twilight sleep and breastfeeding

[Aidens_mama]

I have a colonoscopy scheduled and they will be using twilight sleep on me. How long do I have to pump and dump before I can start nursing my 6 month old? The nurse told me a day but I have found that nurses and doctors often don't actually know. The last time I had something done the nurse told me to pump and dump for the first 2 hours and my mid-wife said as soon as I could ask for my baby I could nurse. So... any answers would be very much appreciated.

Thank you!

Mama to and

[Heba]

If you let me know the actual drugs that they will be using, I can look them up in Hale's for you.

[Heba]

If it's Propofol, Hale classifies it as L2 (= "safer");
Pediatric concerns: None reported in several studies.

Nitrous Oxide is L3 (= "moderately safe") - there have been no studies assessing transfer into breastmilk.

So if you're comfortable with that, there isn't necessarily any reason to pump and dump.

[SpunkyMama]

Do you have a LLL leader that you could contact about it?

[Jilian]

I'm not familiar with twilight sleep but when DS1 was 6 weeks old I had a minor procedure done under general anesthesia and my LC told me that as soon as the general anesthesia came out of my system and I wasn't feeling drowsy anymore then it was safe to nurse.

[Aidens_mama]

Originally Posted by Heba

If you let me know the actual drugs that they will be using, I can look them up in Hale's for you.

So I called and they use Fentanal and Versed.

thank you SO much!!

[MountainMamaGC]

I had a colonoscopy and was able to breastfeed as soon as I was able to hold her. No need to pump and dump as these drugs are metabolized rapidly.

[Heba]

From Hale's (2008):
Fentanyl - L2 "Safer"- low transfer into milk, low oral bioavailability, short half-life. "It is apparent that fentanyl transfer to milk under most clinical conditions is poor and is probably clinically unimportant."

Midazolam (trade name Versed) - also L2. Rapid metabolic elimination (as Lydiah says) - in one study, maximum level in breastmilk 1-2 hours after administration, undetectable 4 hours after administration. Pediatric concerns "none reported in several studies. Milk levels exceedingly low after brief wait."

Let me know if you'd like the full entries for these (I can't do that until Sunday, though).

Good look with the procedure!

[Jilian]

Wow, I'm SHOCKED that fentanyl is safe. That is what they had DS2 on after his heart surgery and they said it was stronger than morphine. It knocked him OUT.

[balancedmama]

Yep, when you're awake enough to nurse, it's fine. I had a colonoscopy this year as well. The actual procedure was a breeze, but the prep was heinous.

[fruitfulmomma]

Wow, I'm SHOCKED that fentanyl is safe....they said it was stronger than morphine.

I was given it while in late labor with dd1. I bf'ed her immediately at birth, less than 2 hours later.

I wonder why they would say that. DH's nurse (had his gall-bladder out last week) said they use it because it leaves the system really quickly.

[Heba]

Originally Posted by Jilian

Wow, I'm SHOCKED that fentanyl is safe. That is what they had DS2 on after his heart surgery and they said it was stronger than morphine. It knocked him OUT.

As well as its fast metabolism, the other things of significance are the low transfer into breastmilk, and the low oral bioavailability (so what does make it into breastmilk will have a lower effect on the little one as it's taken orally as opposed to intravenously).

[MountainMamaGC]

Originally Posted by balancedmama

Yep, when you're awake enough to nurse, it's fine. I had a colonoscopy this year as well. The actual procedure was a breeze, but the prep was heinous.

I agree the prep is worse than the procedure. I was sooooo hungry.