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When you’re pregnant and you think about delivering your baby, you might worry about the pain during childbirth. But many women might not think too much about the pain that can continue after childbirth. Right after you have a baby, whether you’ve had a regular vaginal delivery or if you’ve had a Caesarean section, which requires abdominal surgery, women typically feel very tired and pretty sore for a few days.

Jade Elliott spoke with Kim Compagni, a pharmacist and executive operations director of pain management services for Intermountain Healthcare and Amy Campbell, a nurse and the Interim executive director for the women’s health clinical program at Intermountain Healthcare, about the things you can do to manage the pain after childbirth.

How does the pain after childbirth vary depending on the kind of delivery you have? What’s typical for a vaginal delivery?

Uterine cramping is the most common pain women experience after childbirth. The body releases oxytocin after your baby is born to begin the process of shrinking the uterus back to its pre-pregnancy size. There is also pain as the uterus begins to contract and tighten back up. This also slows post-partum bleeding. This cramping pain may also increase during breastfeeding. Uterine cramping is typically described as dull, aching pain. Women typically also have perineum pain and some swelling. Most women describe it as a stinging type pain, sometimes throbbing pain. It’s common to have pain in the vaginal wall from an episiotomy or tearing of the perineum.

And what about if you have complications like delivering by Caesarean section, how can that affect your pain level?

Uterine cramping is normal after a Caesarean section as well. A C-section procedure is done by making a horizonal incision just above the pubic bone. The pain from a C-Section is incisional pain or surgical pain in that lower abdominal muscle. Women describe this as stinging, throbbing or sharp shooting pain.

How does pain tolerance vary from woman to woman?

Pain tolerance varies from person to person. Every woman is different and the trauma to the mother’s body varies during every birth. Typically, when it’s a second or subsequent birth, women have more cramping and after pains. Pain varies from woman to woman by her ability to cope and her endurance for pain as well. Rest is so important to improve pain tolerance. Many women have adopted the practice of meditation and hypnosis to prepare for the birth experience, and these same methods can be used after birth. Pain tolerance can be improved greatly with these practices.

In childbirth, the amount of after pains depend on if it’s your first birth. Typically, when it’s a second or subsequent birth, women have more cramping and after pains.

What should new moms know about alleviating pain after childbirth?

Pain is part of childbirth. It’s normal. Have realistic expectations afterward. Talk to your doctor, midwife and pharmacist to help determine if you might need pain control after childbirth.

Your postpartum nurses can help teach you simple ways to help alleviate postpartum pain. Positioning your body is important. You can use pillows for your back, or under your arms or knees. Ice packs placed on your perineal area or Caesarean incision are very helpful. Witch hazel pads help both soothe perineal pain and keep the area clean. Lidocaine spray or gel can be applied for instant topical pain relief.

5 Simple Ways to Relieve Pain After Childbirth

1. Use ice packs for soreness
2. Apply topical Lidocaine spray or gel
3. Use witch hazel pads to soothe and clean the perineal area
4. Use over the counter pain relievers like ibuprofen
5. For complications, use non-opioid prescription pain relievers.

What types of pain relief may be used?

The key to pain management is to take scheduled acetaminophen and Ibuprofen around the clock for 2-3 days postpartum. The scheduled doses of medications will allow for an opioid free postpartum period. Rotate every 3-4 hours taking 1000 mg acetaminophen and alternating with 600 mg of ibuprofen. Ibuprofen also reduces swelling. You should only rarely need an opioid after childbirth and usually only for one to two days.

After childbirth is a time period where constipation can be troublesome, and opioids compound the problem. Taking stool softeners, drinking plenty of fluids and getting a short walk in each day can alleviate the constipation.

Over the counter topical medications such as dibucaine ointment and witch hazel can provide some additional pain relief and can help with swelling. We want women to be comfortable, so discuss on-going pain issues with your provider.

Why might postpartum women be at risk for becoming addicted to prescription pain relievers?

Childbirth is difficult. You’re tired, you’re in pain, especially with a c-section. Your hormones are fluctuating. It’s a big life change and adjustment. The combination of all those things could lead to postpartum depression, anxiety or addiction.

In the past, opioids were a common solution for pain. But now, we know more of the risks about opioids and about many opioid alternatives.

Are opioids safe for your baby if you plan to breastfeed?

When you’re nursing, medications can end up in your breastmilk and affect your baby. Check with your provider or pharmacist about what medications are safe when breastfeeding. If opioids are used by the mother, the infant should be monitored for sedation and respiratory depression. Withdrawal symptoms can occur in breast-fed infants when moms stop taking an opioid or when breast-feeding is stopped.

Is it safe for moms to take opioids short term after delivery?

In recent years, we’ve become much more aware of the risks of prescription opioids and opioid addiction. We recommend not taking opioids for more than three days after childbirth. If you have an opioid prescription and it says you can take it every four hours, you don’t need to take it every four hours. As your pain lessens, you should cut back the dose and frequency.

Why is it good to avoid opioids?

A side effect of opioids is drowsiness. Women have oxytocin in their body naturally after delivery and that makes you tired. So those things combined, can make it hard to take care of your baby. Your baby needs your full attention.

Opioids can be highly addictive. Taking opioids can lead to addiction, which can lead to other problems that could interfere with your ability to take care of your baby or family, maintain relationships, make good decisions, keep yourself and your baby safe, go to work or school or achieve your goals.

What is the potential for opioid addiction?

Physical dependence typically takes about seven days. The likelihood of developing opioid use disorder increases with time and dose. That is why it’s best to try to limit the number of opioids prescribed.

If your pain continues or increases after you get home from the hospital, when should you call your provider?

It’s normal to have perineal pain or C-section incision pain. But call your provider if you have chest pain or a hard time breathing, or pain or a lump in your legs or if you notice any redness, swelling, or heat on your body.

For more information about women’s health services and postpartum care at Intermountain Healthcare visit:

https://intermountainhealthcare.org/services/womens-health/

https://intermountainhealthcare.org/services/women-newborn/conditions/postpartum-care/

https://www.youtube.com/watch?v=dX22DuYu1Yk&list=PLIWYdYatjvoNTVyRVDOPeDfuER5vLTgum&index=3

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.