Breastfeeding after Surgery: “Pump and Dump” is most often passé

by Marissa Mery

Ask an expert, Breastfeeding

It’s commonly known that women who undergo caesarean sections with anesthesia (general, spinal, or epidural) are encouraged to initiate breastfeeding as soon as they are awake, alert and able to safely hold their newborn. Yet for surgeries other than the birth of their child, many breastfeeding mothers are reflexively told to “pump and dump” breastmilk for up to 24 hours following surgery and anesthesia. Why opposing instructions? Limited knowledge around the safety profiles of medications used during and around the time of surgery has led many to adopt the most conservative approach, avoiding breastfeeding to avoid any potential adverse event.

Yet the data we do have suggests we aren’t adequately supporting breastfeeding women or their children by instructing every woman to “pump and dump” following surgery. Most women can safely breastfeed following anesthesia once they are awake, alert and otherwise stable in a recovery room. However, some women will receive medications that are not compatible with breastfeeding, so it’s essential that you have an individualized discussion with your physician regarding their recommendations for you. This article is intended to facilitate a discussion with your healthcare provider, it should not be considered medical advice!

My aim here is to provide a way to think about potential risks, a brief touch on medications commonly administered, and a list of recommended sources to help you engage your health care providers (most often physicians and nurses) in an informed discussion. This post is not medical advice, it’s simply mom-to-mom sharing. If you have any questions about taking medications while breastfeeding, please contact your healthcare provider.

General questions to contemplate the risk

Whenever we administer medications to breastfeeding women, we ask ourselves a few general questions and consult sources such as the National Institute of Health’s  LactMed.

  1. What is the potential harm if this medication were given directly to an infant? For example, could a baby’s breathing slow? Are there potential long-term complications?
  2. Is the medication even secreted in breastmilk? If so, how long does it remain? And how much is there compared to the initial dose?
  3. If the medication is secreted into breastmilk, is it even able to be absorbed by the baby? Meaning, if a baby drinks milk containing this medication, would the drug be absorbed into the baby’s bloodstream or will it simply pass on through to the next poopy diaper?

What types of medications are you most likely to receive? 

Nowhere other than an operating room will healthy individuals receive so many medications in such rapid succession. Let’s approach this chronologically. Pain control often begins in the pre-operative waiting area and continues through the recovery period. This can encompass over-the-counter medications such as ibuprofen or Tylenol, local anesthetics for regional anesthesia (especially for orthopedic procedures), and opioids. Most of these medications are generally considered to have an acceptable risk for use in breastfeeding women, with the caveat that certain opioids such as meperidine and codeine should be avoided entirely, and others including morphine and hydromorphone come with the recommendation that the mother and infant be monitored closely for signs of drowsiness or slowed breathing.

Once in an operating room, your anesthesiology team will administer sedation or a combination of medications to induce general anesthesia. Once “asleep,” your anesthetized state will be maintained with intravenous medications or inhaled gases, and you may receive paralytics and/or antibiotics depending on your procedure. At the end of a procedure, additional pain medications may be administered and the effects of the general anesthetics and paralytics are reversed or otherwise removed, sometimes using additional drugs. Again, the medications most commonly used for these processes are often safe for breastfeeding, but check with your health care team to make sure this is the case! Situations requiring additional or unanticipated medications occur frequently, and only your physicians and nurses can provide you with personalized advice.

What resources can you use to learn more about the medications you might receive to have an informed discussion with my physicians and nurses? 

Reading and referencing some of the literature read by your physicians and nurse anesthetists can help prepare you for preoperative discussions and planning.

  1. This infographic by Dr. Jonathan Wanderer of Vanderbilt University and Dr. James Rathmell of Brigham & Women’s Hospital is a fantastic one-page reference, in the shape of a baby bottle no less!
  2. Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk written by physicians at the University of Pennsylvania, this succinctly reviews common medications administered in the periods before, during and after surgery.
  3. LactMed is the NIH’s Drugs and Lactation database with open access information on drugs and their potential for adverse effects on nursing children.  

Marissa Mery

Marissa is a mom to two kids, ages 2.5 years and 6 months, as well as a critical care physician and anesthesiologist. She has lived and worked on projects to improve maternal and child health across four continents and now happily calls Houston home.