Sent home from hospital after c-section without ANY analgesia

[TeaJunky]

The title says it all.

The night before coming home I was up all night in hospital crying with pain after having taken pain relief. This was noted by the midwives.

Yet the next day I was discharged from hospital without as much as a single paracetamol. I asked several times about it, and was eventually told that as its so cheap to buy over the counter, the hospital is cutting costs.

This is St Mary's in Manchester. Otherwise, I had fantastic, round the clock care and support and the teams were excellent.

But sending a woman home, who has just given birth via major abdominal surgery, without any pain relief (at 6pm evening), with a newborn to look after is just criminal.

The community midwife that came to see me today said it has started happening only in the past few weeks, and they initially thought the hospital/staff were forgetting - but it was becoming more apparent now that it's just cost cutting. She suggested I tell the local press, which I will be doing.

I also wanted to raise awareness of this on mumsnet and ask other women to add similar experiences about such incidents.

I spent the night in pain of course - I think I must have overdosed myself with ibuprofen and a bad mixture of other odds and sods of pain killers I had in my kitchen drawer

This has to fit into an MN campaign somewhere, surely? It's just not right.

[doublecakeplease]

I was sent home without pain meds too - Sunderland hospital. Ds was in scbu so missed most of the meds the 2 days post birth too as I wasn't on the ward at drug times.

Really struggled the first 2 nights but, having never had an operation before assumed I was being a wimp.

Didn't kill me but I'd def rather have had them! wasn't asked about my pain and just muddled through. Only had my scar checked by a student and an auxiliary too

[JaffaSnaffle]

And, yes I was shocked by it. It was abdominal surgery, for heavens sake, not a small procedure. Why should women be expected to endure pain like that, I've no idea. Because it's childbirth? It's hard enough recovering, when you've got a small baby to care for and you are sleep deprived and on a learning curve...

[JaffaSnaffle]

Had the same experience in a different part of the country, Cambridge. No analgesia to take home. In the hospital, it was oramorph and diclafenac round the clock, and tbh the thought of having to manage on lower painkillers was a factor in when I felt happy to go home.

Once it was clear that there would be no pain relief coming home with me, I was on to the GP,, who prescribed co-codamol. There is no way I could have managed the early days without it.

But I didn't save NHS money, just charged a different budget I guess.

[VivaLeBeaver]

You can buy voltarol/disclofenac over the counter now. It comes in a 12.5mg dose rather than the 50mg dose that hospitals dispense. But you can take 4 tablets to get it up to 50mg and take 3x a day.

[TeaJunky]

I agree with you rain all the way, especially that last bit.

I would also like to add that I wanted to breastfeed, but the constant pain of sitting up for long periods of time, without pain relief, has not allowed me to do this.

[rainrainandmorerain]

rezieken - you don't actually work in a profession where you care for people, do you?

YOU personally have taken diclofenac and ibuprofen and you personally found ibuprofen more effective? Great! You do know that different painkillers work differently on different people? So a mw or nurse dismissing a patient in pain with the argument that 'paracetamol works perfectly well for ME, so what are YOU complaining about?' is just badly informed nonsense.

And I sound like an angry and 'quite a nasty' person, do I. Oh, my heart breaks.... I tell you what does make me angry. Mad as hell, in fact. Poor patient care, vicious woman hating nonsense, and carers who abuse their power. Not to mention new mothers whose first precious days with their newborn are spent in needless pain and distress. So shoot me.

[nooka]

Sorry rain, my point was simply that the pain that I thought was totally unbearable, when the idea of getting up and walking was to me unthinkable was actually manageable. The staff who I thought were uncaring were actually giving me the right advice and support to achieve my objective (to get home as soon as possible).

Otherwise I would certainly agree with you that pain should be managed on an individual basis as much as possible. Sadly from my experience (I'm not a healthcare worker but I did manage a NHS complaints service for a few years a while back) post natal care is a bit of a Cinderella and not at all well funded. My personal experience is over ten years ago when funding was generally better, given the pressure the whole service is under now I suspect it is a great deal worse.

[fedupwithdeployment]

I had a nasty episotomy several years ago and was presceibed voltarol...not much, but enough.

This year I had a hip replacement privately. I was in for 6 days, and had my pills brought round. Before discharge I went to the pharmacy and paid for additional medication (that I would need at home). I also knew to stock up on ibrorofen and paracetamol.

It seems totally inappropriate to discharge post CS without some drugs - although usually I would think it apprpriate to let people buy their onw OTC meds. IT seems to me that they were pretty negligent in not explaining what you would need, and enabling you / DH to stock up.

[rainrainandmorerain]

I'm sorry, but someone not bringing you toast when you want it is not the same as leaving a woman in serious pain because a carer personally feels she should be managing on paracetamol shortly after a cs.

NICE guidelines say this: "WOMAN WHO HAVE A CS SHOULD BE PRESCRIBED AND ENCOURAGED TO TAKE REGULAR ANALGESIA FOR POST OPERATIVE PAIN, USING - FOR SEVERE PAIN, CO-CODAMOL WITH ADDED IBUPROFEN. FOR MODERATE PAIN, CO-CODAMOL. FOR MILD PAIN, PARACETAMOL."

Here - www.nice.org.uk/nicemedia/live/13620/57163/57163.pdf - page 28.

And that's after recommending patient controlled opioid anaesthetics in the immediate post operative period.

so OP, I would recommend asking your local hospital to justify their reasons for not following nice guidelines for a start.

The idea that you should not be discharged from hospital if you require painkillers stronger than paracetamol is daft. A night in hospital is far more expensive than a packet of pills. Apply that rule to all post operative patients (and why should women post-birth be treated differently) and you've just bumped up your local nhs hospital bill considerably.

by ALL means, ask women to buy a box of paracetamol prior to birth. Why not. But that has nothing to do with discharging women 24 hours after major abdominal surgery with no painkillers and no sensible means of getting hold of them. Expecting them to jump through hoops trying to get hold of prescription medication from their gp when it turns out they need something stronger than a painkiller for 'mild pain' is just cruel. Sod buying paracetamol - you cannot buy the co-codamol I was on over the counter. It just isn't legal.

How long til someone overdoses on otc painkillers because it is the middle of the night, and they are in desperate pain? Or takes a relative's medication, not prescribed for them, with bad consequences?

I am left wondering how much of this is connected to the idea that birth, vaginal or cs, SHOULD be painful, and women should just be putting up with this pain.

[Sweetiesmum]

wow.... seems the staff are not working on keeping patients pain under control but some other policy??

[bissydissy]

Hi - to clarify - I did not throw away my drugs - I returned them to a pharmacy - who then throw them away. They gave me several weeks worth. The solution to nhs over prescription is not, however, to cease prescribing but to prescribe sensible ammounts.

[nooka]

You should not use prescription medicines except under medical advice. Neither should you just throw them away, they should be taken to a pharmacy for safe disposal. Many prescription medicines including painkillers have significant side effects, some can be dangerous if taken in the wrong circumstances.

After my first section I remember thinking that the midwives were very mean when they didn't bring me toast (we had a unit with a communal room for breakfast) and kept telling me to get up, and I remember the first trip to the bathroom being very scary. Second time around knowing that if I wasn't up and about they wouldn't let me go home as soon as I possibly could I made myself move early, and it wasn't nearly as scary (even though that labour was physically and emotionally much more traumatic than the first, which was in retrospect very easy).

Sometimes you get healthcare workers that are simply not very caring. Sometimes they are overwhelmed and supportive. But other times they are telling you what you need to know, even if you don't want to hear it.

[TackyChristmastreedelivery]

Our unit has just moved from diclofenac to ibuprofen as it is considered a bettter option by the anaesthetics department. Less tummy upset for the pain relief gained. People seem to do ok on ibuprofen and paracetamol, with codeine in the first 24 hrs or so. At least, women often turn down the codeine and accept the others on drug rounds.

I think the issue is just how utterly insane it is that a person can buy a box of paracetamol for 22p but a trust has to spend many many times more to buy in, prescribe and supply that drug.

That's the issue here

Obviously anyone who needs anything extra should get it. Although perhaps if greater amounts of analgesia are needed then discharge should be postponed? The thought of climbing stairs or climbing into a shower-over-bath post section makes me cringe! I always try to remind families who are desperate to be home at 24 hrs, these things aren't always obvious until you get home!

I'm a bit nervous of very newly, knackered delivered mums being home at night and taking tramadol etc. That's probably a personal thing though, I know I'd be out of it.

I am sad for postnatal care. It's always been the poor relation in maternity and obstetrics (imo).

[MaggieMaggieMaggieMcGill]

I was discharged with about two months worth of diclofenic after my c-section. I only took it for three weeks BUT I certainly did not throw the rest away, the remaining pills got used over a period of two years.
Why would you bin perfectly good painkillers?

[TeaJunky]

Thanks Nordic feeling do much better tonight, even managed to have a rummage through my bounty pack

And rain - you said it so much better than me. It IS barbaric. Rez mentioned about it not being about c-sections only etc and how her husbands knee(?) operation was a similar experience. Now in hindsight, I had to physically 'chase' (read hobble in excruciating pain) the midwives at night a couple of times to get some painkillers. I was told by a midwife that I could help myself to the infant feeding room (which was miles down the corridor) when I buzzed her to get me a feed in the night, although she said it after she brought it. I said I was in too much pain to walk the length of the corridor and back. Re the painkillers, It's not that they didn't readily give them out while I was there - they just didn't seem to think a c-section as 'major abdominal surgery' that you hear so often. It was the whole attitude, verbal and non verbal around it that just made me feel like it wasn't taken seriously. at all.

And that, I think is scarier for women than nhs cut backs.

[rainrainandmorerain]

reikizen, i hope you have nothing to do with caring for women post cs. And if you do, you never ever come anywhere near me.

'In your opinion' voltarol isn't as good as otc ibuprofen? and many women manage on paracetamol 24 hours after a cs? and btw, the co-codamol you get otc is a LOT weaker than what you get on prescription, where there are different strengths of codeine according to need.

Thank god I had consultant care, where adequate analgesia was discussed with me beforehand. What a shame the only low point of my cs was when 2 bitches of mws told me to 'manage' on paracetamol only, 24 hours after me cs, going against the specificied pain relief protocol in my notes, leaving me in such pain that I needed tramadol. Which is expensive and strong, and which I would most likely NOT have needed had they stuck to the agreed pain relief. Oh, and the humilation and fear of BEGGING them for more pain relief is something that will stay with me for a while.

For a woman crippled with agonising pain after a cs, who needs more pain relief, getting to a GP can be impossible. Or add to the agony. What we need is rest, right? so what good does hauling myself physically to the gp's surgery to physically pick up a prescription do?

WOMEN SHOULD BE GIVEN ADEQUATE PAIN RELIEF WHEN THEY ARE IN HOSPITAL AND WHEN THEY LEAVE. If they find they can manage on less, good for them. If cheap otc painkillers form part of the regime, then fine, warn women in advance of what they need to buy.

But sending women home from hospital without the prescription medicine they are likely to need is barbaric.

[Nordicmom]

Happy you got your prescription Tea! To be honest the first few weeks were a blur of pain, tiredness etc after my CS but after a month or so I was feeling much better :) . You'll be ok . In the meantime take all the painkillers you need , rest as much as you can and make other's do everything possible for you if you can . Congrats on your little one :) My littlest one is now 7m . Time goes fast !

[TeaJunky]

Topsmart - it's ok, didn't mean to sound snappy - I blame the no/shit analgesics!
I had an emergency section - dd was brow presentation and I pushed for all I was worth but nothing happened

I called my surgery again and it turns out the cow receptionist had left my message in the book for a gp that isn't in until tomorrow- after knowing the whole story of why I desperately needed to speak to a gp. (Me: can I please explain..."no , can you explain to the doctor please what the problem is, me: if you just give me a quick minute I can explain why it's so urgent)

Anyway the gp was shocked and astounded by this, and has also suggested I complain, at the very least. He said the surgery was about to close but has written out a prescription (with all them glorious pain killers!) and dropped it off at the pharmacy next door, and dh has gone to pick it up < sigh of relief>

Hoping tonight will be a tear-free night. Thank you Nhs for ruining my precious first days with dd

[tears roll]

[whatsoever]

Sorry Tea, I haven't read all the posts but I was sent home from St Mary's in October after an episiotomy with no pain relief either. My dad gave me a few strips of his diclofenac or I wouldn't have managed.

When I had cervical cautery at Wythenshawe in 2010 (very minor and I left same day in no pain) they gave me tons of paracetamol and diclofenac to take home.

[reikizen]

Firstly, some units do not prescribe codeine to breastfeeding mothers full stop, although the evidence for this is very weak, but you can buy co-codamol (at a lower dose) from a pharmacy. Secondly, I do not rate voltarol as a painkiller and I think that your standard 15p ibuprofen will work better. So, a good idea to stock up on both these before you have a baby.
Secondly, although paracetamol & ibuprofen cost 15p from your local shop, for the hospital to buy them from the pharmacy costs at least 10 times this. I'm not sure it makes sense for the NHS to spend this money on an easily bought OTC painkiller (as bissydissy says, she threw most of hers away - probably about 50 quids worth of drugs) when we are losing staff and resources hand over fist but I understand that some will disagree with this. Many women don't require anything over and above paracetamol in my experience after the first 24 hours anyway.
Thirdly, it isn't just maternity as my DH was sent home following a major operation with totally inadequate pain relief, GP was happy to prescribe something stronger.
I'm pretty sure going to the press will be pointless tbh, the NHS is getting squeezed so much ( I know midwives who share one sonicaid and one set of scales between a team of 6 people and I have had to buy my own neonatal resus equipment for homebirths) I think most people will think nothing of it. As long as St Mary's are advising people in advance (as I am doing at my antenatal classes) they can make appropriate provision. Perhaps getting GP to prescribe it if having an elective section.
I am truly sorry that people have had a shit time with their maternity provision but believe me, it is going to get much, much worse.

[Pourquoimoi]

It's wrong isn't it. I think unfortunately that it is cost cutting throughout. I had major knee surgery on both knees at once earlier this year and they tried to send me home two hours after the op with no painkillers!!

The nurse tried to tell me to get paracetamol from the supermarket as it was cheap!! I was in agony and couldn't walk!! I really had to be strong to insist that they got me the stronger medication that the anaesthetist had prescribed. She reluctantly agreed and said grumpily that it'd take an hour as if I'd tell her that it didn't matter! I waited and got the necessary painkillers. I was really quite shocked by the treatment though.

Thankfully my c sections were years ago and the cost cutting wasn't in place then so I got plenty of painkillers.

I am all for making savings where appropriate but skimping on painkillers is just ridiculous.

[Sweetiesmum]

Tea junky I agree the hospital has a duty of care that you are discharged home with pain adequately controlled. With a tiny baby needing 3 hourly feeding and a painful incision that is barely beginning to heal you have every right to expect at least 24 hours of pain relief medication to take home. (A period of grace for you to hobble to pharmacy and stock up on meds) Why dont they cut costs with cutting the managers pay that made this nasty decision to disregard the wellbeing of new mothers