Explore the safety of ketamine during breastfeeding and essential guidelines for moms. Read more to ensure informed choices for your health and baby.
Introduction
For a woman who is breastfeeding, making decisions about medications and procedures is especially important. Ketamine use—whether for ketamine anesthesia, general anesthesia, or mental health treatments—raises concerns about infant exposure through breast milk. This article explores the latest evidence, guidelines, and what every breastfeeding mother should know.
Ketamine and Breastfeeding: What We Know
Research shows that ketamine and its active metabolite pass into human milk, but usually at very low concentrations. Ketamine and its metabolites can be detected in breast milk. The relative infant dose (RID) is used to measure safety, and in most cases, the RID for ketamine is low, meaning breastfed infants face limited risk. Relative infant doses are also used to compare drug transfer across different medications.
Studies suggest that ketamine is rapidly metabolized and has low oral bioavailability, which means a breastfeeding infant absorbs only a fraction of the drug. Fully breastfed infants are exposed to only a small fraction of the maternal dose. As such, ketamine is generally considered safe for lactating women when used in low dose or as a single dose. However, it is important to monitor infants who continue to breastfeed after maternal ketamine use for any potential adverse effects.
Clinical Contexts: When Ketamine Is Used
1. Ketamine Anesthesia in Mothers
Ketamine is sometimes given as part of maternal anesthesia during cesarean delivery, cesarean section, or postpartum tubal ligation. International guidelines on anaesthesia in breastfeeding mothers often address the safety of ketamine use. In many resource limited settings, ketamine is used because of its safety profile and low cost.
2. Mental Health Treatment
For conditions such as major depressive disorder, postpartum depression, and other psychiatric disorders, ketamine therapy may be offered when other medications fail. S ketamine (esketamine) is also used for depression treatment, but there is limited data on its transfer into breast milk and the safety for breastfeeding infants, so careful monitoring and consultation with a healthcare provider are important. Patients who are breastfeeding should discuss risks with their healthcare provider and consider whether to temporarily stop or continue feeding.
3. Chronic Pain & Anesthetic Drugs
Ketamine may also be used as a local anesthetic or for sedation during minor surgical procedures. Compared to other anesthetic drugs like diazepam, ketamine has been associated with fewer adverse neonatal effects.
Lactation and Breastmilk Production
Lactation is a remarkable process that enables women to nourish their infants with breastmilk, which is uniquely designed to support healthy growth and development. The production of breast milk relies on a delicate balance of hormones, including prolactin and oxytocin, which work together to stimulate milk synthesis and release. For lactating women, any medication—including ketamine—can potentially pass into breastmilk and reach the nursing infant. This is why healthcare providers pay close attention to the relative infant dose (RID) when evaluating the safety of medications during breastfeeding. The RID compares the amount of medication a breastfed infant receives through milk to the mother’s dose; an RID below 10% is generally considered safe. When considering ketamine or any other drugs, it’s essential for breastfeeding women to consult with their healthcare provider to ensure that both their own health and their infant’s well-being are protected. Understanding how medications interact with lactation helps mothers make informed choices about their treatment and breastfeeding journey.
Evidence from Studies and Databases
- Drugs and Lactation Database (LactMed), maintained by the National Library of Medicine, is a key resource for moms and healthcare providers.
- Case studies, including a systematic review published in BMC Pregnancy Childbirth, show that when mothers received ketamine for anesthesia, adverse effects in infants were rare. Additionally, a case report documented ketamine use in a breastfeeding woman, with no significant adverse outcomes observed in the infant.
- In some reports, breastfeeding infants had poor feeding, poor weight gain, or weight loss, though these outcomes were not common.
Guidelines for Breastfeeding Mothers
- Resuming breastfeeding
- After a single dose of ketamine for anesthesia, most experts recommend that mothers can resume breastfeeding once they are awake, alert, and able to safely hold their baby.
- Repeated doses or high dose use
- Repeated doses or high dose ketamine may increase adverse effects such as sedation, poor feeding, or developmental concerns in infants born to mothers exposed during pregnancy or postpartum.
- Careful infant monitoring
- If mothers received ketamine, careful infant monitoring is advised. Look for signs of slurred speech, poor feeding, or sleepiness in the breast feeding infant after maternal ketamine use, as adverse effects may occur.
- Consult a provider
- Always involve a healthcare provider when considering ketamine use while nursing. They can check resources like the lactation database LactMed and provide individualized recommendations.
Resuming Breastfeeding after Ketamine
For many breastfeeding women, knowing when it’s safe to resume nursing after receiving ketamine is a top concern. According to the American Society of Anesthesiologists and other expert guidelines, the relative infant dose (RID) of ketamine is typically low, suggesting that most lactating women can safely resume breastfeeding once they are fully awake and alert after anesthesia. However, because ketamine can cause sedation and other side effects, careful infant monitoring is recommended after resuming breastfeeding. Healthcare providers often consult trusted resources like the Drugs and Lactation Database (LactMed) to provide up-to-date, individualized advice for each breastfeeding mother. By considering the specific dose of ketamine administered and the unique needs of the mother and infant, healthcare providers can help ensure that resuming breastfeeding is both safe and supportive of the family’s health.
Special Considerations
- Human development & child health: Protecting long-term child health and human development is the top priority.
- National Institute and World Health Organization emphasize the need for more data on ketamine safety during lactation.
- While ketamine is low risk in most cases, decisions depend on the mother chooses—whether to continue nursing or use formula during treatment.
Ketamine Use in a Resource Limited Setting
In many resource-limited settings, ketamine is a vital medication for anesthesia due to its effectiveness and accessibility. The World Health Organization recognizes ketamine as an essential medicine, especially where other anesthetic options may not be available. For lactating women in these environments, healthcare providers must carefully weigh the benefits of ketamine use against potential risks of infant exposure through breast milk. Fortunately, ketamine’s low oral bioavailability means that only a small fraction of the drug is absorbed by the breastfeeding infant, reducing the likelihood of adverse effects. Still, it is important for healthcare providers to offer clear guidance on breastfeeding and medication use, taking into account the specific circumstances and available resources. By staying informed about the latest evidence and using resources like LactMed, providers can help ensure safe anesthesia care for women and their infants, even in challenging settings.
Postpartum Tubal Ligation and Ketamine
Postpartum tubal ligation is a common procedure performed shortly after childbirth, often using ketamine anesthesia. Research, including studies published in BMC Pregnancy and Childbirth, has shown that ketamine use during postpartum tubal ligation is generally safe for breastfed infants, with no significant adverse effects reported. However, as with any medication, the relative infant dose (RID) should be carefully considered, especially if higher doses of ketamine are used. Healthcare providers are encouraged to monitor breastfed infants for any signs of sedation or feeding difficulties and to consult authoritative resources such as the National Library of Medicine and the Drugs and Lactation Database (LactMed) for the most current safety information. By providing individualized guidance and careful infant monitoring, healthcare providers can support lactating women in making informed decisions about breastfeeding after postpartum tubal ligation with ketamine anesthesia.
Concluding Thoughts
Ketamine is a valuable drug for anesthesia, psychiatric disorders, and postpartum depression treatment. For breastfeeding mothers, evidence shows that ketamine breastfeeding exposure results in a relative infant dose that is usually safe due to low oral bioavailability and rapid metabolism. However, caution is still needed with repeated dosesor high dose use.
At PointHealth Clinic, our healthcare providers work with breastfeeding women to weigh the benefit ratio of ketamine in the context of both maternal anesthesia and mental health treatment. With careful infant monitoring, informed choices, and guidance from resources like LactMed, moms can balance their own healing with their baby’s child health.
👉 If you’re a mother exploring ketamine therapy, book a consultation with our expert team to ensure safe and supportive care for both you and your baby.
