Reducing Opioid Use After Childbirth

Cesarean birth is the most common major surgery in the United States. As part of postoperative care, women are commonly given opioids in greater quantities than needed to adequately manage postpartum pain. In a cohort of 246 patients who underwent cesarean birth, 75% had unused opioids resulting in an excess of more than 2,500 unused 5 mg oxycodone tablets (Osmundson, et al., 2017). There also is evidence to suggest that 5,800 opioid-naïve new mothers per year in the United States develop persistent opioid use after cesarean (4,200) and vaginal (1,600) births. Opioid exposure after birth potentially increases the risk for not only long-term chronic opioid and other substance use, but also postpartum depression and difficulty bonding with the newborn. Despite this growing body of evidence, limited research has been conducted to understand why rates of opioid prescriptions are so high after childbirth and what strategies may effectively reduce prescription opioid use in this setting.

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.

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 of 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.

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.

Find the full findings here.

• Downs, Danielle Symons PhD;
• Pauley, Abigail M. PhD;
• Leonard, Krista S. PhD;
• Satti, Mohamed MD;
• Cumbo, Nicole BS;
• Teti, Isabella BS;
• Stephens, Mark MS, MD;
• Corr, Tammy DO;
• Roeser, Robert PhD;
• Deimling, Timothy MS, MD;
• Legro, Richard S. MD;
• Pauli, Jaimey M. MD;
• Mackeen, A. Dhanya MD, MPH;
• Bailey-Davis, Lisa DEd, RD