Get help when you need it

If you’re experiencing pain, the first question to answer is: what is causing the pain? Pain is the body’s way of protecting itself, so if you are concerned that your pain may be due to something worrying, seek advice from your midwife, GP or, if necessary, the Emergency Department.

It is not uncommon for breastfeeding mothers to require pain relief, as they may be recovering following the delivery of their baby, or they may be experiencing pain associated with breastfeeding itself, including mastitis. New mothers also experience normal aches and pains like everyone else: toothaches, headaches and lower back pain are all common.

However, many mothers may either stop breastfeeding or avoid taking essential medicines because they fear possible side effects on their babies. This article aims to help new mothers choose effective medications for pain relief that will be safe for both them and their baby while breastfeeding.

How are drugs transferred to breast milk?

When a medication is taken, it is absorbed into the bloodstream where it can then travel to the part of the body where it is needed. When a medication is circulating around the body, it may be taken up by the mammary glands in the breast, which are responsible for producing milk, so the medication could then be transferred into the breast milk itself.

Not all medications can pass into the breast milk, and of those medications that do, not all are found in sufficient amounts or in the right form to be of any concern for a feeding baby. This makes it difficult to identify which medications are safe when breastfeeding. The list of painkillers discussed below is by no means comprehensive, and if you have questions about specific medications that aren’t mentioned, please discuss them with your doctor.

What pain relief medications are safe for breastfeeding mothers?

Paracetamol – Taking 1g (2 tablets of 500mg) of paracetamol every six hours is safe for you and your breastfeeding baby. Paracetamol is more effective when taken regularly, so continue to take it until your pain has fully resolved. However, if you weigh less than 50kg, only take 500mg (1 tablet) every 6 hours.

Ibuprofen – Although not safe in pregnancy, ibuprofen is safe for you and your breastfeeding baby. It comes in a variety of different strength preparations, so be careful to read the advice on the packaging regarding doses.

Although paracetamol and ibuprofen should have no adverse effects on you or your baby, if one of you is taking other medications or has an existing medical condition – such as asthma or liver, kidney or heart disease – it is important that you discuss which painkillers are safe with your doctor so you’re aware of any potential risks. For instance, some people find that ibuprofen makes their asthma worse.

What pain relief medications are not safe for breastfeeding mothers?

Codeine – should be avoided if you are breastfeeding. It is a naturally occurring opioid that is changed in the body into morphine. The amount of morphine and the speed which it’s produced is very variable between different people, so an ultra-fast metabolizer of codeine would produce a lot of morphine and can expose their baby to higher-than-expected morphine concentrations, which could be dangerous. Following the death of a breast-fed baby in 2005 due to morphine toxicity, the Medications and Healthcare products Regulatory Authority (MHRA) and the European Medicines agency both advise that codeine is contraindicated in breastfeeding mothers. Dihydrocodeine, a synthetic structure that is similar to codeine is considered safe for use as it is not metabolised in the same way to morphine. It should be used at the lowest dose for the shortest duration possible

Opioid Medications – This is a group of painkillers that contain morphine or are metabolised in the body into morphine. Codeine, discussed above, is an example of an opioid. Other examples include tramadol, oxycodone, oramorph, and fentanyl. Opioid medications should only be used following discussion with your doctor and with careful monitoring of you and your baby.

Opioid medications that pass into the breast milk can have a variety of effects on your baby, from mild to severe. Babies exposed to opioids may be sleepier or more irritable, and they may also struggle to feed. In severe cases where a baby is exposed to higher opioid doses, it may slow their breathing or even cause them to stop breathing. For these reasons, these drugs are usually reserved for hospital settings where women may have just undergone a caesarean section or instrumental delivery and babies can be closely monitored.

If you were taking opioids during pregnancy, your baby may be used to opioids and at risk of neonatal withdrawal symptoms. In this case, the opioids that may be present in breast milk can be of benefit to your baby because they will reduce their withdrawal symptoms. If you were taking opioids during pregnancy, please discuss this with your doctor.

Main Points

• If you are experiencing pain, the most important thing is to find out what is causing it. If you’re worried, speak to your midwife, GP, or, if necessary, the Emergency Department.
• It’s normal for breastfeeding mothers to require pain relief as they’re still recovering from the delivery of the baby and may also be experiencing pain from conditions directly linked to breastfeeding, such as mastitis.
• Many mothers may worry whether their medication will transfer into their breast milk and be passed to their child. When medication is taken, it’s absorbed into the bloodstream and may be taken up by the mammary glands in the breast (which produce milk), meaning the medication could be transferred into the breast milk.
• As not all medications can pass into a mother’s milk, and not all that can do so in amounts sufficient enough to cause any harm to the baby, it can be difficult to identify which medications are unsafe.
• Some pre-existing medical conditions may be affected by pain relief medication. This is why it’s very important to remember to consult your doctor if you have any concerns about whether painkillers or any other medication is safe to take while breastfeeding.
• A 1g dose (2 500mg tablets) of paracetamol taken every 6 hours is safe for breastfeeding mothers, but women who weigh less than 50kg should only take 1 tablet (500mg).
• Ibuprofen is also safe for breastfeeding mothers, but be sure to read the packaging for guidance on doses.
• Codeine should be avoided.
• Other opioid medications, such as tramadol, oxycodone, oramorph, and fentanyl have associated risks for the baby and should only be used after medical advice.
• Speak to your doctor if you took opioids while pregnant, as your baby may be at risk of neonatal withdrawal symptoms.

References

Oxford University Hospitals NHS Foundation Trust Acute Pain Team, Pain Guidelines 28 Apr 2018.
Lamvu G, Feranec J, Blanton E. Perioperative pain management: an update for obstetrician-gynecologists. Am J Obstetr Gynecol. 2017. doi:10.1016/j.ajog.2017.06.021
Sachs HC; Committee on Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics 2013;132:e796-809
Seaton S, Reeves M, McLean S. Oxycodone as a component of multimodal analgesia for lactating mothers after Caesarean section: relationships between maternal plasma, breast milk and neonatal plasma levels. Aust N Z J Obstet Gynaecol. 2007;47 (3): 181-185