There is no specialty in healthcare that is innocent of contribution to the nationwide opioid epidemic in America. Over the last decade, doctors across the spectrum have written opioid prescriptions liberally. The results have been disastrous.
A new study examining the use of opioids among new mothers has found that almost half of women in the last decade received a prescription for opioids either before or after delivery. Though this figure may seem initially disturbing, opioid use immediately after delivery is not the problem by itself. Childbirth is famously painful, and many women benefit from the use of opioid prescriptions to break through intense moments of pain in the immediate postpartum period.
Opioid Prescriptions – A Necessary Evil?
In addition to finding that 50 percent of women are prescribed opioids, researchers from the University of Michigan also found that one in 75 new mothers were still taking opioids when their babies were one year old. The most common risk factor for persistent use was using opioids prior to delivery. Among those, the women who received high initial doses were more likely to still use opioids a year later.
Overall, the strongest risk factor for both new and persistent opioid use is being prescribed an opioid before delivery. This presents challenges and risks for both mother and child. According to the Centers for Disease Control and Prevention (CDC), opioid use prior to delivery is associated with these birth defects:
- Spina bifida
- Gastroschisis (a defect of the abdominal wall)
- Congenital heart defects
- Conoventricular septal defect
- Atrioventricular septal defect
- Hypoplastic left heart syndrome
- Atrial septal defect
- Pulmonary valve stenosis
These birth defects may result from use of common opioid analgesics including codeine and hydrocodone.
Opioid Prescriptions Associated with C-Sections
For this study, researchers reviewed the medical records of more than 300,000 women who gave birth between 2008 and 2016. They found that mothers who delivered via c-section were far more likely to receive an opioid prescription than mothers who delivered vaginally. According to the study, 75 percent of new mothers who had a c-section managed their pain with opioids. This is compared with 25 percent of mothers who delivered vaginally.
These findings are perhaps not surprising. A c-section is major abdominal surgery, and pain management is a key element of healing. The concern is not the way in which new mothers are managing pain, but rather the persistent use of opioids after the pain should have subsided.
The lead author of the study expressed concern that that the instances of opioid persistence are higher than any previously recorded levels. In the last decade, about two percent of c-section moms persisted with opioid use after the standard recovery period. About one percent of mothers who delivered vaginally were still using opioids months after their birth experience.
Perhaps one reason for the difference is that doctors work up to opioid prescriptions after a vaginal birth. Medical professionals first encourage the use of non-narcotic pain management before prescribing opioids to mothers who deliver vaginally.
Treating Pain Without Opioid Prescriptions
The conclusion of the study is that doctors should opt for non-opioid approaches to pain management before and after delivery. There is nothing in particular about new mothers that makes them more susceptible to opioid use persistence than any other population. Rather, it seems that doctors are more willing to prescribe opioids for new and soon-to-be moms. This puts them at risk for opioid addiction.
According to the author of the study, the goal of managing the pain of childbirth should be to prevent a new mom from getting to the peak of her pain. Early intervention while the pain is still manageable could be the key to reducing the need for opioid pain medications.
The standard discharge practice for the last several decades has been for OB/GYNs to send new mothers home with a prescription for opioid medication. This trend is changing. Newly implemented prescribing restrictions limit the number of opioid pain pills doctors and pharmacies can dispense. Both patients and medical professionals are becoming more mindful of the ongoing opioid epidemic.
Alternatives to Opioids
In today’s opioid crisis, doctors should write opioid prescriptions judiciously. Allowing a patient to languish in pain is certainly not the goal. Many hospitals have adopted the practice of long-lasting opioids for the height of birth pain as part of an epidural. This allows practitioners to reserve oral opioids for the postpartum period.
Acetaminophen and NSAIDS like ibuprofen are also excellent choices for effective postpartum pain relief. Employing the use of non-narcotic analgesics in preference to opioid medications in the postpartum period has been effective in reducing post-discharge opioid use, according to the study.
More research from the University of Michigan is showing success with an opioid-sparing approach after c-sections, called enhanced recovery after surgery (ERAS). This protocol is showing to be effective in managing pain from other surgeries such as a hysterectomy, which is the most common surgical procedure performed in the United States.
When treating postpartum pain, the most important aspect is determining the cause of the pain. Numbing away a serious complication can have fatal consequences for a new mother. This is why acetaminophen or ibuprofen is normally the first line of pain management. Ideally, these drugs should effectively manage pain while leaving room for doctors and nurses to become concerned if extreme pain continues or worsens.
Persistent Use of Opioids
Again, the management of pain with opioids is not so much a concern as the persistent use of opioids. The study focuses on identifying women who exhibit persistent use of opioids, namely:
- Those who filled at least one, possibly more, opioid prescriptions within three months of delivery
- Those who filled prescriptions up to a year after delivering
To truly understand the impact of the introduction of opioids into a new mother’s life, the study excluded women with prior opioid use as well as those in treatment for substance abuse. Other exclusions included women who required surgery within a year of delivering and women who were hospitalized for more than a month after giving birth. In this way, the results of the study and their overarching conclusions apply to new mothers who had never taken opioids before and who took them only in connection with childbirth.
Groups of New mothers with the Highest Risk of Persistent Use
Among the mothers included in the study, certain patterns emerged showing that subgroups of women were at a substantially higher risk for persistent use of opioid prescriptions including:
- Women who gave birth in their teens or early twenties
- Those with chronic pain or mental health issues at the time of birth
- Midwestern and Southern mothers who smoked during pregnancy
More indicative than demographic information, however, is the manner in which the medications were prescribed. The study concluded that the highest risk factors for persistent opioid use were:
- A large number of pills in the initial prescription
- Filling the prescription prior to birth
Both of these risk factors are ones that can be regulated by the medical industry by creating prescribing guidelines. Opioids are rarely necessary before birth. Many pregnant women manage the pain of surgical events, like an appendectomy, with non-narcotic medications.
There is a high rate of persistent use and abuse among patients who receive opioid prescriptions. This is a very well known fact and yet, doctors still overprescribe opioids.
Need to Know More? Contact Birth Injury Guide
Research like this study provide information about potential problems. The goal is not to suggest that all opioid prescriptions are unnecessary. What this means for pregnant mothers, however, is that you have to be incredibly careful when taking medications during pregnancy. Not only do you risk the health of your baby, but you also risk possibly becoming addicted.
If you have questions or concerns about opioid prescriptions, birth injuries or defects, and your legal rights, contact Birth Injury Guide. As a patient, you have certain rights. You should receive information about risks of medications. You should also have a care plan that is in your best interests. Call 1-877-415-6603 or contact us online to learn more.