Breastfeeding patient

Definition and mechanisms

Breastfeeding, or nursing, is the process by which human breast milk is fed to a child and is one of the most effective ways to ensure the health and survival of the infant
Breastfeeding has many health benefits for the mother and infant
Women who are breastfeeding may require anesthesia or sedation
Concerns regarding the passage of medications into breast milk may lead to inconsistent advice resulting in:
- Interruption of feeding for 24 hours or longer
- Pumping and discarding of milk
- Early cessation of breastfeeding
All anesthetic and analgesic drugs transfer to breastmilk, however, only small amounts are present and in very low concentrations considered clinically insignificant
It is safe to breastfeed as usual after anesthesia and surgery
There is no need to express and discard breast milk (“pump and dump”) after anesthesia

Neonatal agent exposure is expressed by the relative infant dose (RID)
The RID takes into account maternal and infant weight as well as the concentration of drug in breastmilk and indicates the percentage of drug in the baby relative to the mother
RID levels < 10% are considered safe
Nearly all anesthetic agents have RID values significantly less than 10%, except for morphine (9%)
Certain opioids (i.e., codeine and tramadol) and drug classes (i.e., amphetamines, chemotherapy agents, ergotamines, and statins) are not recommended in breastfeeding mothers
Due to pharmacogenetic variability in metabolizing codeine or tramadol, there is a risk of a neonatal opioid overdose if an “ultra-metabolizer” mother breastfeeds a “slow metabolizer” neonate