Sunday, December 27, 2009

Cesarean recovery, with note on medication and breastfeeding

I just came across this extremely helpful blog post by Birth Activist - and mother who's been through it herself - and I had to share it here. I really like how she breaks it down for both in the hospital and after, and also acknowledges emotional recovery.

The entire post is a definite must-read and must-bookmark-for-future-reference, but here's an excerpt from the section on recuperating while in the hospital:
  • Get as much help as you can from family members, your partner, nurses, and other hospital staff. That is what they are there for and during the hours, and days immediately after your surgery, you will need it even if you do not want it.
  • Stay hydrated and eat. You may not want to eat, but working on eating a well balanced and healthy diet, as well as staying hydrated (stay away from sugary drinks such as fruit juice and soda) will help to make you start to feel semi human again.
  • If private rooms are available opt for one so someone (family member or friend) can stay with you to help you during this time.
  • Use a pillow between your legs, and/or on your side to help sleep to be more comfortable. In the days, and even weeks following your cesarean it will not be easy to get comfortable. This is completely normal. It took me almost a full 2 months to even get comfortable in my own bed at home after my second c-section.
  • Take pain medication that is being offered if you are in pain. With my first child, I was breastfeeding and was overly concerned about any of the medications being transfused though my milk so I opted for over the counter pain medication such as motrin instead. But it certainly made my recovery longer, and made taking care of my son harder. (As ICAN recommends, ask your provider about a stool softener, as narcotic pain medication can cause constipation.) [See Dou-la-la's note below.]
  • Get up and walk around. It may hurt like hell, but it will help to get you back on your feet sooner rather than later. The longer you wait, the more painful it will get up, and the harder it will be.
  • The use of a pillow to protect your stomach while coughing, standing up, nursing or moving around in bed is a smart idea.
  • Do not hesitate to ask for a lactation consultant in the hospital. Breastfeeding after a cesarean section is more difficult not just for mom because of her incision, but also for baby. Check out the ICAN white paper on Breastfeeding After a Cesarean.
I have something to add on the breastfeeding and medication issue: this is one area where MANY doctors, nurses and other practitioners are simply ignorant on the safety of many medications. This is especially true for cesarean recovery and for postpartum depression: women are given the choice between being in pain (physical for the former, emotional for the latter) and breastfeeding. This is patently unfair to both mom and baby. There's a fantastic post from Raising My Boychick on this - it's specifically about mental health, but the general principle is very much the same:

Perhaps you've been lucky enough to have missed this scenario, but I, at the intersection of those with lactating breasts and those with mental illness, have seen it far too often: a woman goes to her psychiatrist, generalist, family doctor, nurse practitioner, or psych nurse, for help with, oh, depression (postpartum or otherwise), or anxiety, or mood disorder, or sleep problem. Being a careful parent and a conscientious patient, she discloses that she is breastfeeding her child, so that she and her health care practitioner can find the healthiest, most appropriate medications for her (should they mutually decide medications are necessary).

This is when, in a sane society, her physician or nurse would nod, draw on hir vast knowledge of and experience with medications appropriate for breastfeeding, and say "No problem, that only rules out a very few classes of drugs, there are lots of things we can try still." Or, barring that, would reach for the copy of Hale's zie keeps handy in hir office, or would call one of the many breastfeeding-knowledgeable pharmacists zie keeps on file as references. The woman and the health care provider she employs would then work together to pick a medication most appropriate for her particular situation.

That is not what usually happens. Too often (ever would be too often), the physician, upon hearing said disclosure, automatically replies "I don't want to give you anything until you wean/terminate breastfeeding/stop doing that."

There is so much wrong with this situation, I hardly know where to start.
(Read on, it's well worth it.)

Many, MANY more medications are perfectly safe for breastfeeding moms than some physicians and other care providers are aware, and in the cases of some medications that are unsafe for breastfeeding moms, it is usually just a matter of substituting another medication that has equivalent benefits for mom, and no side effects for baby. Some doctors know the difference, but alas, some don't. This is where being your own advocate is vital!

THE bible for medication and lactation is the Thomas Hale guide. Owning the book is a great idea if you're a nut like me (plus it's fun to throw "lactational pharmacology" into casual conversation), but if not, do check out his website and bookmark it for future reference.

Tangent aside - thanks again, Birth Activist!

5 comments:

  1. Amen to the stool softeners. I brought my own to the hospital, and was super glad after I ended up with a c section. I took the one they gave me, plus a double dose morning and night. Still took 2 weeks to get back to normal and straining with an incision is not a good time. Anytime people ask what to do to prepare for a scheduled section, I tell them to start them a day or two ahead of time. I'd rather have the runs before then have issues after.

    ReplyDelete
  2. I wish I had had this when I had my c-section. I know this will be so useful to women who end up going through this. The only problem is, at least it was for me, that no one really plans a cesarean (except those who do!:) and so you always end up with this kind of info too late. I'm going to tweet this for you. Thanks.

    ReplyDelete
  3. Great advice. It also took me a couple months to get comfy after my cesarean. Also, I really had to remind the nurses to bring my pain meds on time but it made a huge difference. In the early days, if you're due for another dose in 8 hours, take it even if you feel ok. It'll keep you feeling human enough to walk around and breastfeed.

    ReplyDelete
  4. I could have used a stool softener after my vaginal delivery, frankly. The hemorrhoids made for lots of fear, which made me hold back, making things much worse in the long run.

    (AM I REALLY TALKING ABOUT THIS OUT LOUD ON THE INTERNET??)

    ReplyDelete
  5. Great post. I really agree with the pain meds after c-section. I may support natural child birth, but it makes me sad to see women who end up with cesareans advised to avoid stronger pain meds because they are breastfeeding. I would venture to say that if you are in awful pain that it could actually impede breastfeeding.I certainly would have not been able to get comfortable or relaxed only taking ibuprofen.

    ReplyDelete

Sociable