In a recent opinion summary published in Obstetrics & Gynecology, a committee from the American College of Obstetricians and Gynecologists formulated several recommendations for safely managing pain and fatigue in women during the early postpartum period.

The Committee on Obstetric Practice introduced its recommendations for addressing the complications that arise from untreated postpartum pain, which include greater opioid use, postpartum depression, and development of persistent pain.

As non-pharmacologic and pharmacologic therapies are essential in the management of postpartum pain and because 81% of women begin breastfeeding after giving birth, the committee deemed it important to carefully consider the effects of all medication prescribed during this period.

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To effectively individualize pain management and allow for the administration of lower doses of opioids, the committee encouraged using a stepwise approach with a multimodal combination of analgesic agents. It is further recommended that care providers limit prescription duration to the shortest reasonable course.

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They also suggested using parenteral or oral opioids to treat breakthrough pain only if neuraxial opioids and non-opioid adjunctive agents do not suffice. When prescribing postpartum discharge opioids, obstetrician-gynecologists and care providers should employ a shared decision-making approach to optimize pain control and reduce the number of unused opioid tablets. In addition, care providers who opt for codeine-containing medication should inform families about medication risks and benefits and teach patients how to identify signs of toxicity in their newborns.

Regardless of the chosen treatment, the committee asserts that women who are prescribed opioid analgesics need to be educated about the risk for central nervous system depression in both themselves and their infants.

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Committee on obstretrics practice. Postpartum pain management: ACOG committee opinion summary [published online July 2018] Obstetrics & Gynecology. doi:10.1097/AOG.0000000000002683