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 Table of Contents  
LETTER TO THE EDITOR
Year : 2011  |  Volume : 1  |  Issue : 1  |  Page : 46-47

Breastfeeding in the perioperative period


1 Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana - 141 001, India
2 Department of Pediatrics, Christian Medical College and Hospital, Ludhiana - 141 008, Punjab, India

Date of Web Publication25-Aug-2011

Correspondence Address:
Sandeep Kundra
Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana - 141 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4472.84257

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How to cite this article:
Kundra S, Kundra S. Breastfeeding in the perioperative period. J Obstet Anaesth Crit Care 2011;1:46-7

How to cite this URL:
Kundra S, Kundra S. Breastfeeding in the perioperative period. J Obstet Anaesth Crit Care [serial online] 2011 [cited 2020 Nov 25];1:46-7. Available from: https://www.joacc.com/text.asp?2011/1/1/46/84257

Sir,

Perioperative advice regarding breastfeeding to a lactating patient posted for surgery is a dilemma for the anesthesiologists in the absence of clear cut guidelines. [1] There is a concern that drugs given to mother may be excreted in the breast milk resulting in adverse effects on the newborn. Most drug inserts carry an instruction that these should be used with caution in lactating mothers adding to the anxiety of mothers and healthcare providers. However, depriving the neonate of the beneficial effects of mother's milk is a major decision which requires careful consideration.

Perioperatively, there are certain myths and beliefs that deprive the baby of his/her mother's milk. These are:
  1. Breastfeeding needs to cease for 24 hours to 7 days after a surgical procedure.
  2. Breast milk can be replaced with formula feedings without adverse effect on the neonate.
  3. Breastfeeding can be resumed without difficulty once it has been temporarily stopped.
  4. Animal milk can be a good substitute for mother's milk.
Various studies and meta-analysis have proved that mother's milk is the best an infant can get and nothing can be substituted for it. [2] The advantages of mother's milk led American academy of pediatricians recommend that mother's milk be the only and exclusive milk that a baby should receive during first 6 months and then supplemented breastfeeding for another 6 months. [3] In developing countries such as India, breast milk is the cheapest milk available to a neonate and because it is freshly available to the baby and needs no sterilization, it attains greater importance. When mother is in hospital, care of baby is likely to suffer and if she can feed the baby, it not only prevents many complications in the baby but also is immensely beneficial to the mother and the baby.

We have the following points to make in this regard:
  1. Proper planning of surgery timing and anaesthetic technique can minimize interruption in breastfeeding for the infant.
  2. The fact that infants have limited capacity for metabolism of drugs used for anaesthesia should be taken into account while planning any anaesthetic technique for mothers who are breastfeeding their children.
  3. Such an anaesthetic technique should also take into account the age and maturity of baby, the stage of lactation (early or late), and the drugs should be so planned that they interrupt feeding only for the shortest period of time.
  4. Whenever feasible, regional anaesthesia should be preferred over general anaesthesia because feeding can be resumed almost immediately postoperatively in most cases. [1],[4],[5]
  5. Premature infants or those prone to apnea, hypotension, or weakness probably should be protected by a few more hours of interruption from breastfeeding before resuming (12-24 h) nursing following GA. [6]
  6. Limited information is available regarding anaesthetic agents and their compatibility with breastfeeding, although most of the agents used for anaesthesia practice (propofol, thiopental sodium, midazolam, etomidate, vecuronium, rocuronium, succinylcholine, halothane, isoflurane, sevoflurane, atropine, commonly used NSAIDs, and short-acting opioids) are considered safe, whereas ketamine and diazepam are best avoided. [1],[7],[8],[9],[10] There have been some reports regarding safety of xenon also. [11]
  7. In our opinion, some measures that can help in limiting the time the baby is without mother's milk are breastfeeding the baby as close to time of surgery as possible, preferably just before shifting to operation room, storing the breast milk by freezing it, breastfeeding the baby as early as possible-once the mother is fully awake and there is no residual effect of any medications and preferring day care surgery.
Unfortunately, there are no guidelines to direct anesthesiologists on how to manage such patients in the best possible way. Formulation of protocols for lactating mothers scheduled for surgery will not only reduce anxiety of mother but also of the caregivers. Adequately trained and motivated nursing staff can provide invaluable help in the overall management of these patients. It would be prudent if the Association of Obstetric Anaesthesiologists, India, takes a lead in this field to guide obstetricians, anesthesiologists, and surgeons in promoting minimal or no interruption in breastfeeding to infants by mothers scheduled for emergent or incidental surgery.

 
  References Top

1.Garg R, Trikha A. Anaesthesia implications for breast feeding mothers Obstetric Anaesthesia Update. AOA News Letter 2010;2:3-6.   Back to cited text no. 1
    
2.Heird WC. The feeding of infants and children. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson Textbook of Pediatrics. 19 th ed. Philadelphia, PA: WB Saunders Co; 2010. p. 157-65.  Back to cited text no. 2
    
3.Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D, Schanler RJ, et al. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2005;115:496-506.  Back to cited text no. 3
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4.Howie WO, McMullen PC. Breastfeeding problems following anaesthetic administration. J Perinat Educ 2006;15:50-7.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Berlin CM, Briggs GG. Drugs and chemicals in human milk. Semin Fetal Neo Med 2005;10:149-59.  Back to cited text no. 5
    
6.Spigset O, Hagg S. Analgesics and breast feeding. Paediatr Drugs 2000;2:223-38.  Back to cited text no. 6
    
7.Spencer JP, Gonzalez LS 3rd, Barnhart DJ. Medications in the breast-feeding mother. Am Fam Physician 2001;64:119-26.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.Lee JJ, Rubin AP. Breast feeding and anaesthesia. Anaesthesia 1993;48:616-25.  Back to cited text no. 8
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9.McElhatton PR. The effects of benzodiazepine use during pregnancy and lactation. Reprod Toxicol 1994;8:461-75.  Back to cited text no. 9
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10.Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:137-50.  Back to cited text no. 10
    
11.Stuttmann R, Schafer C, Hilbert P, Meyer MR, Maurer HH. The breast feeding mother and xenon anaesthesia: Four case reports. Breast feeding and xenon anaesthesia. BMC Anesthesiol 2010;10:1.  Back to cited text no. 11
    




 

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