Dr. Thomas Hale has addressed this issue, and it has been found that it is due 
to an enzyme which causes the morphine, (which this drug metabolizes into) 
to be present in large quantities for longer periods of time than in most 
women. 

It is NOT common. Only 1% of the Caucasian population has this genotype, 
somewhere around 10% of Greeks do, and the percentage is higher in people 
from Ethiopia (it appears directly from this country, the majority of African 
American Women have Ancestors from other parts of Africa, and most are not 
100% Ethiopian.)  This would not effect the majority of Americans, for 
Europeans. 

Dr. Hale recommends that hydrocodone or oxycodone be used instead, as it 
metabolizes differently, or use a NSAID for postpartum or C Sec pain. 

Having had 3 C Sections, being given codeine with Tylenol after the first two, 
and Hydrocodone with Tylenol, along with Ibuprofen with the second, I can 
say that the Hydrocodone was *highly* superior in not only pain suppressing 
effect, but was not as sedating OR constipating as the codeine was. The 
addition of the 600 mg Q 6 h of Ibuprofen was a very very good addition to 
the mix, and helped control the pain well. I used a similar treatment for severe 
migraines, while nursing my last baby, and afterward. IMO, codeine is fraught 
with problems, and the synthetics are not only more effective, but have 
a "cleaner" side effect profile and can be safer during lactation. 


Luckily for Moms who need pain control while breastfeeding, the preferred and 
more efficacious drug is also better for lactation, as well. It is pretty much a 
non-issue, as hydrocodone is as available and as usually as inexpensive as 
codeine.

Mary Jozwiak IBCLC, RLC, LLLL
Private Practice 

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