Is Nalbuphine Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Nalbuphine? Is Nalbuphine safe for nursing mother and child? Does Nalbuphine extracts into breast milk? Does Nalbuphine has any long term or short term side effects on infants? Can Nalbuphine influence milk supply or can Nalbuphine decrease milk supply in lactating mothers?

Nalbuphine is excreted into breastmilk in amounts much smaller than the dose given to infants for analgesia. Because nalbuphine has poor oral absorption, it is unlikely to adversely affect the breastfed infant. No special precautions are required. Labor pain medication may delay the onset of lactation.

Nalbuphine can increase serum prolactin.[3] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed. A study compared women who received nalbuphine or butorphanol during labor (n = 26) to those who received no analgesia (n = 22). The time to effective breastfeeding was longer (46.5 minutes) in the analgesia group than in the no analgesia group (35.4 minutes).[4] A national survey of women and their infants from late pregnancy through 12 months postpartum compared the time of lactogenesis II in mothers who did and did not receive pain medication during labor. Categories of medication were spinal or epidural only, spinal or epidural plus another medication, and other pain medication only. Women who received medications from any of the categories had about twice the risk of having delayed lactogenesis II (>72 hours) compared to women who received no labor pain medication.[5]