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Breastfeeding and anaesthesia

How to manage breastfeeds if you or your baby needs surgery. 

anaesthesia

If you or your baby are preparing for surgery, you may have questions about breastfeeding after anaesthesia.

It’s important that your surgeon and anaesthetist know that you are breastfeeding or that your baby is breastfed. They will be able to advise you about how long you or your baby will need to fast before surgery and when it is safe to begin breastfeeding again afterwards.  

For a breastfed baby or child

Let your anaesthetist know at your first consultation that your baby or child is breastfed because they may need to go without breastmilk (and solid food if they are having this) in the lead up to their surgery. It is important that you do not fast them for longer than the recommended times.

Different times are usually given for breastmilk, formula, solid foods and clear fluids. The Australian and New Zealand College of Anaesthetists (ANZCA) recommends that:  

  • babies under the age of 6 months can continue to drink breastmilk up to 3 hours before anaesthesia

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

Discuss with your care providers to make a plan that everyone is aware of in regard to when your baby can breastfeed. 

A young baby will not know why they are not allowed to breastfeed. While your baby is fasting, you may find it easier not to be close by. It may help if your partner, friend or a family member comforts your baby during this time. Older babies and toddlers may be more easily distracted until the time of the operation. 

Depending on how long it will be before your baby can breastfeed again, you may need to express for comfort and to maintain your milk supply.

If your baby is having a minor procedure and they are otherwise healthy and stable, you may be able to start breastfeeding again as soon as they are awake. Toddlers coming out of an anaesthetic are often worried and confused. A breastfeed can be calming and soothing. 

For a mum who is breastfeeding

Make sure 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.

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 procedure. Feeding or expressing just prior to your procedure is recommended to minimise engorgement, especially if you will be asleep for a while.  

Once you are conscious, breastfeeding is usually safe, but discuss this with your surgeon and anaesthetist. Most anaesthetics and 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. If your baby is premature or sick or if you are taking strong pain medications, you may need to take extra care. Discuss your personal plan with your doctors.

After you wake up, you may feel drowsy and even nauseous. You may need some support at first to hold and breastfeed your baby safely. You 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 recover. If 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. Talk to your doctors about suitable pain relief to manage your pain if needed.  

When there is no time to plan

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

Patient information pamphlets about anaesthesia are published by the Australian Society of Anaesthetics. 

 

The information on this website does not replace advice from your health care providers.
© Australian Breastfeeding Association May 2022

References

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  

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 

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 

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 

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  

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 

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

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  

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.