When mother or baby is experiencing illness, it can be scary for everyone. If mom is the sole source of baby’s food, it can be even more stressful for them to be separated. If you’re breastfeeding and need to have a medical procedure, can you continue or do you need to pump? Or, if your baby needs to have surgery, can you keep breastfeeding? Here are the answers to the most common questions:
I NEED AN MRI. IS THE CONTRAST DYE SAFE WHEN BREASTFEEDING?
Whether it’s an MRI or other radiologic scan, sometimes a contrast dye is needed to get a good image of the way the body's functioning. It’s important to know exactly what contrast agent the radiologist will use; but, for the most part, these are safe if you’re breastfeeding. There is no need to pump or to wean for any length of time. Often, these same substances are used with infants who need radiographic imaging, and the dose through breastmilk would be less than the baby would get directly. According to the most recent guidelines from the American College of Radiology, most iodinated and gadolinium-based contrasts are transferred to breastmilk in very small amounts. Their recommendation: “we believe that the available data suggest that it is safe for the mother and infant to continue breast-feeding after receiving such an agent.” Kay Hoover has an excellent handout in her Clinical Lactation article that can be shared with your healthcare provider or individual contrast agents can be searched on the LactMed database if you or your doctor need more information.
I NEED A DENTAL X-RAY OR SURGERY. CAN I HAVE IT DONE IF I’M BREASTFEEDING?
Many times moms need to put off dental treatment during pregnancy, but want to have it done once the baby arrives. Or maybe you’re a mom who doesn’t miss her cleaning appointments every 6 months. Whether you’re just there for hygiene or you need dental work done, you can rest assured that it’s fine if you’re breastfeeding. Dental x-rays prove no hazard to your milk or your supply. There is no evidence of harm when it comes to inserting or replacing fillings. Local anesthetics, like lidocaine or bupivacaine, don’t require interruption in feeding as they transfer to breastmilk in very small amounts. Even intravenous sedation for tooth extraction or other procedures does not require you to stop breastfeeding. If you require antibiotics or pain medication after the procedure, one compatible with breastfeeding can be prescribed. There isn’t really any research about tooth whitening agents in relation to breastfeeding, but it’s unlikely the ingredients would be cause problems.
DO I NEED TO PUMP AND DUMP IF I’M HAVING SURGERY?
In general, breastfeeding may need to be interrupted briefly if you need to have surgery, but this depends on a number of factors. It’s unlikely that you would need to wean completely, and the interruption is often short. You will need to pump enough milk ahead of time so that your baby has something to eat while you’re in surgery or recovery, unless you plan to supplement with formula or your older baby is already eating solids and won’t need to nurse during the time of the procedure. Experts recommend that a mother can resume breastfeeding as soon as she is “awake, alert and able to hold her infant” (Cobb et al, 2015) even with general anesthesia. You will need to have someone with you who can care for the baby apart from feedings, and you will need to observe your baby for any behavioral changes. Concerns about post-operative pain medications or antibiotics may also present challenges. Most often a drug compatible with breastfeeding can be found.
MY BABY NEEDS TO HAVE SURGERY. CAN I STILL BREASTFEED THEM?
Whether your infant is 2-days-, 2-weeks- or 2-years-old, the prospect of surgery for your precious little one is fraught with emotion. Whether your baby can continue to breastfeed before the procedure will sometimes depend on whether they will be sedated, will receive a local anesthetic, or will be under general anesthesia. If your doctor has recommended your baby fast before the procedure, according to the Academy of Breastfeeding Medicine, the last breastfeeding session should be 4 hours before surgery. This will help to keep their systems stable but also prevent complications related to possibly vomiting during surgery. So you may need to miss a feeding or two at the breast - plan to pump at these times and save that milk for your baby. Once your baby is in recovery and awake enough or cleared to take clear fluids, breastfeeding can resume. Keep in mind your baby might not feel up to it right away, so plan to provide plenty of closeness and cuddles during this transition. Your baby’s doctor will let you know if a longer post-procedure time is needed - some surgeries might require baby to take nothing orally for a longer stretch as they recover.
With these concerns, or any others, it’s always best to work with your healthcare provider or surgeon, as well as your baby’s doctor. Keep in mind, though, they may not have much background in lactation. Do the research and share resources with them - we’ve provided links to the most important ones below. Look up specific drugs on LactMed. Don’t be afraid to ask questions and keep asking until you get a satisfactory answer. A lactation consultant, like Milk Diva Lactation Services, can be a helpful advocate to have on your team during this time. If breastfeeding really needs to be interrupted, she can help you come up with a plan for maintaining your supply and being sure baby gets what they need. Most importantly, keep the main goal in mind - providing for your baby while keeping them safe.
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References:
Academy of Breastfeeding Medicine. (2012). ABM Clinical Protocol #25. recommendations for preprocedural fasting for the breastfed infant: “NPO” guidelines. Breastfeeding Medicine, 7(3), 197-202.https://www.liebertpub.com/doi/pdf/10.1089/bfm.2012.9988
Children’s Hospital of Philadelphia. Surgery and the breastfeeding infant. Accessed online 07/18/2019. https://www.chop.edu/conditions-diseases/surgery-and-breastfeeding-infant
Cobb, B., Liu, R., Valentine, E., & Onuoha, O. (2015). Breastfeeding after anesthesia: a review for anesthesia providers regarding the transfer of medications into breast milk. Translational perioperative and pain medicine, 1(2), 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582419/
Cohan, R., Dillman, J. R., Hartman, R. P., Jafri, S. Z., Wang, C. K., & Newhouse, J. H. (2018). American College of Radiology Manual on Contrast Media. American College of Radiology. Version 10.3. pp 99-100. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf#page=82
Hoover, K. (2011). Breastfeeding and the Use of Contrast Dyes for Maternal Tests. Clinical Lactation, 2(2), 31-32. https://www.ingentaconnect.com/content/springer/clac/2011/00000002/00000002/art00011#
La Leche League International. Anesthesia. Accessed online 07/18/2019. https://www.llli.org/breastfeeding-info/anesthesia/
Newman, J. (2007). Breastfeeding and radiologic procedures. Canadian family physician, 53(4), 630-631. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1952588/
Puac, P., Rodríguez, A., Vallejo, C., Zamora, C. A., & Castillo, M. (2017). Safety of contrast material use during pregnancy and lactation. Magnetic Resonance Imaging Clinics, 25(4), 787-797. https://www.infantrisk.com/blog/safety-%C2%A0contrast-material%C2%A0use-during-pregnancy-and-lactation
Reece-Stremtan, S., Campos, M., Kokajko, L., & Academy of Breastfeeding Medicine. (2017). ABM Clinical Protocol# 15: analgesia and anesthesia for the breastfeeding mother, revised 2017. Breastfeeding Medicine, 12(9), 500-506. https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/15-analgesia-and-anesthesia-protocol-english.pdf
Sachs, H. C. (2013). The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics, 132(3), e796-e809. https://pediatrics.aappublications.org/content/132/3/e796
Woods, RG. (1997). Dental implications: Drug distribution in human milk. Aust Prescr, 20, 12. https://www.nps.org.au/australian-prescriber/articles/drug-distribution-in-human-milk
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