Studies have shown that breastfeeding has extensive benefits for both infant and mother. Breast milk is the best source of nutrition for a child, decreasing the risk of many infanthood diseases as well as the long-term risk of obesity.i The World Health Organization recommends exclusive breastfeeding for the first six months of life, minimum.ii Moreover, mothers who choose to breastfeed experience a reduction in the risk of developing breast and ovarian cancer, as well as improved bone health.iii Therefore, breastfeeding is a critical child-development process that plays a large role in the wellbeing of both parent and offspring.
Despite its positive effects, breastfeeding can be complicated by maternal anesthesia and sedation. There is inherent risk that the infant will be indirectly exposed to harmful agents through breast milk, or that mothers may stop feeding and discard safe breast milk unnecessarily due to anxiety. To this end, Mitchell et al. from the Association of Anesthetics published the 2020 guidelines for anesthesia and sedation in breastfeeding women.iv The authors sought to create a comprehensive review of quality research concerning safe practices for both medicated women and their children.
Mitchell et al. found that choosing certain methods of sedation and anesthesia may mitigate the risk of adverse effects in breastfeeding mothers. For example, regional anesthesia often does not interfere with the mother’s ability to feed her child and is therefore preferable to general anesthesia. Many anesthetic agents— such as propofol, paracetamol, and sugammadex— pass into breast milk at very low levels, and therefore do not pose a significant risk to breastfeeding infants. Women who still do not feel comfortable breastfeeding are strongly recommended to consider prior breast milk storage and create an evidence-based drug elimination plan with their physician.
Strong dosages of opioids, on the other hand, can pose a tangible risk for breastfeeding infants, particularly neonates. Immature hepatic and renal function causes children six weeks of age and younger to be highly sensitive to the adverse effects of opioids. Mothers who are taking opioids are therefore advised to carefully monitor their children for sedation and drowsiness, and immediately seek medical attention if necessary. In the cases where an opioid prescription is required, dihydrocodeine or morphine are preferred.
Certain analgesics should not be prescribed to breastfeeding mothers at all. For example, women who are ultrarapid metabolizers of codeine produce high concentrations of morphine in breast milk, which can lead to neonatal depression and death of the infant.v Analgesic doses of aspirin can pose a similarly high risk.
In summary, research indicates that breastfeeding status should be a considerable factor in determining the ideal anesthetic and sedative option for mothers with infants.
i National Institute for Health and Care Excellence (NICE). Maternal and child nutrition public health guideline PH11, updated 2014. https://www.nice.org.uk/guidance/ph11 (accessed 23/03/2019).
ii World Health Organization. The optimal duration of exclusive breastfeeding. Report of an expert consultation, 2001. https://apps.who.int/iris/bitstream/handle/10665/67208/WHO_NHD_01.08.pdf?ua=1 (accessed 23/03/2019).
iii United Nations Children’s Fund (UNICEF). Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK, 2012. https://www.unicef.org.uk/wp‐content/uploads/sites/2/2012/11/Preventing_disease_saving_resources.pdf (accessed 23/03/2019).
iv Mitchell, J., Jones, W., Winkley, E. and Kinsella, S.M. (2020), Guideline on anaesthesia and sedation in breastfeeding women 2020. Anaesthesia, 75: 1482-1493. https://doi.org/10.1111/anae.15179
v Koren G, Cairns J, Chitayat D, Gaedigk A, Leeder SJ. Pharmacogenetics of morphine poisoning in a breastfed neonate of a codeine‐prescribed mother. Lancet 2006; 368: 704.