Am I allowed to use this as a midwife?

Midwives and Anaesthesia/Sedation in Breastfeeding Women

Yes, as a midwife, you are allowed to use anaesthesia and sedation in breastfeeding women according to the 2020 guidelines from the Association of Anaesthetists, which provide comprehensive guidance for healthcare professionals including midwives. 1

Key Principles for Midwives

• Midwives can administer and manage various medications for breastfeeding women, following appropriate guidelines and within their scope of practice 1, 2
• Most anaesthetic and sedative agents used in clinical practice are compatible with breastfeeding, with minimal transfer into breast milk or minimal oral bioavailability to the infant 1
• The hospital environment should support breastfeeding women undergoing procedures, including providing appropriate facilities and minimizing disruption to breastfeeding routines 1

Safe Use of Specific Medications in Breastfeeding Women

Induction and Volatile Agents

• Volatile agents (sevoflurane, isoflurane, desflurane, nitrous oxide) are rapidly cleared after anaesthesia through exhalation and do not preclude subsequent breastfeeding 1
• Ketamine should only be used with careful monitoring, with mothers advised to observe infants for drowsiness and poor feeding 1

Sedative Agents

• Shorter-acting benzodiazepines (lorazepam, midazolam, temazepam) are preferred over diazepam 1
• Breastfeeding can be resumed after a single dose of midazolam once the woman has recovered from the procedure 1
• Diazepam should be used cautiously as it has an active metabolite with prolonged half-life and transfers into breast milk in significant levels 1

Analgesic Agents

• Paracetamol and NSAIDs (ibuprofen, diclofenac, naproxen) are considered safe during breastfeeding 1
• If opioid analgesia is required, use the lowest effective dose for the shortest time possible 1
• Morphine is recommended as the opioid of choice if strong analgesia is required, with monitoring of the infant for sedation and respiratory depression if repeated doses are used 1
• Codeine should be avoided due to genetic variability in metabolism (CYP2D6) that can lead to unpredictable effects 1

Local Anaesthetics

• Local anaesthetics can be used in lactating women with no need to interrupt breastfeeding 1
• These compounds may be secreted in small amounts in breast milk but show no evidence of harm to the infant 1

Other Medications

• Neuromuscular blocking drugs have poor oral bioavailability and are unlikely to be present in milk in significant amounts 1
• Anti-emetics such as ondansetron, granisetron, cyclizine, and prochlorperazine are generally compatible with breastfeeding 1
• Metoclopramide and domperidone may increase milk supply and are safe to use in lactating women 1

Clinical Considerations for Midwives

• Time procedures so that the woman can feed her infant just before leaving the ward for surgery 1
• Provide a suitable environment for breastfeeding, including a single room where family members can accompany the woman 1
• Minimize the time the woman spends in the theatre suite 1
• Observe infants for signs of drowsiness and poor feeding after maternal medication, and advise mothers to contact a healthcare professional if these are observed 1

Professional Scope and Standards

• Midwifery practice extends beyond direct clinical care to include roles in management, education, research, and policy development 3
• Midwives should practice within their regulatory framework, which varies by jurisdiction but generally includes provisions for medication administration 4, 2
• Midwifery care should be woman-centered, safe, supportive, and collaborative, incorporating clinical knowledge and skills with interpersonal and cultural competence 3

By following these guidelines, midwives can safely administer anaesthesia and sedation to breastfeeding women while supporting continued breastfeeding and ensuring optimal outcomes for both mother and infant.