With the opioid crisis in full swing, some doctors have expressed concerns about using them in pain relief after C-section. Here's what you need to know.
Having a baby by C-section is not easy. After having major surgery, you're expected to take care of your newborn baby in addition to dealing with your recovery. Most doctors will tell you the best way to do that is to stay on top of your pain—and that usually means taking opioids such as Percocet or Vicodin for pain relief. Opioids were created for surgical concerns like this—and you shouldn't feel bad about using them to reduce pain and enable you to recover and take care of your baby. But opioid abuse has become a crisis, and the more prescriptions floating around and the more unused pills in homes, the greater the likelihood of misuse. So, what should you know if you're concernedf?
Pain management isn't one-size-fits-all
A recent study found that women are being over-prescribed pain pills after their C-sections. "We found that most women use fewer opioids than what they are prescribed and most have leftovers—these results are not terribly surprising," lead study author Sarah Osmundson, MD, an assistant professor of obstetrics and gynecology at Vanderbilt University Medical Center, tells Parents.com. "Over-prescribing is a major source of misuse, and we should not be prescribing more than what is actually needed."
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But simply cutting all opioid prescriptions isn't necessarily the best course of action, Dr. Osmundson says. "What is important and surprising [about the study] is that roughly 25 percent of women used all opioids and said they did not receive enough," she says. "If we were to uniformly cut the amount we prescribe we would risk under-prescribing to a significant proportion of our population."
The problem with waiting to see if you need the drugs is that a physical visit is required for an opioid prescription, which could be difficult for a woman recovering at home while caring for a newborn. But could alternate pain meds be a solution? Dr. Osmundson says it's possible. "Multimodal therapy is a great option to treat all types of pain," she says. "High-dose ibuprofen is probably the best first-line medication for pain, with opioid use sparingly if at all. There is currently a lot of research into other forms of pain management."
Other options for handling pain
One doctor in Texas thinks he might have found a different, opioid-free approach to managing post C-section pain. Ob-gyn Richard Chudacoff, M.D., who is affiliated with several hospitals in northwest Texas, has been using alternate pain management protocols for the several decades he's been in practice. "My concern about opioid use is my concern about the opioid crisis in the USA," Dr. Chudacoff tells Parents.com. "Not only has this devastation visited my family, but I am sure there are few families in the USA not affected by opioid misuse or addiction." According to Dr. Chudacoff, 75 percent of patients who are discharged with an opioid prescription do not take all their pills, almost 80 percent of these pills are not locked up, and around 85 percent of those with an opioid or heroin addiction began with these pills.
Recently, Dr. Chudacoff began using Exparel, a non-opioid injection that slowly releases pain relief for several days post-surgery. "When I heard that knee replacement surgeries and mastectomies were being done opioid-free I modified their protocol, incorporating it into my own post-op regimen, and performed my first opioid-free cesarean section," he says. "She did very well—never required in-house opioids and did not need them at home. I have done about eight C-sections since then, all opioid-free, and all have done better than any protocol I used before." Although the drug is somewhat expensive, Dr. Chudacoff says the cost is offset by shorter hospital stays and faster recoveries.
If you're concerned about opioid use after your C-section, definitely bring it up to your doctor, and see what other options are available. "Unfortunately most providers are accustomed to a 'one size fits all' method of opioid prescribing—almost all patients get the same thing," Dr. Osmundson says. "Ultimately I think we need applications that analyze what a patient has been using and provide a customized prescribing recommendation. Pain is different for everyone, and women should feel empowered to have proactive conversations with their physicians about their options for pain management, including opioid alternatives."