Surgery

How can I breastfeed if I’m having surgery?

Surgery does not need to interfere significantly with breastfeeding. Mothers can ask whether they can bring the baby to hospital and if their surgery can be done early in the day so they don’t have to go for long without food and drink. They can ask whether it can be done without general anesthetic to limit the amount of medication used and ensure that any medication they will receive are safe for breastfeeding. Mothers should express and store milk to use when they cannot breastfeed. They need to arrange for a helper to help look after both themselves and the baby. If possible, mothers should breastfeed or express right before surgery. If surgery is longer than three hours, health-care providers may express for them. When it’s over, they should resume breastfeeding as soon as they feel able, unless there is concern about a particular medication.

A) Considerations for breastfeeding mothers who need surgery

Surgery does not have to interfere with breastfeeding for long (Mitchell 2020; Reece-Stremtan 2017). However, there are issues that a breastfeeding mother should address before having surgery. 

B) Before hospital

To minimize the time without breastfeeding, mothers may wish to have the baby nearby in hospital. Some hospitals will accept babies staying with their mothers before and after surgery as long as someone is available to care for the baby when the mother is unable to do so. 

Before your surgery:

  1. Ask your health-care providers:
    1. Whether your operation can be done early in the day to minimize the time you cannot eat or drink.
    2. Whether your operation can be done without you being put to sleep (general anesthetic) to limit the amount of medication you will need.
    3. About options for pain medication.
    4. Whether your hospital has a breastfeeding specialist to help you in hospital.
    5. If your baby can be with you in hospital.
  2. Arrange for a helper to look after the baby while you have surgery and to help both of you after surgery.
  3. Express and store breast milk for the baby when breastfeeding is not possible and prepare feeding tools, such as bottles.
  4. Pack a breast pump and containers for expressed milk. The hospital should be able to store the milk in a refrigerator.  
  5. Familiarize yourself with online resources about the safety of particular medications when breastfeeding in case there are concerns in hospital.  

C) Before surgery

On the day of your surgery

  1. Tell all of your health-care providers you are breastfeeding.
  2. Speak with the staff about having them help you express during surgery or right after if your surgery takes longer than three hours (Dumphy 2008).
  3. If possible, keep the baby with you until right before surgery.
  4. Breastfeed right before surgery and, if possible, before you are given any medications in preparation for surgery.
  5. Discuss any last-minute concerns about medications with your health-care providers.

D) After surgery

1) Resuming breastfeeding

After surgery:

  1. Unless there is a specific concern about a particular medication, you can breastfeed as soon as you feel able (Cobb 2015; Smathers 2016):
  2. When you are ready to breastfeed, have your helper position the baby away from any painful areas.
  3. If your baby has just been fed and is not hungry, express your milk.
  4. Pain medication should be used as necessary but for the shortest times and in the smallest effective doses (Reece-Stremtan 2017).

2) Risks to the baby

Opoid medications, also known as morphine-type drugs, are often used to control pain from surgery and can increase the risk of sleepiness in the baby when transmitted through breast milk. Prolonged use of benzodiazepines may cause a similar effect. Term and healthy babies are less likely to be affected in this way. A baby may benefit from stopping breastfeeding for 6 to 12 hours after surgery if the baby is premature or at risk of any of the following:

  • Not breathing
  • Low blood pressure
  • Muscle weakness

Mothers need to express for every breastfeeding session the baby misses during this time. The baby can be given previously expressed breast milk or other appropriate milk instead.

Alternatively, fresh expressed milk can be mixed with previously expressed milk to decrease the amount of medication in the milk (Reece-Stremtan 2017).

E) At home

Once you are back home:

  1. Unless your health-care providers tell you otherwise, eat when you are hungry and drink when you are thirsty.
  2. Resume your normal breastfeeding pattern.
  3. Ensure that your baby gets enough milk and that your milk supply does not drop.
  4. Make sure you have enough help at home and can rest and recover.

References

Cobb B, Liu R, Valentine E, et al. Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk. Transl Perioper Pain Med. 2015;1(2):1-7
 
Dumphy D. The breastfeeding surgical patient. AORN J. 2008 Apr;87(4):759-66

Mitchell J, Jones W, Winkley E, et al. Guideline on anaesthesia and sedation in breastfeeding women 2020: Guideline from the Association of Anaesthetists. Anaesthesia. 2020 Nov;75(11):1482-1493

Reece-Stremtan S, Campos M, Kokajko L, The Academy of Breastfeeding Medicine.  ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeeding Medicine. November 2017, 12(9): 500-506
 
Smathers AB, Collins S, Hewer I. Perianesthetic Considerations for the Breastfeeding Mother. J Perianesth Nurs. 2016 Aug;31(4):317-29
 
United States National Institute of Health (NIH). National Library of Medicine, Toxnet, Drugs and Lactation Database (LactMed) [Internet]. Bethesda: U.S. National Library of Medicine; [date unknown] [cited 2018 Oct 10]