Obstetric Physicians' Beliefs and Knowledge on Guidelines and Screening Tools to Reduce Opioid Use After Childbirth

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 137; no. 2; pp. 325 - 333
• Main Authors: Downs, Danielle Symons, Pauley, Abigail M., Leonard, Krista S., Satti, Mohamed, Cumbo, Nicole, Teti, Isabella, Stephens, Mark, Corr, Tammy, Roeser, Robert, Deimling, Timothy, Legro, Richard S., Pauli, Jaimey M., Mackeen, A. Dhanya, Bailey-Davis, Lisa
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-02-2021
• Subjects: Adult; Aged; Analgesics, Opioid; Delivery, Obstetric - adverse effects; Drug Prescriptions; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Pain Management - standards; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Physicians - psychology; Postpartum Period; Qualitative Research
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/AOG.0000000000004232

To examine obstetric physicians' beliefs about using professional or regulatory guidelines, opioid risk-screening tools, and preferences for recommending nonanalgesic therapies for postpartum pain management.
A qualitative study design was used to conduct semi-structured interviews with obstetric and maternal-fetal medicine physicians (N=38) from two large academic health care institutions in central Pennsylvania. An interview guide was used to direct the discussion about each physicians' beliefs in response to questions about pain management after childbirth.
Three trends in the data emerged from physicians' responses: 1) 71% of physicians relied on their clinical insight rather than professional or regulatory guidelines to inform decisions about pain management after childbirth; 2) although many reported that a standard opioid patient screening tool would be useful to inform clinical decisions about pain management, nearly all (92%) physician respondents reported not currently using one; and 3) 63% thought that nonpharmacologic pain management therapies should be used whenever possible to manage pain after childbirth. Key physician barriers (eg, lack time and evidence, being unaware of how to implement) and patient barriers (eg, take away from other responsibilities, no time or patience) to implementation were also identified.
These findings suggest that obstetric physicians' individual beliefs and clinical insight play a key role in pain management decisions for women after childbirth. Practical and scalable strategies are needed to: 1) encourage obstetric physicians to use professional or regulatory guidelines and standard opioid risk-screening tools to inform clinical decisions about pain management after childbirth, and 2) educate physicians and patients about nonopioid and nonpharmacologic pain management options to reduce exposure to prescription opioids after childbirth.