The treatment of post partum pain: Survey of 26 maternity departments in Israel

Background: The majority of post-partum women suffer from pain after vaginal delivery, more so after cesarean section. In most cases, pain management is needed during the post-partum hospitalization period. In Israel there is no national protocol of post-partum pain management. Goals: Presentation of the current status of post-partum pain management used in Israeli hospital maternity departments as a basis for a national protocol of post-partum pain management. Methods: During the months of July and August 2008, Israeli maternity departments were surveyed by telephone interviews regarding their pain management protocols for post-vaginal deliveries and caesarean sections for both breastfeeding and non-breastfeeding mothers. Results: Treatment protocols were received from 26 maternity departments. All use paracetamol per-os alone or combined with another drug. Dipyrone is used in 22/26 departments, despite the fact that this medication is not approved for use during lactation. In 15/26 departments, diclofenac is used mostly after caesarean sections. In nine departments, ibuprofen is used post-partum, and tramadol is used in seven. In 20/26 departments surveyed, opioids are used after cesarean section, mostly morphine or pethidine. Methadone is used after caesarean section in two departments. Conclusions: Post-partum pain management treatment in Israel is not standardized, especially for lactating mothers and women after caesarean sections. Lactating mothers should be started on paracetamol or ibuprofen per-os, as first-line post-partum pain management treatment. If this is not effective, second line treatment can be short-term morphine, codeine or propoxyphene. These medications are safer than acetylsalicylic acid, dipyrone or pethidine for lactating mothers.