Remarks

• In making this recommendation, the Guideline Development Group (GDG) agreed perineal pain relief should be individualized, considering the presence of perineal trauma, 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. The use of single-dose paracetamol given to the woman in the immediate postnatal period is unlikely to pose any significant risk to the newborn as the amount likely to be excreted in breastmilk would be very little and the volume of breastmilk consumed by the infant in the first days after birth is likely to be small.
• Aspirin is contraindicated during breastfeeding based on evidence of potentially harmful effects on breastfeeding babies due to salicylate and salicylate metabolites excreted in breastmilk.
• All women should be advised about the use of local cooling as a non-pharmacological option to relieve acute pain from perineal trauma sustained during childbirth, based on availability and a woman’s preferences (see Recommendation 4 in this guideline).
• In acknowledgement of the limited evidence on the comparative effectiveness of different oral analgesics, the GDG suggested that when local perineal cooling or paracetamol is not effective in relieving perineal pain, women should be advised of other pharmacological pain relief options based on safety profile (e.g. allergies, adverse effects, contraindications), availability, experience with a particular analgesic and cost.
• All women should be asked about perineal pain and other perineal conditions (e.g. perineal trauma healing and haemorrhoids) during their postpartum stay in health facilities and at each postnatal care contact. Women should be advised on danger signs and symptoms, including any exacerbation of perineal pain as a manifestation of postpartum complications such as haematomas, haemorrhoids and infection.