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Pain management—after childbirth

Most women will experience some pain following childbirth. This brochure explains the pain relieving medicines you may be prescribed, including possible side effects of each medicine.

It is important to tell your doctor or pharmacist about the following:

  • Any medicines you were using prior to coming into hospital. Prescription, non-prescription or over-the-counter medicines, herbs and natural remedies may interact with the medicines you are prescribed in hospital. Some examples include antidepressants, St John's Wort, sleeping tablets or sedatives, anti-epileptics, any medicines for migraines, muscle relaxants or medicines for nausea and vomiting.
  • Any recreational substances, for example alcohol, you are using or have used before your hospital stay, as these may also affect your prescribed medicines.
  • If you suffer from chronic pain as this may need to be considered when treating your pain
    following birth.
  • If you are allergic to any medicines.
  • If you have or have ever had asthma, a stomach ulcer, bowel disorders (such as Crohn's disease), epilepsy, an injury to the head, depression, any mental illnesses, problems with your kidneys or your liver or any other medical condition.

Pain relieving medicines

There are three types of pain relieving medicines:

  1. Simple medicines, such as Paracetamol (Panadol ®)
  2. Anti-inflammatories, such as ibuprofen (Nurofen ®) or diclofenac (Voltaren ®)
  3. Opioids such as oxycodone (Endone ®, OxyNorm ®) tramadol and morphine.

These medicines work in different ways, so it is usually safe to use more than one at a time. In fact, combining different types of pain relieving medicines may give better pain control allowing lower doses to be used.

All medicines may cause side effects, however each person responds differently and most people do not experience any side effects at all.

Most side effects are mild, predictable and easily treated. Allergic reactions (rash, swelling, hives or wheezing) are unpredictable. Speak to your midwife or doctor immediately if you suspect you are experiencing a side effect to a medicine.

Please note that not all pain relieving medicines are suitable for everyone.

Always follow the instructions on the packaging and never take more than the recommended dose.

Paracetamol

Paracetamol is an effective pain reliever and regular dosing can actually prevent pain from developing. When pain does occur, it is usually less severe and requires smaller doses of stronger pain medicines to provide relief. For this reason, for the first few days after the birth of your baby, you will probably be given paracetamol regularly. Paracetamol has been safely used to treat pain after birth for more than 50 years.

The adult dose of paracetamol is two 500 mg tablets four times a day, up to a maximum daily dose of 4000 mg (four grams)—e.g. eight 500 mg tablets.

If you take other medicines containing Paracetamol, eg Panadeine ®, Codral Cold & Flu ® these must be included in the total amount taken. Please discuss this with your pharmacist.

When you get home and become more active, you may experience some increased aches and pains. You can continue to take regular paracetamol at home until your pain settles.

Anti-inflammatories

Anti-inflammatories such as ibuprofen (Nurofen ®) and diclofenac (Voltaren ®) help with swelling as well as pain. You can take an anti-inflammatory, in addition to paracetamol, to help control your pain.

You can take either ibuprofen or diclofenac, but never both together.

The recommended dose of:

  • ibuprofen is 200 mg to 400 mg up to three times a day
  • diclofenac is 25 mg to 50 mg up to three times a day.

Do not take anti-inflammatories continuously for longer than seven days without consulting your pharmacist or doctor.

Common side effects include heartburn, stomach upset or abdominal discomfort, nausea, dizziness, diarrhoea, drowsiness and headache.

Taking these medicines with food usually minimises stomach irritation.

Opioids

Opioids cover a wide range of strong pain relievers including codeine (contained in Panadeine ® and Panadeine Forte ®), morphine, pethidine, tramadol and oxycodone.

Opioids are very effective pain relievers and are used for moderate to severe pain. They mimic the action of certain hormones in the brain, nervous system and gut and work to dull the awareness of pain and prevent its transmission through the body. Tramadol works in two ways: it acts like an opioid, and it also inhibits the reuptake of ‘chemical messengers’ between the nerves in the brain.

If your pain is not adequately controlled with a combination of regular paracetamol and diclofenac or ibuprofen then an opioid may be added either regularly or when required for extra pain relief.

Common side effects include nausea, vomiting, itch, confusion or mental clouding, headache and dizziness, sweating and constipation. However, these side effects are more common with high doses and continued use. The doses used after birth are usually fairly small.

Drowsiness and slow reaction times can sometimes occur with opioids, and may mean that you need your dose reviewed. Speak to your midwife if you become excessively drowsy.

Always be aware when handling your baby that medication can affect your alertness and coordination, making you drowsy and slowing your reaction times.

See how the medication affects you before attempting tasks such as bathing your baby. Take care when standing up from a sitting or lying position, to avoid dizziness.

Time the doses of medicines which make you drowsy to coincide with your baby’s sleep times, if possible.

Always keep medicines out of the reach of children.

Useful contacts

Australian Breastfeeding Association provides advice about breastfeeding and can be contacted via 1800 686 2 686.

This publication is also available in other languages including the following:

© 2012 Mater Misericordiae Ltd. ACN 096 708 922

Mater acknowledges consumer consultation in the development of this patient information.
Last modified 18/12/2015.
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