It’s no secret that having a baby is hard work. But while many women spend time preparing for the pain that is associated with labor, many don’t plan for the postpartum period, particularly in terms of pain relief.
Many people in my childbirth classes tell me that they will take whatever they are prescribed for pain, and they assume that should be adequate. But the truth of the matter is that postpartum pain relief is complicated — this is because the sources of pain can vary greatly depending on a number of factors. These factors can include how you gave birth (vaginally, with forceps or vacuum, or via cesarean section); if you are breastfeeding; your previous medication and health history; and others.
The importance of pain relief in the postpartum period
While pain is a common part of recovery after childbirth, pain management is still important. The good news is that through a combination of medication and non-medicinal pain relief methods, your health care team can help you be comfortable after you give birth.
When you’re comfortable in the earliest hours after you’ve given birth, you’re able to get up and get moving more quickly. This helps you feel better faster and learn to care for your new baby. It also helps to reduce some of the risks of the postpartum period that are associated with bedrest, like an increase in blood clots. You are also more likely to have your catheter removed sooner and, if you have a cesarean birth, you’re able to leave the hospital sooner.
One thing is for sure: After birth, women need and deserve to have their pain adequately managed. Chronic postpartum pain is related to the severity of pain you experience in the first days after birth and not the type of birth you had, vaginal or cesarean.
Postpartum pain relief and the opioid epidemic
The United States is busy discussing the growing opioid epidemic. According to the Centers for Disease Control and Prevention (CDC), more than 42,000 people in the United States died in 2016 from opioid overdoses. What most people may not realize is that this is not simply a problem of illegal drugs; in fact, 40 percent of these deaths involved prescriptions.
This crisis and these facts have led medical organizations and individual practitioners to wonder how they can play a part in reducing the number of women who walk away from birth with an opioid addiction. About 1 out of 300 women will become persistent opioid users following a cesarean birth. Using opioids as postpartum pain medication can potentially increase your risk of addiction.
Pain medication options after birth
The following steps are considered the best line of treatment for pain after childbirth, according to the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO). Following them treats pain and protects you from added risks, including potential issues with opioids.
First-line treatment: Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as acetaminophen, naproxen, and ibuprofen, are some of the most commonly used analgesic medications used for pain relief during the postpartum period. These are the first-line medications most practitioners will offer. They can be given in many ways, including by mouth, by IV, or even through a rectal suppository.
How frequently you are given these medications depends on the amount of pain you have after childbirth. They can be given as needed or, for more severe pain, on a schedule around the clock. One benefit to these medications is that they don’t alter your breathing or consciousness. However, they may not be given if you have certain things in your medical history.
Opioid medication options for pain relief
Oral narcotics are the next line of defense. These are given on a schedule or on an as-needed basis, depending on your recovery. The goal is to balance your postpartum pain and keep the narcotics as minimal as possible. The most commonly used are hydrocodone and oxycodone. Tramadol and codeine are other types, but they are no longer recommended.
IV narcotics are another option. These are used for shorter periods of time. They can be scheduled or given via a pump that you can control. You’re given a small button to release medication. Even though you control it, you can’t overdose with it.
There are also some morphine-based medications that can be added to the epidural catheter before it is removed after the birth that can help with pain relief for up to 18-24 hours. This is a fairly typical practice after a cesarean birth. The epidural can also be extended to after the labor period into the postpartum period if you’ve had a complicated birth.
When using medications for pain relief after childbirth, the goal should be to use them for the shortest possible amount of time while still providing adequate relief. Your practitioner will also try to ensure that you receive a prescription when you’re leaving the hospital that will leave you with as few unused pills as possible. This is a delicate balance that your doctor and midwife will help you determine. However, it is also important to understand that medication is used in conjunction with other methods of pain relief that are not medicinal.
Medications’ effects on breastfeeding
Just over 83 percent of mothers will breastfeed their babies. All medications you take will get through in the breast milk, though most of them come through in amounts that are lower than what you would give a baby as a therapeutic dose. The amount that reaches the baby is one of the determining factors as to whether a medication is considered safe to use during breastfeeding. That said, you will most likely get the same medications for pain relief during the postpartum period, regardless of whether you are breastfeeding.
Breastfeeding and methadone treatment
Mothers who have an opioid problem and are on stable doses of methadone can continue to breastfeed, no matter what the dose of methadone is because it is safe for the baby and the benefits of breastfeeding outweigh the risks of returning to opioid use and not breastfeeding.
Non-medicinal pain relief options after childbirth
There are many ways to control pain after birth that don’t include medication. Some are for specific areas, like hemorrhoidal or perineal pain, including ice packs/pads and topical applications. Others are more emotional and mental, like relaxation and guided imagery to help decrease anxiety and stress. Research has found that something as simple as listening to music reduced pain and anxiety in mothers who had a vaginal birth.
While these tactics won’t necessarily control the majority of pain, they do help the pain medications you take be more effective. This is one of the reasons it’s recommended.
Chronic pain and postpartum pain relief
If you have chronic pain and are currently taking opioid medication to manage that pain, you should take a team approach to controlling your pain after birth. That means staying in close communication your doctor or midwife in charge of your obstetric care as well as your pain management specialist. Together, they can help determine the best course of action to control your pain.
There is pain medication available to you after you have had your baby. You should try non-medical therapies in addition to these medications. The less time you are on opioid-based medications, the faster recovery will tend to be. You and your health care team should weigh the risks and benefits to provide you with the best form of adequate pain relief.