Managing pain in pregnant patients

It is irresponsible and unprofessional to assume that once a patient is pregnant, her pain management is the responsibility of the obstetric team.

Managing pain in pregnant patients
Managing pain in pregnant patients

 A few weeks ago, I saw a patient who was both new to our practice as well newly pregnant. While reviewing her medications, I was alarmed to note that she was taking two oxycodone-acetaminophen (Percocet) three times a day, as well as alprazolam (Xanax).

She reported that she'd been taking these medications regularly for about four months to treat pain and anxiety following a motor vehicle accident. The patient went on to explain that she'd need me to refill those medications since the prescribing physician refused to give them to her now that she was pregnant.

I attempted to explain that these medications were not recommended during pregnancy and could result in a drug withdrawal syndrome in her newborn if she continued to take them during pregnancy. The patient was alarmed to hear this, but equally distressed about having to stop taking the medications. Unfortunately, this is not an uncommon situation.

Although I do have prescriptive privileges, I do not commonly prescribe drugs like oxycodone-acetaminophen unless a patient has just had a cesarean section. Being a midwife, I tend to rely on more natural methods of pain control. I am not trained in pain management and am wary of the growing number of opiate-addicted pregnant women.

I understand that for many practitioners, it is easier to start and continue to prescribe painkillers rather than deal with the complexities of pain or consider alternative methods of management. However, providers who hand out narcotics like candy need to be willing and prepared to support their patients through withdrawal.

It is irresponsible and unprofessional to assume that once a patient is pregnant, her pain management is the responsibility of the obstetric team.

I refuse to continue the cycle of narcotic abuse that has been started by another provider, particularly in a pregnant woman. I also freely admit I am not qualified to knowledgeably guide a patient through withdrawal.

I am thankful that I have a few excellent pain management physicians on speed-dial who can and will skillfully assist these patients with withdrawal and management of dependency. But the problem is widespread and serious.

No one is holding prescribing practitioners accountable for their irresponsible actions. Until they have consequences to face, nothing will change.

Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.

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