Endoscopy and Breastfeeding

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The information provided is taken from various reference sources.  It is provided as a guideline.  No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used.  Clinical decisions remain the responsibility of medical and breastfeeding practitioners.  The data presented here is intended to provide some immediate information but cannot replace input from professionals.

You can breastfeed as soon as you are wide awake after an endoscopy performed under conscious sedation using midazolam, fentanyl, pethidine or propofol

An endoscopy is an examination where the inside of your gut (stomach/intestines) are examined using a long flexible tube with a light source and camera at the end.  It is passed through your mouth, down the throat into the stomach and intestines. It allows the healthcare professional to look for any abnormalities.

An endoscopy is usually carried out with the patient conscious but sedated.  It is not usually painful, but can be uncomfortable.  A local anaesthetic may be sprayed to the back of the throat to make the tube easier to swallow or you may be given a lozenge to suck.  The sedative helps relaxation during the procedure.  It is normally carried out on an outpatient basis.

The sedatives normally used during endoscopy are fentanyl, midazolam, pethidine and propofol.  These have a rapid onset of action but short half-life so that you will be wide awake shortly after the procedure.

Due to the short half-life of the sedative drugs, you can breastfeed as soon as you are awake and conscious of the need to feed.  The local anaesthetic will not be absorbed into your breastmilk.

Midazolam

The small amounts of midazolam excreted into breastmilk would not be expected to cause adverse effects in most breastfed infants.  Two expert panels advocates waiting for at least 4 hours after a single intravenous dose of midazolam (e.g., for endoscopy) before resuming nursing.  However, no waiting period or discarding of milk might be necessary before resuming breastfeeding after a single dose of midazolam in the mothers of infants over 2 months of age. [Lactmed]

Fentanyl

No waiting period or discarding of milk is required before resuming breastfeeding after fentanyl is used for short procedures (e.g., for endoscopy) [Lactmed]

Pethidine

A  single dose for anesthesia or conscious sedation usually does not cause problems in older breastfed infants. [Lactmed]

If the procedure is carried out under general anaesthetic please refer to anaesthetic factsheet.

Bibliography

  • British National Formulary
  • Hale T. W Medications in Mothers Milk
  • Jones W Breastfeeding and Medication 2018 Routledge
  • Lactmed website http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
  • Martindale, the Extra Pharmacopia 2007
  • 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
  • Vargo JJ, Delegge MH, Feld AD et al. Multisociety sedation curriculum for gastrointestinal endoscopy. Gastroenterology. 2012;143:e18-41. PMID: 22624720

©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network Sept 2019