Caesarean section, breastfeeding and pain

Caesarean section is an increasingly common mode of delivery. Despite improvements in both surgical and anaesthetic techniques, this method of delivery still has a negative effect on breastfeeding. Postoperative pain could be a reason. Acute postoperative pain leads to chronic pain and depression. Postoperative pain management is an important part of postoperative care of the caesarean patient. The multimodal approach, which is currently the "state of the art", relies on a combination of analgesic drugs: acetaminophen, NSAID, and opioids. Theoretically, all analgesic drugs can be used during breastfeeding des- pite their transfer into breast milk: neonatal acetaminophen concentrations are lower than those used as paediatric medication. NSAIDs are highly protein bound and are less likely to enter into breast milk. Codeine and other analgesic drugs with CYP2D6 metabolism are more controversial because of the unpredictable risk of serious adverse effects in both mother and infant. Spinal and epidural morphine, used as a perioperative painkiller, is effective and decreases the risk of transfer into breast milk. Effective pain relief with a multimodal approach during the first few days after a caesarean section should be highly recommended and could improve breastfeeding. To cite this journal: Rev. Med. Perinat. 3 (2011).