Duramorph, as I understand it, is a synthetic form of morphine.  The
advantages to duramorph are that the mom is not sedated and that she can move
more freely in bed because she is relatively pain free. this promotes
position changes and deep breathing, helping to avoid respiratory
complications from being in bed.  A big problem with smokers especially.
 Some mother experience some discomfort, especially multiparas who are
experiencing after pains with breastfeeding.  Ibuprofen is made available to
these moms until their 24 hours, from injection of duramorph, has expired.
 Mothers who are not breastfeeding may take Anaprox.  The itching is a common
side effect and the Nubain (naloxone) is effective. It may make some moms
drowsy so we work around breastfeeding.  Benadryl is available as backup.
 Some women are more susceptible to the itching than others.  Not everyone
itches.
My hospital uses duramorph routinely in their c-section patients.  The
fatigue that is often seen is usually due to a prolonged labor and then
c-section and not the effect of the medication.   At another hospital in my
area, where I worked in post partum, for a time, they amublate their
c-sections with duramorph before the 24 hours are up.  These moms do great.
 In both cases, I find moms more alert which promotes bonding and effective
patient teaching without the pain and anxiety that may come with post-op
c-sections.  We do monitor respirations once an hour for 24 hours because
respiratory depression is a possible, although not common, side effect.
In my personal experience, both my sons were c-sections.  The first was a CPD
after 36 hours of labor.  I was exhausted even when I went home, duramorph or
not.  Breastfeeding was great. He knew just what to do!  My second son, 6
years later (now 13 mos) was a planned c-section.  Not only did I receive
duramorph post-op but I also received Toradol 60mg loading IM then 30mg every
6 hours IM for 24 hours.  It was ordered prn (as needed) but I requested
scheduled doses because I find they are more effective, as observed in the
patients I have cared for.  The only pain I felt was the afterpains with
breastfeeding.  They were very uncomfortable and I did take some medication
after my duramorph expired.  I was rested, up out of bed as soon as I could
and generally in better shape than with #1.  I have not seen any problems
associated with duramorph in the patients I have cared for (strictly
anectdotal) and I am enormously pleased with my results as well.
Although I understand the concerns, and duramorph does connote the "opiate"
concept, perhaps we should not throw out this "baby" with the bathwater until
further exploration.  After all, a more comfortable, relaxed mom, is more
likely to be successful with breastfeeding than one who is counting the
minutes on the clock until her next dose of pain medication.!

Jackie Terrebonne, RN  (putting in my two cents personally and
professionally!  : )  )