ACOG Committee Opinion No. 742: Postpartum Pain Management

Abstract

Pain and fatigue are the most common problems reported by women in the early postpartum period. Pain can interfere with a woman's ability to care for herself and her infant. Untreated pain is associated with a risk of greater opioid use, postpartum depression, and development of persistent pain. Nonpharmacologic and pharmacologic therapies are important components of postpartum pain management. Because 81% of women in the United States initiate breastfeeding during the postpartum period, it is important to consider the drug effects of all prescribed medications on the mother-infant dyad. Multimodal analgesia uses drugs that have different mechanisms of action, which potentiates the analgesic effect. If opioids are included, a multimodal regimen used in a stepwise approach allows for administration of lower doses of opioids. Given interindividual variation in metabolism of opioids, as well as the risk of maternal and neonatal adverse effects in women who are ultra-rapid metabolizers of codeine, monitoring for excessive sedation and other adverse effects in infants is prudent for women who are prescribed opiates. Although the U.S. Food and Drug Administration recommendations underscore the need for anticipatory guidance regarding opioid effects in all patients, obstetrician-gynecologists and other obstetric care providers should ensure that the application of this guidance does not interfere with pain control or disrupt breastfeeding during the postpartum period. Women with opioid use disorder, women who have chronic pain, and women who are using other medications or substances that may increase sedation need additional support in managing postpartum pain.