Last update May 21, 2021

Maternal Surgical Intervention

Low Risk

Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.

A surgical intervention, whether under general, epidural, regional or local anesthesia, does not contraindicate breastfeeding.
The mother can breastfeed even before going into the operating room and can breastfeed again as soon as she wakes up from the anesthesia.

Most anesthetics are excreted in small concentrations in milk and/or are very rapidly eliminated, which allows breastfeeding as soon as the mother is awake, alert, and fit and able to hold her baby (Mitchell 2020, Oliveira 2019, Fischer 2019, Reece 2017, Cobb 2015, Dalal 2014, Kranke 2011, Sønderskov 2011, Dahl 2011, Nitsun 2006, Lang 2003, Lee 1993).

The small amount of colostrum obtained by the newborn in the first few feedings makes waiting to breastfeed after a cesarean even more superfluous.

Early initiation of maternal feeding after awakening from anesthesia improves conditions for breastfeeding (Al-Takroni 1999).

Surgery and anesthesia increase prolactin levels (Lawrence 2016 p65 and p606, Morgan 1976). If the intervention is going to last many hours, breast milk can be expressed beforehand, and even while the intervention lasts, to avoid discomfort.

Plastic interventions on the breast can subsequently decrease milk production (Lawrence 2016 p231).

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Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

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  1. Mitchell J, Jones W, Winkley E, Kinsella SM. Guideline on anaesthesia and sedation in breastfeeding women 2020: Guideline from the Association of Anaesthetists. Anaesthesia. 2020 Nov;75(11):1482-1493. Abstract
  2. Oliveira MRE, Santos MG, Aude DA, Lima RME, Módolo NSP, Navarro LH. [Should maternal anesthesia delay breastfeeding? A systematic review of the literature]. Rev Bras Anestesiol. 2019 Mar - Apr;69(2):184-196. Abstract
  3. Fischer A, Ortner C, Hartmann T, Jochberger S, Klein KU. [Which medications are safe while breastfeeding? : A synopsis for the anesthetist, obstetrician and pediatrician]. Wien Med Wochenschr. 2019 Mar;169(3-4):45-55. Abstract
  4. Reece-Stremtan Sarah, Campos Matilde, Kokajko Lauren, and The Academy of Breastfeeding Medicine. Breastfeeding Medicine. ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeed Med. 2017 Nov;12(9):500-506. Full text (link to original source) Full text (in our servers)
  5. Lawrence RA, Lawrence RM. Breastfeeding. A guide for the medical profession. Eighth Edition. Philadelphia: Elsevier; 2016
  6. Cobb B, Liu R, Valentine E, Onuoha O. Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk. Transl Perioper Pain Med. 2015;1(2):1-7. Abstract Full text (link to original source) Full text (in our servers)
  7. Dalal PG, Bosak J, Berlin C. Safety of the breast-feeding infant after maternal anesthesia. Paediatr Anaesth. 2014 Abstract
  8. Kranke P, Frambach T, Schelling P, Wirbelauer J, Schaefer C, Stamer U. [Anaesthesia and breast-feeding: should breast-feeding be discouraged?]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2011 Abstract
  9. Dahl JB. [Infants can be breastfed immediately after general anesthesia of the mother]. Ugeskr Laeger. 2011 Abstract
  10. Sønderskov ML, Albrechtsen CK, Bille AB, Henneberg S, Afshari A. [Most anaesthetics can be used without damaging effects of the breastfed child]. Ugeskr Laeger. 2011 Abstract
  11. Nitsun M, Szokol JW, Saleh HJ, Murphy GS, Vender JS, Luong L, Raikoff K, Avram MJ. Pharmacokinetics of midazolam, propofol, and fentanyl transfer to human breast milk. Clin Pharmacol Ther. 2006 Abstract
  12. Lang C, Geldner G, Wulf H. [Anesthesia in the breast feeding period. Excretion of anesthetic agents and adjuvants into breast milk and potential pharmacological side-effects on the suckling infant]. Anaesthesist. 2003 Abstract
  13. Al-Takroni AM, Parvathi CK, Mendis KB, Hassan S, Qunaibi AM. Early oral intake after caesarean section performed under general anaesthesia. J Obstet Gynaecol. 1999 Abstract
  14. Lee JJ, Rubin AP. Breast feeding and anaesthesia. Anaesthesia. 1993 Jul;48(7):616-25. Review. Abstract Full text (link to original source) Full text (in our servers)
  15. Morgan L, Barrett A, Beswick F, Hollway T, Raggatt PR. Prolactin concentrations during anaesthesia. Br Med J. 1976 Abstract Full text (link to original source)

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