Zeev N. Kain, MD, MBA, MA (Hon), FAAP

The Anxiety of Medicine

What You Need to Know About Opioids and C-Sections

What is the impact of the opioid epidemic on having a baby

Posted Jul 01, 2018

When a woman finds out she is pregnant, several things cross her mind: will my baby be healthy? Will I have a boy or girl? Will the labor and delivery hurt? While most women still have a vaginal birth, the Centers for Disease Control and Prevention (CDC) reports that more than one-in-three women had a C-section delivery in 2016. Since C-sections are the most common surgical procedure in the United States, it’s critical that all moms feel comfortable and empowered to share their pain management preferences with a healthcare professional (OB/GYN, doula, mid-wife) in the event a C-section is needed. 

Used with permission pixabaym
Source: Used with permission pixabaym

Managing pain after surgery, and more specifically the utilization of opioids, has saturated mainstream media in recent years. In fact, women appear to be an increasingly vulnerable patient population when it comes to opioid consumption. Research reveals that women far outpace men in their use of opioids. In 2016, 30 percent more opioid prescriptions were written for women than for men. Further, following surgery, 13 percent of middle age women became newly persistent opioid users (using these medications three to six months after surgery), placing them at risk for dependence and addiction. This information is not meant to scare or alarm moms. In fact, the intent is the exact opposite. As healthcare practitioners, we must educate moms to be empowered patients and ask about opioid alternatives in the case they do have a planned or unplanned C-section. 

During a C-section delivery, a common pain management protocol involves regional anesthesia, such as an epidural or spinal, that numbs a woman’s midsection so that she won’t feel any pain from the surgical incision or the delivery. Keep in mind though, every doctor is different and every patient’s pain management will be specific to their needs. After the surgery, many women will receive an opioid to manage the pain. However, new research found that one in five women are

concerned about the risk of addiction or dependence after taking opioids during or after childbirth.The same research found that nearly nine-in-ten mothers and mothers-to-be have concerns about taking opioids during and after childbirth. If the thought of taking an opioid to manage pain during or after childbirth is a concern, know there are effective non-opioid options available. 

A great way to initiate a dialogue about non-opioid options with a healthcare professional is to develop a birth plan. A birth plan is a tool that can help establish a pain management plan that is suitable and safe for both mom and baby. This is especially important for moms facing an unplanned C-section. By having a birth plan, preferences on how to manage pain during a C-section birth will have already been discussed and documented ahead of time, rather than trying to make these decisions during an anxiety-ridden moment when a woman learns a C-section is necessary. This is also an opportune time to ask about non-opioid options, including a long-acting local anesthetic, like EXPAREL® (bupivacaine liposome injectable suspension), which is injected during the surgical portion of C-section to numb the area for the first few days after birth, the time when the pain is most intense. 

As a practicing healthcare professional for many years, I have experienced the transition from opioids being considered the gold standard to manage pain, to today, having the ability to provide effective pain management with non-opioids. There is a time and place for opioids to be used, but I believe the surgical space is one area where we can significantly decrease opioid prescribing. Some surgeries can be performed without opioids, and I encourage doctors to consider and adopt opioid sparing approaches whenever possible.