“Pump and Dump” After Surgery 

Breastfeeding is a significant public health issue that affects the health of newborn babies and birthing parents (3). Breastfed babies are less likely to develop asthma, obesity, and type 1 diabetes, and mothers who breastfeed have a lower risk of developing ovarian cancer and breast cancer (6). In parallel with these benefits, breastfeeding comes with safety considerations as well. A major consideration is the fact that certain substances can be carried to the infant from the mother’s body via breast milk, including some medications. Many breastfeeding parents have heard the advice to “pump and dump” their breastmilk for twenty-four hours after surgery to avoid passing on anesthetic drugs to their babies (1). However, the recommendation to “pump and dump” after anesthesia is outdated and does not align with existing scientific literature (4). Despite the dated nature of this advice, many breastfeeding parents are still given the recommendation to “pump and dump” after surgery by internet sources and their physicians, nurses, and midwives (1). Ensuring that breastfeeding parents are able to promptly and safely resume breastfeeding after undergoing anesthesia is important to protecting the health and safety of both breastfeeding babies and parents. 

Ultimately, all anesthetic agents will transfer to breastmilk in small amounts (4). However, the quantity and concentration of anesthetic drugs present in breast milk are usually too low to be clinically significant and do not warrant the “pump and dump” approach after surgery (4). The relative infant dose or RID is a number that indicates the percentage of an anesthetic drug that is passed on to the baby from the mother (4). RID values below 10% are generally considered to be safe for infant consumption, and the vast majority of anesthetics have an RID that is far below 10% (4). As a result, breastfeeding and anesthesia are generally compatible. 

Anesthetic drugs travel into breastmilk via passive diffusion, so drugs that are highly lipid soluble, less protein-bound, and have a lower molecular weight can more easily migrate into breastmilk (1). Drugs used during local and regional anesthesia are made up of large, polarized molecules that struggle to travel into the lactating ducts (1). As a result, most local and regional anesthetic agents are safe for use in breastfeeding mothers. With regards to general anesthesia, breastfeeding parents can safely resume breastfeeding once they are awake, alert, and stable after a procedure (1). Once a patient has returned to their baseline mental and physical state, the anesthetic agents in their body will have already migrated from the plasma and milk ducts into adipose and muscle tissues, so breastmilk is safe for the infant to consume (1). Furthermore, breastfeeding mothers should not avoid taking pain medications after surgery, since pain can increase their level of discomfort and interfere with their ability to resume breastfeeding (4). 

During labor and cesarean deliveries, neuraxial anesthesia in the form of local anesthetics and opioid medications are commonly used (1). In one study of women who had a history of successful breastfeeding, the use of epidural analgesia that contained fentanyl during labor did not have a negative effect on breastfeeding outcomes (3). 93% of mothers who participated in the study had continued breastfeeding up to 3 months postpartum, and 77% of participants who had stopped breastfeeding cited personal, maternal reasons (4).  

Although most anesthetic drugs are compatible with breastfeeding, some anesthetic and analgesic agents should be avoided or administered to breastfeeding parents with close monitoring. For example, morphine has been found to be expressed in breast milk and has a risk of sedating infants with morphine serum concentrations at or above 125 ng/mL (1). Both morphine and fentanyl can be used for neuraxial anesthesia during labor and delivery, but providers should carefully monitor infants for signs of respiratory depression and sedation. Moreover, narcotics and their metabolites can transfer at relatively higher levels into breast milk compared to other anesthetics (1). When using any narcotics, providers can mitigate the risk of infant sedation by lowering the amount of narcotics that are used and supplementing narcotics with other analgesic drugs (1). Finally, meperidine and codeine are not recommended for use due to their high risk of respiratory sedation (5). 

References 

1. Cobb, Benjamin et al. “Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk.” Translational perioperative and pain medicine vol. 1,2 (2015): 1-7. pubmed.ncbi.nlm.nih.gov/26413558/ 

2. Dalal, Priti G et al. “Safety of the breast-feeding infant after maternal anesthesia.” Paediatric anaesthesia vol. 24,4 (2014): 359-71. doi:10.1111/pan.12331 

3. Lee et al., “Epidural Labor Analgesia—Fentanyl Dose and Breastfeeding Success: A Randomized Clinical Trial.” Ansthesiology, Oct 2017, vol. 127, pp. 614-624. doi: 10.1097/ALN.0000000000001793 

4. “Statement on Resuming Breastfeeding after Anesthesia.” American Society of Anesthesiologists, Oct 23 2019, www.asahq.org/standards-and-practice-parameters/statement-on-resuming-breastfeeding-after-anesthesia 

5. Wanderer, Jonathan P. and James P. Rathmell. “Anesthesia & Breastfeeding: More Often Than Not, They Are Compatible.” Anesthesiology, 2017, vl. 127, pp. A15. doi: 10.1097/ALN.0000000000001867 

6. “Why It Matters.” Center for Disease Control and Prevention, Breastfeeding, July 31 2023, www.cdc.gov/breastfeeding/about-breastfeeding/why-it-matters.html