My lovely sister-in-law broke her hand, it cannot be casted, and she is in a lot of pain. She has a six-month-old baby and a 3-year-old. Because she is breastfeeding, the ER doc said she can only take acetaminophen and ibuprofen. That seems insane. What does the data say? Are all other painkillers seriously off-limits unless she tries to switch to formula?
—Pam
Your poor sister-in-law — what a nightmare, especially with a baby and a toddler who presumably does not fully understand the idea of being gentle.
Broadly, in terms of pain relief (setting aside breastfeeding for a minute), we have over-the-counter options like acetaminophen and ibuprofen (that’s Tylenol and Advil in the most common brand names). If these are not strong enough, the next stop is some kind of opioid, like oxycodone or hydrocodone.
Over the past few years, there has been a big push away from prescribing opioids for pain relief. The reason is that they are addictive — so addictive that (for some people) even short prescriptions can lead to long-term dependency. Obviously this doesn’t happen for most people, and there is an active debate about the appropriate way to use these medications, since they are much more effective pain relief.
I give this as background because the caution in the ER may have less to do with breastfeeding and more to do with a shift to avoidance of stronger pain relievers unless absolutely necessary.
There is an added concern with breastfeeding, although in practice it is fairly minimal. We have reasonable data on this because some people are prescribed opioid pain relief, typically oxycodone and hydrocodone, after a C-section. The concern with these prescriptions is that because opioids pass through breast milk, they could lead to sleepiness or overdose in infants.
In practice, the data doesn’t suggest risks with typical usage. A large study — almost 90,000 people matched with 90,000 controls — compared infants whose mothers were given opioid pain relief with those who were not and found no difference in outcomes, including readmission to the hospital, emergency room visits, and related outcomes.
These results are focused on newborns, but the risks are likely to be even smaller for an older child. All of this is to say that the caution about opioids is probably more of an overall caution about the mother than a worry about breastfeeding in particular.
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I’m still really bitter about the fact that I was not offered anything more than Tylenol/Advil after birth when I had multiple tears and was in so much pain I couldn’t walk 10 feet. I wish I had been given data and empowered to make my own decision about risks. I realize doctors don’t want to take the liability, but there has to be a better solution.