To ask any midwives or doctors on here about post-operative pain relief?

[Merryoldgoat]

I had my second baby nearly 4 days ago by Cesarean Section. I had a previous section 5 years ago so thought I knew what to expect.

Last time, I was discharged with 6 weeks’ worth of diclofenac and 30/500 co-codamol and was told by midwives and doctors that I was to ensure I didn’t miss a dose for 4 weeks. After that I was to start using them more sporadically and that I shouldn’t need them by the end of 6 weeks. That was spot on and I was totally free of painkillers before 6 weeks was over and felt the recovery was quite good.

This time the policy has changed and they discharged me 2 days post op with nothing at all. I was in obvious pain and had had to request morphine the day prior to my release. I called my GP worried who spoke to them and they very reluctantly gave me 3 days of diclofenac and it was clear they thought I was being unreasonable.

Today I’m finding the pain VERY hard to cope with and I’m shaking and finding it hard to sit down comfortably.

Is this the norm now at every hospital? I can’t believe how in 5 years the protocol can change so much for the same operation but I feel like I’m not coping well and need to understand if it’s me being unreasonable or if I genuinely need more and should see my GP.

Thank you if you got this far.

Are you taking paracetamol. Codeine/ co-co-codamol is not recommended anymore because of the effect it can have on baby through breastfeeding. I don’t think you should be made to feel unreasonable for requesting more pain relief.

Yes, paracetamol isn’t touching it. It’s like I’ve not taken anything. The diclofenac has taken the edge off but I can only take 3 times a day so after 4 hours or so I can’t cope very well.

Thank you for the info about codeine.

It was the same when I had mysection 3.5 years ago , discharged with paracetamol and told if we needed anything stronger then we weren't ready to be discharged 🙄

I'm not a doctor, but I am a nurse and have had 2 sections, one in 2012 and the last in 2014.
Both sections I was discharged with diclofenac and co-codamol 30/500 and told if I needed more then the gp would prescribe them. The motto is 'pain is what the patient says it is' so if you have pain, your gp should provide you with some pain relief. A c section is major abdominal surgery, so make sure you are resting as much as possible too. If the pain increases or you have a temp, the shivers or have redness or swelling near the incision, let your go or midwife know. Take care of yourself

I had a section just over two weeks ago. I was discharged with paracetamol, ibuprofen and dihydrocodeone

The first protocol that you had was very OTT to be honest. 6 weeks of regular diclofenac and co-codomol is too much, should not be needed and risks serious health problems, never mind dependence on codeine.

Were you warned in advance to have paracetamol and ibuprofen ready? I know trusts who don't give discharge meds normally advise this.

We give one weeks worth of diclofenac but are very clear that the course does NOT need to be finished. Most people take it just for a few days. We also advise women to buy their own paracetamol. I honestly have yet to come across anyone who this has been a problem for. Occasionally women are more sore if there has been complications or they had other procedures done at the same time, and we offer to let these women stay longer in hospital for stronger pain relief.

I don't mean to sound unsympathetic. If you are really struggling with simple analgesia (diclofenac and paracetamol) then you need to see your GP to rule out post-surgical complications.

Thank you everyone. I’ll see my GP tomorrow to talk it through with them.

Standard at our hospital is paracetamol and ibuprofen plus some reluctantly given dihydrocodeine for the first few days🙄. Routine cocodamol was discontinued a few years ago as can be excreted in higher doses in breast milk than dihyrocodeine.
Doesn’t surprise me that you may have been discharged with inadequate pain relief as frequently the assumption is made that women have paracetamol/ibuprofen at home and as I say the dihydrocodeine is not a given. Hope you feel better soon x

Whoops posted too soon...

There’s no evidence to suggest any effects on the baby with dihydrocodeine as PP suggested. I had to make sure I didn’t miss a dose and kept on top of it and I’m pretty much painkiller free now although my scar is still sore.

If I were you I’d give your MW/HV a call and see your GP

I had a section nearly 4 weeks ago and like you was prescribed with nothing and told to buy some ibuprofen and paracetomal, I set alarms to take it around the clock and the first week was agony, 10 days in I felt ok. By week 2 I could finally move normally without crying! It’s awful to think you can have a major op like that and be given no pain relief after discharge (24 hours later in my case!)
I said to my Midwife about the pain at my 5 day check, she said if I still had it at 10 days to see about additional meds. I was BFing though so they didn’t want to give anything.

Just to add bf is not the only issue with codeine, it causes constipation which is not what you want after abdominal surgery, and also can lead to dependence if taken for a prolonged period. It really is not a good choice for post-op pain.

I had my c-section abroad so probably different but I wasn't given anything. When I pushed, I was given paracetamol! Having said that, 4 days later I didn't need anything else anyway. If you are still in pain, I would push for something stronger.

I've only ever been discharged from hospital post operatively with instructions to take paracetamol and ibuprofen regularly and I've had organs removed. Speak to your dr.

I will add you will be in discomfort but you shouldn't be in acute pain past a week

I was given dihydrocodeine (4weeks ago + bf) - but this can bung you up so not good for digestion.

Are you getting plenty of fibre? I found the wind pretty painful for phases after but it passed - lots of fibre and dried prunes helped. Trying to move about too.

I was recommended to alternate ibuprofen and paracetamol but didn't need either after about a week. It will get easier.

Ok. So it’s all changed it seems. I have plenty of ibuprofen and paracetamol. The ibuprofen is for after the diclofenac so I’ll start that from tomorrow.

I’m stil attempting to breastfeed (that’s a whole other thread) so I’ll avoid the codeine as I don’t want any other issues.

Thank you all for your replies. I appreciate I might be a bit of a drama queen at times hence seeking some advice, which I really appreciate you all taking the time to give.

I had 2 cs 3 years ago and 3 months ago, both times I was discharged with a difene and paracetamol. This time I was given a prescription for 3 weeks of difene 3 times a day, I was so shocked, I only actually took enough from the pharmacist to do twice a day for a week, I definitely didn't need more than that, only needed difene twice after my first cs. The amount you were given first time round sounds really excessive, so I think it definitely gave you wrong expectations of what you'd get this time. Definitely see your gp if you're in that much pain.

Gosh I'm shocked at this. I've had two sections, one nearly 8 years ago and one a lot more recently and both times I was discharged at 24 hours with nothing to take home. I took paracetamol and got on with it. I really could have used some better pain relief (mainly the first time) but was led to believe this was the norm and I should be fine.

I didn't have a section, but I did have a really terrible assisted birth with surgery after for a retained placenta and to fix me back up. I had morphine then diclofenac in hospital for 5 days afterwards, then was discharged with a week's worth of diclofenac. When that ran out, I was still in pain and spoke to the GP who explained that longer term use of diclofenac can cause real tummy problems as it's very harsh apparently, and she prescribed me a two week course of Naproxen, which is in the same family as ibuprofen I believe. I didn't need to finish the course, was onto paracetamol and ibuprofen after a few more days.

Definitely see or speak to your GP, they might have an alternate painkiller that will help you.

I had a c-section 3 years ago, was discharged on day 4 with just paracetamol. I actually had to stay in an extra night because I expressed concern about being discharged with only paracetamol - I was on 4 hourly Tramadol in hospital. (Tramadol is recommended over co-codamol now I believe if you're BF, which I was). The nurses said they'd get a surgeon to come down to see me and they might be willing to prescribe me something stronger. The (male) surgeon eventually came down to see me, was incredibly condescending and told me that if I was in that much pain that I couldn't cope with just paracetamol, I shouldn't be going home. He also kept telling me that Tramadol is a controlled drug - as though I was a druģ addict, rather than a couple of days post-surgery and trying to deal with a newborn. I was also desperate to go home, I absolutely hated my stay in hospital, but that's another story.

The next day I just kept my mouth shut when a different nurse/midwife came along to discharge me with just paracetamol. (Incidentally, I don't know why the NHS hands out so many prescriptions for paracetamol when it costs about 25p to buy it in the shop. If they had asked me, rather than handing them out automatically to everyone on discharge, I'd have said not to bother because I had loads in the house.)

A couple of hours after I got home, when my last dose of Tramadol wore off, I was in a considerable amount of pain. I phoned my GP surgery and explained, and less than 5 minutes later a (female) GP rang me back, said she couldn't believe they'd only given me paracetamol, that was ridiculous, and that she'd leave a prescription for a few weeks of Tramadol at reception for me. I could have kissed her.

I've mentioned the sex of the HCPs because I think it's very relevant. No man would be discharged as little as 24 hours after any type of surgery with only paracetamol to take home, never mind after major abdominal surgery, and never mind with a newborn baby to look after. But women are expected to just grit their teeth and put up with the pain. Well done to the women who managed to do that, but I couldn't. People have different pain thresholds, and I also had pre-existing gynae issues including adhesions. And even if I could have just gritted my teeth and bore it, being in that much pain continuously, while not really able to rest due to the baby (I EBF for over a year with no problems FWIW) would have seriously put a dampener on the newborn experience.

I think it's disgusting that this now seems to happen routinely for all women who have had a section. No man would be asked to just put up with the pain when there are effective and safe painkillers available which would enable him to function more normally.

About a year before my c-section, I had a laparoscopy (keyhole surgery) at the same hospital. I was discharged with 2 weeks of tramadol and dicloflenac (AND paracetamol) and instructions to take them all religiously at regular intervals, even if I wasn't in pain at that moment, as painkillers work more effectively that way. That's quite a difference isn't it?

Wow that was long! Can you tell I'm still angry?

Take paracetamol and Ibuprofen regularly. Peppermint water may also help or a warm hot water bottle. Also might want to consider gentle laxative if needed. Diclofenac and codeine are no longer regularly given due to their strength and effect with breastfeeding. Hospitals no longer give out OTC meds as they cost so much to the NHS. If you are day 4 I would expect you to still be getting quite a bit of rest in bed and trying to limit visitors etc. Also use a rolled up towel as counter pressure over wound area when coughing or beating down for comfort. If the pain is a lot worse make sure someone takes a look at the wound too. Often subsequent caesarean births are more painful due to the formation of adhesions.

youlookradiant I don't think the sex has any bearing on it. I personally find male HCPs far more sympathetic than female ones especially for gynae issues.

I was discharged with tramadol, dihydrocodeine and paracetamol, I think I had about a week's supply, but was in hospital for a week post section too. I can't imagine how I would have coped without them. That was 8 years ago. I hope you get something sorted xx

That's awful but I'm not surprised. I remember crying on day 4 after my c-section because I asked for stronger painkillers and was told I couldn't have any.