Opioid-Free C-Sections Are Possible.

Dr. Richard Chudacoff
Headshot of Dr. Chudacoff: A white man with a grey beard and glasses, in a pink button down shirt, standing outside

April is Cesarean Awareness Month, bringing attention to cesarean section (C-section) deliveries in the United States. As an OB/GYN with over 30 years of experience, I have delivered thousands of babies via C-section. Several years ago, my labor and delivery nurses and I discovered an astonishing fact: opioids are not the only way to manage pain following a C-section. Knowing how addictive prescription opioids can be, and the unpleasant side effects that often come from these medications, we came upon a solution that effectively treats pain without using opioids. This was not just a professional victory, but a personal one as well.

As a physician, I’ve seen firsthand how addiction can overcome a person. What I never anticipated was that my own daughter would struggle with an opioid addiction.

My youngest daughter developed her addiction at just 15 years young. One morning while waiting for the school bus, a classmate shared his prescription opioids that were given to manage pain after a shoulder injury. That singular moment began my family’s decade long and heartbreaking struggle with addiction, recoveries and relapses. Like most parents who have dealt with a child’s addiction, my wife and I thought this could never happen to us. We learned that addiction does not discriminate. Addictions can happen to anyone, at any time, in every environment.

I deal with the opioid epidemic every day as an OB/GYN, a field where opioids were once considered the gold standard to treat pain after surgery. I see how freely and excessively opioids are prescribed to manage pain after C-sections and other women’s health surgeries. A 2017 report revealed that overprescribing opioids after surgery resulted in 3.3 billion unused pills flooding into our communities, making these drugs available for diversion and misuse. As a father whose daughter began using opioids from diverted pills, these numbers speak loudly to my core.

The surgical setting has become an unintentional gateway to opioid addiction and dependence. Research shows nearly 1-in-10 patients prescribed opioids to manage pain after surgery went on to persistent use of these medications, meaning they were still taking opioids three to six months after their procedure. For women, the risk runs even deeper. A National Institute on Drug Abuse report noted women are twice as likely as men to develop addiction and dependence to opioids, even when they are taken in smaller amounts for shorter periods of time.

My personal experience navigating addiction with a loved one has certainly affected the way I treat my patients, especially when it comes to prescribing opioids. Nine in 10 mothers have concerns about taking opioids during and after childbirth; therefore, providing alternatives is critical. Over the last few years, my colleagues and I started using non-opioid pain medications, including a long-acting local anesthetic injected during surgery to manage postsurgical pain. Since using this protocol, we have found that our patients are recovering faster, bonding better and breast feeding easier. Most importantly, they are not being exposed to the harmful side effects and downstream consequences of opioids, including addiction or dependence. This approach has allowed me to continue my campaign to eliminate or drastically reduce my patients’ opioid exposure, and it’s been very successful.

How do we get other surgeons to implement non-opioid approaches? Conversation and education have always been linchpins for change. My daughter and I recently had the opportunity to share our story as part of a documentary film titled GATEWAY that shines a light on the struggles that can be caused by legal opioid prescriptions when the dangers of these medications are not properly understood. The film features families impacted by opioid addiction that began with a prescription to manage pain after surgery, including a Shatterproof Ambassador who descended into addiction after receiving opioids to manage her C-section pain.

As healthcare professionals, we must educate ourselves on the dangers of opioids and the available non-opioid options to manage pain after surgery and encourage a dialogue with our patients about pain management. It’s also important that people who have struggled with substance use disorder understand there are alternatives available that do not include a reintroduction to opioids, in case of any surgeries or procedures they may face throughout their recovery. Any and all administrations of opioids to a person in recovery, even when they are asleep during surgery, can significantly increase their risk of relapse.

Today my daughter is in recovery, but she fights every day for her long-term sobriety. Her disease made me a better surgeon – encouraging me to seek out and utilize non-opioid medications that safely and effectively manage my patients’ pain without the added risks of addiction or dependence. This has fueled my passionate campaign for expanded awareness and utilization of these opioid-free pain management options.

Changes in my practice may have prevented other families from dealing with the opioid-induced havoc my family has suffered. Still, more than half of C-section patients are prescribed an opioid to manage pain and I know, as health care professionals, we can do better for our patients.

This Cesarean Awareness Month, I urge other OB/GYNs to review their pain management protocols and identify ways they can reduce or eliminate opioid prescribing in their practice. I also encourage mothers and mothers-to-be to have a conversation with their OB/GYNs about how they can manage pain with non-opioid medications and techniques following a planned or unplanned C-section procedure. If we can help prevent one person from experiencing addiction, we have made a positive impact on the opioid epidemic. As it has been written: “one who saves a life can be considered to have saved the world.”