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Date: | Fri, 15 May 2009 22:28:14 -0400 |
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What you have to remember is that the alternative to an epidural infusion with
or without patient controlled anesthesia is some form of narcotics anyway,
just going in via a different route and one that is going to make the mother
very sleepy - the kind of sleepy where you can actually drop your baby (I've
seen it happen), can't focus on breastfeeding, can't walk very well... very
disruptive to all the work that a new mom and baby need to do together over
the first couple of days. When I worked on the floor as an OB nurse I always
felt very disappointed for moms who missed the opportunity to have epidural
anesthesia after their c-sections. It was remarkable how fast the women who
had epidurals were able to get out of bed and start moving around
comfortably and coherently less than 24 hours after having major surgery.In
our hosptial they use an epidural infusion of fentanyl, which has very low
transfer into milk and very poor oral bioavailablity, so the tiny amounts that
get into milk are I think pretty much knocked out in the infants' belly.(Hale
rates it an L2 with no adverse effects reported via milk, though he seems to
be discussing IV admin, not epidural) We used Duramorph in the past but the
women were scratching themselves into a frenzy and its duration was
unpredictable. In our hospital women usually get coverage with epidurals for
48 hours after surgery at which point they are able to take painkillers by
mouth (usally Percocet) which is much less disruptive than IV narcotics, and
they have made it through the two worst days of pain following surgery with
their wits about them and relatively little pain.
Kathy Lilleskov RN IBCLC
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