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 (Matsota 2009), with no side-effect observed on breastfed infants of treated mothers (Matsota 2009). There were no problems in the initiation and duration of breastfeeding (Chen 2008, Radzyminski 2003). Some authors found shorter duration of the first breastfeeding but no delay in onset or other breastfeeding problems (Gizzo 2012).
Their low oral bioavailability (due to negligible oral absorption) hinders the passage to infant plasma from ingested breastmilk (Reece 2017).
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, 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).
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.
We do not have alternatives for Ropivacaine Hydrochloride 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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Thank you for helping to protect and promote breastfeeding.
e-lactancia is a resource recommended by Confederación Nacional de Pediatría (CONAPEME) from Mexico
Would you like to recommend the use of e-lactancia? Write to us at corporate mail of APILAM