Loading ...

TOPLINE:

Opioid prescriptions after vaginal births showed substantial variation at the hospital level. Associated procedures such as operative vaginal birth and severe lacerations were linked to higher odds of receiving an opioid prescription at discharge.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using registry data from a quality improvement collaborative of 67 hospitals in Michigan.
• A total of 14,690 adult patients (average age, 26.8 years; 64.5% non-Hispanic White) who had never used opioids, were nulliparous, and had singleton vertex vaginal births at term between January and October 2023 were included. Among them, 7.2% had operative vaginal births, and 4.9% had third- or fourth-degree lacerations.
• Outcome measures were the proportion of patients receiving opioid prescriptions at discharge documented in electronic health records and the amount of opioids in oral morphine equivalents (OMEs) among those who received the prescriptions.
• Additionally, variation in opioid prescribing rates and prescription amounts by procedure type and hospital was assessed.

TAKEAWAY:

• Overall, 1.8% of patients received an opioid prescription after vaginal birth. Patients who underwent operative vaginal birth had higher odds of receiving an opioid prescription at discharge than those who did not undergo associated procedures (adjusted odds ratio [aOR], 3.05; 95% CI, 2.11-4.41).
• Patients with third- or fourth-degree lacerations also had higher odds of receiving an opioid prescription at discharge (aOR, 11.18; 95% CI, 8.36-14.94).
• Median prescription amounts in OMEs were higher for operative vaginal births (75 OMEs) than for third- or fourth-degree lacerations (50 OMEs) and vaginal births without associated procedures (60 OMEs; P = .013).
• Nearly half of hospitals (47.8%) did not prescribe opioids to any patients for vaginal births, with similar patterns observed for associated procedures: 61.5% vs 43.9% for operative vaginal births vs third- or fourth-degree lacerations. The percentage of patients receiving opioid prescriptions varied by the type of birth: 0%-35% for vaginal births without associated procedures, 0%-50% for operative vaginal births, and 0%-66.7% for third- or fourth-degree lacerations.

IN PRACTICE:

“Given the variation seen in prescription patterns, more robust data are needed to understand the hospital-level drivers of variation in opioid prescribing practice and to inform new guidelines that promote adequate pain control and minimize overprescribing,” the authors of the study wrote.

SOURCE:

The study was led by Kyle R. Latack, MD, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan. It was published online on May 28, 2026, as a research letter in Obstetrics & Gynecology.

LIMITATIONS:

The study did not include information on how much opioid and nonopioid medication patients used while in the hospital or after they were discharged, or their reported pain scores.

DISCLOSURES:

The study received support from the FDA of the US Department of Health and Human Services as part of a financial assistance award. Support for the Obstetrics Initiative was provided by Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network as part of the BCBSM Value Partnerships program. One author disclosed being a paid consultant for Maven Clinic and Mirvie and receiving research support from Pulsenmore. Another author disclosed being a paid consultant for RAND and the Society of Family Planning.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.