When can a mother start breastfeeding after being administered opioids?

From the Guidelines

A mother can generally resume breastfeeding as soon as she is alert and able to hold her baby safely after receiving opioids, typically within 1-2 hours after administration, as the amount of medication that transfers into breast milk is usually minimal and poses little risk to the infant 1.

Key Considerations

• The timing of breastfeeding resumption may vary based on specific medications, such as longer-acting opioids like methadone or buprenorphine, where mothers on stable maintenance doses can breastfeed without interruption 1.
• If the mother received opioids during labor or cesarean delivery, breastfeeding can typically begin as soon as she is conscious and stable 1.
• Healthcare providers should monitor both mother and infant for excessive sedation, especially if the mother is opioid-naive, and seek medical attention immediately if the baby shows signs of respiratory depression, poor feeding, or unusual sleepiness 1.

Benefits and Risks

• The benefits of breastfeeding generally outweigh the minimal risks of opioid exposure through breast milk for most mothers 1.
• Breastfeeding has been shown to decrease the severity of neonatal withdrawal syndrome (NOWS) and reduce the need for treatment of NOWS in infants born to women with opioid use disorder (OUD) receiving pharmacotherapy 1.

Recommendations

• Women should be encouraged to breastfeed as normal following surgery, without the need to express and discard breast milk after anesthesia 1.
• Anaesthetic and non-opioid analgesic drugs are transferred to breast milk in only very small amounts, and there is no evidence of effects on the breastfed infant 1.
• Drugs such as opioids and benzodiazepines should be used with caution, especially after multiple doses and in babies up to 6 weeks old (corrected for gestational age) 1.

From the Research

Breastfeeding After Opioid Administration

• Breastfeeding is recommended for women with opioid use disorder who are treated with methadone or buprenorphine, as it can help improve outcomes for both the mother and the infant 2.
• Infants who are breastfed by mothers with opioid use disorder may experience less severe opioid withdrawal symptoms, have shorter hospital stays, and are less likely to be treated with medication for withdrawal 3.
• The American Academy of Pediatrics suggests that opioid use for pain management during labor and delivery and subsequent short-term use for 2-3 days are compatible with breastfeeding 4.

Timing of Breastfeeding Initiation

• There is no specific time frame provided in the studies for when a mother can start breastfeeding after being administered opioids, but it is recommended that breastfeeding can be initiated soon after birth, with close monitoring of the infant for any signs of opioid withdrawal 4.
• For mothers who are on opioid maintenance therapy, breastfeeding can be initiated as soon as the mother is stable and the infant is able to latch and feed effectively 5.

Barriers to Breastfeeding

• Women with opioid use disorder face significant barriers to breastfeeding, including psychosocial and behavioral challenges, concomitant medications, and tobacco use 3.
• Misinformation from healthcare professionals can also be a barrier to breastfeeding for women on opioid maintenance therapy 5.
• Close monitoring and support from healthcare providers can help overcome these barriers and promote successful breastfeeding outcomes 6, 2.