Saturday, February 5, 2011

Surgery and Medications and Pregnancy and Breastfeeding - Oh My!

To preface this blog, here are the levels and information for pain medication safety for pregnancy (A-X) and lactation (L1-L5). I obtained this information from

A (controlled studies show no risk) L1 (safest)
B (no evidence of risk in humans) L2 (safer)
C (risk cannot be ruled out) L3 (moderately safe)
D (positive evidence of risk) L4 (possibly hazardous)
X (contraindicated in pregnancy) L5 (contraindicated)

Approximately a year ago I had the surprise of my life when I did the simple task of going to the grocery store and stopping to pick up lunch for my family. Upon walking up to the restaurant I slipped on ice... and broke my kneecap. This is something I highly recommend NOT doing. I was taken to the hospital via ambulance, learned I was pregnant with Chicklett, and prepared for surgery the following day. And by "prepared" I mean sat in a hospital room alone for about 18 hours starring at the walls and trying not to move my leg.

Days before my fall and the last time I kneeled without wincing in pain

I learned that because of being pregnant I would receive a local anesthetic instead of being put under. Yep, got to be awake during surgery. Absolutely horrifying. The smells/sights I experienced that day still haunt me, but the risk for miscarriage in using a general anesthetic was too high. It seemed to me that I was in good hands... but 24 hours later little did I know I would be in an argument with several hospital staff about what pain medications were best for me.... and my baby... and my nursing toddler.

I had a spinal block and a nerve block so I couldn't feel anything or move from the waist down for about 10 hours after surgery. Being the tough lady that I am, I had told the nurses several times that I wouldn't need any narcotics once the blocks wore off. This probably would have worked had we started me on something around the 9 hour mark... but they didn't... and at 9 hours and 59 minutes I started to feel a little pain... 10 hours and 1 minute I was in tears so she gave me an Ibuprofen like I had asked since I'm "tough"... 10 hours and 5 minutes and I was in hysterics so the nurse gave me a Percocet pill... 10 hours and 10 minutes and I was hyperventilating/shaking so she gave me a shot of Nubain... 10 hours and 11 minutes and I was asleep.

Okay, so the times are approximate - but you get my point... pain hit fast and without warning and I was given a lot of drugs. For the record, let me just say... Nubain kinda rocked my world and I'm pretty sure it's addictive because I woke up 4 hours later drooling for me, but they wouldn't give it to me.

Two hours after surgery - looking sexy eating a grilled cheese sandwich
The yellow wristband says I am a "FALL RISK" ... yeah... no kidding.

In the morning I must have put something on Facebook about being on Percocet and my cousin-in-law, who is a bit of a breastfeeding guru, told me that I should switch to Darvocet because it was less dangerous for someone who is breastfeeding (at the time Chicken Little was about 17 months old and of course still nursing). I asked the nurse about it and she switched it on my next round of pills.

Then I was playing around on and saw in horror that although Darvocet was indeed better for my breastfeeding toddler, it was WORSE for my few day old fetus. Darvocet fell into the C category which meant that "risks cannot be ruled out," whereas Percocet was a B "no evidence of risk to humans." Gee, which one would you take?? I was furious at the nurse for not explaining this to me. My cousin-in-law had no idea I was pregnant of course, so the blame fell on me and the hospital staff.

After this is became a tug of war with the staff over what to give me. They were incredibly thrown off by a breastfeeding AND pregnant woman. One doctor even had the gaul to tell me that his pregnant wife takes level C drugs "all the time" and their kids are "just fine." Oh how I LOATH when people tell me their kids are "just fine" when trying to defend actions. Why oh why would someone take level C when there are plenty of level B or A options out there?? I wanted them to just leave me on Ibuprofen, which is a B during 1st & 2nd trimester of pregnancy, and an L1 for breastfeeding. They kept trying to tell me that it wouldn't be strong enough. Well, ya know what... #1 - I don't NEED to be completely pain free, comfortable is good enough and #2 - I'm a tough chic so let me try it because it is safest!

When the fighting with this doctor began to interfere with my discharge from the hospital I just started to smile and nod. I accepted a prescription for Percocet and went home. Never took one pill. I stuck with the Ibuprofen for that night and slept just fantastically (well, as fantastically as anyone could after such a wildly disastrous weekend).

In the morning I called my midwife office because it occurred to me that perhaps they would know what is best for a breastfeeding/pregnant woman to take. The nurse told me to stop Ibuprofen immediately and to obtain a prescription for Tylenol 3 from my doctor. After hanging up the phone with her I learned that Tylenol 3 was a C AND L3... basically the worst of both worlds between the Darvocet and Percocet. AHHHH!!!!! But, regular Tylenol is a B & L1 just like Ibuprofen.... so I went that route instead. After a few days I stopped taking anything and just sucked it up.

The point of my story? Do research and ask lots of questions when dealing with medications. You pretty much need to go to med school and pharmaceutical school to get away with being fully protected, but since that probably isn't going to happen... ask questions before hand (if possible) and find out what the best solution will be for your situation. And ask around for other opinions... because although one person may seem like an expert and authority... they're all human... and we aren't always right. Try talking direction to the pharmacist instead of going through nurses or doctors and hearing information third hand.

And lastly, but not least, trust your instincts.

P.S. My knee still sucks and I'm having surgery again on February 9th 2011. Send healing vibes my way please!


  1. Ok--go get the book:

    Medications and Mother's Milk by Dr. Thomas Hale.

    It is a life line. I even purchased one for our pediatrician who loves it. :-)

  2. I had no choice but to be on class c drugs (did my own research into why it was a class c) through most of both my pregnancies and was closely monitored throughout by multiple physicians. But the same specialists who were ok with this class c drug told me ibprofen/NSAID was X, contraindicated. So that's weird. I think the worst part about having to take a class c drug during pregnancy is that I have relatives who are convinced that it caused problems (it didnt but you can't tell them that). A lot of people look at me like I was a bad mom for being on medication during my pregnancies, even though I've had 2 term pregnancies end in spontaneous natural births and have 2 very healthy kids! (One had unrelated issues at birth that caused a NICU stay, but according to both common sense and all the doctors it was....unrelated)

  3. With that said, there are times when a cesarean section is necessary to save the mother and/or baby’s life.
    mesa ob gyn

    1. Agreed, an INCREDIBLY SMALL amount of cesarean sections are actually necessary.


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