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

Anaesthetic drugs are used to put you to sleep and keep you asleep during surgery. These medications are very short-acting and are turned off at the end of the operation. This allows you to wake up gradually. By the time you are alert enough to breastfeed, the levels of these drugs in your body will be very low. This makes it safe to breastfeed. But, having someone with you is important as you may still be drowsy.

Painkillers

Painkillers vary depending on the nature of surgery. There are “simple” painkillers such as paracetamol and ibuprofen. These can 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 you may be drowsy or queasy when you wake up. Your anaesthetist will give you anti-sickness medication for this.

Antibiotics

Painkillers are often given during and after your operation to manage discomfort.

• Simple painkillers, such as paracetamol and ibuprofen, are safe to use while breastfeeding.
• Stronger painkillers, including opiates like morphine and fentanyl, may also be used. But these can cross into breast milk and could make your baby drowsy. Rarely, more serious effects like a slower breathing rate can occur, particularly in newborns. To minimise risks, these drugs should be taken at the lowest effective dose for the shortest possible time. Be vigilant for any signs of drowsiness or unusual behaviour in your baby. Consult your healthcare provider with any concerns. Your anaesthetist can provide guidance tailored to your situation.

Medications to prevent blood clots

Depending on the type of surgery, you may require daily injections to reduce the risk of blood clots. These injections, usually given into the skin of your abdomen, are safe to use while breastfeeding.

Antibiotics

Antibiotics are sometimes needed during or after surgery. While these are generally safe for breastfeeding mothers, a small amount of the drug may pass into breast milk. This can occasionally cause your baby to have runny poo. This is typically temporary. Speak to your anaesthetist if you have any worries.

Current evidence does not recommend the use of codeine phosphate in mothers who are breastfeeding. Codeine can be found in medicines from the pharmacy and hospital e.g. Co-codamol.

Aspirin should also be avoided, unless your doctor tells you the benefits outweigh the risks.

Anaesthetic drugs will remain in your body for around 24 hours. During this time you should not drive a car, operate machinery or ride a bike.

Most people feel normal within hours of waking from anesthesia. For many procedures, you can go home the same day if a responsible adult accompanies and stays with you. You'll be told if it's an option for you.

If you are taking strong painkillers, you need to be aware that these can make you feel drowsy. This will affect your ability to safely co-sleep, drive and perform other tasks. You need to consider this when recovering from surgery and get extra support.

If your surgery is non-urgent, you may be able to postpone it until your baby is older or you’ve stopped breastfeeding. Discuss this with your surgeon.

If surgery proceeds, alternative anaesthesia options may be available:

• Local anaesthetic: Used for minor procedures, similar to dental anaesthesia. Safe for breastfeeding.
• Spinal or epidural: Injected into the lower back to numb the abdomen and legs. Common for caesarean births and gynaecological procedures. Safe for breastfeeding.
• Regional anaesthesia: Numbs specific nerves, such as for shoulder surgery. Often guided by ultrasound. Not suitable for all surgeries, so consult your anaesthetist. Safe for breastfeeding.