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I'm in ICU. Help!

Posted by on Feb. 9, 2013 at 2:07 AM
  • 23 Replies
1 mom liked this
I went in for a laparoscopic gall bladder surgery this morning, and everything was fine until recovery, where I had 4 seizures. Now I'm in ICU and I can't nurse my baby because of the meds that they had to give me to stop the seiZures. She hasn't had milk since 7am. I am pumping when i can, but I had to go from 7am - 4pm today without pumping because I was knocked out. I am so worried that this is gonna be the end of our nursing relationship :(

She's 11 months old, btw. What can I do to maintain my supply?
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by on Feb. 9, 2013 at 2:07 AM
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SewingMamaLele
by Leanne on Feb. 9, 2013 at 2:09 AM

Honey, it's never the end.   If you both want to continue to nurse, you will.    My LO stopped nursing for a week during a hospitalization (we tried!   Was just too painful for him), and he went right back to it after and nursed for another year.  

Get yourself better, worry about the rest later.  Stress doesn't help anything.

SewingMamaLele
by Leanne on Feb. 9, 2013 at 2:12 AM

You can pump... but I didn't even do that (they brought me one, but I would get drops so it was pointless, IMO!).   He was 21 mo old at the time.   They can always, always increase your supply.  

IrishIz
by Silver Member on Feb. 9, 2013 at 8:14 AM
What meds? There are plenty of seizure meds okay with breastfeeding. Get a list of your meds! Also...pump and pump until we really know the med story.
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K8wizzo
by Kate on Feb. 9, 2013 at 8:20 AM

Yep.  Although I would keep everything you pump from now until we give you the med info, just labeled so that if it's safe you aren't wasting it (but you knwo what to dump if it's not).

Feel better soon!!

Quoting IrishIz:

What meds? There are plenty of seizure meds okay with breastfeeding. Get a list of your meds! Also...pump and pump until we really know the med story.


asmalltowngirl
by Member on Feb. 9, 2013 at 8:23 AM
They gave me zofran, Valium, Maalox, fentanyl, versed and Marcaine

Quoting IrishIz:

What meds? There are plenty of seizure meds okay with breastfeeding. Get a list of your meds! Also...pump and pump until we really know the med story.
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moroccanmommy
by Robin on Feb. 9, 2013 at 8:29 AM
Just rest ......get better
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Kristen.Marie
by Member on Feb. 9, 2013 at 8:45 AM
Keep pumping while you're there. Most hospitals have IBCLC on staff and maybe they could come do a consult with you in the ICU. The doctor probably has to pit in an order for it first. Or call then yourself, or have a family member go walk to their office in the hospital and talk to them.
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shortyali
by Alicia on Feb. 9, 2013 at 8:52 AM
1 mom liked this
Search Term:Valium
Drug Name:Diazepam
CASRN:439-14-5
******************************************
Summary of Use during Lactation:

Diazepam is excreted into breastmilk and it and its active metabolite, nordiazepam, accumulate in the serum of breastfed infants with repeated doses. Because the half-life of diazepam and nordiazepam are long, timing breastfeeding with respect to the dose is of little or no benefit in reducing infant exposure. Other agents are preferred, especially while nursing a newborn or preterm infant.

After a single dose of diazepam, as for sedation before a procedure, there is usually no need to wait to resume breastfeeding, although with a newborn or preterm infant, a cautious approach would be to wait a period of 6 to 8 hours before resuming nursing.
Drug Levels:

Diazepam is metabolized to the active metabolites nordiazepam (desmethyldiazepam) and temazepam, which are in turn metabolized to the active metabolite oxazepam.

Maternal Levels. Three patients were given diazapam10 mg orally 3 times daily for the 6 days after delivery. Average milk levels of diazepam plus nordiazepam were 79 mcg/L after 4 days (total diazepam dosage130 mg) and 130 mcg/L after 6 days (total diazepam dosage 190 mg). Oxazepam was not detected.[1]

In a 1-day postpartum woman, a colostrum diazepam level of 100 mcg/L milk level was found 25 hours after the last of 3 intravenous 5 mg doses of diazepam given over a 4-hour period.[2]

Four women were given diazepam 10 mg at bedtime for 6 days, beginning 3 days postpartum. Each had also received intravenous diazepam 20 mg immediately prior to delivery. Milk levels were collected 9.25 and 23.5 hours after each dose from days 3 to 9 postpartum. Milk levels of diazepam and nordiazepam did not differ markedly between the collection times and ranged from 17 to 39 mcg/L for diazepam and 19 to 52 mcg/L for nordiazepam.[3]

Breastmilk levels of 27 to 164 mcg/L of diazepam plus nordiazepam were found at various times between 9 days and 3.5 months postpartum during an irregular regimen of 6 to 10 mg daily of oral diazepam in 1 woman.[4]

A woman who had been abusing benzodiazepines was taking diazepam 80 mg and oxazepam 30 mg daily at the time of study. Milk samples were taken before and after the morning feeding following the morning dose of diazepam during a 30-day tapering dosage regimen. The average of the pre- and post-feed diazepam milk levels were 185 and 307 mcg/L and average nordiazepam milk levels were 124 and 141 mcg/L on days 14 and 15 during maternal intake of diazepam 40 mg daily. The average of the pre- and post-feed diazepam milk levels were 200 and 158 mcg/L and average nordiazepam milk levels were 140 and 85 mcg/L on days 23 and 25 during maternal intake of diazepam 30 mg daily. The average of the pre- and post-feed diazepam milk levels was 67 mcg/L and average nordiazepam milk levels was 42 mcg/L on days 30 during maternal intake of diazepam 10 mg daily. Nine days after discontinuing diazepam, milk diazepam and nordiazepam were both 6 mcg/L.[5]

Eight women who were at least 1 month postpartum received intravenous diazepam during a surgical sterilization procedure. Dosages ranged from 2.5 to 10 mg. Diazepam and nordiazepam were undetectable (<150 mcg/L) in the breastmilk of any of the women. The authors estimated that the maximum systemic exposure of one of the breastfed infants would be 3% of the mother's.[6]

Infant Levels. Three infants were breastfed from birth while their mothers were receiving diazepam 10 mg 3 times daily. Infant serum levels were measured on days 4 and 6 of life. On day 4, average infant serum levels were 172 mcg/L of diazepam and 243 mcg/L of nordiazepam. On day 6, average infant serum levels dropped to 74 mcg/L of diazepam and 31 mcg/L of nordiazepam, mostly due to a large drop in one of the infants.[1]

A fully breastfed infant was 32 days old at the time of serum sampling. His mother was taking diazepam 6 to 10 mg daily and had taken 2 mg of diazepam 10 hours before infant serum samples were taken. The infant's diazepam serum level was 0.7 mcg/L and nordiazepam was 46 mcg/L. The mother's simultaneous serum levels were 100 and 200 mcg/L for the drug and metabolite, respectively.[4]
Effects in Breastfed Infants:

Three infants were breastfed from birth while their mothers were receiving diazepam 10 mg 3 times daily. The authors noticed no lethargy or hypoventilation in the infants during the 6-day observation period. The authors expressed concern that nordiazepam may compete with bilirubin for hepatic glucuronide conjugation in the neonate.[1]

A nursing mother was given diazepam 10 mg orally 3 times a day beginning on day 5 postpartum. Weight loss, lethargy and an EEG consistent with sedative effect in her 8-day-old was probably caused by diazepam or its metabolites in breastmilk.[7]

Of 8 infants breastfed from birth during maternal diazepam therapy (dosages unspecified), 3 had mild jaundice during the first few days postpartum, although this was not thought by the authors to be unusual.[8]

Sedation was reported in the breastfed newborn infant of a mother taking oral diazepam 6 to 10 mg daily if the infant was nursed within a few hours of a dose, but not if she nursed 8 or more hours after a dose. Infant sedation was probably caused by diazepam and its major metabolite in breastmilk.[4]

In a telephone follow-up study, 124 mothers who took a benzodiazepine while nursing reported whether their infants had any signs of sedation. About 10% of mothers took diazepam while breastfeeding and none reported sedation in her infant.[9]

In a longitudinal study of women taking medications during breastfeeding, some mothers who were taking diazepam reported discontinuing breastfeeding because of drowsiness in their breastfed infants.[10]
Possible Effects on Lactation:

Relevant published information was not found as of the revision date.
Alternate Drugs to Consider:

Lorazepam, Midazolam, Oxazepam
References:

1. Erkkola R, Kanto J. Diazepam and breast-feeding. Lancet. 1972;299:1235-6. Letter. PMID: 4113217
2. Horning MG, Stillwell WG, Nowlin J et al. Identification and quantification of drugs and drug metabolites in human breast milk using GC-MS-COM methods. Mod Probl Pediatr. 1975;15:73-9.
3. Brandt R. Passage of diazepam and desmethyldiazepam into breast milk. Arzneimittelforschung. 1976;26:454-7. PMID: 989345
4. Wesson DR, Camber S, Harkey M et al. Diazepam and desmethyldiazepam in breast milk. J Psychoactive Drugs. 1985;17:55-6. PMID: 3920372
5. Dusci LJ, Good SM, Hall RW et al. Excretion of diazepam and its metabolites in human milk during withdrawal from combination high dose diazepam and oxazepam. Br J Clin Pharmacol. 1990;29:123-6. PMID: 2105100
6. Borgatta L, Jenny RW, Gruss L et al. Clinical significance of methohexital, meperidine, and diazepam in breast milk. J Clin Pharmacol. 1997;37:186-92. PMID: 9089420
7. Patrick MJ, Tilstone WJ, Reavey P. Diazepam and breast-feeding. Lancet. 1972;299:542-3. Letter. PMID: 4110044
8. Cole AP, Hailey DM. Diazepam and active metabolite in breast milk and their transfer to the neonate. Arch Dis Child. 1975;50:741-42. PMID: 1190825
9. Kelly LE, Poon S, Madadi P, Koren G. Neonatal benzodiazepines exposure during breastfeeding. J Pediatr. 2012;161:448-51. PMID: 22504099
10. Chaves RG, Lamounier JA, Cesar CC. Association between duration of breastfeeding and drug therapy. Asian Pac J Trop Dis. 2011;1:216-21.
Substance Identification:

Substance Name:Diazepam

CAS Registry Number:439-14-5

Scientific Name:N/A

Drug Class:
Hypnotics and Sedatives, Anti-Anxiety Agents, Benzodiazepines

Administrative Information

LactMed Record Number:349

Last Revision Date:20120831





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shortyali
by Alicia on Feb. 9, 2013 at 8:53 AM
Search Term:Maalox
Drug Name:Magnesium Hydroxide
CASRN:1309-42-8
******************************************
Summary of Use during Lactation:

A study on the use of magnesium hydroxide during breastfeeding found no adverse reactions in breastfed infants. Intravenous magnesium increases milk magnesium concentrations only slightly. Oral absorption of magnesium by the infant is poor, so maternal magnesium hydroxide is not expected to affect the breastfed infant's serum magnesium. Magnesium hydroxide can be taken during breastfeeding and no special precautions are required.
Drug Levels:

Maternal Levels. Ten women with pre-eclampsia were given 4 grams of magnesium sulfate intravenously followed by 1 gram per hour until 24 hours after delivery. While the average serum magnesium was 35.5 mg/L in treated women compared to 18.2 mg/L in 5 untreated controls, colostrum magnesium levels at the time of discontinuation of the infusion was 64 mg/L in treated women and 48 mg/L in the controls. By 48 hours after discontinuation, colostrum magnesium levels were only slightly above control values and by 72 hours they were virtually identical to controls.[1]

Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants:

Fifty mothers who were in the first day postpartum received 15 mL of either mineral oil or an emulsion of mineral oil and magnesium hydroxide equivalent to 900 mg of magnesium hydroxide, although the exact number who received each product was not stated. Additional doses were given on subsequent days if needed. None of the breastfed infants were noted to have any markedly abnormal stools, but all of the infants also received supplemental feedings.[2]
Possible Effects on Lactation:

Relevant published information was not found as of the revision date.
Alternate Drugs to Consider:

Bisacodyl, Docusate, Psyllium, Sodium Picosulfate, Sodium Phosphate
References:

1. Cruikshank DP, Varner MW, Pitkin RM. Breast milk magnesium and calcium concentrations following magnesium sulfate treatment. Am J Obstet Gynecol. 1982;143:685-8. PMID: 7091241
2. Baldwin WF. Clinical study of senna administration to nursing mothers. Can Med Assoc J. 1963;89:566-7.
Substance Identification:

Substance Name:Magnesium Hydroxide

CAS Registry Number:1309-42-8

Scientific Name:N/A

Drug Class:
Antacids, Cathartics, Gastrointestinal Agents, Magnesium Compounds

Administrative Information

LactMed Record Number:463

Last Revision Date:20120814





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shortyali
by Alicia on Feb. 9, 2013 at 8:54 AM
Search Term:Fentanyl
Drug Name:Fentanyl
CASRN:437-38-7
******************************************
Summary of Use during Lactation:

When used epidurally or intravenously during labor or for a short time immediately postpartum, amounts of fentanyl ingested by the neonate are small and are not expected to cause any adverse effects in breastfed infants. The results of studies on the effect of epidural fentanyl on breastfeeding initiation and duration are mixed and controversial, because of the many different combinations of drugs, dosages and patient populations studied as well as the variety of techniques used and deficient design of many of the studies. However, it appears that with good breastfeeding support epidural fentanyl plus bupivacaine has little or no effect on breastfeeding success.[1][2]

Because there is no published experience with repeated doses of intravenous fentanyl during established lactation, other agents may be preferred, especially while nursing a newborn or preterm infant. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants. Once the mother's milk comes in, it is best to limit maternal intake of fentanyl and to supplement analgesia with a nonnarcotic analgesic if necessary. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.

No waiting period or discarding of milk is required before resuming breastfeeding after fentanyl is used for short procedures (e.g., for endoscopy).[3][4] After general anesthesia, breastfeeding can be resumed as soon as the mother has recovered sufficiently from anesthesia to nurse. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. Limited information indicates that transdermal fentanyl in a dosage of 100 mcg/hour results in undetectable fentanyl concentrations in breastmilk.
Drug Levels:

Plasma fentanyl levels of 0.2 to 1.2 mcg/L are required for analgesia via the nonepidural route and plasma levels over 1 to 2 mcg/L may cause respiratory depression. Plasma levels are markedly lower when the epidural route is used. The oral bioavailability of fentanyl is 33% in adults. The usual intravenous of fentanyl for an infant is 1 to 2 mcg/kg. Fentanyl is metabolized to norfentanyl and inactive metabolites.

Maternal Levels. Eight women who had undergone cesarean section received fentanyl 100 mcg epidurally immediately after delivery. Fentanyl was undetectable (<0.1 mcg/L) in colostrum at about 1 hour after the dose.[5]

Thirteen women were given a single fentanyl 2 mcg/kg intravenous dose during either cesarean section or postpartum tubal ligation. Colostrum was collected at 0.75, 2, 4, 6, 8, and 10 hours after the dose. The average peak fentanyl level was 0.40 mcg/L and occurred 45 minutes after the dose. Average levels declined to 0.22 mcg/L at 2 hours and to 0.15 mcg/L at 4 hours then to the lower limit of the assay (0.05 mcg/L) at 6, 8, and 10 hours after the dose.[6] Based on the peak milk fentanyl level reported in this study, an exclusively breastfed infant would receive a fentanyl dose of 0.06 mcg/kg daily.

Ten women were given 50 to 100 mcg of intravenous fentanyl every hour during labor. Their breastmilk was sampled 4 and 24 hours after delivery. The cumulative maternal fentanyl dosages ranged from 50 to 400 mcg and the longest time from last dose to delivery was 3.1 hours (range 0 to 3.1 hours). Fentanyl was undetectable (<0.05 mcg/L) in the milk of 8 of the women 4 hours after delivery and in 2 of the women 24 hours after delivery. Detectable milk levels of fentanyl ranged from 0.12 to 0.15 mcg/L at 4 hours after delivery and from 0.12 to 0.14 mcg/L at 24 hours after delivery.[7] Based on the highest milk level reported in this study, an exclusively breastfed infant would receive a fentanyl dosage of 0.02 mcg/kg daily.

Five women who were 6 to 15 weeks postpartum were given a single dose of 100 mcg of fentanyl intravenously before undergoing general anesthesia. Several milk samples were collected between 5 and 24 hours after the injection from each woman. The authors estimated that the infants would receive an average of 0.005 mcg/kg in the 24 hours after a single dose of fentanyl. This corresponds to about 0.38 % of the maternal weight-adjusted dosage. The women's milk output following the surgical procedure was less than half of the normal milk output of nursing mothers. The authors concluded that this amount of fentanyl in milk is unlikely to affect a healthy, term infant.[8] The infants of mothers not undergoing a surgical procedure might receive a greater dose of fentanyl in breastmilk, but it would be unlikely to be a large dose.

A randomized, prospective study measured colostrum fentanyl concentrations following epidural or intravenous fentanyl during delivery in 100 multiparous mothers undergoing cesarean section and delivering full-term, healthy infants. Epidural fentanyl was given to 50 women in a dose of 100 to 150 mcg in divided doses followed by a continuous epidural infusion of 20 mcg/hour. Intravenous fentanyl was given to 50 women as a single dose of 50 mcg after delivery. Both groups received epidural or spinal bupivacaine in addition. Colostrum samples were obtained 45 minutes and 24 hours after the initial fentanyl dose. At 45 minutes, colostrum fentanyl concentrations were 0.4 mcg/L in the epidural group and 0.19 mcg/L in the intravenous group. At 24 hours, colostrum fentanyl concentrations were 80 ng/L in the epidural group and 0.05 mcg/L in the intravenous group. The authors estimated that in the worst-case scenario, a fully breastfed infant would absorb a fentanyl dose of 0.016 mcg/kg.[9]

A woman was using a transdermal fentanyl patch for chronic back pain during pregnancy and postpartum. The mother required additional analgesia during labor and the infant required treatment for neonatal abstinence syndrome. By 2 weeks postpartum, the mother was using a fentanyl patch in a dosage of 100 mcg/hour which was changed every other day. A sample of pumped breastmilk from one breast contained fentanyl 6.4 mcg/L and norfentanyl 6.2 mcg/L.[10]

Infant Levels. An infant whose mother was using a fentanyl patch in a dosage of 100 mcg/hour which was changed every other day was fed her mother's milk either by bottle or by the breast every 3 hours beginning about 2 weeks postpartum. On day 27 of life, the infant was fed 380 mL of maternal milk following several feedings during the prior 24 hours. The infant's serum fentanyl and norfentanyl concentrations were not detectable (<0.1 mcg/L).[10]
Effects in Breastfed Infants:

Fentanyl was possibly the cause of statistically significant, but clinically unimportant, lower neurobehavioral scores in a group of 32 newborns who were less than 24 hours old and whose mothers had received epidural fentanyl during labor.[11]

An epidural fentanyl dosage greater than 150 mcg during labor was associated with slightly lower neurobehavioral scores in the newborns of 177 breastfeeding mothers on postpartum day 1 compared to a lower total dosage or to no fentanyl;[12] however, this might have been a chance association[13] and was probably due to placental transfer of fentanyl prior to delivery and not from breastmilk after delivery. All women also received epidural bupivacaine.

A woman was using a transdermal fentanyl patch for chronic back pain during pregnancy and postpartum. The mother required additional analgesia during labor and the infant required treatment for neonatal abstinence syndrome. By 2 weeks postpartum, the mother was using a fentanyl patch in a dosage of 100 mcg/hour which was changed every other day and the infant was being fed the mother's milk every 3 hours. The infant had no additional medical problems and fed well until discharge after day 27 of life, gaining 500 g.[10]
Possible Effects on Lactation:

Fentanyl can increase serum prolactin.[14][15] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.

In 58 breastfeeding mothers who received an epidural fentanyl dosage greater than 150 mcg during labor, 21% reported more difficulty in establishing breastfeeding at 24 hours after delivery compared to 10% of mothers who received to a lower dosage or to no fentanyl. There was no difference in breastfeeding difficulty noted between the groups 24 hours after delivery when the assessment was performed by a lactation consultant. Women in the high-dose group who could be contacted were more likely to discontinue breastfeeding by 6 weeks after delivery and there was a higher rate of breastfeeding discontinuation at 6 weeks among mothers who reported breastfeeding difficulty 24 hours after delivery.[12] A relatively high dropout rate from the study at 6 weeks clouds the results.[13]

A retrospective study of a random sample of 425 mothers delivering in a maternity unit found a dose-related increased risk of bottle feeding at hospital discharge associated with fentanyl administered during labor.[16]

A prospective cohort study compared women who received continuous epidural analgesia with fentanyl and either bupivacaine or ropivacaine during labor and delivery (n = 52) to women who received no analgesia (n = 63). The average total fentanyl dosage was 124 mcg and the average total infusion time from start to delivery was 219 minutes. The study found no differences between the groups in breastfeeding effectiveness or infant neurobehavioral status at 8 to 12 hours postpartum or the number exclusively or partially breastfeeding at 4 weeks postpartum.[17]

A randomized, prospective study measured infant breastfeeding behavior following epidural or intravenous fentanyl during delivery in 100 multiparous mothers undergoing cesarean section and delivering full-term, healthy infants. Epidural fentanyl was given to 50 women in a dose of 100 to 150 mcg in divided doses followed by a continuous epidural infusion of 20 mcg/hour. Intravenous fentanyl was given to 50 women as a single dose of 50 mcg after delivery. Both groups received epidural or spinal bupivacaine in addition. A slight difference was seen in breastfeeding behavior between the groups, with the infants in the intravenous fentanyl group performing slightly worse than those in the epidural group. However, all mothers were able to breastfeed their infants at 24 hours. None had severe breastfeeding problems; 10 women in the epidural group reported mild or moderate problems and 7 women in the intravenous group reported breastfeeding problems. Twenty mothers in the epidural group and 14 in the intravenous group used supplemental bottle feeding, with the difference not statistically significant.[9]

A randomized, multicenter trial compared the initiation rate and duration of breastfeeding in women who received high-dose epidural bupivacaine alone, or one of two low-dose combinations of bupivacaine plus fentanyl. The average fentanyl dosages in the two groups were 97 and 151 mcg in the first stage of labor and 10 and 12 mcg of fentanyl during the second stage of labor, respectively, with great variability. A nonepidural matched control group was also compared. No differences in breastfeeding initiation rates or duration were found among the epidural and nonmedicated groups, but women in the nonepidural group who received systemic meperidine had a lower breastfeeding initiation rate than in the other groups.[18]

A nonrandomized study in low-risk mother-infant pairs found that there was no difference overall in the amount of sucking by newborns, whether their mothers received bupivacaine plus fentanyl, or fentanyl alone by epidural infusion in various dosages, or received no analgesia for childbirth. In a subanalysis by sex and number of sucks, female infants were affected by high-dose bupivacaine and high-dose fentanyl, but male infant were not.[19] However, the imbalances of many factors between the study groups makes this study difficult to interpret.

In a prospective cohort study, 87 multiparous women who received epidural bupivacaine and fentanyl for pain control during labor and vaginal delivery. A loading dose of 0.125% bupivacaine with fentanyl 50-100 mcg. Epidural analgesia is maintained using 0.0625% bupivacaine and fentanyl 0.2 mcg/mL. The median dose of fentanyl received by the women was 151 mcg (range 30 to 570 mcg). The women completed questionnaires at 1 and 6 weeks postpartum regarding breastfeeding. Most women had prior experience with breastfeeding, support at home and ample time off from work. All women were breastfeeding at 1 week postpartum and 95.4% of women were breastfeeding at 6 weeks postpartum.[20]

A study at one Italian hospital compared primaparous mothers undergoing vaginal delivery who received epidural analgesia (n = 64) to a random sample of those who did not (n = 64). Mothers who requested the epidural analgesia received an initial dose of 100 mcg of fentanyl diluted to 10 mL with saline. After the initial fentanyl, doses of 15 to 20 mL of 0.1% ropivacaine were administered if needed. The only difference between the groups of mothers was a longer duration of labor among the treated mothers. The quality of infant nursing was equal between the 2 groups of infants on several measures; however, more infants in the treated group breastfed for less than 30 minutes at the first feeding.[21]
Alternate Drugs to Consider:

Acetaminophen, Ibuprofen, Morphine
References:

1. Reynolds F. Labour analgesia and the baby: good news is no news. Int J Obstet Anesth. 2011;20:38-50. PMID: 21146977
2. Loubert C, Hinova A, Fernando R. Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years. Anaesthesia. 2011;66:191-212. PMID: 21320088
3. Shergill AK, Ben-Menachem T, Chandrasekhara V et al. Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2012;76:18-24. PMID: 22579258
4. Vargo JJ, Delegge MH, Feld AD et al. Multisociety sedation curriculum for gastrointestinal endoscopy. Gastroenterology. 2012;143:e18-41. PMID: 22624720
5. Madej TH, Strunin L. Comparison of epidural fentanyl with sufentanil. Anaesthesia. 1987;42:1156-61. PMID: 2963561
6. Steer PL, Biddle CJ, Marley WS et al. Concentration of fentanyl in colostrum after an analgesic dose. Can J Anaesth. 1992;39:231-5. PMID: 1551153
7. Leuschen MP, Wolf LJ, Rayburn WF. Fentanyl excretion in breast milk. Clin Pharm. 1990;9:336-7. Letter. PMID: 2350936
8. Nitsun M, Szokol JW L et al. Pharmacokinetics of midazolam, propofol, and fentanyl transfer to human breast milk. Clin Pharmacol Ther. 2006;79:549-57. PMID: 16765143
9. Goma HM, Said RN, El-Ela AM. Study of the newborn feeding behaviors and fentanyl concentration in colostrum after an analgesic dose of epidural and intravenous fentanyl in cesarean section. Saudi Med J. 2008;29:678-82. PMID: 18454213
10. Cohen RS. Fentanyl transdermal analgesia during pregnancy and lactation. J Hum Lact. 2009;25:359-61. PMID: 19286842
11. Ekwa-Ekoko C, Beilin Y, Abramowitz S et al. Labor epidural fentanyl and new-born breast-feeding. Pediatr Res. 2000;47:187A. Abstract.
12. Beilin Y, Bodian CA, Weiser J et al. Effect of labor epidural analgesia with and without fentanyl on infant breast-feeding: a prospective, randomized, double-blind study. Anesthesiology. 2005;103:1211-7. PMID: 16306734
13. Halpern SH, Ioscovich A. Epidural analgesia and breast-feeding. Anesthesiology. 2005;103:1111-2. Editorial. PMID: 16306720
14. Frecska E, Perenyi A, Arato M. Blunted prolactin response to fentanyl in depression. Normalizing effect of partial sleep deprivation. Psychiatry Res. 2003;118:155-64. PMID: 12798980
15. Naito Y, Tamai S, Fukata J et al. Comparison of endocrinological stress response associated with transvaginal ultrasound-guided oocyte pick-up under halothane anaesthesia and neuroleptanaesthesia. Can J Anaesth. 1989;36:633-6. PMID: 2555076
16. Jordan S, Emery S, Bradshaw C et al. The impact of intrapartum analgesia on infant feeding . BJOG. 2005;112:927-34. PMID: 15957994
17. Chang ZM, Heaman MI. Epidural analgesia during labor and delivery: effects on the initiation and continuation of effective breastfeeding. J Hum Lact. 2005;21:305-14. PMID: 16113019
18. Wilson MJ, Macarthur C, Cooper GM et al. Epidural analgesia and breastfeeding: a randomised controlled trial of epidural techniques with and without fentanyl and a non-epidural comparison group. Anaesthesia. 2009. PMID: 19912160
19. Bell AF, White-Traut R, Medoff-Cooper B. Neonatal neurobehavioral organization after exposure to maternal epidural analgesia in labor. J Obstet Gynecol Neonatal Nurs. 2010;39:178-90. PMID: 20409118
20. Wieczorek PM, Guest S, Balki M et al. Breastfeeding success rate after vaginal delivery can be high despite the use of epidural fentanyl: an observational cohort study. Int J Obstet Anesth. 2010;19:273-7. PMID: 20627690
21. Gizzo S, Di Gangi S, Saccardi C et al. Epidural analgesia during labor: impact on delivery outcome, neonatal well-being, and early breastfeeding. Breastfeed Med. 2012;7:262-8. PMID: 22166068
Substance Identification:

Substance Name:Fentanyl

CAS Registry Number:437-38-7

Scientific Name:N/A

Drug Class:
Analgesics, Opioid, Narcotics, Anesthetics, Intravenous, Opiates

Administrative Information

LactMed Record Number:356

Last Revision Date:20120831





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