Breastfeeding After Conscious Sedation

Great news! Medications used for the operating room is not harmful for breastfeeding mothers and their babies

Many breastfeeding mothers have intravenous sedation from time to time. The safety of these drugs need to be evaluated to ensure that mother, baby, and breast milk are safe.

Often times, discontinuing breastfeeding for a surgical or diagnostic procedure requiring sedation is the only alternative suggested to a nursing mother. Discontinuing breastfeeding is typically not necessary. Good news!

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Today, many women, armed with knowledge and assertiveness, search for other ways or other practitioners who are willing to work with them as they have their procedure with sedation and continue nursing. They know that for most medications, very little of the drug is transferred to their milk. Additionally, very few medications have adverse effects in breastfed babies because the dose transferred to the milk is in such a low dose or it is poorly bioavailable to the infant.

The medications often used for sedation procedures in dental offices include:

  • Triazolam (Halcion)
  • Diazepam (Valium)
  • Nitrous Oxide
  • Phenergan
  • Decadron
  • Fentanyl
  • Versed
  • Propofol

Many medical professionals use these same or similar drugs for other surgical or diagnostic procedures requiring sedation.

Oral Agents

Triazolam and diazepam are used as oral pre-operative sedatives, often taken one hour prior to a procedure with a sip of water. If a patient is breastfeeding, the oral sedative of choice would be triazolam with a half life of 1.5-5.5 hours compared to diazepam’s half life of 43 hours. Some pediatric concerns of poor suckling, lethargy and sedation have been reported with Valium. The milk to plasma ratio with Valium has been reported to be as high as 2.8.

Inhalation Agents

The inhalation agent of choice in dentistry is nitrous oxide blended with oxygen, also know as “laughing gas”. A nitrous oxide/oxygen blend helps to reduce anxiety and works as a sedative. In the dental office, the patient breathes the gas through a nasal mask. Patients describe a sense of well being and relaxation. It works quickly and wears off quickly, making it a good choice for breastfeeding mothers and breastfed babies. Its half life is less than 3 minutes.

Agents Used for IV Sedation include:

Benzodiazepines

  • Diazepam (Valium)
  • Midazolam (Versed)

Narcotic Analgesics

  • Alfentanil (Alfenta)
  • Fentanyl (Sublimaze)
  • Hydromorphone (Dilaudid)
  • Morphine

Barbiturates

  • Methohexital (Brevital)
  • Thiopental (Pentothal)

Sedative/Hypnotics

  • Propofol (Diprivan)

Reversal Medication

  • Flumazenil (Romazicon)
  • Naloxone (Narcan)

IV sedation is a great alternative for breastfeeding mothers undergoing surgical or diagnostic procedures.  The IV medications listed above produce quick, effective sedation.  Recovery time from these sedative agents is also short.  The majority of patients tell us they were comfortable and do not remember much if anything about the procedure.

The  IV medications listed above have a very short half life and the milk to plasma ratio is low for most of these drugs, except Valium and Morphine.  The half lives of these drugs are quite long and the milk to plasma ratio is somewhat higher than the other drugs listed.  Some references suggest using caution with these drugs, and some do not. My advice is to use caution when using these drugs with the breastfeeding mother, or even better, chose a more appropriate alternative besides diazepam or morphine.

More guidelines

These medications often used for sedation procedures in dental offices include:

  • Triazolam (Halcion)
  • Diazepam (Valium)
  • Nitrous Oxide
  • Phenergan
  • Decadron
  • Fentanyl
  • Versed
  • Propofol

Many medical professionals use these same or similar drugs for other surgical or diagnostic procedures requiring sedation.

Oral Agents

Triazolam and diazepam are used as oral pre-operative sedatives, often taken one hour prior to a procedure with a sip of water. If a patient is breastfeeding, the oral sedative of choice would be triazolam with a half life of 1.5-5.5 hours compared to diazepam’s half life of 43 hours. Some pediatric concerns of poor suckling, lethargy and sedation have been reported with Valium. The milk to plasma ratio with Valium has been reported to be as high as 2.8.

Inhalation Agents

The inhalation agent of choice in dentistry is nitrous oxide blended with oxygen, also know as “laughing gas”. A nitrous oxide/oxygen blend helps to reduce anxiety and works as a sedative. In the dental office, the patient breathes the gas through a nasal mask. Patients describe a sense of well being and relaxation. It works quickly and wears off quickly, making it a good choice for breastfeeding mothers and breastfed babies. Its half life is less than 3 minutes.

Agents Used for IV Sedation include:

Benzodiazepines

  • Diazepam (Valium)
  • Midazolam (Versed)

Narcotic Analgesics

  • Alfentanil (Alfenta)
  • Fentanyl (Sublimaze)
  • Hydromorphone (Dilaudid)
  • Morphine

Barbiturates

  • Methohexital (Brevital)
  • Thiopental (Pentothal)

Sedative/Hypnotics

  • Propofol (Diprivan)

Reversal Medication

  • Flumazenil (Romazicon)
  • Naloxone (Narcan)

IV sedation is a great alternative for breastfeeding mothers undergoing surgical or diagnostic procedures.  The IV medications listed above produce quick, effective sedation.  Recovery time from these sedative agents is also short.  The majority of patients tell us they were comfortable and do not remember much if anything about the procedure.

The  IV medications listed above have a very short half life and the milk to plasma ratio is low for most of these drugs, except Valium and Morphine.  The half lives of these drugs are quite long and the milk to plasma ratio is somewhat higher than the other drugs listed.  Some references suggest using caution with these drugs, and some do not. My advice is to use caution when using these drugs with the breastfeeding mother, or even better, chose a more appropriate alternative besides diazepam or morphine.

Bottom line

There is great news Mamas! It is important for the health care professional to inform the mother of the risks and benefits, possibilities and options given the evidence available about the safety of breastfeeding and using the medications discussed in this article. 

It is not appropriate for health care professionals to advise ALL mothers to discontinue breastfeeding or to “pump and dump” for surgical or diagnostic procedures requiring oral, inhalation or intravenous sedation because most medications used for oral, inhalation and IV sedation are compatible with breastfeeding.  They have no effect on milk supply and very minimal or no effect on the infant.

With breastfeeding mothers, the health care professional should consider avoiding diazepam and morphine as sedative agents for a surgical or diagnostic procedure because of their long half life and higher milk to plasma ratio.  Alternative medications that do not impact the breastfeeding relationship are readily available for sedation for surgical and diagnostic procedures.

Thank you for stopping by today. I hope you learned something from this post. It is not a very common topic, but I think you need to know how safe it is for you, your breast milk and your baby. If you have any comments feel free to comment. I wish you a successful breastfeeding journey Mama and I encourage you dad to support Mama as much as possible. May God bless you all. Please like and join in the fun of following us!

Thought for today:

Excellence is to consistently striving to be better continually growing. If you grow everyday, everything will get better because excellence takes you higher!

Myles Munroe

Published by Marilyn Smith

Hello. My name is Marilyn Smith. I am a Health Specialist with specialized skills in Clinical Practical Nursing, and Midwife of thirty six years. I am also a certified Lactation and Grief Specialist. I am well qualified to assist in meeting your breastfeeding needs. Breastfeeding is indeed the best for your baby. Congratulations on making such a wonderful decision. Consider this your home as we learn about the joys and pains of pregnancy & breastfeeding

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