Is Taking Opioids For Postpartum Pain Safe?

Women who give birth and are prescribed opioids for postpartum pain are at risk for opioid addiction, according to a new University of Michigan (U of M) study published in the Journal of the American Medical Association (JAMA).

12/27/20223 min read

Women who give birth and are prescribed opioids for postpartum pain are at risk for opioid addiction, according to a new University of Michigan (U of M) study published in the Journal of the American Medical Association (JAMA). Most women will have discomfort after giving delivery, which is referred to as postpartum pain. After giving birth, the perinum that surrounds the vaginal opening may be bruised or torn, and a doctor may need to perform an epistiotomy incision through the vaginal wall to aid the birthing process. Although the damage will heal, it may cause pain. Pain at the incision site can make it unpleasant to accomplish common actions like walking, laughing, or coughing for women who give birth via cesarean section (aka C-section), which requires an incision through the full thickness of the abdominal wall. After childbirth, the uterus contracts, generating cramps known as afterpains. Both C-section and vaginal births include postpartum pain that normally goes away six weeks following the delivery.

Even though postpartum pain is completely common, it can make life difficult for new mothers. As a result, doctors prescribe opioids to help with postpartum pain management. Doctors may prescribe acetaminophen (Tylenol) or nonsteroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen in some cases (Motrin, Advil). An opioid may be provided to a lady experiencing postpartum pain in some cases. This is where the issue arises. Dr. Alex Friedman Peahle, M.D. of the University of Minnesota studied women with private health insurance across America and discovered that 76 percent of those who had a C-section would be prescribed an opioid. The figure for vaginal deliveries was 27 percent. C-sections, of course, produce more postpartum pain, thus the disparity in opioid prescription rates between the two groups is understandable. The study's other alarming result was that 2.2 percent of women who had a C-section and 1.7 percent of women who gave birth naturally went on to refill their opioid prescription at least twice and for up to a year following childbirth. After childbirth, more than one in every 100 women becomes a chronic opioid addict. Women who are younger and have a history of mental health/substance use disorders, as well as other types of pain, are more prone to develop an addiction after childbirth.

Another study from Vanderbilt University, this time of Medicaid-eligible Tennessee women, published in the American Journal of Obstetrics and Gynecology (AJOG) in 2019, reported substantially greater rates of opioid prescriptions for postpartum pain: 89 percent for C-sections and 53 percent for vaginal births. The Tennessee study found that, similar to the U of M study, the rate of persistent opioid usage among women prescribed opioids after childbirth was low, but that rates were greater in women who had C-sections than in women who had vaginal deliveries. Both studies looked at women who were opioid naive, meaning they hadn't filled an opioid prescription in a particular amount of time prior to giving birth (365 days in the U of M study, 180 days in the Tennessee study).

While the rate of persistent opioid users identified in these studies may appear low, keep in mind that the United States had over four million births last year. To convert percentages to numbers, the 2.2 percent from the University of Minnesota study equates to 2,633 women who became chronic opioid users following a C-section. Because the study did not include women with Medicaid or no health insurance, who are a more susceptible demographic, the rates in the U of M study may be lower than the real rate of opioid abuse among new mothers.

When providing opioids to women after childbirth, doctors have the greatest of intentions, and these prescriptions can make life simpler. Opioids, on the other hand, are exceedingly addicting. In fact, according to a 2017 government research, the risk of addiction climbs daily after just three days of opiate use. However, there is some good news. Doctors administered less opioids to women after childbirth in 2016 than they did in 2008, according to the University of Minnesota study, owing to improved awareness of the risk of addiction. Furthermore, the C-section rate is at its lowest level since 2009, and the number of women who had a C-section before opting for vaginal birth during their subsequent pregnancy climbed by 13.3% between 2017 and 2018. Vaginal births, while not always the case, can result in less postpartum pain than C-sections. Doctors are less likely to prescribe opioids to women who give birth vaginally, according to both the University of Minnesota and the University of Tennessee research. Thankfully, the medical world is paying attention to this problem. When doctors do opt to prescribe opioids for postpartum pain, the Michigan Opioid Prescribing Engagement Network (Michigan OPEN) and other advocates recommend that they prescribe less opioids (i.e. 20 pills instead of 30). Dr. Peahle told Bridge Magazine in an interview about her research that she believes doctors administer opioids to make women's lives easier after childbirth, and that the women take them because their doctor recommended them.