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Breastfeeding and anaesthesia

If you or your baby are preparing for surgery, you may have questions about breastfeeding after anaesthesia. In all cases, it is important to discuss with your doctor when it will be safe for you to start breastfeeding againIf you will miss some feeds, you may find it helpful to chat to an ABA breastfeeding counsellor about ways you can protect your supply and keep your breasts healthy. 


The breastfed baby 

Let your anaesthetist know that your baby is breastfed at their pre-anaesthesia consultation. Your baby may need to fast in the lead up to their surgery. Different times are usually given for breastmilk, formula, solid foods and clear fluidsThe Australian and New Zealand College of Anaesthetists (ANZCA)1recommends that: 

  • babies under the age of 6 months can continue to drink breastmilk up to3 hours before anaesthesia. 

  • babies 6 months or older can continue to drink breastmilk for up to 6 hours before anaesthesia and clear fluids may be given up to one hour before.  

It is important that babies and young children are not fasted for longer than the recommended times. Plans should be in place for breastfed babies and children to avoid long fasting times and should be flexible to allow them to breastfeed or drink fluids, including expressed breastmilk.2 

A young baby will not know why they are not allowed to breastfeed. Many breastfeeding mothers faced with this issue find that they need to be out of sight of their babies while they are fasting. You may find it helps if your partner, friend or family member comforts your baby during this time. Older babies and toddlers may be more easily distracted until the time of their procedure. 

Depending on the length of time before your baby is able to breastfeed again, you may need to express for comfort and to maintain your milk supply. After a minor procedure, a baby who is otherwise healthy and stable will often be able to start breastfeeding again as soon as they are awake.3 Toddlers coming out of an anaesthetic are often worried and confused. Breastfeeding can be calming and soothing. 


The breastfeeding mother 

Make sure that your healthcare team know that you are breastfeeding. This way they can make sure that any medications you are given before, during or after your surgery are compatible with breastfeeding. If your doctor is unsure whether or not you can breastfeed safely while taking a particular medication, ask that they check with drug information experts. 

It is likely that you will need to fast prior to any procedure that involves sedation or anaesthesia. You may prefer to ask for an early morning appointment. Your doctor may discuss ways for you to keep hydrated and protect your milk supply, such as drinking clear fluids or receiving fluids via a drip into your bloodstream.4,5 

If you will be separated from your baby for one or more feeds you may wish to express and store some of your milk in the lead-up. This can be used to feed your baby while you are apart. In most cases, you will be able to breastfeed right up until the time of your procedureFeeding or expressing just prior to your procedure is recommended6to minimise engorgement, especially if you will be asleep for a while.  

Expert bodies agree that the mother of a healthy, term baby or older child can safely resume breastfeeding after anaesthesia as soon as she is alert and feels able to feed.1,4,6,7Most anaesthetics and analgesics (pain relief drugs) pass into breastmilk at very low levels and are not thought to pose a risk to babies and young children. There is usually no need to discard (or “pump and dump”) your breastmilk.1,4,6 Mothers of premature or sick babies and those taking strong pain medications may need to take extra care. Discuss your personal plan with your healthcare provider. 

After you wake up you may feel drowsy and even nauseous. You may need some support at first to hold and breastfeed your baby safelyYou will also need someone (your partner, family member or a friend) to be with you to help you to feed and care for your baby as you recoverIf you are not well enough to breastfeed, expressing can help to maintain your supply.  

Oxytocin is a hormone that controls your let-down reflex, making the milk in your breasts available to your baby. Hormones released in response to stress or pain may inhibit the release of oxytocin.8,9Talk to your healthcare team about suitable pain relief medication to manage your pain if needed.  


When there is no time to plan 

Sometimes, a breastfeeding mother or baby will require an urgent procedure and there may be little time to plan ahead. This may disrupt breastfeeding and can cause a temporary drop in milk supply. In these cases, it is reassuring to know that many mothers and babies have gone on to resume breastfeeding and rebuild their supply as soon as they are well enough. Talk to a breastfeeding counsellor or see our article about breastfeeding and hospitalisation if you need support to get things back on track. 

The information on this website does not replace the advice of your health care provider. 


Resources 

For more information about preparing for a hospital stay for you or your breastfed baby, see the Breastfeeding and hospitalisation web article. 

 

Breastfeeding after anaesthesia information sheet(The Australian Society of Anaesthetists) 

 

 

LactMed Drugs and Lactation Database(U.S. National Library of Medicine) 

A freely accessible drugs and lactation database containing information about drugs and other chemicals to which breastfeeding mothers may be exposed. 

 

References 

  1. Australian and New Zealand College of Anaesthetists (ANZCA). (2021). PG07(A)Guideline on pre-anaesthesia consultation and patient preparation. https://www.anzca.edu.au/getattachment/d2c8053c-7e76-410e-93ce-3f9a56ffd881/PG07(A)-Guideline-on-pre-anaesthesia-consultation-and-patient-preparation  

  1. Frykholm, P., Schindler, E., Sümpelmann, R., Walker, R., & Weiss, M. (2018). Preoperative fasting in children: review of existing guidelines and recent developments. British Journal of Anaesthesia, 120(3), 469-474. https://doi.org/10.1016/j.bja.2017.11.080 

  1. The Academy of Breastfeeding Medicine. (2012). ABM Clinical Protocol #25: Recommendations for Preprocedural Fasting for the Breastfed Infant:‘‘NPO’’ Guidelines. Breastfeeding Medicine, 7(3), 197-202. https://doi.org/10.1089/bfm.2012.9988 

  1. Mitchell, J., Jones, W., Winkley, E. Kinsella, S.M. and the Association of Anaesthetists (2020), Guideline on anaesthesia and sedation in breastfeeding women 2020. Anaesthesia, 75(11), 1482-1493. https://doi.org/10.1111/anae.15179 

  1. Westmead Hospital Women’s and Newborn Health. (2016). WSP-509 Breastfeeding and having surgery (v2)[Fact sheet].Western Sydney Local Health District,New South Wales Government. https://www.wslhd.health.nsw.gov.au/ArticleDocuments/1371/WSP-509%20Breastfeeding%20and%20having%20surgery%202.pdf.aspx  

  1. Reece-Stremtan, S., Campos, M., Kokajko, L. and The Academy of Breastfeeding Medicine (2017). ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother. Breastfeeding Medicine, 12(9), 500-506. https://doi.org/10.1089/bfm.2017.29054.srt 

  1. American Society of Anesthesiologists. (2019). Statement on resuming breastfeeding after anesthesia. https://www.asahq.org/standards-and-guidelines/statement-on-resuming-breastfeeding-after-anesthesia 

  1. Uvnäs Moberg, K., Ekström-Bergström, A., Buckley, S., Massarotti, C., Pajalic, Z., Luegmair, K., Kotlowska, A., Lengler, L., Olza, I., Grylka-Baeschlin, S., Leahy-Warren, P., Hadjigeorgiu, E., Villarmea, S., & Dencker, A. (2020). Maternal plasma levels of oxytocin during breastfeeding-A systematic review. PloS one, 15(8), e0235806. https://doi.org/10.1371/journal.pone.0235806  

  1. Ueda, T., Yokoyama, Y., Irahara, M., & Aono, T. (1994). Influence of psychological stress on suckling-induced pulsatile oxytocin release. Obstetrics and Gynecology, 84(2), 259–262. 

 

© Australian Breastfeeding Association 

 

 

Last reviewed: 
Mar 2022