Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb 1;137(2):325-333.
doi: 10.1097/AOG.0000000000004232.

Obstetric Physicians' Beliefs and Knowledge on Guidelines and Screening Tools to Reduce Opioid Use After Childbirth

Danielle Symons Downs  1 , Abigail M Pauley, Krista S Leonard, Mohamed Satti, Nicole Cumbo, Isabella Teti, Mark Stephens, Tammy Corr, Robert Roeser, Timothy Deimling, Richard S Legro, Jaimey M Pauli, A Dhanya Mackeen, Lisa Bailey-Davis
Affiliations

Obstetric Physicians' Beliefs and Knowledge on Guidelines and Screening Tools to Reduce Opioid Use After Childbirth

Danielle Symons Downs et al. Obstet Gynecol. .

Abstract

Objective: To examine obstetric physicians' beliefs about using professional or regulatory guidelines, opioid risk-screening tools, and preferences for recommending nonanalgesic therapies for postpartum pain management.

Methods: A qualitative study design was used to conduct semi-structured interviews with obstetric and maternal-fetal medicine physicians (N=38) from two large academic health care institutions in central Pennsylvania. An interview guide was used to direct the discussion about each physicians' beliefs in response to questions about pain management after childbirth.

Results: Three trends in the data emerged from physicians' responses: 1) 71% of physicians relied on their clinical insight rather than professional or regulatory guidelines to inform decisions about pain management after childbirth; 2) although many reported that a standard opioid patient screening tool would be useful to inform clinical decisions about pain management, nearly all (92%) physician respondents reported not currently using one; and 3) 63% thought that nonpharmacologic pain management therapies should be used whenever possible to manage pain after childbirth. Key physician barriers (eg, lack time and evidence, being unaware of how to implement) and patient barriers (eg, take away from other responsibilities, no time or patience) to implementation were also identified.

Conclusion: These findings suggest that obstetric physicians' individual beliefs and clinical insight play a key role in pain management decisions for women after childbirth. Practical and scalable strategies are needed to: 1) encourage obstetric physicians to use professional or regulatory guidelines and standard opioid risk-screening tools to inform clinical decisions about pain management after childbirth, and 2) educate physicians and patients about nonopioid and nonpharmacologic pain management options to reduce exposure to prescription opioids after childbirth.

PubMed Disclaimer

Conflict of interest statement

Financial Disclosure Mohamed Satti disclosed that Geisinger received subcontracts for projects related to this work, both from The Pennsylvania State University grants noted above in the acknowledgements. Nicole Cumbo disclosed receiving a Russell C. and Ann E. Seward Work Study Award in Women's Health. Richard S. Legro's disclosures are available as Appendix 1, online at http://links.lww.com/AOG/C168. The other authors did not report any potential conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Physician toolbox for postpartum pain management. Downs. Beliefs on Opioid Screening Tools and Guidelines. Obstet Gynecol 2021.
See this image and copyright information in PMC

References

    1. Martin JA, Hamilton BE, Osterman MJK, Curtin SC, Matthews TJ. Births: final data for 2012. Natl Vital Stat Rep 2013;62:1–68. - PubMed
    1. Peahl AF, Smith R, Johnson T, Morgan D, Pearlman M. Better late than never: why obstetricians must implement enhanced recovery after cesarean. Am J Obstet Gynecol2019;221:117. e1–7. doi: 10.1016/j.ajog.2019.04.030 - DOI - PubMed
    1. Bateman BT, Franklin JM, Bykov K, Avorn J, Shrank WH, Brennan TA, et al. Persistent opioid use following cesarean delivery: patterns and predictors among opioid naïve women. Am J Obstet Gynecol 2016;215:353.e1–18. doi: 10.1016/j.ajog.2016.03.016 - DOI - PMC - PubMed
    1. Jarlenski M, Bodnar LM, Kim JY, Donohue J, Krans EE, Bogen DL. Filled prescriptions for opioids after vaginal delivery. Obstet Gynecol 2017;129:431–7. doi: 10.1097/AOG.0000000000001868 - DOI - PMC - PubMed
    1. Lavoie A, Toledo P. Multimodal postcesarean delivery analgesia. Clin Perinatol 2013;40:443–55. doi: 10.1016/j.bpa.2017.01.003 - DOI - PubMed

Publication types

Substances