Emily Oster

2 min Read Emily Oster

Emily Oster

Is It Safe to Take Opioids While Breastfeeding?

Q&A on safety

Emily Oster

2 min Read

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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Juno123
10 days ago

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.

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👉Comment “Link” for a DM to an article that summarizes all of the best potty training advice we collected.

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Comment “Link” for a DM to an article on the data around sun and heat exposure for babies.

#sunsafety #babysunscreen #babyhealth #parentdata #emilyoster

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☀️ Most importantly, limit their time out in hot weather. (They get hotter than you do!)
☀️ Keep them in the shade as much as possible when you’re out.
☀️ Long-sleeve but lightweight clothing is your friend, especially on the beach, where even in the shade you can get sunlight reflecting off different surfaces.
☀️ If you want to add a little sunscreen on their hands and feet? Go for it! But be mindful as baby skin tends to more prone to irritation.

Comment “Link” for a DM to an article on the data around sun and heat exposure for babies.

#sunsafety #babysunscreen #babyhealth #parentdata #emilyoster
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OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio! ...

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio!

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio! ...

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio!

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio! ...

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Sources:
📖 #ExpectingBetter pp. 160-163
📈 Robert M. Silver et al., “Prospective Evaluation of Maternal Sleep Position Through 30 Weeks of Gestation and Adverse Pregnancy Outcomes,” Obstetrics and Gynecology 134, no. 4 (2019): 667–76. 

#emilyoster #pregnancy #pregnancytips #sleepingposition #pregnantlife

Is side sleeping important during pregnancy? Comment “Link” for a DM to an article on whether sleep position affects pregnancy outcomes.

Being pregnant makes you tired, and as time goes by, it gets increasingly hard to get comfortable. You were probably instructed to sleep on your side and not your back, but it turns out that advice is not based on very good data.

We now have much better data on this, and the bulk of the evidence seems to reject the link between sleep position and stillbirth or other negative outcomes. So go ahead and get some sleep however you are most comfortable. 💤

Sources:
📖 #ExpectingBetter pp. 160-163
📈 Robert M. Silver et al., “Prospective Evaluation of Maternal Sleep Position Through 30 Weeks of Gestation and Adverse Pregnancy Outcomes,” Obstetrics and Gynecology 134, no. 4 (2019): 667–76.

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#pregnancy #pregnancycomplications #pregnancyjourney #preeclampsiaawareness #postpartumjourney #emilyoster

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I co-wrote #TheUnexpected with my friend and maternal fetal medicine specialist, Dr. Nathan Fox. The unfortunate reality is that about half of pregnancies include complications such as preeclampsia, miscarriage, preterm birth, and postpartum depression. Because these are things not talked about enough, it can not only be an isolating experience, but it can also make treatment harder to access.

The book lays out the data on recurrence and delves into treatment options shown to lower risk for these conditions in subsequent pregnancies. It also guides you through how to have productive conversations and make shared decisions with your doctor. I hope none of you need this book, but if you do, it’ll be here for you 💛

#pregnancy #pregnancycomplications #pregnancyjourney #preeclampsiaawareness #postpartumjourney #emilyoster
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Only two weeks until our book “The Unexpected” is here! Preorder at the link in my bio. 💙
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