Guidelines Developed for Opioid Use in Vaginal Birth

The American College of Obstetricians and Gynecologists has released clinical practice guidelines for prescribing opioids during labour and delivery and at discharge for patients with uncomplicated normal spontaneous vaginal delivery. The guideline appeared in the journal Obstetrics & Gynecology.

The panellists formed to formulate the guidelines were obstetrician-gynaecologists identified by the ACOG as being thought leaders in the obstetrics field and who had also demonstrated an active interest in the opioid epidemic and its effect on women's health.

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After the panelists viewed the opioid administration data, they were presented with an adapted version of the CDC’s guidelines for opioid prescribing for chronic pain management.

The panelists examined the prevalence of opioid administration for deliveries of uncomplicated vaginal births. The researchers found that 78.2% of the 49,133 women who met inclusion criteria were administered opioids during hospitalization, and 29.% were administered opioids on the day of discharge. Patient- and hospital-level variables were presented in a survey to 14 obstetrician-gynecologists.

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Eight guidelines were constructed, and 7 of these were endorsed by the survey participants. The guidelines include the use of the lowest effective dosage and smallest quantity of opioids needed for the expected duration of pain necessitating opioid use. They also indicate that immediate-release opioids should be prescribed instead of extended-release or long-acting opioids. Concurrent prescription of opioid pain medications and benzodiazepines should be avoided. Options and expectations for intrapartum and postpartum pain management should be customized to women's needs and history.

According to the authors the seven draft consensus guidelines could now be used as a starting point to develop more broadly endorsed and studied guidelines for appropriately managing pain control for women with uncomplicated spontaneous vaginal birth.