Ironically, I have just finished a post on a lactation education FB closed group I keep.  This one was on anesthesia, analgesia and surgery.  I get the occasional call from moms that question their providers or the pre-op staff instructions to "pump and dump for 24 hrs after surgery".  I think I have finally gotten thru to the head of anesthesia that this is not evidence-based practice!  Time will tell.

Anyway, in educating our staff, the question came up about Demerol PCAs for csections as we have one OB that still orders the Demerol PCA. I shared LACTMED and Hale's info.   

LACTMED:  analgesic alternatives to Demerol:  Stadol, Fentanyl, Morphine and Dilaudid. 

Hales Meds & Mother's Milk: L2 

"Butorphanol was used in labor and delivery in women who subsequently nursed their infants, although, it has been noted to produce a sinusoidal fetal heart rate pattern and dysphoric or psychotomimetic responses in the fetus. Butorphanol use in breastfeeding is expected to be of minimal risk to the normal term infant; however, other pain medications are preferred in lactation."  

Anecdotally, have not seen this used in our L&D unit.  I DO remember getting it 26 years ago sometime during my 36 hours of labor(!) with my first child and he had no problems with his start to breastfeeding!

FYI, I paid for the individual online version of Hale's (about $70) and it has been invaluable!

Holly Prescott RN BSN IBCLC
South Carolina

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