breastfeeding and sedation

[Ellaroo]

Hello. Wondered whether any of you could give me some advice. I am currently bf dd, who is nearly 12 months. However, I need to have a tooth extracted and the dentist wants to give me some sort of Valium while this is done (medazolam) to sedate me as for some reason anaesthetics are not working on me (am not altogether sure whether I like this idea, surely it means I am still in intense amounts of pain, but am such a mess that I will be unable to complain about it!????). However, my main concern is whether this is really safe for dd. The dentist says if I wait to feed her for 6 hours after it should be fine, but when I rang Boots Pharmacy about it they said it was best avoided completely. Not much point in going to my doctor and asking her as she is very unsupportive about breastfeeding and will just tell me to give up completely or at least for a few days, neither of which I am willing to do. Do any of you have any experience with this. Also if I decided to request a general anaesthetic what are the implications for bf with this option? Many thanks.

[Snugs]

I was told by my dentist that I couldn't have this sedation until I had finished B/F.

I can recommend the treatment though - I have an awful phobia about dentists and have to be dragged kicking and screaming (luckily dh takes the kids so they don't see me setting a bad example ) I had an extraction and a filling - and don't remember a thing! No pain at all.

[pupuce]

Hi Ellaroo.... here is what Hales (book on medication) says...
Midazolam is a very short acting benzodiazepine primarily used as an induction or preanaesthetic medication. The onset of action of midazolam is extremely rapid, its potency is greater than diazepam, and its metabolic elimination is more rapid. With a plasma half life of only 1.9 hrs, it is preferred for rapid induction and maintenance of anaesthesia.
After oral admin of 15mg for up to 6 days postnatally in 22 women, the mean milk/plasma ratio was 0.15 and the maz level in breastmilk as 9ng/ml and occurred 1-2 hrs after admin. Midazolam and its hydroxymetabolite were undetectable 4hrs after admin.
Pediatric concerns - none reported in several studies. Wait 4 hours after dose.

Ref Brit J Clin Pharmacol 30: 787-93, 1990 Matheson I et al.


Can you take this info to discuss with your dentist?

[bundle]

Ellaroo, most large hospitals have pharmacologists who know all about impact of drugs on the body..& presumably your baby. could you persuade your gp to ring one for advice?

[Mog]

Ellaroo,
Don't know much about the sedation but had to have a wisdom tooth extracted when dd was 10 months. Dentists are not my favourite place but just want to offer reassurance that having a tooth extracted was fine, over very quickly relative to a filling and much easier than I expected as I'd never had one out before. My dentist referred me to a specialist dental clinic because I was nervous and I don't know if that helped because they are doing extractions all the time and presumably are quicker at doing it. I had mine out with a local anaesthetic which is fine when breastfeeding.

[Ellaroo]

Wow, thank you so much for all that information. Snugs seems to be suggesting it's not okay, while Pupuce's research says it probably is - don't know what to do now! Mog, I have had 3 teeth removed already under local aneasthetic, and like you found it not to be too bad, however, with this tooth they have tried to do root canal on it four times and failed each time to numb any of the nerves or area surrounding it, hence the extraction and need for sedative. (I am not actually a toothless old devil! They were all back ones that don't show!). Snugs, can you walk and talk after the sedation? - I feel really scared about it.

[Tissy]

The midazolam will probably be given intravenously, rather than orally, so the onset will be quite rapid. They will give you just enough to sedate you (inject it bit by bit until the required effect is achieved) and it will probably wear off pretty quickly afterwards. I would say that given the info. in Pupuce's book, your dentist is probably right. Pharmacists are programmed to tell b/f mothers ( and pregnant women) to avoid things. A pharmacist told me not to take Gaviscon or Ranitidine for my heartburn when I was pregnant, when it was so bad I couldn't eat or drink, and was losing weight. Obstetrician said both were fine.

[Snugs]

Ellaroo - coming home was a bit of a blur. You have to have some one with you. All I remember is counting to 10 and then someone helping me out of the chair - everything in between is a mystery! I pretty much came round after 1/2 hr or so of fresh air. Talking/eating etc was pretty much ok, no numbness from an injection in the mouth and very little soreness from the extraction site.

My dentist may well have been erring on the side of caution, but since my dental work wasn't urgent I had no problem with waiting until I had stopped B/F.

[mears]

You will be perfectly safe to B/F after Medazolam as your dentist has said. Do not worry if you need to feed within 6 hours because it is a one off dose of medication and will very quickly be excreted. All drug compendiums are cautious about drugs in B/F and pregnent women. I have seen medazolam given at difficult C/S and women are not restricted breastfeeding.

[Jasper]

Can you walk and talk after sedation? Yes, this is the beauty of midazolam, it really is a wonderful drug.
You can walk and talk( you may be a bit unsteady on your feet) but you may not remember too much about it.
About 85% of patients have no memory at all of what went on while sedated. The other 15% may remember snatches of what was going on around them but it will be a relaxed memory if that makes sense.
Patients fequently do not remember anything about being driven home or the few hours after going home despite the fact they were chatting almost as normal to those around them during this period.

[SofiaAmes]

Ellaroo, when my ds was 4 mo or so and I was still exclusively bfing him, I pulled my back really badly (lifting him). I took a Vicodin which is an American sedative given after operations and often for dental work. It is a really strong narcotic and I was very concerned about the bfing. My doctor in la (land of the overcautious doctors) said not to worry. At most he suggested waiting 4-6 hours before bfing, but said that very little actually makes it into the breastmilk and certainly not enough to harm the baby. At most it could make him a little drowsy. During the 4 hour period I gave my ds a bottle of expressed milk and expressed and threw out the milk I produced.
As Mears said, they gave me just as strong stuff and for several days after my c-section and no one even suggested I not breasfeed because of it.
Chances are you are going to be feeling a little woozy and might be glad of a bfing break for half a day.

[Ellaroo]

Thank you so much for all your reassurance. I was feeling really worried about it, but feel much better now!