The opioid crisis is changing how new moms approach pain relief.
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From picking a hospital to choosing a birth position, pregnant women have a lot to consider when planning for the arrival of a baby.
But here’s one more thing they’re adding to their list of concerns: opioids.
Many doctors prescribe opioids to women to help with postpartum pain, especially if they deliver via cesarean section.
But most new moms — about 9 out of 10 women — have concerns about taking these drugs during and after childbirth, according to a recent survey of 1,452 moms and moms-to-be, conducted by Moms Meet.
They have reason to be concerned, said Dr. Alyssa Dweck, OB-GYN in Scarsdale, New York. Opioids can cause side effects that could impact a mom’s ability to care for her newborn.
“A lot of women become really groggy on opioids and experience constipation, which puts increased strain on an area of the body that’s already strained after childbirth,” said Dweck. “Women want to be mobile and able to care for their babies independently. They don’t want to be in a disoriented state.”
Additionally, opioids are highly addictive and for many pregnant women, the time during and after childbirth may be the first time they’re exposed to these drugs.
Whether or not a woman needs opioids or other pain relievers depends on her experience during and after childbirth.
And the amount of pain that women experience after childbirth varies, depending on whether they gave birth vaginally or by cesarean section, and whether or not there were complications.
But narcotics aren’t the only way to cope with the pain.
Old and new pain relief options
A combination of nonsteroidal anti-inflammatory drugs, such as ibuprofen, and acetaminophen can often be enough to ease the pain after a vaginal delivery, said Dweck.
When Dell Medical School at the University of Texas at Austin and all Seton Healthcare Family hospitals used a combination of acetaminophen and ibuprofen as standard pain relief for women who recently gave birth, their use of opioids in the hospital reportedly dropped 40 percent.
Moms can also rely on alternative techniques to help manage the discomfort of childbirth, said Dweck.
A study out of Brazil showed that warm showers and perineal exercises could decrease pain and anxiety for women in labor.
“Many women are using relaxation techniques, Lamaze, and the Bradley method. Getting into a mindfulness zone — using breathing and muscle relaxation techniques — has been successful for many women. We also use massage therapy with essential oils at my hospital,” she said.
While vaginal deliveries without complications lend themselves well to non-opioid pain management solutions, women undergoing cesarean deliveries should expect to receive narcotics during and after the procedure.
One study found that 91 percent of women who had a cesarean delivery needed opioids to cope with the pain.
In its recent opinion on postpartum pain management, the American College of Obstetricians and Gynecologists recommends that when moms do need opioids, doctors should educate patients and their families on the health risks of those drugs to women and babies.
“No one expects you to go through a major surgical procedure without pain medication — that’s inhumane,” Dweck said. “But it’s reasonable to use other medication in combination with or instead of opioids.”
She routinely uses an injectable anesthetic, called bupivacaine, at the site of the cesarean incision to give patients postoperative pain relief for days. The drug results in a 78 percent reduction in opioid consumption, according to drug manufacturer Pacira Pharmaceuticals.
Furthermore, managing patients’ and doctors’ expectations regarding pain after childbirth can go a long way toward reducing reliance on opioids, said Dweck.
“Back in the day, we were trained to keep people pain-free. The goal was zero pain. But now, we counsel patients to expect a healthy amount of pain. People going to med school today will have a different take on this than I did 20 years ago — it evolves over time,” she said.
Talking to the doctor
There’s no one-size-fits-all formula to ease women’s pain after childbirth. It’s a personal decision that women need to make in partnership with their doctors.
But despite moms’ heightened concern about narcotics, only 11 percent of survey respondents said they discussed non-opioid pain management solutions with their doctors before having a baby.
“It can be a taboo subject. Women might be afraid to ask about pain management. And both women and doctors have limited time, which could push this to the bottom of the concerns,” said Dweck. “But it’s starting to get spoken about more often.”
A simple conversation can help decrease the amount of opioids given to people, which can save lives.
Opioid overdoses kill more than 115 U.S. people every day, according to the National Institute on Drug Abuse. Curbing the use of opioids among moms may be a step in the right direction in the fight against this crisis, said Dweck.
Data available from some states, such as Virginia and Maryland, show that drug use and overdose is a major contributor to the deaths of women while pregnant, or within a year of being pregnant.
“[Childbirth] is, in some cases, a woman’s very first exposure to pain medication, since most young, healthy women haven’t been in and out of the operating room too many times,” she said.
One study found that about 1 in 300 women who hadn’t previously used narcotics could become persistent opioid users following a cesarean delivery.
Opioid risks can even spread to people who aren’t prescribed the medication. In one study, more than 95 percent of women who were prescribed opioid medications after a cesarean delivery didn’t dispose of excess pills, leaving themselves and members of their household vulnerable to potential misuse or accidental ingestion of the painkillers.
“In addition, women are the entry into the healthcare world for their families. They’re often the ones making decisions for their children and partners, so it’s even more important that they get educated about the dangers of opioids,” said Dweck.
The opioid epidemic doesn’t mean that new moms should completely avoid this effective painkiller. But reducing the number of opioids they’re prescribed and utilizing other pain-management techniques may mean fewer women end up addicted to opioids or left to deal with side effects of these drugs.
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