Care on the Postnatal Ward For Mother

Pain Relief Following Birth

Most women will experience some pain after giving birth. It is very important that your pain is well controlled so you can look after yourself and your new baby.

During your time in the Rotunda you will be offered regular pain relief. Pain will be better managed if you take the prescribed medication at regular intervals, rather than waiting until the pain is bad.

Pain relief medications work in different ways and one pain medicine alone may not be enough to control your pain. Depending on your level of discomfort you may be offered two or more medications to control your pain. Combining different types of pain relieving medications may give you better pain control and allows lower doses to be used.

To assess your pain, you will be asked to score it from 0 to 10 where 0 is ‘no pain’ and 10 is ‘worst pain you can imagine’. This will help us to decide which pain medication is best for you, and how much you need. If your pain is not well controlled, please discuss this with your doctor or midwife.

Pain Relief Medications

The following types of pain medication work in different ways and are safe to take together:

• Paracetamol is a very effective pain medication which also reduces fever (high temperature) and inflammation.
• Anti-inflammatories including Ibuprofen or Diclofenac will help reduce levels of chemicals in your body that cause inflammation and pain.
• Opioids such as Oxycodone, Morphine or Codeine are only used if your pain is not well controlled with a combination of other drugs.

Paracetamol

Paracetamol is a very effective pain medication if it is taken at regular intervals. The adult dose is 1gram (two 500mg tablets) four times a day (maximum dose per day is 4grams or eight tablets). If you are taking other medications for pain or over the counter cold and flu remedies, always check with you doctor, midwife or pharmacist if these contain Paracetamol. You should only take one Paracetamol containing product at the time.

Ibuprofen

This can be safely taken with Paracetamol. The usual dose is 400mgs three times a day. Because these tablets can upset your stomach they need to be taken with or soon after food. If you have asthma, Ibuprofen may make it worse. Tell your doctor, midwife or pharmacist if you have asthma or if you are on any other medications as they may interact with Ibuprofen.

Diclofenac

Diclofenac is usually given as a suppository (100mgs once a day). It provides good control of your pain in the days after vaginal delivery or caesarean section. After the first two days you will usually be given Ibuprofen tablets which act in a similar way to Diclofenac. If you have asthma, Diclofenac may make it worse. Tell your doctor, midwife or pharmacist if you have asthma or if you are on any other medications as they may interact with Diclofenac. Never take Ibuprofen and Diclofenac together.

Opioids

If the above medications do not fully control your pain, Opioids may be used. Opioids provide very good pain relief, but they are not used routinely due to side effects including nausea, vomiting, itch, confusion or dizziness, sweating and constipation.

As Opioids may affect your co-ordination or cause drowsiness, you should be careful handling your baby. If you feel very drowsy or short of breath after taking opioids, contact your midwife immediately. You may have to take laxatives while taking opioids to avoid constipation.

Pain relief after leaving hospital

On discharge you will either be advised to buy your medications without prescription in your local pharmacy or you will be given a prescription for pain medications. Bear in mind that pain is much harder to control if you let it build up so please take your medications regularly as recommended at discharge. Further information for those medications will be available on the patient information leaflet inside the pack or from your pharmacist.

Pain relief medications and breastfeeding

Paracetamol, Ibuprofen and Diclofenac are safe for use during breastfeeding. Pain relief medications that contain Codeine or Oxycodone are not used routinely in the hospital if you are breastfeeding. If you are prescribed these medications and you are breastfeeding you need to tell the midwife or doctor if your baby is difficult to wake, does not feed well, does not gain weight, or appears limp or floppy.

Breast changes

You will experience breast changes in the days after the birth of your baby whether you are breastfeeding or not. This happens as nature prepares to fill your breasts with milk. You will notice your breasts become swollen, hard and sometimes sore. However, this period is short because once you have established breastfeeding your body will regulate the milk supply. If you are not breastfeeding you can help reduce the engorgement by wearing a well-fitting bra with the straps pulled up tightly. It will also help if you avoid stimulating your breasts so don’t put hot water directly on them while in the shower or bath. Breast engorgement will go after a few days if your baby does not stimulate them by sucking to produce milk.

Your perineum is the area between your vagina and back passage. If your baby was born vaginally, you may have stitches that become tighter as the wound begins to heal. This can make sitting down, walking and passing urine uncomfortable. Take regular pain relief. You could also try sitting on a cushion to relieve the discomfort.

Wash the perineal area frequently as this will keep the wound clean. Remember to dry yourself well after washing. There is no need to add any disinfectant or salt to the bath water as research has found bathing in plain water is much better for the healing process. It is also important to change your sanitary towels frequently. Do not use tampons as they can cause infection in the early days and weeks after you give birth.

Even if you did not need any stitches after the birth, you may still experience discomfort and heaviness in your vaginal area. This is normal as you are likely to be bruised and swollen around the vagina. Plenty of rest, warm baths, good hygiene and pelvic floor exercises will all help to heal the area.

Passing urine

Emptying your bladder completely after giving birth is very important. You will be asked to measure how much urine you pass when you go to the toilet for the first couple of times after birth. This is so that we know that you are emptying your bladder completely. You should drink at least two litres of fluid a day.

Bowel movements

Many women worry about opening their bowels for the first time after the birth. They are scared that their stitches might burst. Rest assured that this will not happen and in fact the sooner you start going to the toilet the better. If you put this off you may become constipated.  To prevent this happening, drink plenty of water and eat high fibre foods such as fruit and vegetables. Gentle exercise will also benefit you.

Blood tests

If your blood group is rhesus negative you may need an injection called Anti-D. We will give you this injection within 72 hours of your baby being born.