Anaesthesia in breastfeeding mothers

General anaesthesia consists of a combination of medications. These usually include drugs which put you to sleep, drugs to keep you asleep and painkillers.

Anaesthetic drugs

These are the drugs which put you to sleep and keep you asleep. These medicines are very short-acting. At the end of the operation, these are turned off and you gradually wake up. As they are very short-acting, you tend to recover from their effects very quickly. This also means that by the time you’re awake enough to breastfeed, the levels in your body will be very low and it is safe to breastfeed. However, you should have somebody with you just in case you are still drowsy enough to fall asleep during breastfeeding.

Painkillers

Painkillers vary depending on the nature of surgery. There are “simple” painkillers such as paracetamol and ibuprofen, which might be used during and after surgery. These are safe while breastfeeding. Stronger painkillers include opiates such as morphine and fentanyl. These are often given during your operation and are one of the reasons that you may be drowsy or queasy when you wake up. You will be given anti-sickness medication by the anaesthetist.

Antibiotics

Antibiotics are sometimes given during or after surgery. In general, these are safe for breastfeeding mothers. A small amount of the drug is likely to cross into breastmilk. Occasionally this may cause your baby to have runny poos. Any concerns regarding the above medicines can be discussed further with your anaesthetist who will be familiar with their use in breastfeeding mothers.

You may be given painkillers after your operation. “Simple” painkillers such as paracetamol and ibuprofen are safe to use when breastfeeding.

Stronger opiate drugs like morphine can be used, preferably at as low a dose as practical. Some of the drug can cross into breastmilk and may make your baby drowsy. More serious problems like slower breathing rate can occur, particularly in newborns, so you should take them for as short a time period as practical and be vigilant for any effect on your baby. Your anaesthetist will be able to give you advice on this.

Depending on the operation, you may require daily injections (usually into the skin on your tummy) to reduce the risk of blood clots after your procedure. These are safe when breastfeeding.

Sometimes antibiotics need to be continued for one or more doses after your operation. As above, these are safe but may cause your baby to have runny poos as some of the drug crosses into the breastmilk.

Codeine phosphate is a medium-strength painkiller that can have a serious effect on breastfeeding babies. Current evidence does not recommend the use of codeine phosphate in mothers who are breastfeeding. Codeine can be found in both medicines from the community pharmacy and hospital e.g. Co-codamol.

Aspirin should also be avoided, unless you are told by your doctor that the benefit outweighs the risks.

Generally speaking, anaesthetic drugs will remain in your body for around 24 hours, possibly longer for bigger operations. During this time you should not drive a car, operate machinery or ride a bike. However, most people will feel back to normal within a few hours of coming round from the anaesthetic. For many operations, you may be able to go home later the same day, provided you have a responsible adult who can take you home and stay with you. This is known as day surgery. You will be told if this is a possibility for you.

If you are taking strong painkillers, you need to be aware that these can make you feel drowsy and affect your ability to safely co-sleep, drive and perform other tasks so you will need to take this into consideration when recovering from surgery where these are needed and get some extra support for this time.

If your operation is not urgent, it may be possible to postpone surgery until your baby is older or you are no longer breastfeeding. This is a discussion that you could have with your surgeon.

If surgery is to proceed, there are alternative forms of anaesthesia that do not involve going to sleep. These may not be suitable for all procedures, therefore a discussion with your surgeon and anaesthetist may be required.

Local anaesthetic

Certain procedures can be performed with local anaesthetic only, avoiding the need for general anaesthesia. Local anaesthetic is the type of anaesthetic typically used at the dentist. It is safe in breastfeeding mothers.

Neuraxial block e.g. Spinal or epidural anaesthesia

This involves an injection of local anaesthetic into your lower back, numbing your legs and abdomen for a period of time. It is safe in breastfeeding mothers. This is commonly performed for caesarean sections and lower limb surgery such as knee or hip replacements.

Regional anaesthesia

This is a form of local anaesthetic, where the nerves supplying an area of your body are numbed with local anaesthetic. An example would be an injection to the nerves supplying your shoulder for shoulder surgery. This is usually performed under ultrasound guidance. This technique is growing in popularity but isn’t suitable for all types of surgery so needs to be discussed with your anaesthetist. It is safe in breastfeeding.