Last update: June 2, 2019
Not risky for breastfeeding or infant.
Local anesthetic agent which is used for infiltration and nerve-blocking procedures included Epidural anesthesia.
It is excreted into breast milk in non-significant amount (Bolat 2014, Ortega 1999, Baker 1989), with no side-effect observed on breastfed infants of treated mothers (Ortega 1999). Plasma levels in those infant were undetectable, even after intrapleural administration to the mother(Baker 1989).
Moreover, their low oral bioavailability (due to negligible oral absorption) hinders the passage to infant plasma from ingested breastmilk (Reece 2017).
According to the manufacturer, there is no risk to the infant due to the small quantity excreted in breast milk (Pfizer 2018, AEMPS 2014).
There is controversy about the effect of drug-mediated analgesia used during the child birth (e.g. epidural injection of local anesthetics plus Fentanyl or alone) on the mature milk coming in, whether by delaying the onset of Lactogenesis phase II, or, by affecting the ability of the child for sucking (French 2016, Herrera 2015, Howie 2006).
Some studies have shown that with epidural anesthesia there is a higher risk for delay of initiation of Lactogenesis phase II (milk coming in) longer than 3 post-natal days (Herrera 2015, Lind 2014) and lower frequency and duration of breastfeeding (Thorvaldsen 2006), but without effect on loss of initial weight. On other studies, the newborn infant appears to have higher risk for delay on first latch-on, higher body temperature and irritability or somnolence (Ransjö 2001). Because of the latter, it is argued that those mothers would be in need of more support on breastfeeding when they have received ante or intra partum analgesia (Zuppa 2014).
But other works do not find significant problems in the initiation and maintenance of breastfeeding due to epidural anesthesia in delivery or caesarean (Mahomed 2019, Xu 2019, Grant 2019, Lee 2017, Mauri 2015, Shrestha 2014, Wilson 2010, Wieczorek 2010, Goma 2008, Chen 2008, Wang 2005, Chang 2005, Radzyminski 2003, Abouleish 1978).
The onset of breastfeeding was earlier and with more frequent feedings in vaginal delivery than after cesarean and and with epidural anesthesia that with general anesthesia (Kutlucan 2014, Sener 2003).
Regarding the epidural, general anesthesia was associated with less frequent breastfeeding and exclusive breastfeeding at 6 weeks (Orbach 2018) and at 6 months (Karasu 2018).
Prolactin levels decrease less with epidural anesthesia during labor (Jouppila 1980).
Postoperative pain control with epidural bupivacaine continued for 3 days after caesarean section improved breast milk production and infant weight gain (Hirose 1996), but the opposite occurred when buprenorphine was associated (Hirose 1997).
The use of local anesthetics and regional anesthesia (spinal, epidural, or peripheral block) decreases the need for opioids and other analgesics that may interfere with breastfeeding (Reece 2017).
There is consensus on the achievement of higher milk production and higher body weight increase in the neonate with an adequate pharmacological control of pain after C-section or vaginal childbirth.
The manufacturer (Pfizer 2018, AEMPS 2014) and several medical societies, experts and expert consensus, consider the use of this medication safe or probably safe during breastfeeding (Reece 2017, Cobb 2015, Lee 1993).
List of WHO essential medicines: compatible with breastfeeding (WHO / UNICEF 2002).
We do not have alternatives for DL-Bupivacaine since it is relatively safe.
Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.
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e-lactancia is a resource recommended by Asociación Pro Lactancia Materna (APROLAM) from Mexico
Would you like to recommend the use of e-lactancia? Write to us at corporate mail of APILAM