Your Pregnancy Matters

An honest discussion about opioid use and pregnancy

Your Pregnancy Matters

Recent studies have shown more opioid pain medications are consumed in the United States than anywhere else in the world.

“Americans use far more opioids than anyone else in the world” – this headline caught my attention this month. A recent United Nations report revealed some startling trends: Americans use more of these pain medications than any other country and consume more than 99 percent of the world’s hydrocodone.

While opioid use during pregnancy is not common, it is something that can have a big impact on you and your baby. In this post, we’ll talk about what you need to know about using these pain medications while pregnant, and what to consider if you’re offered them after your delivery.

What are opioids?

Opioids are a type of prescription pain medication that reduce your perception of pain. Opioids include:
  • Oxycodone (OxyContin®, Percoset®)
  • Hydrocodone and codeine (Vicodin®)
  • Fentanyl (Actiq®, Druagesic®, Sublimaze®)
  • Morphine (Kadian®, Avinza®)
  • Tramadol (ConZip®, Ryzolt®, Ultram®)
  • Methadone

What if you already take an opioid pain medication?

Taking opioids during pregnancy can cause serious complications, including neonatal abstinence syndrome after the delivery – when your newborn baby, who is no longer receiving the drug from your bloodstream, may have withdrawal symptoms for days to weeks after being born. Symptoms of the syndrome include: shaking/tremors, crying, fever, poor feeding, diarrhea, vomiting, and sleep problems.

If you are using opioids during pregnancy, the best thing you can do for your baby is to have an honest discussion with your doctor. Together, you’ll talk about what optimal care looks like for you and your baby.

Many experts do not recommend attempting to detox while pregnant. However, at UT Southwestern, our maternal-fetal medicine experts have developed an effective program for weaning pregnant women off of opioids so their newborns do not have to go through withdrawal.

One- and 3-year probabilities of continued opioid use among opioid-naïve patients, by number of days’ supply (expressed in days, 1-40, in 1-day increments) of the first opioid prescription – United States, 2006-2015. Source: Centers for Disease Control and Prevention.

Opioid use after pregnancy

I was surprised by the number of women who are offered opioid prescriptions after giving birth. A recent study in Pennsylvania showed almost one in 10 women filled a prescription for narcotic pain medications after a vaginal delivery without a common medical indication.

Certainly, there are good reasons for women who have had a vaginal delivery to need narcotics after birth – for instance, if you’ve had a tubal ligation or an episiotomy or a bad tear. But none of these patients had any of these conditions. They were prescribed narcotics after having a normal vaginal delivery.

Don’t misunderstand me – vaginal deliveries do involve discomfort related to swelling, and uterine cramping is expected and normal as the uterus returns to normal size. But this discomfort is not necessarily best treated with narcotics. 

This use of opioid pain relievers is concerning because short-term prescriptions can lead to long-term use among patients who have never taken these medications before. The graph at right from the Centers for Disease Control and Prevention (CDC) shows how likely people are to continue opioid use after receiving a prescription. Astonishingly, almost 20 percent of people who had not been using opioids were still using them a year after they received a 10-day supply. 

As you can see, the risk of developing opioid dependence increases with the number of days in the initial prescription.

The risks of opioids in the house

Sometimes patients feel the need to have a prescription filled “just in case,” or end up with leftover medicine after their delivery. Unused medications often end up sitting in medicine cabinets or lying around the house. These can pose a risk to children – from 2000 to 2015, poison control centers reported 188,468 opioid exposures in children younger than 20.

Children younger than 5 accounted for 60 percent of these exposures, primarily from accidental discovery and ingestion. Teenagers may abuse these drugs in an effort to self-medicate or attempt suicide. By keeping extra medications in your house, you risk potential exposure to children of all ages.

My recommendations

If you currently take narcotic medications and your OB provider is not aware, tell him or her. It will make a huge difference in the care for your newborn. Together you can explore the best plan of care for both you and your infant. 

Second, if you’re offered a prescription for narcotics, really think about whether or not you need one. Your pain may be better managed with non-steroidal, anti-inflammatory agents like ibuprofen, which does a great job of easing uterine cramping. These medications also aren’t as sedating as opioids, which can be important for a new mom.

Finally, if you really feel like you need narcotic medications to control your pain, ask for a short course (three to five days). This is safer for you because there is less risk of long-term dependence, and it’s also safer for your family because you won’t have unused medication left over in the house.

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