I don't think it is difficult at all to bring this discussion back to nursing. We have a shockingly high section rate in this country and while we are agitating to bring down those numbers, I think we need to be simultaneously thinking about the pain management protocols that are least disruptive to breastfeeding. Intravenous and injectable narcotics wreak havoc on the initiation of breastfeeding and we need to push for the methods that will leave the mother alert and high functioning. Toradol is an example of a medication that does a pretty decent job of controlling pain without disabling the mother. The most heartbreaking example of the dangers of postoperative pain relief that I can recall in my practice, is that of a mother who was given Demerol to control her pain and the combination of the drug and her prolonged labor prior to her section made her so sleepy that she fell asleep doing the skin to skin that she felt was the best for her baby. The hospital had a practice of not allowing partners to spend the night, so here was this poor soul doing her best to be a good mommy, all by herself in her room, and she dropped her baby onto the floor. Baby was absolutely fine, but the result of this incident was weeks of visits by child protective services to check on her mothering skills and a crushing blow to this woman's confidence.

Too often the people in charge of pain management are trained to treat the woman as a regular surgical case forgetting that there are two people involved in any decision about her medication. Thank goodness for people like you Sarah, who can be out there leading the good fight!!!!!!!!!!!!!!

Kathy Lilleskov

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