I have a question for how hospital based IBCLC's handle opiate use during the postpartum stay. Our facility used to not make a big deal about it but in recent years have had more mothers coming in requesting much higher than normal dosages for their pain (such as Norco 15mg every 4hours and even asking for more or requesting pain management consults). We often have a high risk population that comes in who have already been using opiates during their pregnancy. Our typical dosing for a c/s recovery is 5mg-10mg q 6hrs prn. We have a high exclusive BF rate (we do alot of hand expression too if we need to boost a feed instead of using formula) because we are Baby Friendly. My question is... at what point or what dosage should be the cut off for narcotics during the immediate postpartum period in such these select high risk/higher dosage patients? Our unit QA/Safety team wants a cut off number. I understand the small volume and concentration of meds in the early days but due to the limited studies out there I wasn't sure how other facilities handle this or is it an issue elsewhere. LactMed and Hale give Norco 40mg max and Oxycodone 30mg daily max (both fan favorites here... some patients can't get enough but still want to exclusively BF) many of our mothers can double that amount easily so I am always the "bad guy" when I start to question the safety of it. ("How dare the IBCLC not support exclusive breastfeeding...we are Baby Friendly!")

Any recommendations or information is greatly appreciated!!!

Pam Stehr BSN, RN, IBCLC

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