Breastfeeding mothers are understandably concerned about the effects their sedation may have on their breastfeeding child. Research into the safety of drugs typically used for endoscopic sedation in the breastfeeding mother is limited, but the available data are very reassuring.
Endoscopic procedures are generally short, and the doses of sedatives typically used are low compared to the amounts of medication typically used in providing anesthesia for surgical procedures. While the product labeling for some of these agents takes the regulatory-driven side of caution and advises against their use in breastfeeding mothers, the most current information suggests that these drugs may be used in a safe and effective fashion, for both endoscopic sedation and for general anesthesia.
While recommendations of professional societies vary somewhat, the most current information supports resuming breastfeeding as soon as the mother has recovered sufficiently from endoscopic sedation to nurse, or soon thereafter. Many experts now reject prior recommendations to "pump and dump" prior to resuming breastfeeding, or waiting until the next day, in favor of immediate resumption of breastfeeding after recovery or within a few hours.
The Multisociety Sedation Curriculum for Gastrointestinal Endoscopy, published jointly in 2012 by the American Society for Gastrointestinal Endoscopy, American Association for the Study of Liver Diseases, American Gastroenterological Association Institute, American College of Gastroenterology and the Society of Gastroenterology Nurses and Associates makes the following recommendations for drugs commonly used in endoscopic sedation.
Midazolam (Versed)- Refrain from nursing for at least 4 hours after administration
Fentanyl - Secreted in very low concentrations; considered safe for breastfeeding
Meperidine (Demerol) - Detectable up to 24 hours after administration; although considered compatible with breastfeeding, fentanyl should be used when possible
Propofol - Excreted into breast milk for 4-5 hours after administration; continued breastfeeding after exposure is not recommended; length of prohibition not determined
We recommend that you fully discuss your sedation options and post-procedure care with your gastroenterologist prior to your procedure. Your obstetrician, pediatrician and family physician are also valuable resources who may provide helpful input.
We have provided these links to helpful resources for your review.
LactMed Search Engine from the National Library of Medicine's ToxNet. Enter the drugs commonly used for endoscopic sedation at Digestive Health to check on current recommendations: midazolam, fentanyl, propofol.
After Surgery, How Long a Wait for Safe Breastfeeding from Northwestern University
Pharmacokinetics of Midazolam, Propofol and Fentanyl Transfer to Human Breast Milk research paper
Analgesia and Anesthesia for the Breastfeeding Mother from the Academy of Breastfeeding Medicine
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