Managing pain during pregnancy and breast-feeding

1 February 2011

Pregnant women should not suffer pain unnecessarily as there are treatment options available to them. Leaving pain untreated can actually do more harm than good, according to Debra Kennedy, Director of MotherSafe, writing in the latest edition of Australian Prescriber.

Dr Kennedy says the risks of treating versus not treating pain during pregnancy need to be discussed by both the woman and her health professional. These discussions should be based on clinical evidence for the effectiveness of each pain relieving medicine.

“Inadequately managed persistent pain can result in depression and anxiety. These may impact on a woman's physical and psychological wellbeing and can potentially have an adverse effect on her pregnancy,” Dr Kennedy says.

“Paracetamol is the most widely used pain relief in Australia, particularly by pregnant women. Although paracetamol readily crosses the placenta, at recommended doses it does not appear to increase the risk of birth defects or other adverse outcomes of pregnancy. Despite widespread use of paracetamol there are few studies about its use in pregnancy,” she says.

“Aspirin is not associated with an increased risk of congenital malformations, although one review suggested an association between aspirin use in the first trimester and increased risk of an abdominal defect.”

“Non-steroidal anti-inflammatory medicines such as ibuprofen have not been shown to increase the risk of structural birth defects or other adverse outcomes such as preterm delivery or low birth weight, however they should not be used after 30 weeks because of their potential to cause high blood pressure and early closure of one of the baby's blood vessels. High doses of these medicines in the third trimester may also reduce blood flow to the baby's kidneys.”

“Opioid pain relievers such as codeine have not been associated with an increase in birth defects or miscarriage. The main concern is that persistent use may lead to dependence and tolerance in the mother, with resultant drug withdrawal in the newborn.”

“We recommend paracetamol to treat fever and pain during pregnancy. Codeine or another opioid analgesic can be added to treat more severe pain. Inadvertent use of non-steroidal anti-inflammatory medicines in the first trimester is not usually harmful but these medicines should not be used in the third trimester,” Dr Kennedy concludes.

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Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published by NPS, an independent, not-for-profit organisation for quality use of medicines funded by the Australian Government Department of Health and Ageing. Australian Prescriber is published every two months, in hard copy that is distributed to health professionals free of charge, and online in full text at