soon as possible after surgery so you can breastfeed them once you are awake. If this isn’t possible, you may wish to pump or express once awake. You do not need to discard/’dump’ this milk and can feed it to your breastfed child later.
    • A responsible adult should stay with you during this time to help ensure the safety of your baby or child. This is especially important if you are needing large doses of pain relief after your surgery.
    • If you have a baby with a history of apnoeas (pauses in breathing) or a premature baby you may consider expressing and giving the milk to the baby when they’re older or mixing the milk with expressed milk before surgery, to reduce the amount of sedating medications in it. It would be helpful to talk about your plan with a lactation consultant, as it might not be necessary.
    • Care should be taken with co-sleeping following sedation and anaesthesia because you might not wake as usual in the night. For short procedures not requiring much pain relief afterwards, it is recommended that you avoid co-sleeping for the first night after the procedure. For longer surgery, requiring large doses of pain relief, you should discuss co-sleeping with the doctors caring for you.

    Medications and breastfeeding

    Please note, this is general advice for most patients. It does not replace individual medical advice given to you by your healthcare team. Please discuss any specific information with the doctors caring for you.

    Safe with Breastfeeding

    • Paracetamol – safe with breastfeeding
    • Non-steroidal anti-inflammatory drugs (NSAIDs) e.g. ibuprofen (Nurofen), diclofenac (Voltaren) – safe with breastfeeding

    Generally safe but you should discuss these with a lactation consultant and/or your doctors

    • Opioids (e.g. morphine, fentanyl, oxycodone, tramadol) – generally safe at the lowest doses that provide good pain relief for the shortest amount of time possible. A caesarean section is the most common procedure performed in Aotearoa New Zealand. People are usually prescribed opioids to have afterwards, in the knowledge that these medications are safe to have when breastfeeding a newborn.
    • Ketamine – low doses for pain is likely to be safe for breastfeeding.
    • Gabapentin – likely safe for short-term use while breastfeeding.

    Discuss this with your doctor

    • Pregabalin – there is limited information about its use in breastfeeding parents, discuss this with your doctor.

    Safe with Breastfeeding

    • Local Anaesthetics – safe with breastfeeding.
    • Propofol – safe with breastfeeding.
    • Midazolam – safe with breastfeeding.
    • Volatile (Gas) Anaesthetics – safe with breastfeeding.
    • Neuromuscular Blockers (Muscle Relaxants) and Reversal – safe with breastfeeding.

    Safe with breastfeeding although some may reduce breastmilk supply (e.g. promethazine, scopolamine). You should discuss this with a lactation consultant and or the doctors caring for you.

    Most are safe but you should discuss these with a lactation consultant and/or your doctors first.

    • Antibiotics – most are safe in breastfeeding although some may cause gut symptoms in breastfeeding babies.
    • Radiological contrast – almost all are safe in breastfeeding except Technetium containing contrast which requires breastmilk to be expressed and disposed of for 12 hours after taking it.

    General questions and answers

    This is very unlikely to be required. Unless your baby has significant health issues you can continue to breastfeed as usual after your procedure. Please read the above information and make sure you stay well hydrated as the bowel preparation required can cause dehydration which may affect your milk supply.

    Please discuss this with the doctors caring for your baby. The general advice is to feed your baby or express as close to the start of surgery or procedure as possible. Afterwards you can continue to express and either store that milk for when your baby is older or mix it with milk you expressed before surgery.

    Please let the doctors caring for you know that you are currently breastfeeding. You may wish to express some milk in advance if possible to have some stored for your child if required. You will most likely be able to continue breastfeeding after your surgery but discuss this with your healthcare team.

    No, MRI contrast does not require you to dispose of your breastmilk. You can continue to breastfeed as usual.

    You may be able to have your procedure done under regional anaesthesia (blocking nerves). Please discuss this with the anaesthetist who will be caring for you.

    More information

    As a parent, there are many choices you can make for your whānau: from conception, through birth, breastfeeding and beyond. About 65% of pregnant people in Aotearoa New Zealand choose to or require the services of an anaesthetist during labour. This page and the resources linked below are supported by the National Obstetric Anaesthetists’ (NOA) Network. We hope this information on some of the choices where anaesthetists might be involved can help you feel more confident when the time comes to make those decisions.

    This information is meant as a general guide only. It does not replace individual medical advice given by your healthcare providers. You should always ask your healthcare team If there is anything you’re unsure about. The NZSA does it utmost to keep this information up to date and content is subject to change. If you have any feedback or suggestions for future topics please get in touch.