Women recovering from a cesarean birth often require pain medication. When the patient is also a breast-feeding mother, medication should be kept to a minimum to avoid causing side effects in the nursing newborn. According to breast feeding resource Kellymom.com, even though many pain medications are compatible with breast feeding, they can still cause drowsiness in the newborn. An overly sleepy newborn may challenge the establishment of a successful breast-feeding relationship.
Oxycodone is usually given to a mother immediately following a cesarean birth. It is a narcotic drug that also contains acetaminophen. Gradually, the mother will taper off to weaker medications until she requires no medication at all. The American Academy of Pediatrics has not yet reviewed oxycodone for use by breast-feeding mothers. Dr. Thomas Hale, author of "Medications and Mothers’ Milk," rates it a category L3, or moderately safe, drug for breast-feeding women. This means that it should be given if the risks to the baby don't exceed the benefits to the mother. Oxycodone has the potential to be addictive, so use of this drug is strictly limited. Hale advises parents and doctors to observe the infant closely for signs of excessive drowsiness.
Hydrocodone is a narcotic drug usually taken once a mother has weaned herself from oxycodone. The American Academy of Pediatrics has not yet reviewed its safety for breast-feeding mothers. As with oxycodone, Hale rates the drug as category L3, meaning mothers should use only if the benefits of the drug outweigh the risks. He advises parents and doctors to observe the infant for signs of sedation, constipation or apnea. Hydrocodone, like oxycodone, is a potentially addictive drug for both mother and baby.
Ketorolac is administered through injection usually in four doses about six hours apart. It is an anti-inflammatory drug given immediately following the cesarean and used in conjunction with a narcotic. The American Academy of Pediatrics approves of its use in breast-feeding mothers. Hale rates it category L2, meaning it is relatively safe for lactation, as limited studies show no adverse side effects in infants and evidence of risk is remote.
The American Academy of Pediatrics approves of the use of ibuprofen in breast-feeding mothers. Hale rates it category L1, meaning it is the safest kind of drug for lactation—large studies prove there are no adverse side effects in mother or infant. While a post-operative mother will need the much stronger narcotic drugs immediately following her surgery, ibuprofen will be the drug of choice after about a week.
Acetaminophen is the final drug in the post-operative tapering process. The American Academy of Pediatrics approves of its use in breast-feeding mothers, and, as with ibuprofen, Hale rates it category L1. It is the only pain medication approved by doctors for both pregnancy and breast feeding, making it the safest choice available.
- U.S. Centers for Disease Control and Prevention: Birth, Final Data, 2006
- Kellymom.com: Nursing After a Cesarean Birth
- Kellymom.com: Pain Medications and Breastfeeding
- American Academy of Pediatrics: The Transfer of Drugs and Other Chemicals Into Human Milk
- “Medications and Mothers’ Milk”; Thomas Hale, PhD; 2008