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Opioid prescription-use after cesarean delivery: an observational cohort study



To evaluate current opioid prescription practices following a cesarean delivery.


Women were asked to participate in a prospective observational cohort study following a cesarean delivery. Participants were asked about their opioid use after discharge, amount leftover, subjective pain score, and satisfaction.


A total of 344 women had cesarean deliveries during the study period, 242 were approached, 171 met eligibility criteria, and 109 were included in the analysis. Women in our study were predominantly African American (66.1%), high school graduates (32.1%), publicly insured (65.1%), single (55%) working mothers (68.8%). Most had been previously prescribed opioids (70.6%), of which 58.4% had a prior cesarean delivery. Only 78.8% of study participants took their opioid prescriptions, and 89.6% had an average of 17 pills leftover. The number of pills taken correlated with those prescribed in the study. Improved satisfaction in pain control with opioid and non-opioid alternatives was associated with a decrease in opioids used. Similarly, the participants’ perception of their abundant prescription quantity was associated with a decrease in prescription taken.


Women were prescribed excess opioids. Excess opioids accounted for 63.3% of all pills filled, a total of 1670 pills leftover, most of which were stored in an unlocked location (75.6%). Our data showed a discrepancy of pills prescribed (24) compared to those used (10), which was also perceived as enough or too many by our participants. Our study demonstrates that women would benefit from fewer opioid pills and a discussion based on their pain perception.

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  1. 1.

    Shah A, Hayes CJ, Martin BC. Characteristics of Initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017;66(10):265–9.

    Article  Google Scholar 

  2. 2.

    Osmundson S, Wiese AD, Min JY, Hawley RE, Patrick SW, Griffin MR, Grijalva CG. Delivery type, opioid prescribing, and the risk of persistent opioid use after delivery. Am J Obstet Gynecol. 2019;220(4):405–7.

  3. 3.

    Badreldin N, Grobman WA, Chang KT, Yee LM. Opioid prescribing patterns among postpartum women. Am J Obstet Gynecol. 2018;219(1):103.e1-103.e8.

    Article  Google Scholar 

  4. 4.

    Bateman BT, Franklin JM, Bykov K, Avorn J, Shrank WH, Brennan TA, Landon JE, Rathmell JP, Huybrechts KF, Fisher MA, Choudhry NK. Persistent opioid use following cesarean delivery: patterns and predictors among opioid-naïve women. Am J Obstet Gynecol. 2016;215(3):353.e1-353.e18.

  5. 5.

    Osmundson SS, Schornack LA, Grasch JL, Zuckerwise LC, Young JL, Richardson MG. Postdischarge opioid use after cesarean delivery. Obstet Gynecol. 2017;130(1):36–41.

    Article  Google Scholar 

  6. 6.

    Schmidt P, Berger MB, Day L, Swenson CW. Home opioid use following cesarean delivery: how many opioid tablets should obstetricians prescribe? J Obstet Gynaecol Res. 2018;44(4):723–9.

    CAS  Article  Google Scholar 

  7. 7.

    Bateman BT, Cole NM, Maeda A, Burns SM, Houle TT, Huybrechts KF, Clancy C,Hopp S,EckerJ, Ende H, Grewe K, Corradini BR, Schoenfeld RE, Sankar K, Day LJ, Harris L, Booth JL, Flood P, Bauer ME, Tsen LC, Landau R, Leffert LR. Patterns of opioid prescription and use after cesarean delivery. Obstet Gynecol. 2017;130(1):29–35.

  8. 8.

    Osmundson SS, Raymond BL, Kook BT, Lam LA, Thompson EB, Schornack LA, Voorhees C, Richardson M. Individualized compared with standard postdischarge oxycodone prescribing after cesarean birth: a randomized controlled trial. Obstet Gynecol. 2018;132(3):624–30.

  9. 9.

    Osmundson SS, Raymond BL, Kook BT, Lam LA, Thompson EB, Schornack LA, Voorhees C, Richardson M. Racial disparities across provider specialties in opioid prescriptions dispensed to Medicaid beneficiaries with chronic noncancer pain. Pain Med. 2015;16(4):633–40.

    Article  Google Scholar 

  10. 10.

    Badreldin N, Groban W, Yee L. Racial disparities in postpartum pain management. Obstet Gynecol. 2019;134(6):1147–53.

    Article  Google Scholar 

  11. 11.

    Johnson J, Asiodu I, McKenzie C, Tucker C, Tully K, Bryant K, Verbiest S, Stuebe A. Racial and ethnic inequities in postpartum pain evaluation and management. Obstet Gynecol. 2019;134(6):1155–62.

    Article  Google Scholar 

  12. 12.

    Baruch AD, Morgan DM, Dalton VK, Swenson C. Opioid prescribing patterns by obstetrics and gynecology residents in the United States. Subst Use Misuse. 2018;53(1):70–6.

    Article  Google Scholar 

  13. 13.

    Madsen AM, Stark LM, Has P, Emerson JB, Schulkin J, Matteson KA. Opioid knowledge and prescribing practices among obstetrician-gynecologists. Obstet Gynecol. 2018;131(1):150–7.

    Article  Google Scholar 

  14. 14.

    Peahl AF, Dalton VK, Montgomery JR, Lai Y-L, Hu HM, Waljee JF. Rates of new persistent opioid use after vaginal or cesarean birth among US women. JAMA Netw Open. 2019;2(7):e197863.

    Article  Google Scholar 

  15. 15.

    Bateman BT, Hernandez-Diaz S, Rathmell JP, Seeger JD, Doherty M, Fischer MA, Huybrechts K. Patterns of opioid utilization in pregnancy in a large cohort of commercial insurance beneficiaries in the United States. Anesthesiology. 2014;120(5):1216–24.

  16. 16.

    Pfuntner A, Wier LM, Stocks C. Most frequent procedures performed in U.S. hospitals, 2010: statistical brief #149. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality (US). 2006.

  17. 17.

    Prabhu M, Dolisca S, Wood R, James K, Bateman BT, Barth WH, Wylie BJ. Postoperative opioid consumption after scheduled compared with unscheduled cesarean delivery. Obstet Gynecol. 2019;133(2):354–63.

  18. 18.

    Holland E, Bateman BT, Cole N, Taggart A, Robinson LA, Sugrue R, Xu X, Robinson JN. Evaluation of a quality improvement intervention that eliminated routine use of opioids after cesarean delivery. Obstet Gynecol. 2019;133(1):91–7.

  19. 19.

    Prabhu M, Dubois H, James K, Leffert LR, Riley LE, Bateman BT, Henderson M. Implementation of a quality improvement initiative to decrease opioid prescribing after cesarean delivery. Obstet Gynecol. 2018;132(3):631–6.

  20. 20.

    Strulov L, Zimmer EZ, Granot M, Tamir A, Jakobi P, Lowenstein L. Pain catastrophizing, response to experimental heat stimuli, and post-cesarean section pain. J Pain. 2007;8(3):273–9.

    Article  Google Scholar 

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This work did not receive any financial contributions.


There was no funding for this study.

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Corresponding author

Correspondence to Katrina Mark.

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The authors report no conflict of interest.

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IRB approval/exemption was obtained through the University of Maryland School of Medicine.

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Informed consent was waived as the study was determined to be exempt.

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Avalos, C., Razzolini, G.D., Crimmins, S. et al. Opioid prescription-use after cesarean delivery: an observational cohort study. J Anesth (2021).

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  • Cesarean section
  • Opiates
  • Pregnancy
  • Prescribing