Almost one-third of birthing moms now deliver babies through cesarean section, and many of these moms go home with powerful opioid painkillers.
In a new publication in the American Journal of Obstetrics & Gynecology, Michigan Medicine researchers indicated that there is a better way to take care of patients after C-sections to help them heal faster and manage pain without increasing their risk of long-term opioid use.
Scientists have used standardized, evidence-based pain management protocols that lessen opioid use successfully at a handful of institutions around the country, including the University of Michigan's Von Voigtlander Women's Hospital. U-M has seen opioid prescription levels for cesarean deliveries drop to nearly the same as vaginal births.
According to U-M authors, these care bundles, which involve a set of interventions to improve patient outcomes, need to be more widespread to benefit more birthing moms no matter where they give birth.
The lead author of the study and a U-M obstetrician-gynecologist, Alex Peahl, said that cesarean delivery is the most common abdominal surgery in the world. Despite persistent concerns about high cesarean delivery rates internationally, there has been less attention on improving perioperative outcomes for birthing moms.
She said further that they need to make sure moms are safe in the postpartum period and are receiving the highest quality care possible. This care includes helping patients achieve greater pain control with fewer opioids.
The authors also explained that more effective birth pain management is critical at a time when there are increasing concerns for higher cesarean rates, maternal mortality and morbidity, and risk for persistent opioid use among birthing moms.
According to research, women are at higher risk of persistent opioid use after the postoperative period if an opioid is prescribed.
The team highlight a pain management protocol called Enhanced Recovery After Surgery, which has more commonly been implemented for other types of surgeries, including hysterectomies, but has been slower to be used broadly for cesarean deliveries. While intended for planned operation, the researchers noted that the strategy is useful for unplanned C-sections as well.
ERAS involves a combination of long-acting opioids that last for 18 hours after delivery, reducing the patient's pain immediately after cesarean, and alternating non-narcotic medications around the clock to limit inpatient morphine.
Peahl said that the goal is to get on top of the pain before the surgery even starts. Pain is like a mountain. It's much harder to come down once one is at the top. Scientists are offering a longer, more even level of pain control to keep patients comfortable through the day. This strategy helps avoid those high peaks of pain that are much harder to come down from quickly and when the most potent painkillers are often used for immediate relief.
