Regarding Medications and Cesarean deliveries:  a report from the CS  central 
of South Florida.  I truly see the nearly 60% cesarean rate that we  have 
here not affected by the prescribed meds post delivery as influencing  
breastfeeding, but rather the mind set of the individual mother.  Our  patients receive 
Astromorph 98% of the time.  We see tremendous amounts of  nausea and vomiting 
which I often feel is associated with long periods of  fasting either while 
in labor or waiting for surgery (NPO from midnight is too  long for the 4 PM 
surgical patient). This post surgery  nausea makes breastfeeding difficult and 
those meds often make the patient  groggy.
 We use Percocet and Ibuprofen 600 mg primarily for pain  management.  Our 
patients will ask 9 out of 10 times how this will effect  their ability to 
breastfeed.  But it's their mental attitude of "no milk"  and sending the baby to 
the nursery for the night and allowing the nursery staff  to give formula or 
they themselves thinking they need to give formula because  the baby is still 
acting hungry after feeding, that are the real culprits in  derailing the 
breastfeeding experience. 
The mothers who request their pain med every 4 hours or less and have no  
coping skills will usually not cope with baby who either demands frequent long  
feeds or the one who has a poor latch causing sore nipples.  She  will often 
revert to bottle feeding to give herself a break.
Moms who usually get up and moving and use their meds as needed and allow  
their babies to set the pace and use skin to skin seem to do well. 
Different women respond differently to different pain management tools and  
this can play into the breastfeeding equation but its only a very small part of 
 the picture. I think its is more aligned to the "I'll try versus the I will  
breastfeed" expectation of the mother.  I always remind my patients that  
they need to be comfortable to be able to handle and work with the baby and pain  
medication is a tool just like a pillow and comfortable chair or bed.
Leanne Jewell RNC, IBCLC, LCCE, FACCE
SFL
 

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