Pain relief during pregnancy and after birth

• Always keep medication out of the reach of children.
• Do not let anyone else take your medication.
• Do not take medication that has been prescribed for someone else.
• Keep all your medication in the original containers.
• If you suffer any unpleasant side effects from your medication, speak to your doctor/midwife/pharmacist.
• Inform your midwife if you start a new medication whilst pregnant or breastfeeding.
• Always read the information leaflet provided with each newly prescribed medication.

It is not unusual to require some form of pain relief after giving birth, so please make sure you have enough pain relief available at home after you are discharged from hospital. The most commonly used painkillers paracetamol and ibuprofen are widely available without prescription. If, at the time you are discharged from hospital, you need alternative pain relief that is only available on prescription, you will be supplied with a small supply to take home. Always contact your midwife if any pain does not settle within a week after delivery or if the pain gets worse.

Paracetamol can be taken regularly or when required for pain. If you are prescribed a number of pain killers, it is usually recommended to take your paracetamol regularly to obtain the maximum benefit and to limit the number of other painkillers you may need.

Dosage:

• Two 500mg tablets (total 1g) every four to six hours as required.
• Do not take more than eight tablets of 500mg in a single day (24 hours).

The tablets should be taken with water, leaving at least four hours between each dose. After delivery you may need to take paracetamol regularly for a few days. As the pain settles, take only as much as you need to relieve your symptoms.

Paracetamol is generally well tolerated.

Paracetamol is commonly used in pregnancy and during breastfeeding with very few safety concerns.

Avoid ibuprofen in pregnancy. It should only be used in exceptional circumstances if specifically advised by your obstetrician. Ibuprofen is considered to be safe in breastfeeding.

Swallow the tablets with a glass of water. If possible take the tablets with or after food.

Dosage:

The usual dose is 400 mg three times a day with or after food (if possible), as required. The tablets should be taken with water. Take only as much as you need to relieve your symptoms.

After caesarean section or assisted delivery, we recommend you take ibuprofen 400 mg four times a day as well as paracetamol regularly for a few days. It is safe to take ibuprofen at the same time as paracetamol. Do not take more than 1200mg ibuprofen in 24 hours without medical advice.

Patients with any of the following conditions should consult a doctor/midwife/pharmacist before taking ibuprofen:

• Asthma/breathing problems.
• Previous stomach ulcer.
• Previous reaction to aspirin, ibuprofen or other non steroidal anti-inflammatory drug.
• Other medical conditions: for example kidney disease, heart disease, blood clotting disorders, liver disease.

Common side effects include headache, dizziness, feeling sick and diarrhoea.

Dihydrocodeine can be taken when required or regularly, depending on the level of pain you are experiencing. Do not drink alcohol while you are taking dihydrocodeine.

Dosage:

30-60 mg up to four times a day when needed. You may need to take dihydrocodeine regularly to control the pain effectively for a few days after caesarean section or assisted delivery; however you should aim to take only as much as you need to relieve your symptoms as soon as you feel well enough.

The most common side effects with dihydrocodeine are drowsiness, constipation, feeling sick and dry mouth. You will need to take laxatives regularly to prevent and/or relieve constipation when you are taking dihydrocodeine.

Use of dihydrocodeine during pregnancy for pain relief can be justified where paracetamol has not been effective. This should be prescribed by a doctor.

Dihydrocodeine can be used with caution during breastfeeding, assuming baby is born at term and is well. Use the minimum effective dose for the least amount of time possible.

Oral morphine sulfate is a solution. It should be drunk and then if necessary followed with another drink of water/squash if the taste is unpleasant.

Dosage:

The dose prescribed will be tailored to your individual needs. The usual dose when you are first prescribed morphine sulfate is 5-10mg when required.

You are unlikely to need regular morphine sulfate at any time during your pregnancy or after delivery.

The most common side effects with morphine sulfate are drowsiness, constipation, feeling sick and dry mouth. You will need to take laxatives regularly to prevent and/or relief constipation when you are taking morphine sulfate.

Use of morphine sulfate after delivery can be justified where alternative pain relief (paracetamol, ibuprofen, dihydrocodeine) has not been effective. It should be prescribed by a doctor.

Morphine sulfate can be used with caution during breastfeeding, assuming baby is born term and is well. Some morphine can cross into the breast milk. Your child will not become addicted to morphine, but large doses taken by the mother can make a nursing infant sleepy and may cause problems with feeding. Use the minimum effective dose for the shortest time possible.