Breastfeeding

SPONSORED ADVERTISEMENT

ANAESTHETIC PRACTICE MANAGEMENT

Designed for Anaesthetists by Anaesthetist

Nova streamlines your anaesthetic practice with expert management, billing and financial services – so you can focus on what truly matters.

Learn More
View Notes

{}

Breastfeeding Patient

Advantages of Breastfeeding

For the Infant

  • Enhanced maternal–infant bonding through skin‑to‑skin contact.
  • Passive immunity: high levels of secretory IgA and lactoferrin protect against gastrointestinal and respiratory infections.
  • Optimal nutrient composition (balanced proteins, fats, carbohydrates) tailored to developmental needs.
  • Reduced risk of necrotising enterocolitis in preterm infants

For the Mother

  • Accelerated uterine involution via oxytocin‑mediated contraction, reducing postpartum bleeding.
  • Decreased long‑term risk of breast and ovarian cancer.
  • Lower incidence of type 2 diabetes and metabolic syndrome.
  • Natural child spacing via lactational amenorrhoea when exclusive breastfeeding maintained.

Physiology of Lactogenesis

  1. Stage I (Secretory Differentiation): mid‑pregnancy to delivery—under progesterone and prolactin influence, alveolar epithelial cells accumulate substrates for milk synthesis.
  2. Stage II (Secretory Activation): 48–72 hours postpartum—fall in progesterone and estrogen unmask prolactin action; onset of copious milk secretion (“milk coming in”).
  3. Stage III (Galactopoiesis): maintenance phase—regulated by supply‑and‑demand; prolactin release with nipple stimulation and oxytocin‑mediated milk let‑down reflex.

Composition of Human Milk

Component Constituents Function
Carbohydrates Lactose (7 g/100 mL), oligosaccharides Energy source; prebiotics facilitating gut flora
Fats Triglycerides (3–5 g/100 mL), cholesterol Essential fatty acids for neurological development
Proteins Casein, α‑lactalbumin, lactoferrin, sIgA Growth factors; antimicrobial and immunomodulatory
Vitamins & Minerals Calcium, phosphorus, vitamins A, D, E, K Bone mineralisation; antioxidant protection
Cells & Hormones Leukocytes, stem cells, leptin, adiponectin Immune protection; metabolic regulation

Drug Transfer into Breast Milk

  • Mechanism: passive diffusion predominates; influenced by molecular weight, lipid solubility, protein binding, and pKa of drug.
  • Relative Infant Dose (RID): (infant dose via milk ÷ maternal dose/kg) × 100%; RID < 10% generally considered safe.
  • Ideal properties: high maternal protein binding; low lipid solubility; short half‑life; poor oral bioavailability.

Anaesthetic and Analgesic Agents
Drug Class Examples Breastfeeding Guidance
Induction Propofol, etomidate, thiopental RID < 1%; safe
Volatiles Sevoflurane, isoflurane Negligible transfer; safe
Opioids Fentanyl (single dose), remifentanil Single IV dose safe; avoid prolonged infusions and codeine/tramadol due to CYP2D6 variability
NSAIDs/Paracetamol Ibuprofen, diclofenac, paracetamol Minimal transfer; first‑line analgesia
Benzodiazepines Midazolam Single doses safe; avoid chronic use of diazepam/lorezepam
Local Anaesthetics Bupivacaine, lignocaine Negligible systemic absorption; safe

Perioperative Management

Preoperative

  • Encourage clear fluids with carbohydrates until 2 h before surgery.
  • Recommend expressing/pumping immediately before anaesthesia to maintain supply.
  • Provide patient education on drug safety and milk expression/storage.

Intraoperative

  • Anaesthetic technique: regional (neuraxial) preferred to minimise systemic drug exposure and expedite recovery.
  • Fluid management: maintain euvolaemia and avoid hypovolaemia to support lactogenesis.
  • Analgesia: multimodal (paracetamol, NSAIDs, regional blocks) to reduce opioid requirement.

Postoperative

  • Resume breastfeeding or pumping as soon as mother is alert and able (usually within 2–4 h).
  • Monitor infant for sedation or feeding difficulties.
  • Store expressed milk appropriately: refrigerate up to 48 h or freeze for longer storage.

Links

References:

  1. Lawrence RM, Lawrence RA. Breastfeeding: A Guide for the Medical Profession. 8th ed. Elsevier; 2020.
  2. Hale TW. Medications and Mothers’ Milk. 2022. Pharmasoft Publishing.
  3. World Health Organization. Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services: the revised Baby-Friendly Hospital Initiative 2018. Geneva; 2018.
  4. National Institute for Health and Care Excellence (NICE). Maternal and Child Nutrition. NICE guideline [NG116]; 2020.
  5. Anderson PO. M/P ratios and infant safety: relevance to analgesics. Pediatr Drugs. 2019;21(4):217–225.
  6. Breastfeeding and Anaesthesia. Dr. M. Mbeki. WITS refresher 2014
  7. Jonathan P. Wanderer, James P. Rathmell; Anesthesia & Breastfeeding: More Often Than Not, They Are Compatible. Anesthesiology. 2017; 127:A15 doi: https://doi.org/10.1097/ALN.0000000000001867

Summaries:

—
Copyright
© 2025 Francois Uys. All Rights Reserved.

id: “883c9e42-d666-42d7-a1dc-a8e3d276623f”

The Brain (all notes)

Please log in to view your notes.

Related article

Load More