If you have any questions about this information, you can contact the Drugs in Breastmilk team through their Facebook page or on druginformation@breastfeedingnetwork.org.uk.
You can have a general anaesthetic and breastfeed as normal as soon as you are awake and alert following surgery.
You should not bedshare with your baby for 24 hours after surgery. See BASIS for more information on safe sleep.
See the 2026 guideline from the Association of Anaesthetists on Anaesthesia and Sedation in Breastfeeding for detailed information.
This factsheet covers general anaesthetics. For more information on…
- Local anaesthetics, please see our factsheet on local anaesthetics.
- Local anaesthetics during dental procedures, please see our factsheet on dental treatment.
- Sedation whilst undergoing a procedure, see our factsheets on dental sedation, endoscopy and colonoscopy.
- Pain relief and analgesics, see our factsheet on pain relief.
Summary
You may need to have an operation under general anaesthetic whilst you are breastfeeding. You, or your healthcare professionals, may be concerned about the safety of exposing your baby to the anaesthetic via your breastmilk. In the past, you might have been advised to avoid breastfeeding for a period after your surgery, or to “pump and dump” your milk. The latest guidelines from the Association of Anaesthetists, published in 2026, are clear that this is not necessary. Instead, they advise to ‘sleep and keep’. This means continuing to breastfeed after surgery as soon as you are awake and feel ready, and using any breastmilk expressed after surgery as usual.
Background
If you have a caesarean section under general anaesthetic (usually as an emergency procedure) you are encouraged to breastfeed as soon as possible after delivery, if you want to. Sometimes, your baby may be helped to latch whilst you are still in the recovery room and drowsy.
General anaesthetics do not stay in your body for long, which is why they must be infused continuously during surgery. Some of the drug is stored within your fat cells and gradually released over the following 24-48 hours, but the level of drug released is low, so you do not need to delay returning to breastfeeding as usual.
In most cases of minor surgery, you will be wide awake within minutes of the end of the operation. Even with major surgery, recovery from the anaesthetic is short, although any opiate pain relief you have during your surgery may cause you ongoing drowsiness. Once you are awake enough to recognise that you have a baby who needs to be breastfed, the level of anaesthetic in your blood is likely to be low.
Bed Sharing
Medicines that make you drowsy can make bed-sharing less safe. Baby Sleep Info Source (BASIS) have more information on sleep and safety. They recommend that you do not share your bed with your baby after you have taken medication that makes you sleepy or drowsy. If you would usually bedshare, ask an adult to help you care for your child at night so that you do not need to share your bed until the effects of the anaesthetic and any other medication have completely worn off. This person may be your nominated family or friend who is looking after you for at least 24 hours after your procedure. For more information on general anaesthetics and precautions to take afterwards, see the NHS webpage on general anaesthesia.
Methoxyflurane (Penthrox, the “Green Whistle”)
Methoxyflurane is an inhalation anaesthetic. It is now being used more often in low doses to relieve pain without making you unconscious. It is most often used for trauma-related pain, such as an injury. You might also be offered it if you have a short procedure that might be painful, but doesn’t need a full general anaesthetic, such as a gynaecology procedure or an endoscopy. You take it though a self-administered, handheld inhaler.
There are no published studies on levels of methoxyflurane in breastmilk. However, as it doesn’t stay in your body for long, it is considered compatible with breastfeeding as soon as you feel ready after your procedure. You should take the same bedsharing precautions as with general anaesthetic, as discussed above.
Practical considerations for breastfeeding parents when planning for surgery:
- Do your surgical team know you are breastfeeding? Many different aspects of your care can impact breastfeeding, so it is important to discuss these in advance.The 2026 Guideline details all the considerations, including your hydration needs, your positioning during surgery, your post-operative pain relief and any other medications you might need.
- Can you breastfeed your baby directly before your surgery, to minimise their time without breastfeeding?
- Can you be first on the surgery list, to minimise the time you are fasting and away from your baby?
- Who will look after your baby whilst you are in surgery?
- If you are to remain in hospital overnight, are there facilities for your baby to remain with you with a responsible adult, if you want them to?
- Is someone able to look after you baby but bring them to you when they need a feed?
- If your baby will not stay with you, are you able to express milk? Can you express some in advance for them to have whilst you are in hospital?
- Will you have access to a breast pump and somewhere to store the milk safely in the hospital? Will someone be able to help you express milk, if needed? It is important that you avoid becoming engorged, as this could cause pain and mastitis, and impact your milk supply.
- You will need help to care for your baby whilst recovering from your surgery at home, regardless of your feeding method.
- The hospital infant feeding team should be able to answer any questions you have about feeding your baby whilst you are in hospital and provide you with support
- You may need pain relief after your surgery. Non-opioid pain relief is less likely to make you drowsy. However, you should have access to opioid pain relief if you need it. See our factsheet on pain relief, and the 2026 guidelines, for more information on pain relief and breastfeeding.
Key recommendations for healthcare professionals, taken from the 2026 guideline
- Any patient with a child aged < 2 y should routinely be asked if they are breastfeeding or expressing breastmilk during their pre-operative assessment for a procedure involving anaesthesia or sedation. However, it is important to consider that patients may continue to breastfeed a child beyond the age of 2 y.
- Patients should be supported to breastfeed immediately before surgery, preferably directly, or by expressing if that is their preference. Patients should be supported to resume breastfeeding after the procedure once they are alert, orientated and able to feed their child or express independently.
- Anaesthetic, sedative and analgesic medicines are transferred to breastmilk in only very small amounts. For almost all medicines used peri-operatively, there is no evidence of adverse effects on the breastfed child.
- Patients should be advised that discarding of breastmilk after anaesthesia (‘pumping and dumping’) is not necessary and that ‘sleep and keep’ is now recommended.
- For patients who are breastfeeding and who are 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.
- Anaesthetic departments should have a breastfeeding champion to support colleagues with patient discussions and advocacy in the peri-operative 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 programme to support the starting and continuation 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 which may result in excessive sedation in some children.
- Patients who are breastfeeding should have appropriate opioid analgesia if needed, and the lowest effective dose should be used for the shortest period of time. Dihydrocodeine or morphine are the preferred medicines.
- Where possible, day surgery is preferable to avoid disrupting normal routines. Consider moving breastfeeding patients to first on the list for their procedure to minimise time away from their child.
- Breastfeeding while on chemotherapy is not recommended due to the passage of the medication into milk with associated adverse effects.
- Patient information leaflets and additional resources should be available containing information on the compatibility of anaesthetic medicines, sedatives and analgesics during breastfeeding, and guidance on breastfeeding support in the peri-operative period.
Related Factsheets
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Bibliography
Click to see bibliography
British National Formulary – https://bnf.nice.org.uk/
Drugs and Lactation Database (LactMed®) https://www.ncbi.nlm.nih.gov/books/NBK501922/
Specialist Pharmacy Service: https://www.sps.nhs.uk/
NHS medicines website: https://www.nhs.uk/medicines/
E Lactancia website: https://www.e-lactancia.org/
Hale T. W. Medications in Mothers Milk. www.halesmeds.com
Jones W Breastfeeding and Medication 2nd Ed Routledge 2018
Mitchell, J., Jones, W., Morris, S., Cohen, M., Breckenridge, F., Baruah-Young, J., Fletcher, G., Edwards, S., White, M., & Wiles, M. D. (2026). Guidelines for anaesthesia and sedation for patients who are breastfeeding: Guidelines from the Association of Anaesthetists. Anaesthesia, 10.1111/anae.70128. Advance online publication. https://doi.org/10.1111/anae.70128
Nitsun M, Szokol JW, Saleh HJ, Murphy GS, Vender JS, Luong L, Raikoff K, Avram MJ. Pharmacokinetics of midazolam, propofol, and fentanyl transfer to human breast milk. Clin Pharmacol Ther. 2006 Jun; 79(6):549-57.
Schneider P, Reinhold P. Anesthesia in breast feeding. Which restrictions are justified? Anasthesiol Intensivmed Notfallmed Schmerzther 2000 Jun;35(6):356-74.
Spigset O. Anaesthetic agents and excretion in breast milk. Acta Anaesthesiol Scand. 1994 Feb;38(2):94-103
©The Breastfeeding Network. Version 2.0. Published January 2026
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