Articles

Key takeaways

• Paracetamol is generally safe for pain relief throughout pregnancy and while breastfeeding.
• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen have pregnancy restrictions.
• Always check with your doctor, midwife, or pharmacist before taking any medication.
• Do not ignore severe pain; seek medical advice if it affects your daily life.

Pain during and after pregnancy

General pregnancy pain

It is very common to experience pain during pregnancy. Backache or back pain is often felt, especially in the early stages. The ligaments in your body soften and stretch to prepare for labour. This can strain the joints in your lower back and pelvis, causing pain.

Pelvic girdle pain

You might also experience pelvic girdle pain (PGP). Symptoms of PGP can include:

• A clicking or grinding feeling in your pelvic area.
• Limited and painful hip movement.
• Difficulty lying in certain positions, such as on your side.
• Pain during normal activities or during sex.

PGP symptoms can increase as your baby grows due to changes in your body's centre of gravity and posture. This condition is thought to be related to the effects of hormones, including relaxin, which softens ligaments and joints in preparation for birth. While PGP is common in pregnancy, it is a treatable condition, so you should seek help if you think you have it.

Postpartum pain and recovery

After giving birth, you may have some tummy pain and cramping. This is due to your womb (uterus) contracting and returning to its normal size. These pains usually last for two or three days. They may feel worse when you are breastfeeding because of the hormones your body makes.

Many women also experience discomfort from perineal soreness or after a Caesarean (C-section). If you have a C-section your wound may feel sore and bruised afterwards. Most women experience some discomfort for the first few days, and for some, it can last several weeks.

Your midwife or doctor will tell you what pain relief medicines you can take after a C-section. It is important to take them regularly and as directed. If you are still experiencing pain despite taking pain relief, speak to your midwife or GP.

Pain relief medicines

During pregnancy

Paracetamol is generally considered safe throughout pregnancy and postpartum. It is often the first choice for mild to moderate pain. Always follow the dosage instructions on the packet. Some paracetamol products also contain caffeine. Caffeine passes into breast milk and could make your baby restless or keep them awake. The NHS suggests you should not have more than 200 mg of caffeine per day while breastfeeding.

Ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) are generally not recommended after 20 weeks of pregnancy. This is because they can affect the baby's heart and kidneys. Always consult your doctor or midwife before taking ibuprofen during pregnancy. Additionally, ibuprofen may not be suitable if you have a history of stomach ulcers or asthma. Always talk to your doctor or pharmacist if you have these conditions.

Breastfeeding

Paracetamol and ibuprofen can usually be taken at their usual recommended doses if you are breastfeeding. Only very small amounts pass into breast milk. Ibuprofen may also help reduce pain and swelling after birth.

You can take paracetamol and ibuprofen together while breastfeeding, provided you do not exceed the recommended daily dose of either medicine. Always read the instructions on the packaging and check the ingredients of any medicine you take, including combination products.

Stronger pain relief medicines may also be suitable while breastfeeding, but these should only be taken if recommended by a healthcare professional. Monitor your baby for any possible side effects and seek advice if you have concerns.

Aspirin

Aspirin is not usually recommended if you are breastfeeding. This is because of a possible link between aspirin and Reye's syndrome, a rare but serious condition that causes swelling in the liver and brain in children. Although the risk is very low, other pain relief options are available and generally preferred. If you take a single dose of aspirin by mistake, you can continue breastfeeding. However, you should avoid taking any more doses.

Diclofenac

Diclofenac is considered compatible with breastfeeding and only small amounts pass into breast milk. It has a short duration of action. Topical forms, such as gels and eye drops, are also safe while breastfeeding. Diclofenac may not be suitable for people with certain long-term conditions, including heart disease, diabetes, or high cholesterol.

Celecoxib

Celecoxib is an anti-inflammatory medicine. Very small amounts are thought to pass into breast milk, and no harmful effects are expected. However, there is less evidence compared with other NSAIDs. As with other NSAIDS, it may be combined with medicines that reduce stomach acid, such as omeprazole, which is safe to take while breastfeeding.

Other NSAIDs

Naproxen and indomethacin stay in your body for longer than diclofenac, and are not usually the first choice of NSAIDs while breastfeeding. This is particularly important if your baby is newborn or premature, due to the risk of side effects.

However, they may be used with caution if alternatives are not suitable. If your baby develops symptoms such as an upset stomach, vomiting, or diarrhoea, speak to your doctor, health visitor, or pharmacist.

Opioids

Opioids include medicines such as codeine, dihydrocodeine, morphine, tramadol, and oxycodone. They are used for moderate to severe short-term pain and can provide effective relief when other painkillers are not enough. They should be used at the lowest effective dose for the shortest time possible, as there is limited evidence of benefit for long-term pain.

When considering opioids while breastfeeding, your doctor will consider the type of opioid, the level of pain, and your baby’s health. Other pain relief options are usually tried first, but effective pain control is important, and opioids may sometimes be the most appropriate choice.

All opioids can cause side effects, and the risk increases with higher doses. They can also be habit-forming, although addiction is rare when used for short-term pain under medical supervision. You should avoid taking opioids for more than three days without medical advice.

Possible side effects include drowsiness, dizziness, or confusion. If you experience these, take extra care when caring for your baby. Medicines that cause drowsiness can also make bed-sharing less safe.

Only small amounts of opioids pass into breast milk, but in some cases they may cause side effects in the baby. Seek medical advice if you notice unusual sleepiness, feeding difficulties, or breathing concerns.

When to seek medical advice

It is important to speak to your doctor about treatment options if your pain is affecting your quality of life or sleep. You should always talk to your doctor if you need to take NSAIDs like ibuprofen after 20 weeks of pregnancy.

Codeine and dihydrocodeine can be used throughout pregnancy if your doctor prescribes them. This is usually if other treatment options have not worked or are unsuitable.

If you need treatment with a group of painkillers used for severe pain (opiates or opioids) during pregnancy, you will usually be cared for by a specialist doctor, such as an obstetrician.