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.

Porky - there was a change in guidelines for codeine and breastfeeding in July 2013. Rare cases of babies having issues metabolising iirc which means that it should avoided when breastfeeding just in case....

I had to argue for proper pain relief. My DH had to back me up. The woman in the bed opposite didn't like to make a fuss and cried due to unmanaged pain.

It's up to people what they would choose to do, but I would take the risk if I was in that much pain. Very rare chance of complication in tiny amount of breastmilk doesn't seem worth not being able to move to look after my newborn properly.

I wouldn't tell anyone to do the same, but that is what I would do if refused meds for that reason.

Off topic, but I think it's awful they are going to send you home the next day. Is this standard practice now across all of NHS England? There's no way I could have walked upstairs the following day

I had much worse pain after my 3rd section 2yrs 3m ago, was given paracetamol and ibuprofen but found myself in a lot of pain suddenly in the middle of the first night and had to ask for something stronger, they gave me a clear liquid which worked pdq, assuming it was oramorph? I only needed it the once tho, and after that i coped on paracetamol and ibuprofen, but it was just coping rather than being comfortable

Whilst visiting the gp a few days later 4/5 days I think, I requested diclofenac as I knew this had been given after both previous sections (2006 & 2009) but was told they didn't give this anymore after sections. I didn't ask why, I wasn't in the right frame of mind. Cant imagine why lol. So yes it seems they've changed their guidelines on what to give for pain relief, I didn't realise it was just for bf mums tho

I had a csection in 2013 and the oromorph did bugger all for me.

Yy to the person who said people would be furious at being offered paracetamol after any other major surgery.

I had a C Section 5 weeks ago. I had one dose of oramorph about 6-8 hours after surgery, then only paracetamol and ibruprofen. Both were "normal" strength but were prescribed by the hospital, I took 2 paracetamol 4 times a day and 2 ibruprofen 3 times per day, I carried on until the end of the packets I was discharged with, so stopped taking then about a week or 10 days later.

I wasn't in pain at any point - mildly uncomfortable at times, but usually because I tried to reach for something and stretched too far . I was in hospital for 2 nights, discharged 48 hours after surgery and it was my first baby.

I had one dose of oramorph in hospital. Other than that I just took paracetamol. I was actually much better than when I took codeine with my first section. Much less drowsy and more active which I think helped with healing.

Thanks for all your messages everyone. I think I'll just have to be very vocal about being in pain and wanting something stronger if I'm not coping. The codeine safety issue is a concern, as I obviously don't want to put the baby at risk, but from my research it does seem like the risk is minimal and dependent on whether the mother has a specific gene that means they process more of the codeine into morphine than normal. Given that I took codeine after my first section for 10 days with no problem, it would suggest that it would be fine...though as some of you have said, I may find I'm fine without - think it's unlikely though, as I'm such a wimp!

Cherryade8 - I was offered the Enhanced Recovery pathway as it's a straightforward second c-section. The pros are that you're given priority over the other planned sections on the day so more likely to be in first thing in the morning (last time i had to wait until 6pm), although obviously you could still be bumped down the list for emergencies. And I guess if breastfeeding is well-established and you're not in too much pain you might prefer to be in your own bed. I'm just a bit anxious of being home in the middle of the night on day 2, in real pain and no oramorph!

Agreeing with Porky here.

I'm having a section 2nd March. I have crohns disease, and cant take any anti inflammatories, so ibuprofen is out for me. As is codeine, I take such a bad reaction to it due to the crohns, my consultant has told me to say I'm allergic. Also cant have pessaries due to fistulas.

I'm taking my own prescribed tramadol in with me, just in case they refuse me painkillers. I wont be breastfeeding, and I know I cope with daily life perfectly well on tramadol.

Falcon that's interesting, thank you. I'll ask whether I'm likely to be on the 'enhanced recovery'. Last time Kingston gave me co codamol and something else beginning with f for pain, I didn't ask they just gave it to me. This was three years ago though, I will also be vocal if in pain! Maybe they are trying to put people off sections. I don't remember pain following the surgery last time, maybe due to good pain relief they must have a plan though.

I bf ds for two years, though he was quite chilled for a few days after birth, I wonder if that was the painkillers...

Had an emcs 6 months ago, was given paracetomal and ibuprofen to take home. First fewdays in hospital was given oramorph for the pain but from day 3 they wouldn't give me anything else as was breastfeeding

Had IV paracetamol in recovery ( had a GA) and then paracetamol after IV removed and on discharge. Had paracetamol in labour so had taken it regularly for 6 days which worked much better than just occasional dose I found. This time I will ask for something stronger if do not get IV paracetamol.

I had one 18 months ago and was completely fine on just paracetamol for about three days afterwards and then nothing. But I knew if I needed more ibuprofen and cocodamol are available over the counter for pennies.
Maybe get some in in advance just incase but to be honest if you are bf (I've not read comments so sorry if you're not) I wouldn't take ibuprofen.

Another poster mentioned having their gall bladder removed and getting similar pain relief to c-section. I had my gall bladder removed and needed next to no pain relief, it was a doddle. But pain relief was on offer.

I had two cs and, particularly after the second, ironically more straightforward, one I was in terrible pain and paracetamol and ibuprofen didn't help at all. But although I begged for help with the pain, all I got was a cup of peppermint tea.

I'm glad to see that so many people on the thread found cs to be relatively pain free, that is obviously a good thing. But I do think there is a problem with post natal pain management, with this idea that we should be able to just grit our teeth and get on with it. When the pain is so severe that you just can't move, being told that other women don't find it painful doesn't suddenly make your own pain disappear sadly.

Had emcs 9 weeks ago. Could have went home 2 days later but wanted to stay another day for support with breastfeeding. Was given paracetamol, diclufenac and dihyrdocodiene in hospital. Upon discharge sent home with prescription of all the above but I only continued taking paracetamol.

everyone's experience of pain is different, as is our experiences of sections. I don't see the point in being a martyr to pain or buying into the idea of being a "good" patient who doesn't need pain relief.

Enhanced recovery my arse!!!!
It's a ploy to get woman shipped home asap because they are short of beds!

I had an EMCS in December 2011. Not sure of what pain relief I had mourning/immediately after the c section although I do know it was a suppository. I took paracetamol, ibuprofen in hospital and not sure about codeine. But I did take codeine the week after and was told by boots pharmacist NOT to take it for more than 3 days.

I was in hospital for a week. I probably would have been discharged after 3 days despite losing 2 litres of blood due to a placenta abruption and uterine tear, but DS was in SCBU due to suspected GBS infection, low blood sugar and then 12 hours after his release he was back having phototheraphy due to jaundice!!!

That was at York District Hospital. Couldn't fault the care I received from SCBU and labour ward. Postnatal ward was 'okay' except for one midwife who was short tempered with me about feeding my baby 'properly' because they were too busy to keep coming to lift him out and put back (I was bed bound having just come out of high depedency unit and still attached to IVs, catheter and a drain). It was early hours of New Years day, only two of us in the 4-bed room and not many other women on the ward!

Goodness, I am in Ireland and received difene and morphene (bf )

Mine was 6 months ago and I had whatever was in the suppository in theatre plus cocodamol and diclofenac. Right from the start I found the pain very manageable, in fact I asked in hospital if I could swap the cocodamol for paracetamol and they advised me not to - they did give me a weaker dose of cocodamol. However if I have another cs and the pain is similar to last time I will be refusing anything with codeine as the horrendous constipation I got last time was a nightmare.

Thank you for all your messages. I think the key will be to very assertive if I'm in pain. It's reassuring that many of you coped ok with just paracetamol and ibuprofen.

Cherryade8 - the Enhanced Recovery pathway is a new initiative. The benefit is that they book you a slot in the morning (last time I didn't go into surgery until 6pm after being nil by mouth since the night before) and I guess if your pain is under control and breastfeeding is established it will be nice to be in your own bed. The downside (and what I'm anxious about) is being at home with no access to decent drugs!

Can't wait to get this baby out of me now...so uncomfortable!

Got DH to look up latest info about codine and breastfeeding in latest BNF (British National Formulary - basically a huge dictionary of drugs used by drs and pharmacists). It says although normally only present in small amounts in bm, there have been cases of morphine overdose in newborns being bf (to do with the way codine is metabolised by the mothers body and no way of telling which mothers will be affected). So understandable why hospitals are trying to make women do without.

I'm worried about pain after my upcoming c section though but codine based products (like co-codamol) make me throw up anyway, so if I'm suffering will push for tramadol and Diclafenac.

Interestingly BNF does not put Diclafenac as any more risk in bf than ibuprofen, so can't understand why some hospitals have moved away from giving that.

Just to throw my experience in, first CS in 2012, had codeine, diclofenac and paracetamol. Got horrendous constipation! Had second CS 7 weeks ago, got paracetamol and diclofenac, as was told codeine has been ditched here (NI). This time I had no constipation, minimal pain and a quicker recovery all round.

I'm really interested to read this as my hospital (Whythenshawe in Manchester) is still, as far as I was told 3 weeks ago sending mums home with morphine. I was surprised when they said that cos last time it was just diclofenac. I'll be asking more qus when I go back for my next pre-elcs appointment in March.

Do you still get morphine immediately after surgery? Slightly concerned as want to bf straightaway. It's never occurred to me with my previous sections.