| Preoperative planning |
Ask all women with infants <2 years of age if they are breastfeeding. For those who are breastfeeding: - Where possible, day surgery is preferable to avoid disrupting normal feeding routines.
- If the mother will be separated from the infant for more than a few hours perioperatively, encourage her to express and store breast milk preoperatively to feed the infant during that time.
- If the infant has not been fed from a bottle, encourage the mother to introduce bottle feeding prior to surgery.
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| Selection of drugs |
| General principles: | - Anesthetic and nonopioid analgesic drugs are generally safe for use while breastfeeding*, because they are transferred to breast milk in only very small amounts. For almost all drugs used perioperatively, there is no evidence of adverse effects on the breastfed infant.
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| Optimal choices: | - Opioid-sparing techniques are preferable for the breastfeeding woman. Local and regional anesthesia have benefits in this regard, and also interfere the least with the woman's ability to care for her infant.
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| Use with caution: | - Ketamine should be avoided if possible and should be used with careful monitoring of the infant during breastfeeding*.
- Opioids and benzodiazepines should be used with caution¶, especially after multiple doses and in infants <6 weeks old (corrected for gestational age). In this situation, the infant should be observed for signs of abnormal drowsiness and ventilatory depression, especially if the woman is also showing signs of sedation.
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| Avoid: | - Codeine should not be used by breastfeeding women due to concerns of excessive sedation in some infants, related to differences in metabolism.
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| Postoperative management |
- Women should be encouraged to breastfeed as normal following surgery.
- There is no need to express and discard breast milk ("pump and dump") after anesthesia.
- A woman having day surgery should have a responsible adult stay with her for the first 24 hours postoperatively. She should be cautious with cosleeping, and be careful not to fall asleep while feeding the infant, as she may not be as responsive as normal.
- Breastfeeding support should be accessible for lactating women undergoing surgical and medical procedures.
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