TFESI while breastfeeding

[schmee90]

---

Members don't see this ad.

Had a patient who is 6 months post partum with a large disc hernation and correlating radiuclar pain referred for a TFESI. I did a lit review and found IPSIS fact finder. I copy and pasted the main findings, however wanted to see the groups thoughts/experiences. Thank you in advance

Myth: Steroid administration via spinal injections is contraindicated in postpartum patients, especially ifbreastfeeding.

Fact: There is no absolute contraindication to steroid injections based on postpartum or lactating status, but there may be disruption of both maternal and breastfed child hypothalamic-pituitary-adrenal (HPA) axisresponse to steroid administration. For the duration of breastfeeding, milk production may be affected after steroid exposure, and withholding breast milk produced for several hours after exposure minimizes infant

 

[SSdoc33]

Pump and dump for 2 days. If that’s not possible then either no shot or mom accepts small dose of steroid to baby. Biggest issue is that neither may sleep well for a couple days

 

[Agast]

The first 3 months are the most vital for breast milk nourishment anyways and at 6 months you start introducing other foods

My X-ray tech was taught not to shoot films on women who breast feed because it would somehow irradiate their milk, that has since been debunked

 

[nvrsumr]

Breast feeding is a religion. I turn this down yearly

 

[Agast]

Breast feeding is a religion. I turn this down yearly

nvrsumr: “no thanks, I’m full”

 

[knoxdoc]

"TFESI While Breastfeeding." I was expecting a completely different thread...

 

[cowboydoc]

Definitely recommend cessation of breastfeeding for the duration of the procedure. Not much concern otherwise, though rec pump and dump if concerned.

 

[SSdoc33]

Breast feeding is a religion. I turn this down yearly

it doesnt work very well. i tried it. kids couldnt seem to latch on. once i put on the nipple guards, my wife finally put a stop to it

 

[interjectionreflection]

Just revisiting this thread to see if y'all still recommend holding breast milk for a short period after steroid shot? Came across a thread on one of the FB groups and there were some strong opinions to never recommend holding but SIS seem to suggest otherwise?

 

[bedrock]

Just revisiting this thread to see if y'all still recommend holding breast milk for a short period after steroid shot? Came across a thread on one of the FB groups and there were some strong opinions to never recommend holding but SIS seem to suggest otherwise?

Pump and dump for 3 days. If mom refuses , no procedure.

 

[mohandess]

I pump and dump for 24 hours post procedure. Love to hear what others are doing.

 

[Agast]

Women on chronic steroids for autoimmune are allowed to continue breastfeeding. If you can dose yourself daily and not be expected to pump and dump I don’t see why a singleton shot would move the needle. I think attitudes have shifted regarding risks and benefits due to the passive immunity and nutritional benefits of breast milk over formula.

 

[Ducttape]

i have told patients to pump or breastfeed just before, then pump and dump after the procedure x1.

most organizations do not recommend pump and dump at all, even after iv contrast nowadays.

no concerns about the steroid or the local anesthetic.

 

[bubaghanush]

Pump and dump is completely unnecessary. Do the shot and feed baby as normal. I did a deep dive on this in anesthesia residency and it is fine to continue breastfeeding. The inconvenience and stress to baby/mother are worse than any theoretical harm.

Open Evidence says less than 1% relative infant dose.

 

[schmee90]

Pump and dump is completely unnecessary. Do the shot and feed baby as normal. I did a deep dive on this in anesthesia residency and it is fine to continue breastfeeding. The inconvenience and stress to baby/mother are worse than any theoretical harm.

Open Evidence says less than 1% relative infant dose.

I came acros some articles that supoprt this as well, wondering if you had any references to shar with us. Thank you in advance for the input

 

[nvrsumr]

If the mom stops lactating or anything weird happens the shot will be blamed.

If it hurts bad enough they will pump or change to formula.

 

[interjectionreflection]

If the mom stops lactating or anything weird happens the shot will be blamed.

If it hurts bad enough they will pump or change to formula.

exactly, I find they tend to get more "freaked out" and generally in my experience most moms appreciate the upfront honesty that its likely safe but it will decrease milk supply for short term and there is still a small amount of the steroid that goes in breast milk (likely negligible). They always opt to forego a feed or two after the shot. Cant say I blame them. Its likely a nothing burger but why even bother with it if the mom is willing.

 

[bubaghanush]

I came acros some articles that supoprt this as well, wondering if you had any references to shar with us. Thank you in advance for the input

Methylprednisolone Concentrations in Breast Milk and Serum of Patients with Multiple Sclerosis Treated with IV Pulse Methylprednisolone - PubMed

Results have shown that the transfer of methylprednisolone into breast milk seems to be low. Although, concentration levels may not seem to pose a threat to the infant, mothers can choose to wait 2 to 4 hours to further limit the level of exposure.

pubmed.ncbi.nlm.nih.gov

Prednisone Pharmacokinetics During Pregnancy and Lactation - PubMed

To evaluate the steady-state pharmacokinetics of prednisone and its metabolite prednisolone in pregnant and lactating female subjects, 19 subjects received prednisone (4-40 mg/day orally) in early (n = 3), mid (n = 9), and late (n = 13) pregnancy as well as postpartum with (n = 2) and without (n...

pubmed.ncbi.nlm.nih.gov

Not a deep dive but basically negligible.