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Date issued: August 2023

Review date: August 2025

Ref: C-465/BG/Maternity/Pain relief after birth and while breastfeeding v3

PDF:  Pain relief after birth and while breastfeeding final August 2023 v3.pdf [pdf] 200KB

Who is this leaflet for?

This leaflet has been written to provide advice on suitable pain relief following the birth of your baby.

It contains general guidance about how you take the medication, possible side effects and the safety of medications while breastfeeding.

The information given in this leaflet is intended as general guidance.  Your medication will be prescribed to cater for your specific needs.  If you have been given different advice by the team caring for you or have any concerns or questions, please speak to your midwife, pharmacist or a doctor.

General advice

Many women require some form of pain relief for a few days after the birth of their baby, especially after caesarean section. The most commonly used pain medications are paracetamol and ibuprofen.  These can be bought without a prescription from a chemist or local supermarket.  We suggest you obtain a supply before your baby is born.

If you need pain relief that is only available on prescription, you will be given a small supply to take home.

Contact your midwife if the pain does not settle within a week after delivery or if the pain gets worse.

All medicines contain information on the packaging or an enclosed leaflet.  It is recommended that you read this information before taking any medication. Any medication should be taken at the lowest dose for the shortest possible time, to control the pain.

By taking pain medications regularly your pain should not build up. This should mean that you are able to move about and care for your baby more easily.

Storage advice

We suggest you keep your medicines in a single place, out of the reach of children.

Once a dose has been measured, take it immediately to prevent it being taken by anyone else, especially children.

Paracetamol

Paracetamol comes in 500mg tablets, and you can take up to two tablets four times in a 24-hour period (a total of 4000mg). 

This can be bought without a prescription from a chemist or local supermarket.

What are the side effects of paracetamol?

Paracetamol is an extremely safe drug for almost everyone. However, if more than eight tablets (a total of 4000mg) are taken in any 24-hour period it can cause liver damage. 

It is very important that you check whether any other tablets or medications you are taking contain any paracetamol to avoid accidently taking more than 4000mg in a 24-hour period.

Is it safe to take paracetamol while breastfeeding?

Paracetamol is the first-choice pain medication during breastfeeding.  While it appears in breast milk, the amount is too small to cause any harm to your baby.

Sometimes paracetamol alone may not control your pain. In this case a non-steroidal anti-inflammatory (NSAID), for example ibuprofen, can also be taken.

Non-steroidal anti-inflammatory pain medications (NSAIDs)

There are different types of anti-inflammatory pain medications including ibuprofen, diclofenac and naproxen. 

The most commonly used anti-inflammatory is ibuprofen (also known as Brufen and Nurofen), which is generally administered as 400mg taken three to four times a day. It can be bought without a prescription from a chemist or supermarket.

You should only take anti-inflammatory pain medications after the birth of your baby and not during pregnancy.

What are the side effects of NSAIDs?

If you have any of the following conditions you should speak to your midwife, pharmacist or a doctor before taking anti-inflammatory painkillers:

Asthma/breathing problems

Previous stomach ulcer

Previous reaction to aspirin or any non-steroidal anti-inflammatory drugs

Other medical conditions, for example, kidney disease, heart disease, blood clotting disorders, liver disease.

Stop taking anti-inflammatory pain medications and seek immediate medical help if you:

Pass blood in your faeces

Vomit any blood or what looks like coffee grounds

Suffer an allergic reaction, such as dizziness, itching, swelling of the lips, face or tongue.

It is important to take anti-inflammatory pain medications with or after food, e.g., a small biscuit, piece of bread or with a glass of milk.

Is it safe to take non-steroidal anti-inflammatory painkillers while breastfeeding?

They are generally considered safe for a breastfeeding mother to take as the amount transferred to breast milk is small.

Aspirin is generally not recommended for treatment of pain during breastfeeding.

If paracetamol and a NSAID does not effectively control your pain, morphine sulphate for example, Oramorph, can also be taken.

Morphine sulphate 

If your pain is moderate to severe you may be prescribed morphine sulphate as a liquid (Oramorph) to drink. This can be taken both in hospital and at home.  

Morphine sulphate should be taken at the lowest dose for the shortest possible time, to control the pain.

For the safety of your baby, after taking a dose of morphine sulphate, do not sit or lie with your baby in case you fall asleep. If you feel drowsy at any point, call for help to assist you with putting your baby back in its cot.

Codeine is not generally recommended while breastfeeding and should not be prescribed or purchased for use by a breastfeeding mother.

The usual dose when you are first prescribed morphine sulphate is one or two 5ml spoonfuls (10-20mg), when needed, but with at least four hours between doses. You are unlikely to need regular morphine sulphate at any time.

We suggest you keep your medicines in a single place, out of the reach of children. Once a dose has been measured, take it immediately to prevent it being taken by anyone else, especially children.

Once your pain has improved enough that you no longer need to take morphine sulphate, any that is left over should be returned to the hospital pharmacy or your local community pharmacy for safe disposal. 

What are the side effects of morphine sulphate?

The most common side effects with morphine sulphate are:

• Drowsiness

• Constipation

• Feeling sick 

It is therefore important to drink enough water and eat high fibre food.

Is it safe to take morphine sulphate while breastfeeding?

Morphine sulphate can be used with caution during breastfeeding. Please be assured that your baby will not become addicted to morphine, but large doses taken by the mother can make a breastfeeding infant sleepy and may cause problems with feeding. 

If you are at all concerned seek immediate advice from your doctor or midwife.

Further information and advice can be obtained from:

Your Anaesthetist, Obstetrician or Midwife.     01752 430200

Lloyd’s Pharmacy at Derriford Hospital.          01752 777422

NHS 111                                                          111
NHS Choices Online                                       www.nhs.uk

Breastfeeding Network                         www.breastfeedingnetwork.org.uk/factsheet/analgesics/

University Hospitals Plymouth NHS Trust welcomes all forms of feedback from our service users.  If the standard of service you have received from the Trust does not meet your expectations, we want to hear from you.  Please speak with the ward manager or the nurse in charge in the first instance, or you can contact the Patient Advice and Liaison Service (PALS) on: Telephone: 01752 439884 (internally 39884)

Email: plh-tr.PALS@nhs.net

You can be confident that your care will not be affected by highlighting any areas of concern or making a complaint.  The Trust will retain a record of your contact, which is held separately to any medical records.  If you are acting on behalf of a patient, we may need to obtain the patient’s consent in order to protect patient confidentiality.  More information on PALS or making a complaint can be found on the Trust’s website:  https://www.plymouthhospitals.nhs.uk/pals