Safe Pain Management During Lactation

First-Line Safe Options

The American College of Obstetricians and Gynecologists and other medical societies recommend paracetamol and ibuprofen as the safest first-line analgesics for breastfeeding mothers, which can be used immediately without interrupting nursing, with high-quality evidence supporting their safety 1, 2.
Paracetamol is extremely safe for breastfeeding mothers, as the amount transferred to breast milk is significantly less than pediatric therapeutic doses, according to the World Health Organization and other health organizations 3, 1.
The European Society of Anesthesiology and other medical societies suggest that no waiting period is needed after taking paracetamol, and breastfeeding can occur immediately, with a strength of evidence rated as high 1.
The American Academy of Pediatrics and other pediatric societies recommend that no special monitoring of the infant is required when the mother is taking paracetamol, with a strength of evidence rated as moderate 1.
Ibuprofen has the most reassuring safety data among all NSAIDs, with minimal milk excretion, and is used extensively for postpartum pain, according to the National Institute for Health and Care Excellence and other health organizations 1, 3.
The use of ibuprofen does not require expressing and discarding milk or waiting between doses and feeding, with a strength of evidence rated as high 1.

Morphine is the preferred opioid for breastfeeding mothers, as it is transferred to milk in small amounts, and is recommended as the opioid of choice by the American College of Obstetricians and Gynecologists and other medical societies, with a strength of evidence rated as moderate 3, 2.
Single doses of morphine pose no risk, but repeated doses require infant monitoring for drowsiness and poor feeding, according to the World Health Organization and other health organizations, with a strength of evidence rated as low 3, 2.

Aspirin in analgesic doses should not be used during breastfeeding, as recommended by the American College of Obstetricians and Gynecologists and other medical societies, with a strength of evidence rated as high 3, 2.
COX-2 inhibitors, except celecoxib, should be avoided due to limited data, according to the National Institute for Health and Care Excellence and other health organizations, with a strength of evidence rated as low 1.

Extra caution is required for infants less than 6 weeks of age, due to immature hepatic and renal function, as recommended by the American Academy of Pediatrics and other pediatric societies, with a strength of evidence rated as moderate 1, 4.
Preterm infants have the highest medication sensitivity, according to the World Health Organization and other health organizations, with a strength of evidence rated as low 1.

The American College of Obstetricians and Gynecologists and other medical societies recommend that mothers should never co-sleep with their infant when taking sedating medications, such as opioids, as maternal responsiveness may be inhibited, with a strength of evidence rated as high 2.
There is no need to "pump and dump" with paracetamol or ibuprofen, as recommended by the American Academy of Pediatrics and other pediatric societies, with a strength of evidence rated as high 1.
Breastfeeding can resume as soon as the mother has recovered from the procedure when these medications are used, according to the World Health Organization and other health organizations, with a strength of evidence rated as moderate 3, 1.