In response to the following questions, my remarks are below***
 
1/What is the analgetic drug of choice to give to a post operative  =
(CS) woman during the first hours/ days of her birth?  In my hospital  we =
encourage breastfeeding within  hours of the operation, but drugs  are =
known to pass into colostrium even more than breast milk, and  if/when  =
an analgetics is needed it should be given BEFORE the  breastfeeding so =
that the mother will feel at ease while she is BF.  I  have read that =
NSAID drugs such as Brufen can be given- does anyone have  experience =
with its effectiveness for the CS woman?  Any  comments  would be =
appreciated.=20

**I don't think Ibuprofen as an analgesic would be very effective against  
the pain of an operative delivery. In my experience, more than 13 years in a  
hospital setting as LC in two different states, the pain reliever of  choice  
has ranged from a PCA pump with morphine (morphine works well, fast  and doesn't 
stay on board for that long), Duramorph (a long acting morphine  derivative) 
to Demerol (not a good choice for breastfeeding moms since it has a  very long 
half life) to Toradol by injection,  oral Tylenol 3, and  Ibuprofen. 
Ibuprofen works fairly well after 24 hours or so. I may be  wrong but I've always 
thought that meds are no more concentrated in colostrum  than in mature milk - 
concepts of drug transfer are based on several different  aspects of the 
medication. And since colostrum is taken in small amounts, I  don't believe the 
relative amounts of medication are that risky to baby. That  being said - I'd rather 
have a comfortable mom and baby going to breast, than a  mom is suffering by 
her choice because of fears of baby being exposed to the  medication who is 
reluctant to hold the baby. It is also not our call as RNs or  LCs to tell a mom 
what drugs to take. We have to follow orders from the  Physician, although 
women deserve to make an informed choice if they are offered  that opportunity. 
If the original poster is not familiar with the concepts of  medication 
transfer to human milk, I encourage her to read the introductory  chapter of Hale or 
check his website for that information.

2/ Does anyone know of an article/ study  concerning the  attitudes, =
beliefs of obstetricians concerning breastfeeding?=20
**Try a  Medline Search or contact the Center for Breastfeeding Information 
at La Leche  League.
 
Mary Kay Smith, RN, IBCLC, LLL Leader
Canton MI USA

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