There is a long-held belief that women who breastfeed should avoid nursing for twenty-four hours after receiving treatment involving anesthesia. This was based off old policies established by several organizations. The thing is these policies were put in place before there was data on how much anesthetic crosses into the milk. And risk to the infant who consumes the breastmilk. Well, my friends, research published over the last couple of years shows it’s time to dump the “pump and dump” method.
In August of 2020, the Association of Anaesthesia (Great Britain and Ireland, AA) published the Guideline on Anaesthesia and Sedation in Breastfeeding Women 2020. Also, in October 2019, the American Society of Anesthesiologists (ASA) released their statement about resuming breastfeeding after anesthesia. Both organizations recommend that breastfeeding should continue as normal without disrupting any routine or discarding milk after the use of anesthetics.
These organizations based their policies off research which shows that such a small amount of anesthetic transfers into the breastmilk. In concentrations too low to be clinically significant. These guidelines say the benefit of using anesthetics far outweighs the risks. Stating that disrupting the pattern of feeding can affect milk production. This recommendation is applicable for general and local anesthesia. The ASA and the AA both highly stressed the importance to use caution if opioid based pain management techniques are administered.
While I know this information can be a challenging concept for some clinicians, I believe it is important to recognize the research these associations have done on this topic. Plus, when looking at the big picture it makes sense. How many women have epidurals and c-sections associated with labor and delivery? These women are getting higher dosages of anesthetics than what is typically given at a dental office. After reviewing several articles, lidocaine and bupivacaine are often the local anesthetics used. If it’s o.k. to breastfeed after a procedure like an epidural, then why wouldn’t it be ok after dental treatment?
I do want to point out that the ASA and the AA organizations did not provide any anesthetic choice recommendations with their guidelines. They left these broad, other than the caution of opioid based medications. However, Stanley Malamed DDS suggest using an anesthetic with a short half-life, such as articaine. He points out articaine (Septocaine) has an average half-life of 27 minutes. This means it clears the system quicker than other commonly used anesthetics. Which would further reduce the amount entering breastmilk.
So, if you are treating a patient who is breastfeeding you no longer need to recommend that your patient pump and dump. Also, pause for a moment and think about your anesthetic choice. Using an anesthetic which metabolizes quickly, could help alleviate any added concerns you or your patient may have.
I encourage you to share this information with everyone in your office…there was a study published in March 2019 by the Journal of Scientific and Technical Research which discovered that most U.S. dentists are not aware of what treatments can be done during breastfeeding. So, my bet is not very many hygienists or assistants are aware either.
Happy injecting and go HIT YOUR BEST SHOT!