Opioid Medications for Postpartum Pain: Are They Safe?

Opioids carry inherent risks and shouldn’t be used without first talking to a doctor. However, they do have a legitimate place in the treatment of postpartum pain, depending on the severity of a person’s pain and their unique needs.

What Is Postpartum Pain?

Postpartum refers to the first 12 weeks after a person has given birth.[1] Birth can be a strenuous process. Even a healthy, fairly normal birth can often be followed by weeks of recovery time. 

One potential postpartum symptom is postpartum pain. The type and intensity of this pain vary widely even among women who seem to have had superficially similar birthing experiences.

Common types of pain a woman who has given birth might experience include the following:

• Pain in the back, neck, or joints
• Pain in the perineum
• Pain around a cesarean incision 
• Pain due to swelling of the breasts

How Can Opioid Medications Help?

Opioids are prescription painkillers that, when used carefully and as prescribed, can help individuals manage moderate to severe pain. They can be a potentially valuable option for treating postpartum pain, as this type of pain can sometimes be particularly severe. This pain is also temporary, meaning the window of time for a person to become dependent on the drugs and/or misuse them (intentionally or not) is smaller. 

What Medications Are Used for Postpartum Pain?

If a doctor believes opioids may be useful in treating postpartum pain, they will typically prescribe the lowest potency opioid at the lowest dose that they believe will provide sufficient relief. If the initial prescription turns out to be inadequate, they may then prescribe a higher dose and/or higher potency opioid. 

The preference is usually for short-acting opioids, which spend less time in the body. Codeine is a common first choice opioid when opioids are deemed a good fit.

Studies suggest that 80 percent of women fill opioid prescriptions after cesarean birth, and about 54 percent of women fill them after vaginal birth, noting that specific rates can vary significantly by region. These studies also found the median number of opioid tablets used after a cesarean birth is roughly 10, and the majority of opioids dispensed to an individual usually go unused.[2] 

Potential Risks

The biggest worry when prescribing opioids for postpartum pain is generally that a person may develop a chronic opioid use problem, such as an opioid use disorder (OUD). Opioids have legitimate value as prescription painkillers, but the country is also in the middle of a long-lasting opioid misuse epidemic. 

If misused, these drugs have significant addiction potential. Both doctors and patients need to stay vigilant about these risks and only use opioids as needed.

Another worry is that opioids can affect the properties of breast milk, with experts noting milk can take on significant analgesic and sedative effects in the baby if a breastfeeding mother uses opioids.[3] This is mostly an issue for those who aren’t aware of these risks or who choose to breastfeed despite knowing their baby might be affected. One can avoid exposing a baby to potentially affected milk by feeding them through other means, such as formula (which admittedly can be expensive in the United States). 

Other Options to Treat Postpartum Pain

Opioids aren’t the ideal treatment for postpartum pain unless alternative, less risky options can’t provide the needed relief. The “first-line” agents, meaning the drugs least associated with harm that can still provide potentially sufficient pain relief, are generally nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen.

Pain relief is a complicated topic that always bears discussing with a doctor. While postpartum pain isn’t itself inherently life-threatening (assuming you don’t have other complications as the result of giving birth), it can still be debilitating. 

Even if your pain isn’t the result of any issue likely to cause long-term harm, you still need relief if your pain makes functioning difficult. Uncontrolled pain can lead to depression and various other issues, so it’s important to address the situation promptly. 

In some cases, opioids might be the best option for you. It’s important to understand your options and avoid taking on unnecessary risk when a safer option can still provide needed relief.