Home
> Is This Safe When Breastfeeding?
> Medications
Conscious Sedation and Breastfeeding:
Recommendations for Patients
by Maurenne Griese, RNC, BSN. Reprinted with permission
from the author.
www.breast-pumps.com
Intro | Oral
Agents | Inhalation Agents |
IV Sedation | Additional
guidelines for care | Conclusion
Online Resources | References
As a lactation professional, I am often asked
about the compatibility of breastfeeding with certain medications.
I refer to both my experience and knowledge of the drug in question
as well as what the medical literature has to say about the safety
of the drug for both mother and baby.
As a registered nurse working part-time for an oral surgery practice,
I often administer drugs for IV conscious sedation for dental procedures,
most commonly for wisdom tooth extractions. We also offer nitrous
oxide sedation and oral sedation for patients who do not wish to
be as sedated as they might be for IV sedation.
The majority of female patients we see in our clinic for IV sedation
are of childbearing age. Some of our patients are breastfeeding
mothers and they often have questions about what drugs for sedation
are safe in terms of:
- Safety for the baby
- Safety for the mother
- Effect on milk supply
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.
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.
Thomas Hale is one of the world's expert on Pharmacology and Lactation.
His book, Medication's and Mother's Milk, is an excellent reference
for lactational pharmacology and a resource guide I use frequently.
Dr. Hale has an informative article on his website that discusses
how
drugs enter human milk.
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
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.
Additional guidelines for
care
Prior to surgery, encourage the mother to plan for
assistance at home after surgery to allow time for recovery.
Arrange for nursing her baby immediately prior to surgery.
If her baby is exclusively fed from the breast, it is important
to refer her to a lactation consultant to assist her with coordinating
supplementary feedings and assisting with arrangements for a breast
pump on a temporary basis. If necessary, she can express and
freeze a supply of breast milk before surgery.
Postoperatively, the mother can safely nurse her baby
once she feels more alert. Pain medication can be taken safely
as prescribed. Most practitioners prescribe the exact same
pain medications for postoperative pain relief as are prescribed
for postoperative pain relief following a Cesarean birth.
Conclusion
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.
Maurenne Griese graduated from the
Northeast Louisiana University School of Nursing in 1989. She served
as a US Army Nurse for 5 years and has experience in labor and delivery,
mother baby nursing, childbirth and breastfeeding education and
continuing education for health professionals. Maurenne has published
in several nursing journals on the topics of perinatal nursing and
breastfeeding. She runs a pregnancy and breastfeeding website and
also speaks regularly to health care professionals about perinatal
topics. Maurenne's favorite lecture topic is how to optimize first
feedings through minimal birth interventions. She also runs a breastfeeding
retail station from her home and works part time as an RN for a
private oral surgery practice. She is the proud mother of four breastfed
children.
Copyright © Maurenne
Griese, RNC, BSN. Permission to link to or reprint this article
lies solely with the author. Please contact
her if you wish to link to the article or reprint it.
Added to website: 4/29/2004
Page last modified:
03/16/2005
Excellent Online Resources:
References:
La Leche League. "The Breastfeeding
Answer Book" (1997) by Nancy Mohrbacher, IBCLC and Julie
Stock, BA, IBCLC
Medications and Mothers' Milk
by Thomas Hale, PhD 10th Edition (2002)
Handbook of Nurse Anesthesia by Nagelhout,
Zaglaniczny and Haglund, 2nd Edition (2001)
Breastfeeding and Human Lactation
by Jan Riordan and Kathleen Auerbach 2nd Edition (1999)
Drugs in Pregnancy and Lactation by
G Briggs, R Freeman and S Yaffe 4th Edition (1994)
