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The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used. Clinical decisions remain the responsibility of medical and breastfeeding practitioners. The data presented here is intended to provide some immediate information but cannot replace input from professionals.
We know that the rate of caesarean sections continues to rise in UK, accounting for 19.7% of births in 2000 to 26.2% in 2015 (Wise J. 2018).
Codeine (and co-codamol) is no longer recommended for breastfeeding mothers due to the risk of accumulation of morphine in some babies whose mothers have a particular metabolism (www.breastfeedingnetwork.org.uk/wp-content/dibm/2019-09/Codeine%20and%20Breastfeeding.pdf). So, what happens after birth for a mum who has had a section?
The standard drugs of paracetamol plus ibuprofen/naproxen/diclofenac are sufficient for some mothers but others (I would have to say most) need something stronger. Whilst in hospital it seems as if oral morphine solution (oramorph) is commonly used with the amount required varying. This is safe in breastfeeding even a newborn because of the way the drug is handled in the mother’s body. The preferred alternative opiate table is dihydrocodeine (co-dydramol when administered with paracetamol) which is handled by the body in such a way that drowsiness is much less common.
Opiate drugs tend to cause constipation so a mother who needs these drugs should be given a laxative or stool softener (www.breastfeedingnetwork.org.uk/wp-content/dibm/2019-09/Constipation%20Treatment%20in%20Breastfeeding%20Mothers.pdf) The fourth stage of labour – passing that first bowel motion is no fun!
In certain situation mothers may be given low molecular weight heparin injections to avoid the risk of blood clots. These are self- administered and are safe in breastfeeding as the molecules are too large to pass into milk (www.breastfeedingnetwork.org.uk/wp-content/dibm/2019-09/Anticoagulants%20and%20Breastfeeding.pdf).
Every mother having a c section will receive an injection of antibiotic in theatre to avoid the risk of infection – these will be safe in breastfeeding (www.breastfeedingnetwork.org.uk/wp-content/dibm/2019-09/Antibiotics%20and%20Breastfeeding.pdf).
Getting around after a caesarean section can be painful so pain relief is necessary. Strong painkillers are usually not needed for more than a few days. They are addictive so it is unlikely that you will be prescribed many but please don’t put up with pain, tell someone.
- Wise J. Alarming global rise in caesarean births, figures show BMJ 2018; 363
©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network Sept 2019