Guidelines for anaesthesia and sedation for patients who are breastfeeding

INTRODUCTION: Breastfeeding is acknowledged widely as one of the most effective ways to ensure the health and well-being of both child and birth parent. Historically, advice given to patients who required an anaesthetic while breastfeeding was variable and inconsistent, sometimes resulting in the interruption of feeding for ≥ 24 h, or expressing and discarding breastmilk because of concerns regarding the possible adverse effects secondary to medicines passing into the breastmilk. This can be a contributory factor in the early cessation of breastfeeding. Peri-operative decisions can normally be made on the basis of pharmacokinetic data rather than on the precautionary principle. METHODS: This multidisciplinary consensus guideline included anaesthetists, pharmacists, midwives, infant feeding advisers and people with lived experience relevant to these guidelines. Following the targeted literature review, a three-round modified Delphi process was conducted to produce and ratify recommendations. RESULTS: Any patient with a child aged < 2 y should routinely be asked if they are breastfeeding or expressing breastmilk during their pre-operative assessment for a procedure involving anaesthesia or sedation. Anaesthetic, sedative and analgesic medicines are transferred to breastmilk in only very small amounts. For almost all medicines used peri-operatively, there is no evidence of adverse effects on the breastfed child. Patients should be advised that discarding of breastmilk after anaesthesia ('pumping and dumping') is not necessary and that 'sleep and keep' is now recommended. DISCUSSION: This pragmatic, multidisciplinary guideline aims to facilitate the peri-operative management of patients who are breastfeeding. It is hoped that these will be of value to both clinicians and patients in determining the optimal anaesthetic management strategy to support breastfeeding in the peri-operative period while ensuring minimal risk to the breastfed child.