Remarks

• In making this recommendation, the Guideline Development Group (GDG) agreed uterine pain relief should be individualized, considering the intensity of the pain, multiple sources of postpartum pain (e.g. perineal, uterine, breast pain), the use of the lowest effective dose for the shortest period of time, and adverse effects and contraindications, including breastfeeding.
• Aspirin is contraindicated during breastfeeding based on evidence of potentially harmful effects on breastfeeding babies due to salicylate and salicylate metabolites excreted in breastmilk.
• In acknowledgement of the limited evidence on the comparative effectiveness of different pharmacological and non-pharmacological interventions for postpartum uterine pain relief, the GDG suggested that women should be advised of different options based on safety profile (e.g. allergy, adverse effects, contraindications), availability, experience with a particular analgesic and cost.
• The GDG noted that use of opioids for the relief of pain due to uterine cramping should be discouraged as opioids showed no advantage over NSAIDs, are associated with maternal adverse effects, are contraindicated during breastfeeding and are associated with a risk of developing psychological and physical dependence.
• All women should be informed about uterine involution and changes in lochia postpartum. They should be asked about abdominal pain and vaginal discharge during their postpartum stay in health facilities and at each postnatal care contact. Women should be advised of danger signs and symptoms, including any exacerbation of uterine pain as a manifestation of postpartum complications such as endometritis.