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What New Mothers Need to Know about Postpartum Pain Meds

Armen Hareyan's picture

Postpartum women often request strong analgesia to assist with uterine cramping, perineal soreness, or, for one out of three birthing women in the United States, postoperative pain from a cesarean section. Historically, obstetric providers prescribed codeine-based pain medications to breastfeeding mothers. Tragically, an infant died after exposure to codeine via breastmilk, raising questions about how certain mothers and babies metabolize codeine. Many health care providers changed the medications they prescribe for postpartum breastfeeding mothers. Often these providers prescribe analgesia that contains oxycodone. Unfortunately, this medication may also offer potential problems for newborn babies who are exposed to oxycodone through breastmilk.

A September 2011 study in the Journal of Pediatrics gathered information provided by 533 breastfeeding women who reached out to the Motherrisk Program, the teratology risk evaluation program associated with The Hospital for Sick Children in Toronto, Canada. Motherrisk provides counseling to concerned patients and gathers data on medication exposure.

These mothers contacted Motherrisk with questions about taking postpartum analgesics while breastfeeding. The women were prescribed acetaminophen, codeine or oxycodone. Researchers asked these mothers to describe any symptoms they noted in themselves or their babies. Researchers focused on symptoms that indicated central nervous system depression, such as sleepiness or lethargy. Babies who have central nervous system depression from medications may demonstrate difficulty breastfeeding in addition to excessive sleepiness.

Two hundred and ten breastfeeding mothers reported they were taking codeine-based analgesics. Of these mothers, 16.7% observed that their babies showed sleepiness, difficulty breastfeeding or lethargy. There were 139 breastfeeding women who took oxycodone in this study. Of these women, 20% noted similar symptoms reflecting depression of the central nervous system. Of the 184 breastfeeding mothers who took plain acetaminophen, only 0.5% indicated concerns about their babies wakefulness and ability to breastfeed.

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Breastfeeding mothers must carefully weigh the risks and benefits of medication use during the postpartum period. Breastfeeding offers many important health benefits to both mother and baby and should be encouraged for the vast majority of mothers and babies. However, new mothers often experience pain related to their births, and healthcare providers must consider how to care for the needs of the postpartum mother while minimizing the risk presented to the newborn infant.

Healthcare providers should encourage mothers to use plain acetaminophen over oxycodone and codeine whenever possible. They should also provide nonpharmacologic pain relief options, including heating pads for postpartum uterine contractions in low-risk women who have delivered vaginally. Another strategy to reduce the need for postpartum narcotic use is to reduce the number of women who deliver via cesarean section as appropriate.

Mothers who use postpartum codeine or oxycodone should be thoroughly counseled regarding the risk and the benefits of taking these medications while breastfeeding. Their infants should be carefully monitored with close follow up to evaluate for symptoms of central nervous system depression.

Journal of Pediatrics: Mother’s Postpartum Oxycodone Use: No Safer for Breastfed Infants than Codeine

This page is updated on May 12, 2013