I have permission from this client to share this case.

I have a client who was a midwifery client through her pregnancy and birth
and early postpartum.  She had a back injury years ago and has always had
moderate, but manageable back pain.  The pain was managed through the
pregnancy with massage and chiropractic care.  After we ended midwifery
postpartum care at 6 weeks, her back pain increased.  She called in tears at
2.5 months postpartum and could not tolerate the pain any longer.  She had
already started taking ibuprofen, which was not enough.  She saw a primary
care physician, who prescribed Vidocin (the 5-500 formulation) as well as a
steroid.  She discontinued the steroid after 2 weeks, and continued the
Vicodin.  The pain has become even more unbearable and her prescription was
changed to Norco 10 (10-325, so twice as much hydrocodone) and takes it
every 4-6 hours.  She notices that her daughter (who is 4 months old now)
does get drowsy.  She wants to continue exclusively breastfeeding, but is
uncertain if she should pump and dump etc.  She is devastated that she is in
such pain, and that when she gets relief from the pain by taking the
medication her infant is drowsy and may have other unseen side effects.
Lactmed (http://toxnet.nlm.nih.gov/cgi-bin/sis/search/f?./temp/~Kf2Y8R:1)
does mention infant drowsiness and recommends daily dosage be limited to
30mg per day (which the client is taking 40-60 per day at this point).  Does
anyone have a suggestion of a good alternative medication without the side
effects for the infant?  I could not find information on Lactmed about the
half-live of the medication.  Should the mother pump and dump initially?
Any other suggestions?

Many thanks in advance for your wisdom, as I am a Lactation Consultant
"newbie" (just heard yesterday that I passed the exam).

-- 
Sharon Craig Economides, LM, CPM, MMid, IBCLC

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