The short answer
Anaesthetic medicines and most pain medicines pass into breast milk in only very small amounts. For almost all medicines used around surgery, there is no evidence that these amounts harm a breastfed baby.
Current guidance from the Association of Anaesthetists (UK) is that you can breastfeed as soon as you are awake, alert and able to feed or hold your baby. You do not need to express and throw away (“pump and dump”) your milk after an anaesthetic.
Before your anaesthetic
- Tell Dr Halvey and the hospital team that you are breastfeeding, and how old your baby is. This helps with choosing medicines.
- Feed your baby, or express, just before you come in if you can. This keeps you comfortable.
- If you use a breast pump, bring it with you. Ask the hospital whether your baby and a support person can stay with you.
- Fasting rules apply to you, not your baby. Your baby can feed as normal.
- If you can, arrange for another adult to help care for your baby for the rest of the day after your anaesthetic.
After a general anaesthetic
Once you are awake and alert, you can usually feed your baby. If you feel too drowsy to hold your baby safely, wait until you feel more awake, or ask someone to help. Expressed milk from before or after the anaesthetic can be kept and used.
Where it suits the operation, local anaesthetic, a nerve block or a spinal can reduce the need for strong pain medicines. Dr Halvey will discuss this with you.
After a caesarean
Most caesareans are done with a spinal or epidural, so you are awake. The medicines used reach your milk in tiny amounts. You can usually hold your baby skin to skin and start feeding in theatre or the recovery area, if you and your baby are well.
After a general anaesthetic for a caesarean, you can feed as soon as you are awake and able to hold your baby.
Pain medicines and breastfeeding
Good pain relief helps you move, rest and feed your baby. The table gives general guidance. Your team will choose medicines and doses for you.
| Medicine | What to know |
|---|---|
| Paracetamol | Considered safe while breastfeeding. The amount in milk is much less than a baby's own dose. |
| Anti-inflammatories such as ibuprofen | Very little passes into milk. Breastfeeding can continue as normal. |
| Strong opioids such as oxycodone or morphine | Used for short periods at the lowest dose that controls your pain. Watch your baby for sleepiness or poor feeding. Extra care is needed for newborns, premature babies and babies who are unwell. |
| Tramadol | Can be used with caution. Watch your baby for extra sleepiness or changes in breathing. |
| Codeine | Not recommended while breastfeeding. Some women turn codeine into morphine very quickly, which can make a baby dangerously drowsy. This includes codeine in combination products you can buy from a pharmacy. |
| Sleeping tablets and sedatives | A single dose around surgery is usually acceptable. Repeated doses need more care. Ask before taking any at home. |
| Anti-sickness medicines | The medicines commonly used around surgery are usually compatible with breastfeeding. |
Check with a doctor, midwife or pharmacist before you take any new medicine at home, including products from a pharmacy or supermarket.
Watch your baby
If you are taking strong pain medicines, watch for changes in your baby. Stop breastfeeding and get advice the same day if your baby:
- is much sleepier than usual or hard to wake
- is not feeding well, or is too sleepy to feed
- seems floppy.
Sleep and safety at home
Anaesthetic and pain medicines can make you less responsive than usual, even when you feel fine.
- Take care with bed-sharing, and with feeding in a chair or on a sofa where you might fall asleep with your baby.
- Have another adult with you, especially on the first night.
- Avoid alcohol while you are taking strong pain medicines.
Who to ask
- Dr Halvey, your midwife, your obstetrician or the hospital pharmacist.
- Your community pharmacist or GP once you are home.
- King Edward Memorial Hospital Obstetric Drug Information Service: (08) 6458 2723, weekdays during business hours.
- Australian Breastfeeding Association Breastfeeding Helpline: 1800 686 268.
- healthdirect: 1800 022 222, at any time.