Breastfeeding and painkillers "will it hurt my baby?"

[Conejita, BSN]

Just curious what other post-partum nurses say to post c-section patients (or SVDs with lacs or episiotomies) when asked "Is this Percocet (or vicodin, or fentanyl, etc, etc) i'm taking going through my breastmilk and hurting my baby?"

I've gotten this question many times and I still fumble over an answer.

Thanks in advance!

[CEG]

I say that it is safe for two reasons: 1) these drugs are used in infants and children for pain relief so if some gets to the baby it it safe 2) the amount that gets to the baby is so small that it isn't enough to have an effect. I also tell them that baby needs a mom who is comfortable, rested, and happy.

[sample24]

According to the certified lactation consultant at my facility, the molecular weight is such that the pain medication (percocet) will/can not cross over into the breast milk, so there is no risk fo sedation for the infant. I hope that helps.

K

[Wicked Wahine]

That isn't true, opiates will cross over into breastmilk. Usually in doses so small that it doesn't really affect the infant, but in any case a postpartum unit really should have a copy of Hale's Medications and Mother's Milk. He has studied this subject intensely and lists tons of medications as well as how they affect breastmilk.

[sample24]

Just passing on what they (our lact. nurses) tell our pts...I'm not saying they are wrong or right, but we have 3 lactation nurses, with stacks and stacks of books, so I tend to lend an ear when they're talking. I'll have to see if they have the book you mention.

Thanks.

[GrumpyRN63, ADN, RN]

I agree with CEG , I would question tho Fentanyl and when/where that would be appropriate. The only exception I see pertains to pts who are greastfeeding and then need General Anesthesia for a surgery, they usually have them pump and dump for about 24 hrs post op

[Elvish, BSN, DNP, RN, NP]

I LOVE Dr. Hale. That book has been my salvation in many many situations. I tell moms that most medications are safe for breastfeeding, and that the medication does cross into breast milk in minute amounts. Not generally enough to affect baby. If I ever have a question, Medications and Mother's Milk is one of the first places I turn.

[bagladyrn, RN]

I tell them pretty much what the others have said, only reminding them that if the pain med makes them groggy (some people react even with mild pain meds) we need to make sure someone is right there to assist when they are breastfeeding (or even just holding) the baby, for safety sake.

[GOMER42]

The mother should avoid breastfeeding at times when the medication is at peak. This is the time when the most amount of medication will be dispelled in the breast milk. If possible she should wait until after breastfeeding to take the meds.

[Elvish, BSN, DNP, RN, NP]

The mother should avoid breastfeeding at times when the medication is at peak. This is the time when the most amount of medication will be dispelled in the breast milk. If possible she should wait until after breastfeeding to take the meds.

Really? What medications are you referring to? We give patients Motrin, Percocet (or Darvocet), and (if situation warrants it) antihypertensives, Synthroid and lot of other stuff. Shoot, moms on mag sulfate can breastfeed if they feel like it. Some things are contraindicated yes, but meds and breastfeeding is a far less restrictive scenario than meds in pregnancy. In most cases, the benefits of getting Mom's milk far far outweighs the slight risk posed by some meds in breast milk. Case-by-case scenario, as always.

[Conejita, BSN]

Thanks for all your answers!

[paintedbison]

I agree with CEG , I would question tho Fentanyl and when/where that would be appropriate. The only exception I see pertains to pts who are greastfeeding and then need General Anesthesia for a surgery, they usually have them pump and dump for about 24 hrs post op

My understanding is that it is safe to breastfeed immediately after general anesthesia as soon as mom is coherent enough to hold the baby.