Minimizing Genital Tract Trauma and Related Pain Following Spontaneous Vaginal Birth

Leah L. Albers, CNM, DrPH; Noelle Borders, CNM, MSN


J Midwifery Womens Health. 2007;52(3):246-253. 

In This Article

Analgesia for Perineal Pain

Treatment of perineal pain after childbirth has received surprisingly little research attention, given the large number of women affected. Two Cochrane reviews have found that therapeutic ultrasound[41] and topical analgesics[42] are not harmful, but neither demonstrated any compelling benefits. Oral ibuprofen has been compared with acetaminophen with codeine in one randomized trial.[43] Women were randomized to receive 400 mg of ibuprofen or 600 mg of acetaminophen with 60 mg of codeine and 15 mg of caffeine (Tylenol #3; Ortho-McNeil Pharmaceutical, Raritan, NJ). These 233 new mothers who had episiotomies or third- or fourth-degree lacerations rated their pain relief as equivalent in the first 24 hours after birth, but the women in the ibuprofen group had fewer drug-related side-effects. Finally, a Cochrane review assessed rectal analgesia to treat postdelivery perineal pain.[44] Nonsteroidal anti-inflammatory drug suppositories conferred more pain relief than placebo in the first 2 days after birth in women who had episiotomies or second-degree lacerations. The rectal route may allow faster pain relief than oral administration without side-effects, but its acceptability to women outside of research settings is not known.


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