[Do women with Caesarean section have to choose between pain relief and breastfeeding?]

The Caesarean section is a unique surgical procedure in that physicians postoperatively not only have to cater to the mothers' need for analgesics, but must also take into account the impact of this medication on the infant. Too cautious prescription of strong analgesics postoperatively may have untoward consequences, such as immobilisation and delayed onset of breastfeeding.

A questionnaire on procedures for standard postoperative analgesics after Caesarean section was sent to the 46 Norwegian hospitals with anaesthesiology departments organized in conjunction with delivery units. 38 questionnaires were returned to us.

Most of these hospitals routinely prescribe both Paracetamol (95%) and NSAID (90%) in postoperative care immediately after Caesarean section. However, only 61% routinely prescribed an opioid.

When the mother is most in need of opioid analgesics, lactation is barely established. Therefore, even if traces of opioids are absorbed into the mother's milk, the doses will be very small and the infant's oral bioavailability at this time is likely to be low. Consequently, there is little evidence to support a policy of overly restrictive use of opioids.