New consensus guidance on anesthesia and sedation while breastfeeding

Breastfeeding is one of the most effective ways to ensure the health and well-being of both child and birth parent. Patients who require an anesthetic while breastfeeding have been given variable and inconsistent advice concerning breastfeeding, sometimes resulting in the interruption of breastfeeding for ≥ 24 h, or expressing and discarding breastmilk because of concerns regarding the possible adverse effects of anesthetic and sedative medications passing into breastmilk. This can contribute to early discontinuation of breastfeeding. A multidisciplinary group acting on behalf of the Association of Anaesthetists (UK), indicates that perioperative decisions regarding breastfeeding can usually be made on the basis of pharmacokinetic data for medications used during anesthesia. The multidisciplinary group included anesthetists, pharmacists, midwives, infant feeding advisers and people with lived experience relevant to the perioperative management of patients who are breastfeeding. The group developed a consensus guideline to provide updated information for all health professional groups involved in the perioperative care of patients who are breastfeeding. After a targeted literature review, a three-round modified Delphi process was conducted to produce and ratify the recommendations.Key results:Any patient with a child aged < 2 years should routinely be asked if they are breastfeeding or expressing breastmilk during their preoperative assessment for a procedure involving anesthesia or sedation.Anesthetic, sedative and analgesic medications are transferred to breastmilk in only very small amounts. For almost all medications used perioperatively, there is no evidence of adverse effects on the breastfed child.Patients should be advised that discarding of breastmilk after anesthesia ('pumping and dumping') is not necessary and that 'sleep and keep' (i.e., continuing breastfeeding after surgery, as soon as the patient feels ready) is now recommended.Key recommendationsAny patient with a child aged < 2 years should routinely be asked if they are breastfeeding or expressing breastmilk during their preoperative assessment for a procedure involving anesthesia or sedation. (It is also important to consider that patients may continue to breastfeed a child beyond the age of 2 years.)Patients should be supported to breastfeed immediately before surgery, preferably directly, or by expressing milk if that is their preference. Patients should be supported to resume breastfeeding after the surgical procedure once they are alert, orientated and able to feed their child or express milk independently.Anesthetic, sedative and analgesic medications are transferred to breastmilk in only very small amounts. For almost all medications used perioperatively, there is no evidence of adverse effects on the breastfed child.Patients should be advised that discarding breastmilk after anesthesia (`pumping and dumping´) is not necessary and that `sleep and keep´ is now recommended.For patients who are breastfeeding and admitted for urgent or emergency surgery or inpatient care, it is important that the patient and child remain together wherever possible with appropriate support for care of the child.Anesthetic departments should have a breastfeeding champion to support colleagues with patient discussions and advocacy in the perioperative period, and to provide departmental and patient education.Hospitals are encouraged to engage with the United Nations Children’s Fund Baby Friendly Initiative, an evidence-based program to support the starting and continuation of breastfeeding.Hospitals should provide a suitable environment for breastfeeding such as a single room, where another adult can be present to care for the child as required.For all patients, including those who are breastfeeding or expressing milk, postoperative analgesia should be multimodal and opioid-sparing when possible.If opioid pain relief is required, codeine is not recommended due to concerns related to differences in metabolism that may result in excessive sedation in some children.Patients who are breastfeeding should have appropriate opioid analgesia if needed; the lowest effective dose should be used for the shortest period of time. Morphine and dihydrocodeine (not available in Canada) are the preferred medications.Where possible, day surgery is preferable to avoid disrupting normal routines. Consider moving breastfeeding patients to ﬁrst on the list for their procedure to minimize time away from their child.Breastfeeding while on chemotherapy is not recommended due to the passage of chemotherapy medication into milk, with associated adverse effects.The guidelines include a box that reviews various preoperative considerations for patients who require surgery and are breastfeeding. A table is also included summarizing:Medications used during anesthesia and after surgery that pass in low levels into breastmilk (and therefore patients can breastfeed as normal), including intravenous and inhalation anesthetics, sedatives, analgesics, local anesthetics, neuromuscular blocking agents and antiemetics (see list of agents in the table, as well as a more detailed discussion of each agent in the text of the article)Analgesics that must be used with caution while breastfeeding (tramadol, oxycodone, codeine, meperidine)Analgesics that are contraindicated while breastfeeding (acetylsalicylic acid).Overall, this multidisciplinary guidelines aim to facilitate the perioperative management of patients who are breastfeeding. The document is designed to help parents and healthcare staff determine the optimal anesthetic management strategy to support breastfeeding in the perioperative period while ensuring minimal risk to the breastfed child. The consensus document was produced by members of a Working Party established by the Association of Anaesthetists (UK). It was approved by the Board of Directors of the Association of Anaesthetists, and endorsed by the Royal College of Anaesthetists and the British Association of Day Surgery.Reference:Mitchell J, Jones W, Morris S, et al. Guidelines for anaesthesia and sedation for patients who are breastfeeding: guidelines from the Association of Anaesthetists. Anaesthesia 2026. Published online January 14, 2026. (accessed January 14, 2026).

New consensus guidance on anesthesia and sedation while breastfeeding

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