New guideline: Breastfeeding safe after anaesthesia | Association of Anaesthetists

New guideline: Breastfeeding safe after anaesthesia

New guideline: Breastfeeding safe after anaesthesia

Saturday 1 August 2020

Mothers should be encouraged to breastfeed as normal after anaesthesia, says the new guideline being published today in the Association’s journal Anaesthesia. Breastfeeding is safe as soon as the mother is alert and able to feed.

“The guideline says there is no need to discard any breast milk due to fear of contamination, since evidence shows that anaesthetic and non-opioid painkiller drugs are transferred to breast milk in only very small amounts,” explain the authors who include Dr Mike Kinsella of the Association’s Safety Committee based at St Michael’s Hospital, Bristol, UK, and colleagues. “For almost all of these drugs, there is no evidence of effects on the breastfed infant.”

However the guideline also says drugs such as opioids and benzodiazepines should be used with caution. For women breastfeeding after this type of anaesthesia they say: “The infant should be observed for signs of abnormal drowsiness and respiratory depression, especially if the woman is also showing signs of sedation. Techniques that reduce opioid usage are preferable for the breastfeeding woman. Local and regional anaesthesia have benefits in this regard, and also have the least interference with the woman’s ability to care for her infant.”

They also add that codeine should not be used by breastfeeding women following concerns of excessive sedation in some infants, related to differences in metabolism.

The guideline also recommends that any women with an infant aged two years or younger should routinely be asked if they are breastfeeding during their preoperative assessment, so that it can be explained to them that breastfeeding will be safe after their surgery.

“Where possible, day surgery is preferable to avoid disrupting normal routines. A woman having day surgery should have a responsible adult stay with her for the first 24 hours. She should be cautious with co-sleeping, or sleeping while feeding the infant in a chair, as she may not be as responsive as normal,” say the authors.

They conclude: “In summary, the pharmacological aspects of anaesthesia and sedation require little alteration in breastfeeding women. However, supportive care for the woman in the peri-operative period, and accurate advice, will ensure minimal disruption to this important part of childcare.”

Read the full guideline in Anaesthesia