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What pain relief is safe in pregnancy?

Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 4 minutes read
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Pregnancy can be a tough time; it can bring on new muscle and ligament aches, backaches, and it can worsen headaches or migraines. It’s hard to know what pain relief is safe to reach for, so let’s talk you through what’s available to you, while keeping you comfortable and your baby healthy and happy.

The general rule of thumb is, don’t take anything unnecessarily. If your pain is mild and bearable, hold off on medication, especially in the first 12 weeks (first trimester). Try non-medicated solutions first, such as lying down in a dark room to help with a headache, having a warm bath or using a hot water bottle to relieve muscle aches.

Some medications are known to cause harm to your pregnancy and should be avoided. Other drugs may not have been through clinical trials on pregnant women, so there may be a theoretical risk, or they are not known to be either safe or harmful. Drug manufacturers usually err on the side of caution in saying their medication should be avoided during pregnancy. Thankfully, the Food and Drug Administration (FDA) has advised on what’s safe and what’s not. They stress that if you need to take pain medication, it should be at the lowest effective dose and for the shortest time possible.

The American College of Obstetrics and Gynecology (ACOG) also recognize that inadequate pain relief can carry a psychological and physical burden, causing anxiety and depression in a new mother and disrupting bonding with the baby. It may also prevent you from getting that all-important rest you need to revive.

What can I buy from the pharmacy?

Acetaminophen has an excellent safety profile and should be your go-to for pain relief should you need it. It is not known to be harmful in pregnancy to you or your baby if taken in doses advised on the pack.

Ibuprofen belongs to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs), which are not recommended beyond 30 weeks of pregnancy, as they can cause low levels of amniotic fluid and high pressure in your growing baby’s lungs. In the first trimester, NSAIDs may put you at risk of miscarriage, so they are only suggested if you are in severe pain, such as a severe migraine, and only after a discussion with your doctor about risk versus benefit.

You should be aware that some medicines available to buy over the counter contain multiple drugs. Cold and flu remedies often contain acetaminophen.

What can my doctor prescribe me?

Opioids are safe in pregnancy but should be given under the guidance of a doctor. These include codeine phosphate or hydrocodone, but these are only considered if acetaminophen has been ineffective or you are unable to take it. Stronger options include tramadol and morphine, if necessary and depending on the problem.

Are there any natural remedies?

A transcutaneous electrical stimulation (TENS) machine can be used as a battery-operated device on your back to relieve lower back ache and pelvic pain. This does not risk harm to your baby and is a popular and effective means of non-medicated pain relief.

Massage and aromatherapy should be used with caution. Although many expectant mothers feel reassured with the “natural” label, many of the oils contain essential oils, which are strong chemicals and not recommended during pregnancy. There may be other options, so visit a reputable practitioner who should be able to advise.

What can I take while breastfeeding?

Acetaminophen is safe during breastfeeding and should be your first choice if you need it. NSAIDs, including ibuprofen, are also safe to use during breastfeeding. According to the standard ladder of pain relief, these are usually second choice after acetaminophen has failed, and you can combine them if one or the other alone is not enough.

Codeine phosphate is available by prescription, but you should avoid it in breastfeeding, as small amounts can pass into breast milk and may rarely cause drowsiness and reduced breathing rate in your baby. Hydrocodone is a related pain reliever, and passes to breast milk and on to your baby, but you should only use it if you and your doctor feel it’s necessary. This is important, as it may be needed in the days immediately after delivery, in addition to acetaminophen and ibuprofen – your maternity team will be on hand to give you tailor-made advice.

Diclofenac, a stronger NSAID than ibuprofen, may be prescribed by your doctor if necessary and is not known to cause harm to your baby. Still, manufacturers suggest avoiding NSAIDs unless essential. The same caveat is true for tramadol, a stronger opioid than codeine, available on prescription and not known to be harmful, but manufacturers suggest avoiding it.

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This article has been written by UK-based doctors and pharmacists, so some advice may not apply to US users and some suggested treatments may not be available. For more information, please see our T&Cs.
Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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