This response is for Royce and Trisha.   Things are not always  black and 
white in OB. 
As a LDRP nurse who labored and delivered many a trial of labor baby and  
helped initiate breastfeeding, one needs to understand the conflict of having a  
cesarean delivery versus a vaginal delivery with a repair of an 
episioproctatomy  type incision aka, repair of a 4th degree laceration (it extends through  
the muscles into the rectal area and may eventually heal with a  fistula or 
other perianal issues.  
Maternal pain in cesarean deliveries can be controlled with the addition of  
Duramorph after the surgery and the use of Percocet and other analgesics.   
Yes, this type of Mom has problems getting up and down, but our gal with the 4th 
 degree maybe so uncomfortable for weeks with the swelling in her perineum 
and  bum as well as the healing of the sutures.  This poor lady will be given  
Sitz baths that often promote further edema, Tucks, Epifoam and Anusol  
preparations that are only topical.  Her well meaning family members will  encourage 
soft poofy cushions under her tender tush that add increased pressure  on the 
suture repair.  She will be taking Ibuprofen and Percocet or Tylenol  #3 for 
pain and then she will need to add stool softners or mineral  oil to prevent 
constipation.  She will not sit pretty for more than a  few minutes and so 
breastfeeding will definitely be VERY UNCOMFORTABLE  (not shouting).  She will be 
listing to one side and may try  breastfeeding on her side, but she will have 
far greater discomfort than a  cesarean.  
I am not a fan of elective cesareans but if she has had difficulties in  
previous deliveries then this may be the solution for an easier healing and  
better breastfeeding experience.  
I work with a young woman who had such an experience with her first child;  
she elected for a cesarean for her second delivery and breastfed longer and  
more comfortably. 
This young mother needs to consider her choices and options very  carefully 
and speak to more than one caregiver to very this other doctor's  suggestion. 
 I see docs who embrace the elective section as quick and easy for  
themselves,but  they will not be doing the healing or breastfeeding.
 
Nice day in Miami.
Waiting on a "cool snap" to take us down to 70's
Leanne Jewell RNC, IBCLC, LCCE.  FACCE    

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