Obstetricians’ Prescribing Practices for Pain Management After Delivery

Abstract

Aim: To examine postpartum opioid prescribing practices. Materials & methods: Obstetricians were interviewed about opioids: choice of opioid, clinical factors considered when prescribing, thoughts/beliefs about prescribing, and typical counseling provided. Inductive thematic analyses were used to identify themes. Results: A total of 38 interviews were analyzed. Several key points emerged. The choice of opioid, dosing and number of pills prescribed varied widely. The mode of delivery is the primary consideration for prescribing opioids. All providers would prescribe opioids to breastfeeding women. Some providers offered counseling on nonopioid treatment of pain. Discussion: At two large tertiary centers in Pennsylvania, the 38 physicians interviewed wrote 38 unique opioid prescriptions. Patient counseling addressed short-term pain management, but not the chronic overuse of opioids.

Plain language summary

We wanted to look at the way opioid pain drugs are provided to mothers after the birth of their children and see what doctors tell mothers about the pain drugs. We interviewed doctors and asked which opioid pain drug they would choose, what made them prescribe the drug, the thoughts about giving mothers the drug and what they told the mothers about the drug. We then looked at all the responses to look for patterns in how doctors gave pain drugs to mothers. Our team interviewed 38 doctors. Some key points were seen; first is that the choice of opioid pain drug, dose and number of pills prescribed was different from doctor to doctor; second is that whether the baby was delivered vaginally or by cesarean was the main factor upon which doctors based their decisions for giving opioid pain drugs. Whether a mother was taking medications that help with addiction, the doctor’s assessment of the mother’s pain and the doctor’s thoughts on the mother’s risk of opioid addiction were also considered. All doctors would give opioid pain drugs to breastfeeding mothers. Finally, some doctors talked to mothers about using other medications for pain, but not about the overuse of opioid pain drugs. At our two hospital centers in Pennsylvania, the 38 doctors gave opioid pain drugs to mothers in 38 different ways. Doctors said that opioids are necessary after cesarean, but not after vaginal birth, unless there is a problem. A mother’s history and social situation inform decision making. Doctors talk to mothers about short-term pain, but not about the overuse of opioid pain drugs.

Keywords::

• cesarean
• childbirth
• opioid
• pain management
• postpartum
• qualitative

Study site locations

Geisinger Medical Center, PA, USA; Hershey Medical Center, PA, USA.

Financial & competing interests disclosure

The project described was supported by The Pennsylvania State University Social Science Research Institute Consortium to Combat Substance Abuse and the Clinical and Translational Science Institute, National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1 TR002014. Information presented in this manuscript has not been presented at any meetings. There have been no previous posting or publications of earlier versions of this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved. The Pennsylvania State University Institutional Review Board (IRB; CATS #00009937; https://www.research.psu.edu/irb); Geisinger IRB (2018-0518; https://www.geisinger.edu/research/research-and-innovation/resources/human-research-protection-program-hrpp).

Additional information

Funding

The project described was supported by The Pennsylvania State University Social Science Research Institute Consortium to Combat Substance Abuse and the Clinical and Translational Science Institute, National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1 TR002014. Information presented in this manuscript has not been presented at any meetings. There have been no previous posting or publications of earlier versions of this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.