Almost half of new mothers in the United States were prescribed opioids before or after delivery, according to results of a new study from researchers at the University of Michigan (U-M) who examined medical records of more than 308,000 women who gave birth from 2008 to 2016.  The study also found that 1 in 75 new mothers were still taking these addictive opioids one year later, a practice most common in those who received the highest initial doses of the drugs.  The likelihood of receiving an opioid prescription was also higher among those women who had undergone a C-section rather than a vaginal delivery.U-M researchers evaluated opioid prescribing to new mothers with private insurance who had never received a prescription for opioids one year before delivering, did not undergo any postpartum procedures or experience any surgical or medical complications after delivery.  “The highest risk for new and persistent opioid use among new mothers was being prescribed an opioid prior to delivery,” they found.“Overall, we see rates of opioid persistence higher than previously documented for women having C sections, at about two percent,” said lead author Alex Peahl, M.D. “For women who delivered vaginally, one-quarter received opioid prescriptions, although current guidelines call for a stepwise approach to pain management, starting with non-narcotic medications such as ibuprofen and acetaminophen.  One percent of vaginal birth mothers were still receiving opioids months later.”

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Peahl’s advice to new moms is, “Pain after birth is like a mountain: once you’re at the peak, it is harder to get down.  Using non-narcotic pain medications before opioids can help better manage your pain by preventing you from reaching that peak.”  She hopes that the study will provide support for alternative pain management strategies, adding, “Shifting prescribing patterns to nonopioid medications after discharge home is essential…Employing long-lasting opioids for the height of birth pain as part of an epidural and reserving oral opioids for ‘breakthrough’ post-birth pain, is clinically sound.”U-M’s approach to decrease prolonged opioid use after C-sections is referred to as Enhanced Recovery After Surgery (ERAS).  The approach has been proven to be useful for other painful procedures, too, in eliminating opioid overprescribing.  ERAS includes a patient education portion about pain management before surgical procedures, pre-emptive pain management, use of general anesthesia during surgery, modified blocks of the abdominal nerves, and postoperative programmed non-narcotic analgesics.“Whenever women complain of pain before or after birth the most important factor is to determine the etiology of the pain and to treat the underlying cause,” said Adi Davidov, MD, Director of Gynecology and Program Director, OB-GYN Residency, Staten Island University Hospital, Staten Island, New York. “The ideal medication is usually one that has little to no side effects, is non-addictive, and is efficacious…Tylenol and Ibuprofen are usually first line. In addition, after vaginal delivery - perineal pain can be treated with local measures and cesarean delivery incisional pain can be treated with ERAS protocols that include various nonnarcotic medications.”Davidov explained that “opioids are rarely necessary before birth, and even women that undergo major non-obstetrical surgery while pregnant such as an appendectomy can avoid using opioids.”

Sources:

Nearly 50% Of New Mothers In U.S. Prescribed Opioids During Last Decade, Study FindsOhio Physicians Opt to Use ERAS Protocol Instead of Opioids