C-sections - recent experiences of pain relief provided please!

[Falcon1]

I am having an ELCS next week and have been told that it is now Kingston Hospital's policy not to prescribe any pain relief stronger than paracetamol and ibuprofen after C sections. After my last one I was given 10 days worth of Co-codamol and Diclafenac and I still struggled with the pain. So now I'm really worried! Especially as they want me to do the 'enhanced recovery' path which means being sent home the next day.

According to the Midwife, the policy has come about because of concerns about the effect on babies through breastmilk of stronger painkillers, despite having prescribed them with no problem for years.

Does anyone have any recent experience of being refused decent pain relief and how did you manage on just paracetamol and ibuprofen?

Many thanks.

I had an ELCS in 2013 and was just given paracetamol and ibuprofen. It worked well for me; I didn't need anything stronger. But I did make sure that I took them regularly.

EMCS in 2003, Paracetamol only, ELCS 2007 paracetamol only.

Coped fine, yes it was painful but bearable.

The thing about paracetamol is when it is taken regularly in stated doses it is actually a very effective pain relief. Taken in one off doses it's crap!

I refused to take anything other than paracetamol and ibuprofen after my section because I was worried about the other drugs they prescribed - tramadol etc affecting DC through my breast milk. I am not surprised to hear that they are now cutting back on stronger pain meds for that reason. I managed ok with paracetamol and ibuprofen - it did really hurt, but I think that is probably to be expected post section! Without wishing to sound too self righteous - I would rather just put up with the pain than risk having opiates etc in my breastmilk.

EMCS Feb 2013. Had two doses of tramadol immediately after the spinal block wore off, so well before my milk came in (not that that would have concerned me too much tbh). Just paracetamol and ibuprofen after that. I didn't have any pain at all, except from where my wound got a little infected but as soon as the midwife removed the staples that stopped too.

It never occurred to me to ask for anything else.

MW's explanation is probably bollocks - here you are not given any pain relief to take home for cost cutting reasons. You are told to go to your GP, which is of course trivial after major surgery and with a newborn.

In 2013 I got some diclofenac after DH kicked up a fuss.

Above post referred to meds to take home; on the ward they happily handed out Oramorph, which was amazing.

Take it from someone who was on oxycontins after a spinal fusion, the comedown from taking opiates as pain relief is really not worth it.

Also there are risks with you looking after a baby whilst on these strong medications (obviously not if you have only had a couple of doses)

IMO, always best to have the minimum pain relief which you can cope with.

I cannot take opiates so had minimal in spinal block an abdominal deep local block under ultrasound and then just paracetamol and brufen it was all fine

I was given paracetamol and ibuprofen but didn't need either. They did give me morphine in my cannula the first time round but I reacted badly to it so declined it the second time. They also gave an anti-inflammatory suppository as soon as the stitching up was done.

I had no pain at all at any point and you may be pleasantly surprised.

And remember, they may prefer you to go home after one night (I had a 12hr discharge and a 36hr discharge) but if you are in pain and not ready, then speak up. If you are in pain, then speak up and they can discuss options with you if the paracetamol/ibuprofen doesn't work.

Ibuprofen and co-drydamol here, but I stopped the codeone once home as Didnt need it and it's constipating.

I had an EMCS in 2013 and was quite surprised to only be given paracetamol afterwards! It was ok, although I took a few days to get mobile again.

I had an ELCS two weeks ago in Bristol and was given paracetamol and oramorph while in hospital (I cannot take anti inflammatories) and was given 30mg Codeine tablets to come home with. I did find the pain hard the first four/five days but it was also my third CS. I think that anti inflammatories make a big difference but it seems to be true that there has been a policy change on what will be prescribed since my last CS (2010).

I have had no problems breastfeeding but would rather minimise what goes into the baby.

I found the early discharge a bit too early (48 hours for me) due to pain and mobility though - I could barely get onto my own bed as it is quite high, the sofa and loo were too low and hurt a lot to sit down onto and get up from. With hindsight I would have stayed an extra night in hospital just for these physical issues.

I had an ELCS IN London five weeks ago. Sent home with co-codamol, ibuprofen, and paracetamol. The codeine ran out first, but I was fine with the paracetamol and ibuprofen by then. Still taking the odd paracetamol for pain as have had a mild infection in my scar.

Tramadol, dyhyrocodiene and paracetamol - I was also written up for oramorph but did not require it. Although I had some breakthrough pain.

This was in 2013 and I breastfed.

Kick up a fuss if your pain isn't being managed adequately.

Jeez this sounds awful. What is the 'enhanced revovery' path? I'm due to have a section at Kingston Hospital too, I'm scared now! Last time I had two nights stay and proper pain relief...

Had my third section 3 weeks ago. This time I was given paracetamol and ibuprofen, which I needed for about a week, and prescribed dihydrocodeine, which I didn't actually take or feel that I needed. After my second section I didn't need any pain relief once I left hospital (48 hours post OP). After my first (EMCS) I had fairly strong painkillers (can't remember what, but more than just paracetamol and ibuprofen), and needed some analgesia for quite a while -maybe around 3 weeks.

I'd see how you go, you may be fine with just these.

Wow! I have needed quite alot of pain relief after each of my sections, but the pain has definitely increased with each one (I've had 3).

I faced some resistance when asking for more while in the ward with the most recent section but I kept badgering and asking anyone who would look in my direction and eventually they gave me stronger stuff.

If you find paracetamol and ibuprofen are enough then great but make sure you speak up if you're in pain. You need to get mobile asap after the op and if you're in pain it can hamper your ability to do that.

With both of mine I had codeine, paracetamol and diclofenac. It is major surgery, can you imagine having any other surgery and being offered paracetamol afterwards! You wouldn't be, but since it's childbirth it just wouldn't be cricket to have a comfortable experience.
Speak to your anaesthetist before the surgery and discuss your options, I had my pain management plan mapped out, including what i'd be sent home with (as I wanted discharging the following day if everything went well), before we went into theatre.
You may be fine with paracetamol and ibuprofen but do not suffer, tell them you're in too much pain and you want something stronger, and keep telling them, and refuse to be discharged until your pain is under control. An awful lot of enhanced recovery is linked to cost saving and you being in too much pain to go home is a lot more costly than a weeks worth of painkillers. I think you'll be amazed at what is deemed safe to prescribe if you tell them you're in too much pain to feed baby yourself (I really hope it doesn't come to that though).
Best of luck.

I think to only offer paracetamol and ibruprofen as standard is pretty shocking to be honest. I had wildly varying levels of pain after my three sections, with the last being the most painful afterwards. That was the one they did not give out codeine or diclofenac routinely and I had to argue for it.

What other surgery would they routinely offer such minimal pain relief for? It makes me rather cross. I am sure all of you who managed fine on paracetamol would not be insinuating that everyone should have to, just because it worked for you.

In July 2014 I had paracetamol, ibuprofen and oromorph while in hospital (2 night stay) and came home on paracetamol and diclofenac. I had to request the diclofenac though, as I wasn't coping well with the pain while in hospital (though a large part of that was due to gut stasis and constipation as a result of the oromorph!). Once home I was pretty much pain free as long as I took it easy.

I had my first section in 2010 and used codeine for three weeks after the section (was a bit scared to come off it!).

I had my second section in December 2014 and was horrified to find out on the postnatal ward that paracetamol and ibuprofen are the only sanctioned pain relief for breast feeders

I kept asking for more pain relief (which I needed), and was eventually seen by my registrar and the consultant anethetist, an prescribed oramorph. Oramorph worked fine, and I used it for the three days I was in hospital, then came home with just paracetamol and ibuprofen. It's worked fine.

I don't think the change in codeine rules should be anything to panic about. They just start you on paracetamol and ibuprofen only and then see how you are. There are other options if they're needed, albeit with a registrar/anethetist needed to prescribe.

Good luck!

Oh, and I did the enhanced recovery pathway too! It basically meant I got a fortified drink before the section to boost recovery, and extra deep pain relief given during the section. I took all of those things willingly, and then just repeatedly said I wasn't ready to go home/still in a lot of pain etc. I stayed three nights (and probably could have wangled another one if I'd wanted to) :)

This wasn't at kings though.

This sounds like a load of nonsense. I was on strong codeine for virtually the whole time I was breastfeeding due to back pain.

I would hide OTC co-codamol and diclofenac in my bag and take that instead of their meds. Might not be an idea for everyone, but personally I wouldn't give a stuff after major surgery.

Paracetamol and ibuprofen, and a prescription for tramadol in case it was needed (it wasn't). Trick is to keep taking both paracetamol and ibuprofen at the prescribed intervals (every 4 hours, or whatever) whether you feel like you need it or not for the first week. After that, I didn't need anything both times (EMCS first time, planned CS second time). I wasn't going to be running any marathons at that point but I wasn't in pain anymore unless I moved quickly or something.

By the way, I had my gall bladder out last year too. I was given paracetamol, ibuprofen and a prescription for tramadol in case I needed it (I didn't). So I'm not sure that I'd agree that women are being short changed on the pain relief front after CS. For me, paracetamol and ibuprofen are pretty good if you keep on top of taking them.

I had my first EMCS in 2009 and was given paracetamol, codeine and diclofenac to take home.

For my second in 2012 I had a diclofenac pessary straight after then paracetamol and ibuprofen to take home. My midwife team arranged some diclofenac to be brought to me after I phoned the helpline in pain once home.

After my third EMCS and emergency hysterectomy in 2013 I had epidural top ups for two days in hospital then Oramorph, codeine,paracetamol and ibuprofen. I went home after six days with just paracetamol and ibuprofen which was fine.

I breastfed all three. TBH the codeine made me constipated so I tried to stop that asap as that caused more pain.