Pain Relief in Pregnancy - What is Safe?
Pregnancy can be a tough time, it can throw up new muscle and ligament aches, back ache, and it can make headaches or migraines worse. It’s hard to know what pain relief is safe to reach for, so let’s talk you through what’s available to you, while keeping you comfortable and your baby healthy and happy.
The general rule of thumb is, don’t take anything unnecessarily. If your pain is mild and bearable, hold off on medication, especially in the first 12 weeks (first trimester). Try non-medicated solutions first, such as lying down in a dark room to help a headache, or having a warm bath or hot water bottle to relieve muscle aches.
Some medications are known to cause harm to your pregnancy and should be avoided. Others drugs may not have been through clinical trials on pregnant women, so there may be a theoretical risk or they are not known to be either safe or harmful. Drug manufacturers usually err on the side of caution in saying their medication should be avoided in pregnancy. Thankfully the Royal College of Obstetrics and Gynaecology (RCOG) has advised on what’s safe and what’s not. They stress that if you need to take pain medication, is should be at the lowest effective dose and for the shortest time possible.
The RCOG also recognise that inadequate pain relief can carry a psychological and physical burden, causing anxiety and depression in a new mother and disrupting bonding with baby. It may also prevent you from getting that all-important rest you need to revive.
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What can I buy from the pharmacy?
Paracetamol has an excellent safety profile and should be your go-to for pain relief should you need it. It is not known to be harmful in pregnancy to you or your baby, if taken in doses advised on the pack.
Ibuprofen belongs to a class of drugs called NSAIDs (non-steroidal anti-inflammatory drugs), which are not recommended beyond 30 weeks pregnancy, as they can cause low amniotic fluid and high pressure in your growing baby’s lungs. In the first trimester, NSAIDs may put you at risk of miscarriage, so are only suggested if you are in severe pain, such as a severe migraine, and only after a discussion with your doctor about risk versus benefit.
You should be aware that some medicines are available to buy and you may not realise that they contain certain drugs. Cold and flu remedies often contain paracetamol
What can my doctor prescribe me?
Opioids are safe in pregnancy but should be given under the guidance of a doctor. The RCOG suggests that are all equally safe. This includes codeine phosphate or dihydrocodeine, but these are only considered if paracetamol has been ineffective or you cannot take it. Stronger options include tramadol and morphine, if necessary, depending on the problem.
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Are there any natural remedies?
A TENS machine (transcutaneous electrical stimulation) can be used as a battery-operated device on your back to relieve lower back ache and pelvic pain. This does not risk harm to your baby and is a popular and effective means of non-medicated pain relief.
Massage and aromatherapy should be used with caution. Although many expectant mothers feel reassured with the “natural” label, many of the oils contain essential oils, which are strong chemicals and not recommended in pregnancy. There may be other options, so visit a reputable practitioner who should be able to advise.
What can I take while breast feeding?
Paracetamol is safe during breast feeding and should be your first choice if you need it. NSAIDs including ibuprofen are also safe to use during breast feeding. According to the standard ladder of pain relief, these are usually second choice after paracatemol has failed, and you can combine them if one or the other alone is not enough.
Codeine phosphate is available in a low doses to buy over-the-counter, but the RCOG advises you to avoid it in breast feeding, as small amounts can pass into breast milk and may rarely cause drowsiness and reduced breathing rate in your baby. Dihydrocodeine is a related pain reliever that is considered safer, as less passes to breast milk and on to your baby, but you should only use it if you and your doctor feel it’s necessary, and it needs to be prescribed. This is important, as it may be needed in the days immediately after delivery, in addition to paracetamol and ibuprofen – your maternity team will be on hand give you tailor-made advice.
Naproxen and diclofenac, both stronger NSAIDs than ibuprofen, may be prescribed by your doctor if necessary and are not known to cause harm to your baby, but manufacturers suggest to avoid them unless essential. The same caveat is true for tramadol, a stronger opioid than codeine, available on prescription and not known to be harmful, but manufacturers suggest avoiding it.
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