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From:
Katherine Lilleskov <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 23 Oct 2010 22:57:36 -0400
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At the hospital I am affiliated with, a big teaching hospital in NYC, they stopped using Duramorph more than 10 years ago, for all the reasons that have been discussed. What they do for a planned C/S sometimes is to give the women a spinal block for the surgery and simultaneously insert an epidural for post-op pain relief, using the bupivicaine/fentanyl combo. When it is possible to do this, it does seem a best of both worlds solution. They get a great block and therefore painfree surgery and then don't have to suffer all the complications of IV pain killers, esp the sleepy out of it feeling, which can interfere enormously with the initiation of breastfeeding. The "walking epidural" leaves them mobile and much better equipped to care for themselves and their babies. If they already have a functioning epidural and they are in labor when the decision to do the c/s is made then they use the epidural that is in place and it is left in place so that they can have the fentanyl and bupivicaine for 24 to 48 hours postop. It is a gazillion times better than the duramorph which used to turn our post-op mom into crazed itchy and sometimes pukey women....it was not good for them or their efforts to begin breastfeeding!!!! Even in a perfect world we would still have to do some c sections and the spinal/epidural combo is the best I have seen at dealing with this scenario....though I do remember seeing a documentary in the 70's where they showed a c section being done in China under accupuncture for anesthesia and the woman seemed completely comfortable. That concept has always intrigued me :)

Kathy Lilleskov RN IBCLC

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