Women prescribed more opioids than needed after C-sections, but decision tools can help

Two papers, published in Obstetrics & Gynecology, examine the number of opioid pills women are prescribed following cesarean sections.

The first paper details a survey including responses from 720 women across six academic medical centers in the U.S. The median number of pills prescribed to women who underwent C-sections was 40, which was significantly higher than the number of pills the women actually used. The survey showed women received double the number of pills than they took and had 15 pills leftover on average.  

Additionally, 95 percent of women had not disposed of extra pills at two weeks post-discharge. Women who were prescribed a higher number of pills were more likely to use more pills than needed. This suggests providers "are setting patient expectations based on the number of pills that we prescribe," said Brian Bateman, MD, chief of obstetric anesthesia at Boston-based Brigham and Women's Hospital and corresponding author of the two papers.

The second paper involved the testing of a shared decision making tool. Researchers studied 50 women who viewed a decision tool on tablets that included clinician information regarding expected pain patterns in the two weeks after a C-section. It also included information on advantages and disadvantages of opioids and instructions for disposing or refilling the medications.

The women were then allowed to choose the number of pills they would be prescribed at discharge, up to a total of 40 pills. The use of the shared decision making tool helped reduce the number prescribed opioid pills by 50 percent. Also, the refill rate remained low, irrespective of the number of pills prescribed and most women were satisfied with their pain management.

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