Breastfeeding Is Safe After Anesthesia, New UK Guidelines Say

By Lisa Rapaport

August 31, 2020

(Reuters Health) - Breastfeeding women who receive anesthesia or non-opioid painkillers don't need to stop nursing their babies because only trace amounts of these drugs are transferred to breast milk, according to new guidelines from the Association of Anesthetists in the UK.

"The new guidelines advocate the support of breastfeeding throughout the surgical journey which may entail the provision of storage for breastmilk, readily available breast pumps, and lactation support from a suitably trained member of staff," said Dr. Wendy Jones, a co-author of the guidelines and a specialist pharmacist in breastfeeding and medication in Portsmouth, UK.

"The most significant change is that lactating mothers undergoing anesthesia can continue to breastfeed as soon as they are awake and alert and should be supported to do so," Dr. Jones said by email.

While in the past clinicians have advised women to pump breast milk and discard it, known as "pumping and dumping," to avoid feeding infants any milk contaminated by anesthesia or painkillers, the new guidelines stress that this isn't necessary in most cases.

Certain drugs, including opioids and benzodiazepines, should still be used with caution because the amount of these medicines that passes into breast milk may impact newborns, especially up to six weeks old, according to the new guidelines in the journal Anaesthesia.

If mothers have taken opioids or benzodiazepines, infants should be monitored for signs of respiratory distress and abnormal drowsiness - especially if mothers also have signs of sedation after taking these medicines, the guidelines note. Codeine should also be avoided due to the risk of excessive sedation in infants, according to the guidelines.

"Certain opioids particularly codeine are no longer recommended during breastfeeding due to the fact that the mother's metabolism may concentrate it in milk," Dr. Jones said.

Long term use of benzodiazepines should never be used as they are addictive, Dr. Jones added. Short term use such as midazolam for sedation for colonoscopy is acceptable, however.

"With other opioids e.g. oxycodone the mother needs to be aware that she should use the lowest dose for the shortest time possible and that she should observe her baby for drowsiness and continued effective breastfeeding," Dr. Jones said. "However, no mother should be left in pain because she is breastfeeding."

Clinicians should try to reduce opioid usage among breastfeeding women and as much as possible use local and regional anesthesia, according to the guidelines.

In addition, clinicians should routinely discuss breastfeeding with women with infants up to two years old prior to surgery to ensure that patients understand that breastfeeding can be done safely after surgery, the guidelines advise.

And, to minimize disruption to breastfeeding, outpatient surgery should be scheduled during times of day that may be least disruptive to normal routines with infants.

Breastfeeding women should have an adult with them for the first 24 hours after surgery, however, to ensure that they have support with their infants. Women should also initially be cautious about co-sleeping or sleeping while feeding an infant in a chair because mothers may not be as responsive as they normally might be in the first 24 hours after surgery.

These guidelines are in line with recommendations from other medical societies. The American College of Obstetricians and Gynecologists (ACOG) recommends that mothers who receive anesthesia for surgery and have healthy infants be allowed to breastfeed as soon as they're alert and strong enough to safely hold their babies. (https://bit.ly/32zilKD) The American Society of Anesthesiologists and the American Academy of Pediatrics have similar recommendations. (https://bit.ly/32zcll8, https://bit.ly/3jgMpS2)

The take-home message for clinicians is that breastfeeding women who receive anesthetics or sedation can resume breastfeeding as soon as they are alert enough to do so, and they don't need to pump and dump expressed milk, said Dr. Grace Lim, chief of obstetric and women's anesthesiology at the University of Pittsburgh Medical Center and UPMC Magee Womens Hospital.

"Anesthesia clinicians should thoughtfully plan anesthetic care for breastfeeding mothers, by minimizing certain medications in the perioperative period, and by sharing decision-making with breastfeeding mothers," Dr. Lim, who wasn't involved in the new guidelines, said by email. "Clinicians should engage breastfeeding mothers to develop a plan around surgery, that includes breastfeeding support and a plan for safe breastfeeding at home after surgery."

SOURCE: https://bit.ly/2G7afRY Anaesthesia, online August 1, 2020.

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