Many non-opioid treatments, such as physical therapy, may actually work better than an opioid for treating pain. Mom should talk to her provider about non-opioid treatment options first, and only use opioids as a last resort and in the lowest possible dosage and for the shortest duration possible to be effective. Most prescription opiates, such as morphine, hydrocodone, and oxycodone, can be used in pregnancy and breastfeeding under the care of the provider treating the cause of the pain. Research studies show there is not likely an increase in birth defect from using these prescription medications in pregnancy since there is no pattern of birth defects or problems seen in the studies. We have seen some individual studies that raise some concerns, but the results are not consistent, indicating that the results may be due to chance.
For less severe pain, over-the-counter medications may be considered, depending on your trimester. Aspirin and ibuprofen should not be used after the 20th week of pregnancy since they can affect kidney development and fetal circulation. Research studies of acetaminophen (Tylenol) have raised some concerns, but those studies had issues in how they were conducted, so there are questions about the results. Occasional use is not likely to cause problems, but pain requiring long-term use should be discussed with your provider to determine the best treatment plan.
Codeine or tramadol should generally be avoided during breastfeeding. Remember that codeine can be found in some combination medications such as Tylenol #3. If codeine or tramadol are used, they should be used with caution: Don’t use longer than 4 days. Monitor the baby for sleepiness, not wanting to nurse or having a hard time breathing. If codeine makes mom drowsy, it may make baby drowsy also because some people have a genetic predisposition to metabolize (or convert) codeine to morphine faster which can build up in the baby and make baby drowsy.