Clinical Review: Management of Acute Postpartum Pain

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  • Racial and ethnic disparities are prevalent in maternal care, and improving health equity has been identified as a priority focus for the Medi-Cal program.
  • ACOG recommends shared decision-making using a stepwise, multimodal approach that includes acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) as first-line analgesics, especially for individuals who are breastfeeding.
  • If first-line options do not provide adequate pain control, ACOG recommends a low-dose, low-potency, and short-acting oral opioid, with appropriate options including codeine, hydrocodone, oxycodone, tramadol, and morphine. Codeine and tramadol should be avoided when breastfeeding.
  • The most important factor in the management of acute postpartum pain is the mode of delivery. After years of consistent decline, the rate of cesarean deliveries within the Medi-Cal MCP population has increased each year since 2019, going from 17.3% of deliveries in 2019 to 31.9% in 2022. Planning for pain management must begin during pregnancy and aim to avoid marginally-indicated cesarean delivery

Posted on May 11th, 2023 and last modified on May 11th, 2023.