Becoming a new mom is supposed to be a joyous and exciting time. However, it can be overshadowed by the risks that come with the over-prescription of opioids following childbirth, specifically cesarean sections. According to…
Becoming a new mom is supposed to be a joyous and exciting time. However, it can be overshadowed by the risks that come with the over-prescription of opioids following childbirth, specifically cesarean sections. According to The American College of Obstetricians and Gynecology, 1 in every 300 women who has never taken an opioid before giving birth will continue to take opioids a year after surgery. And a 2016 QuintilesIMS report found that women far outpace men in their use of opioids, as 30 percent more opioid prescriptions are written for women. With such startling statistics, it’s imperative that we explore other approaches for managing postsurgical pain in this vulnerable population.
As a practicing OB/GYN for more than 20 years, I’ve experienced the transition from opioids being considered the standard of care after surgery to now working to minimize patient exposure to opioids and managing postsurgical pain with alternative methods, such as non-opioid options. It’s possible to perform many common surgeries, including C-sections, with limited opioids, and it behooves us to adopt opioid sparing approaches when possible.
A recent survey conducted by Moms Meet found that nearly 9 in 10 moms and moms-to-be have concerns about taking opioids during and after childbirth. It’s hardly surprising that so many mothers are worried about taking prescription opioids to manage their pain, especially considering the current opioid epidemic grappling the country. In 2016 alone, there were an average of 115 opioid overdose deaths each day.
The awareness of this opioid crisis has been elevated by an increased number of education campaigns, like Choices Matter, that encourage patients to speak to their doctors about non-opioid pain management options before their surgery takes place. I encourage all women to talk to their OB/GYN or health care professional about pain management concerns for childbirth, including preferences on how pain should be handled (opioids, non-opioids, etc.).
Know Your Options
A recent survey of American women’s perceptions of opioid use in the U.S., commissioned by Shatterproof and conducted by Morning Consult, found that although most women would prefer a non-opioid medication, only 3 in 10 were informed about these options by their doctor before receiving an opioid prescription. Expectant mothers need to have an open dialogue with their doctors about the type of pain management that best fits their individual needs. Even women who plan to forgo pharmacologic forms of pain management should proactively discuss options with their doctors in case of an emergency that requires deviation from their original pain management plan.
And while some women may require opioids, they’re not the only option for easing post-delivery pain. Prior to surgery, I talk with my patients about an alternative approach that I routinely use to manage pain while minimizing or, in some cases, eliminating the need for opioids after surgery. It’s a local analgesic that’s injected directly into the site of the cesarean incision, giving patients postoperative pain relief for up to 72 hours. Non-opioid options like this help patients recover comfortably and return to their normal activities faster. Yet not all patients have access to these types of medications. In the Morning Consult survey, 84 percent of women said they support improving patient access to non-opioid medications, and 79 percent would support change in payment policy so that more patients could have access to non-opioid pain management options.
There are many other opioid alternatives women can consider for their birth plan. Whether it be non-narcotic analgesics, including acetaminophen, nonsteroidal anti-inflammatory drugs like ketorolac or ibuprofen, relaxation techniques (such as Lamaze or the Bradley Method), warm baths, heating pads or even massage therapy with essential oils, there are numerous ways women can offset the pain after childbirth. Pain is different for everyone, but expectant mothers should feel empowered to discuss these opioid alternatives with their physicians before delivery.
Pain management should be a thoughtful and informed decision, with the help and guidance of a health care professional. New mothers can take steps to reduce their exposure to opioids by talking with a doctor about pain management options and creating a birth plan that represents their individual needs.
For more information about pain management options, and to take a pledge against opioid overprescribing, visit PlanAgainstPain.com.
Alyssa Dweck, MS, MD, FACOG, is a practicing gynecologist at the CareMount Medical in Westchester County, New York. She is proficient in minimally invasive surgery including robotic surgery and has a special interest and expertise in female sexual health and medical sex therapy.