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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