Dr. Cynthia English, OB/GYN, On How Non-Opioid Options Can Improve C-Section Recovery

Women make over 80% of the healthcare decisions in the United States alone, which means they have a tremendously powerful voice to make change happen. It starts with having the knowledge, perspective, and confidence to address important issues that could not only affect them personally, but millions of other women as well. 

One specific area that women often gloss over when it comes to making decisions about their health is pain management – especially following surgery and childbirth. While women proactively plan for nearly every aspect of their labor and delivery, they often miss a key component that can actually improve their recovery experience – especially after cesarean sections (C-section) – and that’s discussing how their pain will be managed. This is surprising, because a recent survey found that 96% of women are motivated to return home and get back to their daily routine after surgery and nearly 84% of women have concerns related to being prescribed or taking opioids.  In addition women appear to be at greater risk of transitioning to persistent opioid use than men, 40% more women than men become persistent users.

We had the opportunity to chat with Dr. Cynthia English, OB/GYN, about the importance of advocating for non-opioid pain management options and how these treatments can change – and even improve – the way we bounce back from common surgical procedures like C-sections.  

Can You Share a Little Background on Yourself?

I am a board-certified OB/GYN at Fort Worth Obstetrics & Gynecology in Fort Worth, Texas. I completed medical school at the University of North Texas Health Science Center-Texas College of Osteopathic Medicine and residency at Texas Tech University Health Science Center in Amarillo. Throughout my career, I have received numerous awards, including the Patients Choice Award and was voted a Top Doctor by peers as seen in Fort Worth Magazine. 

As a mother of two, I am an advocate for early prenatal care, which includes providing access to the most advanced and up to date services, while being an active participant in helping to educate my patients throughout their healthcare journey. One of my passion points is ensuring that my patients are aware of all their pain management options, especially non-opioids, as recent innovations in this area have proven to enhance a patient’s overall recovery process.  

What Can Expecting Mothers Anticipate if They Need a C-Section?

A C-section is the delivery of a baby through incisions in the mother's abdominal wall and uterus. While C-sections are very common – more than 30% of babies are delivered this way – it is considered a major surgery. Whether planned or not, the procedure can take anywhere from 25-60 minutes and many patients can expect to spend two to three days in the hospital post-procedure as it takes longer to recover from a C-section than a vaginal birth.  

It is important to note that postpartum care doesn’t end once the new mother leaves the hospital. In fact, the American College of Obstetricians and Gynecologists (ACOG) recommends that postpartum care be an ongoing process and patients should check in with their provider within the first three weeks. Many new mothers may experience cramping, fatigue, weakness, and other side effects – especially if they’re prescribed opioids, which can hinder their ability to be present with their newborn. It is important that patients continue to speak with their provider about all their symptoms once they are home. 

What Options Are Available for Pain Management?

Opioids are routinely prescribed to new mothers to manage pain after surgery even though they can delay recovery and have also been shown to impact a mother’s ability to breastfeed. For new mothers who are intending to breastfeed, the transfer of opioids through breast milk should also be considered.  The physical properties of opioids allow for transfer into the breast milk which is a concern for many mothers.  FDA warning label was issued stating not to breastfeed while using codeine or tramadol due to infant opioid overdose risk.  Thankfully, there are non-opioid options available that can reduce the common side effects – constipation, dizziness, dependence, etc. – of opioids and provide effective pain control that allows for  new mothers to return to their “new normal” quicker.

In my practice, I have found success with a non-opioid option called EXPAREL® (bupivacaine liposome injectable suspension), which is a long-acting numbing medication that is injected into the surgical site. As it slowly releases over time, it provides effective pain relief for the first few days following your C-section, when pain is often at its worst.  

How Has EXPAREL Impacted Your Patients Recovery Process? 

Implementing EXPAREL into my pain management protocol for C-sections, hysterectomies, and all gynecological procedures has helped my patients get home sooner, experience less pain, and have a better recovery overall. This non-opioid option has allowed my C-section patients to be up and moving in about six hours, eating, and engaging with their newborn. In fact, this option has allowed about one-third of my patients to be completely opioid-free, and we’ve seen an approximate 70% reduction in opioid prescribing overall.

When Should New Mothers Reach Out for Additional Pain Management Support After a C-Section? 

While all patients experience pain differently and discomfort is expected, patients shouldn’t be in excruciating pain. Most of my patients have reported that their pain is appropriately managed since I began using a multimodal approach, which includes a variety of non-opioid options. For example, EXPAREL works to reduce pain for up to three days post procedure. After that, many patients can reduce and/or eliminate any existing pain with over-the-counter medications like acetaminophen or ibuprofen. In fact, using this method has allowed many of my patients to experience opioid-free procedures. 

If patients are still experiencing pain, they should speak with their provider about additional pain management options. 

Why Is It Important for Providers and Patients to Work Together on A Pain Management Plan?

Recent data from the Centers for Disease Control and Prevention (CDC) shows that there were over 100,000 drug overdose deaths in the U.S. during the 12-month period ending in April 2021. Armed with these startling statistics, I believe it is imperative that patients and providers discuss postsurgical pain management options during the surgical consultation. Although non-opioid options have been found to reduce the hospital stay for mothers, only 26% of women discussed these options prior to surgery. Below are a few questions patients can ask their provider prior to delivery to better understand how their pain will be managed:

• How much pain is associated with this procedure?

• What is expected of me after I deliver my newborn (what activities will I be expected to do) and for how long should I be experiencing pain?

• What non-opioid options are available for this procedure?

• In addition to non-opioid options, what additional over-the-counter options can help alleviate pain?

• When I return home, what restrictions do I have/what guidelines should I follow? 

Implementing options like EXPAREL into a patient’s individualized pain management plan can help enhance their recovery while also ensuring that their recovery expectations and goals are being met. I urge patients to start these conversations and visit WeAreWomensHealth.com to learn more about non-opioid options like EXPAREL.

Full Prescribing Information is available at www.EXPAREL.com.

This article is sponsored by Pacira BioSciences, Inc.

Indication

EXPAREL® (bupivacaine liposome injectable suspension) is indicated for single-dose infiltration in patients aged 6 years and older to produce postsurgical local analgesia and in adults as an interscalene brachial plexus nerve block to produce postsurgical regional analgesia. Safety and efficacy have not been established in other nerve blocks.

Important Safety Information

EXPAREL should not be used in obstetrical paracervical block anesthesia.

In studies in adults where EXPAREL was injected into a wound, the most common side effects were nausea, constipation, and vomiting.

In studies in adults where EXPAREL was injected near a nerve, the most common side effects were nausea, fever, and constipation.

In the study where EXPAREL was given to children, the most common side effects were nausea, vomiting, constipation, low blood pressure, low number of red blood cells, muscle twitching, blurred vision, itching, and rapid heartbeat.

EXPAREL can cause a temporary loss of feeling and/or loss of muscle movement. How much and how long the loss of feeling and/or muscle movement depends on where and how much of EXPAREL was injected and may last for up to 5 days.

EXPAREL is not recommended to be used in patients younger than 6 years old for injection into the wound, for patients younger than 18 years old for injection near a nerve, and/or in pregnant women.

Tell your health care provider if you or your child has liver disease, since this may affect how the active ingredient (bupivacaine) in EXPAREL is eliminated from the body.

EXPAREL should not be injected into the spine, joints, or veins.

The active ingredient in EXPAREL can affect the nervous system and the cardiovascular system; may cause an allergic reaction; may cause damage if injected into the joints; and can cause a rare blood disorder.

Full Prescribing Information is available at www.EXPAREL.com.