Safety in Local Anesthetics and Breastfeeding

Is it safe to go to the dentist for elective care and then resume breastfeeding after being numb?

We know that breastfeeding is some of the best nutrition for babies. The American Public Health Association advocates for mothers to breastfeed their children for at least six months, and up to two years of life. Evidence is continuing to mount proving the immense benefit for the neonate/child to receive its mother’s milk^1,2.

Some medical professionals may still be instructing mothers to “pump and dump” breastmilk after receiving local anesthetics for dental care. Although understandable, the thought process behind this is outdated and not founded in science³. We want to put the baby’s best interests first, and keeping the mother healthy is paramount in doing so, of course this also includes oral health. Surprisingly, mothers can transmit the bacteria that causes cavities to her newborn in a process called vertical transmission⁴. So, allowing a mother to delay dental care is not healthy for the baby in the grand scheme.

Multiple studies, guidelines, and reviews have shown that using Local Anesthetics during dental procedures, particularly Lidocaine with or without epinephrine, is safe for the mother and child^5,6,7,8. The American Society of Anesthesiologists published these recommendations: “1) All anesthetic and analgesic drugs transfer to breastmilk; however, only small amounts are present and in very low concentrations considered clinically insignificant… 2) Patients should resume breastfeeding as soon as possible after surgery because anesthetic drugs appear in such low levels in breastmilk”. It is not recommended that patients “pump and dump”⁹.

Lidocaine, currently deemed the safest anesthetic during pregnancy and breastfeeding, has been proven to be safe to the mother and fetus before childbirth and typically a fetus receives more of a drug in the womb vs during breastfeeding^10,11. Fetus’ would also be directly affected by anesthetic blocks during pregnancy: “As local anaesthetics are commonly used during labour analgesia or obstetric anaesthesia, there has been extensive investigation on possible neonatal effects secondary to direct placental transfer, with no evidence of harm⁶.”

Another concern a mother may have regards the use of Epinephrine contained in the local anesthetic. This chemical is naturally found in our bodies, helps with hemostasis, and duration of the local anesthetic so dentists may use less of it. “No studies currently exist describing the use of epinephrine during human lactation; however, because of its short half-life, it is unlikely that epinephrine distributes into breast milk and, therefore, it is not contraindicated for use during lactation¹⁰.”

In Summary: According to the American Academy of Pediatrics the local anesthetic, Lidocaine with or without epinephrine, used for dental care is safe for mothers and their babies. There is no need to “pump and dump” the mothers milk anytime after given the local anesthetic¹². Of course, consult your dentist if you have any questions about this topic.

This information is specific to the Local Anesthetic Lidocaine, used specifically for dental work. It may not apply to other pharmaceuticals, again consult with your dentist or medical doctor.

1. American Public Health Association. American Public Health Association Policy Statement 2001-14. APHA supports the Health and Human Services Blueprint for Action on Breastfeeding. Washington, DC: American Public Health Association; 2001. Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=253. 
2. A Call to Action on Breastfeeding: A Fundamental Public Health Issue. (n.d.). Retrieved January 20, 2021, from https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/29/13/23/a-call-to-action-on-breastfeeding-a-fundamental-public-health-issue
3. Cobb, B., Liu, R., Valentine, E., & Onuoha, O. (2015). Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk. Translational perioperative and pain medicine, 1(2), 1–7.
4. Colak, H., Dülgergil, C. T., Dalli, M., & Hamidi, M. M. (2013). Early childhood caries update: A review of causes, diagnoses, and treatments. Journal of natural science, biology, and medicine, 4(1), 29–38. https://doi.org/10.4103/0976-9668.107257
5. Dalal, P. G., Bosak, J., & Berlin, C. (2014). Safety of the breast-feeding infant after maternal anesthesia. Paediatric anaesthesia, 24(4), 359–371. https://doi.org/10.1111/pan.12331
6. Mitchell, J., Jones, W., Winkley, E., & Kinsella, S. M. (2020). Guideline on anaesthesia and sedation in breastfeeding women 2020: Guideline from the Association of Anaesthetists. Anaesthesia, 75(11), 1482–1493. https://doi.org/10.1111/anae.15179
7. Mustafa, H. J., Wong, H. L., Al-Kofahi, M., Schaefer, M., Karanam, A., & Todd, M. M. (2020). Bupivacaine Pharmacokinetics and Breast Milk Excretion of Liposomal Bupivacaine Administered After Cesarean Birth. Obstetrics and gynecology, 136(1), 70–76. https://doi.org/10.1097/AOG.0000000000003886
8. Cobb, B., Liu, R., Valentine, E., & Onuoha, O. (2015). Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk. Translational perioperative and pain medicine, 1(2), 1–7.
9. Statement on Resuming Breastfeeding after Anesthesia. (n.d.). Retrieved January 20, 2021, from https://www.asahq.org/standards-and-guidelines/statement-on-resuming-breastfeeding-after-anesthesia
10. Donaldson, M., & Goodchild, J. H. (2012). Pregnancy, breast-feeding and drugs used in dentistry. Journal of the American Dental Association (1939), 143(8), 858–871. https://doi.org/10.14219/jada.archive.2012.0290
11. Henderson E, Mackillop L. Prescribing in pregnancy and during breast feeding: using principles in clinical practice (published online ahead of print Jan. 27, 2011). Postgrad Med J 2011;87(1027): 349-354. doi:10.1136/pgmj.2010.103606.
12. American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics 2001;108(3): 776-789.

The Author of this post does not assume any liability for any injury and/or damage to persons or property as a matter of products liability, malpractice, negligence, or otherwise, or from any use or operation of any methods, instructions or ideas contained. The foregoing parties will not be liable for any direct, special, indirect, incidental, consequential, or punitive damages as a result of the reader’s use of this information.