Why have I been given this leaflet?
This information is for patients discharged after giving birth. You have been given this leaflet because it contains useful information about some of the medicines that you may be discharged with or advised to take following the birth of your baby.
It helps you understand the medication that is available to you, how to effectively use them, explain some of the common side effects associated with them and their safety around breastfeeding.
Find information below on:
Pain relief
Iron supplementation
Venous thromboembolism (VTE) prophylaxis
Constipation and laxatives
If you have any further questions or concerns, please do not hesitate to ask your midwife, doctor or pharmacist for advice.
General advice about your medication:
Always keep medication out of the reach of children.
Do not let anyone else take medication that is prescribed for you.
Do not take medication that has been prescribed for someone else.
Keep all your medication in the original containers.
If you suffer any unpleasant side effects from your medication, speak to your doctor/midwife/pharmacist.
Always read the information leaflet provided with each newly prescribed medication.
Inform your midwife, doctor, or pharmacist if you start a new medication whilst pregnant or breastfeeding.
Always read the information leaflet provided with each newly prescribed medication.
Pain relief after giving birth.
Why do I need pain relief after giving birth?
It is normal to experience discomfort after giving birth, therefore it is important to make sure you have enough of a supply of commonly used pain relief medication at home, such as paracetamol and ibuprofen. If, at the time of discharge, you require alternative or additional pain relief then these will be prescribed and supplied to you when you are discharged from hospital.
What pain relief can I take after giving birth?
Paracetamol
What is paracetamol?
Paracetamol is a medication that is used to relieve both pain and fever.
Where can I get a supply of paracetamol?
This medication is available to buy over the counter in pharmacies or supermarkets and will not be supplied by the ward on discharge.
What dose of paracetamol shall I take for my pain?
Each paracetamol tablet contains 500mg. The usual dose to take is one or two tablets (500mg to 1gram) four times a day as required. You should not take more that more than 4g (8 tablets) in 24 hours.
Your doctor or midwife may advise you to take 1gram (2 tablets) of paracetamol four times a day regulaty until your pain in controlled, and then you can go back to taking tas required.
Paracetamol can be taken together with ibuprofen or alternating the two until your pain is controlled.
What should I do if I take more than 4 grams of paracetamol in 24hours?
If you do take more than 4g in 24 hours you should seek medical help via 111.
How should I take paracetamol tablets?
The tablets should be taken with water, leaving at least four hours between each dose. After giving birth you may need to take paracetamol regularly for a few days but as the pain settles, take only as much as you need to relieve your symptoms without exceeding the daily dose.
Can I take paracetamol with other paracetamol containing products, such as cold & flu medication?
It is important that you do not take any other medication that contains paracetamol alongside your paracetamol. For instance, cold and flu medications as these also contain paracetamol.
Always speak to you pharmacist or midwife if in doubt.
Is paracetamol safe during breastfeeding?
It is considered safe to take paracetamol whilst you are breastfeeding.
What are the side effects of paracetamol?
Paracetamol is generally well tolerated but if you experience any unusual side effects speak to your pharmacist.
Ibuprofen
What is ibuprofen?
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) and is used to treat inflammation in a variety of conditions, including pain associated with injury.
Where can I get a supply of Ibuprofen?
This medication is available to buy over the counter in pharmacies or supermarkets and will not be supplied by the ward on discharge.
Can I take ibuprofen?
If you have any of the following conditions you should speak to your doctor/midwife/pharmacist before taking ibuprofen:
Asthma/breathing problems.
Previous stomach ulcer.
Previous reaction to aspirin, ibuprofen, or other non-steroidal anti-inflammatory drug.
Other medical conditions such as kidney disease, heart disease, blood clotting disorders, liver disease.
What dose of ibuprofen shall I take for my pain?
Ibuprofen tablets are available as 200mg tablets and 400mg tablets. The usual dose is 200mg to 400mg three times a day with or after food (if possible), as required. Do not take more than 1200mg in 24 hours.
After caesarean section: Your doctor or midwife may advise you to
take ibuprofen 400mg four times a day (1600mg in 24 hours) for a short period of time of up to 3 days and then to reduce the dose to the above recommended doses depending on your pain at discharge. Do not take these doses for a long period of time.
What should I do if I take more than the recommended dose of ibuprofen in 24hours?
Your doctor may recommend you take up to 1600mg in 24 hours for a short period of time but once your pain is under control you can go back to taking the usual dose as required.
If you do take more than 1600mg in 24 hours you should seek medical help via 111.
How should I take ibuprofen tablets?
The tablets should be swallowed whole with a glass of water. If possible, take the tablets with or after food.
Can I take Ibuprofen with other medication?
Ibuprofen should not be taken alongside aspirin without advice from your doctor/pharmacist/midwife. Ibuprofen should not be taken with other NSAIDs, such as diclofenac or naproxen.
Is ibuprofen safe during breastfeeding?
Ibuprofen is the non-steroidal anti-inflammatory medication of choice during breastfeeding. Very small amounts do pass into breastmilk but are too low to be of any concern to your breast-fed baby. If you are concerned about any unusual signs or symptoms in your baby, such as diarrhoea and vomiting then contact your midwife for advice.
What are the side effects of Ibuprofen?
Common side effects include headache, dizziness, feeling sick and diarrhoea.
Stop taking Ibuprofen and seek immediate medical help if you:
- Pass blood in your faeces (stools/bowel motions)
- Pass black tarry stools.
- Vomit any blood or what looks like coffee grounds.
- Suffer an allergic reaction, such as dizziness, itching, swelling of the lips, face, tongue that may cause problems with breathing or swallowing.
Dihydrocodeine
What is dihydrocodeine?
Dihydrocodeine is an opioid pain medication used for the relief of moderate pain. It is usually recommended for patients who do not have adequate pain relief despite taking paracetamol and ibuprofen regularly or for people who are likely to have severe pain after giving birth.
What should I be aware of before I start taking dihydrocodeine?
If you are breastfeeding your baby, it is important to know that there is no published evidence to confirm its safety or the amount present in milk. However, based on the science of this medication, it is expected to pass into breast milk, but in small amounts.
It is also important to note that dihydrocodeine has been frequently used safely by those breastfeeding for short term use only, with close monitoring of your baby.
If you have been prescribed dihydrocodeine for use after birth of your baby and you are breastfeeding, it is important that you watch your baby for the following signs and symptoms. Please inform your midwife, doctor, or pharmacist immediately if your baby has:
- Signs of drowsiness
- Difficulty feeding
- Breathing problems
- Or anything else unusual
Some babies may be more sensitive than others to the side effects of dihydrocodeine and you may be advised to stop taking it.
It is also important to know that dihydrocodeine may cause you to experience dizziness and drowsiness. Therefore, care should be taken when caring for your baby if you experience these side effects. As these medications can affect your ability to stay alert and care for your baby, caution should be taken particularly in sleep settings. Please be aware that falling asleep whilst holding your baby can be dangerous. Do not drink alcohol while you are taking dihydrocodeine.
Co-sleeping with your baby is very dangerous if you have taken any drugs or medication that make you feel sleepy.
Why have I been prescribed dihydrocodeine?
Dihydrocodeine is used for the relief of moderate pain in patients who are not responding to regular paracetamol and/ or ibuprofen.
Where can I get a supply of dihydrocodeine?
Dihydrocodeine can only be obtained from a pharmacy with a valid prescription. If after giving birth your doctor or midwife feel that dihydrocodeine is needed for discharge, this will be supplied on discharge from hospital.
We will only supply enough dihydrocodeine to last you 3 days. If you are still experiencing moderate to severe pain after discharge, contact you midwife or doctor for advice.
What dose of dihydrocodeine shall I take for my pain?
Dihydrocodeine comes as 30mg tablets. The usual dose is 30mg (1 tablet) four times a day when required. Make sure there is a gap of 6 hours between doses. You may be advised to take the dihydrocodeine in addition to regular paracetamol for a short period.
Can I use dihydrocodeine whilst breastfeeding?
Dihydrocodeine can be used with caution during breastfeeding for a short period of time, assuming your baby was born at term and is well.
What are the side effects of dihydrocodeine?
These are just some of the side effects that you may experience whilst taking dihydrocodeine; drowsiness, dizziness (do not drive if you experience these side effects) constipation, dry mouth, nausea, vomiting, palpitations. It is important to understand that side effects of medication affect some people more than others. For more information, please refer to the manufacturer's patient information leaflet that has been supplied with your medicines.
What should I do if I am still in pain?
Different people experience pain differently. There may be some people who need more pain relief than others. If after 3 days you are still experiencing pain, contact your midwife for advice.
How can I get the best out of all my pain relief?
- Take paracetamol and/or ibuprofen at regular intervals in the first two or three days after leaving hospital. Taking them regularly for the first few days after giving birth helps to keep on top of the pain better.
- Paracetamol and ibuprofen can be taken safely together if needed or by alternating between them, making sure you do not go over the recommended daily doses of each.
- If you have been discharged with a course of dihydrocodeine, paracetamol and ibuprofen can be taken in combination with the dihydrocodeine when needed.
Enoxaparin for venous thromboembolism (VTE) prophylaxis
What is venous thromboembolism (VTE)?
Venous thromboembolism (VTE) is a term used to describe a deep Vein thrombosis (DVT) and pulmonary embolism (PE).
A deep vein thrombosis is a clot that develops in the vein that runs along your calf or thigh. A pulmonary embolism is when a deep vein clot detaches itself from a vein and travels to the lungs, which can interrupt blood flow through the heart and lungs, which can lead to death. VTE is a major cause of maternal deaths in the UK.
What signs and symptoms should I watch out for VTE?
VTE is a serious condition which may cause severe pain, swelling, skin changes, shortness of breath and sudden collapse.
What is enoxaparin?
Enoxaparin is an anticoagulant medication that is used to reduce the risk of developing blood clots in your body. It works by thinning your blood.
Your doctor has recommended that you take a medicine called enoxaparin to reduce your risk of blood clots.
Why do I need to take enoxaparin?
Your doctor has prescribed you a course of enoxaparin to reduce your risk of developing a clot after giving birth. Some people have a higher risk than others at developing clots, and this is assessed on an individual basis. Your midwife will go through some of the reasons that have put you at an increased risk.
What dose of enoxaparin should I take?
Your midwife will advise of the dose of enoxaparin that you will receive.
How do I administer enoxaparin?
Enoxaparin is given by injection. Your midwife will show you how to inject the medicine before you go home. We have outlined the steps below to remind you if you need them. You will also be provided with the manufacturers leaflet for instruction.
How to inject enoxaparin:
- Wash your hands with soap and water and dry them before injecting your enoxaparin dose.
- Sit or lie in a comfortable position so you are relaxed and can see the place you are going to inject (choose an area on the right or left side of your stomach at least 5 cm away from your belly button).
NOTE: Do not inject yourself within 5 cm of your belly button or around existing scars or bruises.
Remember: Change the place where you inject between the left and right sides of your stomach, depending on the area that was last injected.
- Remove the plastic blister pack containing the pre-filled syringe from the box.
- Open the blister pack and remove the pre-filled syringe.
- Pull off the needle cap. Try not to bend the needle. Don't let the needle touch anything (to keep it clean).
- Hold the syringe in the hand you write with (like a pencil) and with your other hand, gently pinch the cleaned area of your abdomen between your forefinger and thumb to make a fold in the skin. Make sure you hold the skin fold throughout the injection.
- Hold the syringe so that the needle is pointing downwards (vertically at a 90° the skin fold. angle). Insert the full length of the needle into 8. Press down on the plunger with your thumb. This will inject the medicine into the fatty tissue of the abdomen. Make sure you hold the skin fold throughout the injection.
- Remove the needle by pulling it straight out. Do not release the pressure on the plunger!
- Push down on the plunger until it clicks. This releases the protective needle cover, and it will completely cover the needle.
- To avoid bruising, do not rub the injection site after you have injected yourself
How should I dispose of my used enoxaparin injections?
Drop the used syringe into the sharps container provided by your midwife at discharge.
Close the container lid tightly and place the container out of reach of children.
When the container is full, dispose of it as your doctor or pharmacist has instructed. Do not put it in the household rubbish.
What should I do if I forget a dose?
If you forget to give yourself a dose of enoxaparin, have it as soon as you remember. Do not give yourself a double dose on the same day to make up for a forgotten dose. Keeping a diary will help to make sure you do not miss a dose.
How long will I have to be on enoxaparin for?
The duration of prophylactic treatment will depend on your postnatal VTE assessment and what your score from that assessment is. The duration will either be 10 days or 6 weeks depending on your risk assessment score. The midwife or your doctor will explain the reason for its use and the duration of treatment you will need.
What is a postnatal VTE assessment?
Your postnatal VTE assessment is similar to the one you had done at your booking visit. The assessment is based on risk factors that can put you at risk of developing a blood clot after giving birth to your baby. For every risk factor that you have, you get a score against it. The score you obtain from the assessment will determine whether you get enoxaparin or are recommended to wear anticoagulation compression stockings (thromboembolic deterrent stockings) (TEDS) and determines the duration of enoxaparin you should be on if enoxaparin is recommended.
Is enoxaparin safe in breastfeeding?
Enoxaparin can be used safely during breastfeeding. Very small amounts of enoxaparin are expected to pass into breast milk but any drug present in the breast milk would not be expected to be absorbed by the breastfed infant. If you have concerns about your breastfed baby, contact your midwife for advice.
What else can I do to reduce my risk of developing a DVT or PE?
In addition to enoxaparin, you may be discharged with a pair of compression stockings know as Thrombo Embolic Deterrent Stockings (TEDS). These are designed to reduce the risk of developing a DVT in you lower legs. The stockings work by speeding up the circulation of the blood in your veins, which make clotting less likely. Your midwife will show you how to effectively use your TEDS.
Other things that you can do to reduce your risk of developing a DVT or a PE include:
- If you smoke stop or reduce the amount you are smoking.
- Hydration - drink plenty of water.
- Keep active after birth if you are able to do so.
Iron supplements for anaemia
What is anaemia?
Your blood contains red blood cells. Red blood cells contain a substance called haemoglobin, which carries oxygen from your lungs to the rest of your body.
Anaemia is when the red blood cells in your blood are lower than normal or when the haemoglobin in each red blood cell is lower than normal. If you have low red blood cells or low haemoglobin levels, then the amount of oxygen delivered to your body's tissues will be low.
What are the causes and types of anaemia?
One of the commonest causes of anaemia is the lack of iron. Iron is a mineral that is needed to make haemoglobin in your red blood cells. Anaemia that results from a lack of iron is known as iron deficiency anaemia (IDA).
There are other causes and types of anaemia such as, folic acid deficiency anaemia, macrocytic anaemia, vitamin B12 deficiency and pernicious anaemia. However, iron deficiency anaemia is the common cause of anaemia during pregnancy and after the birth of your baby.
Low iron levels can be caused by:
- Bleeding during or after your baby's birth
- High demands needed during pregnancy to meet a growing baby's requirements.
- Low dietary iron intake- tea and coffee can affect iron absorption when drunk with meals.
- Poor absorption of iron from the gut.
How can anaemia affect me?
If anaemia is severe or left untreated in can lead to complications such as leading to fragile and broken nails, hair loss and heart failure. A lack of iron can also affect the immune system so you may become more likely to develop infections.
What are the signs and symptoms of anaemia?
Symptoms of anaemia:
- Tiredness.
- Shortness of breath.
- Palpitations.
- Looking pale.
- Feeling dizzy/faint.
What are the complications of iron deficiency anaemia?
Postnatal anaemia is associated with tiredness and increased risk of postnatal depression. It is also associated with an increased risk of sepsis and poor wound healing. In addition to these, iron deficiency anaemia can cause the following:
- Struggling to concentrate.
- Memory problems.
- Reduced ability to exercise.
- Hair loss.
- Brittle nails.
- A sore tongue.
- Sores at the corners of your mouth.
- Restless legs syndrome
- Pica syndrome (the craving or eating of substances not normally eaten, such as clay, chalk or coal).
How is anaemia and iron deficiency anaemia diagnosed?
You will have a blood test to check your full blood count. This includes red blood cells and haemoglobin levels. If the haemoglobin is lower than normal, then your doctor may diagnose you with anaemia. Your doctor may also carry out tests to assess your body's iron stores. These tests include a serum ferritin, which is used to check if you have iron deficiency anaemia. However, you may not always need a serum ferritin test to diagnose iron deficiency anaemia as a trial of iron supplements may be enough to assess this. If there is improvement, then it can be concluded as IDA, if not then further tests may be needed.
How will my anaemia be treated?
Your treatment will depend on how low your haemoglobin is. Your doctor or midwife will go through all the treatment options available with you.
If your haemoglobin is borderline/mildly low, your doctor or midwife will give you dietary advice, which may be enough to raise your haemoglobin and iron stores in your body.
If your haemoglobin is moderately low, you may be offered oral iron replacement therapy for 3 months and advised to get your full blood count re-checked by your GP at your 6-week postnatal check.
If you have severely low haemoglobin but have no symptoms, you may be offered intravenous iron infusion followed by oral replacement iron after 5 days of your last iron infusion.
If you have severely low haemoglobin and have symptoms, your doctor may consider a blood transfusion following a clinical assessment. All your options will be discussed with you before you receive any treatment.
What do I need to know before I have an iron infusion?
If the decision for an iron infusion is made, your midwife will go through the treatment process and provide you with an iron infusion patient information leaflet for you to read before receiving the infusion. You will be required to provide verbal consent before the infusion can be given to ensure that you understand the potential risks and benefits of the treatment.
What dose of oral iron supplementation should I take?
The dose of oral iron will depend on the iron preparation prescribed. Below is a list of commonly prescribed oral iron preparations and the expected doses.
Ferrous sulphate 200mg - 1 tablet daily.
Ferrous fumarate tablet 210mg - 1 tablet daily.
Ferrous fumarate 305mg capsule - 1 capsule daily
Ferrous fumarate 322mg tablet- 1 tablet daily.
Ferrous fumarate 140mg/5ml oral liquid - 10mL daily
Ferrous feredetate 190mg/5ml elixir- 10mL daily
Oral iron supplements should be taken on an empty stomach to improve absorption. Taking iron supplements with vitamin C can help with absorption, for example take with a glass of fresh orange juice
What are the side effects of iron supplements?
You may experience some side effects with iron supplements, which include an upset stomach or constipation. You may also find that your stools become dark.
What can I eat that is rich in iron?
Food considered rich in iron include but are not limited to:
- Green leafy vegetables
- Figs
- Baked beans
- Roast beef
- Eggs
- Sardines
- Bran flakes
Avoid tea or coffee at the same time as your meal as these can affect the absorption of iron from your diet. Tea and coffee should be drunk one hour before or two hours after your meals.
Is it safe to take iron whilst breastfeeding?
Iron supplements at normal doses are considered safe during breastfeeding. If you are concerned about your baby contact your midwife for advice.
Constipation after giving birth.
What is constipation?
Constipation is a difficulty in passing stool or straining, pain, discomfort when passing stools or passing hard stools. Constipation is common after giving birth and can cause discomfort and pain for a few days after.
What causes constipation after giving birth?
There are a number of issues that can cause constipation following giving birth such as dehydration, dietary changes, reduced mobility, the use of medications such as dihydrocodeine or oral iron supplements, a change in routine and sleep patterns, sore perineum/bottom, especially if you have had a tear from a vaginal birth.
How can I manage constipation?
- Eat foods that are high in fibre such as whole grain cereals, beans, fresh fruit etc.
- Drink plenty of water.
- Drink a glass of fruit juice such as prune juice.
- Go for walks- keep active.
- Don't wait to go to the bathroom when you feel the urge to move your bowels, even though it might be uncomfortable the first few times. Waiting makes your stools drier and harder to pass.
- Take laxatives.
What laxatives are available to take?
Your doctor may prescribe any of the following laxatives to help with your constipation:
- Bulk-forming laxatives e.g. ispaghula husk (Fybrogel)
- Osmotic laxatives e.g. lactulose and macrogol.
- Stimulant laxative e.g. senna
What dose shall I take of the laxative I have been given?
The dose you are required to take will depend on the laxative you are prescribed. Your doctor or midwife will advise you of the appropriate dose to take.
Is it safe to take laxatives whilst breastfeeding?
If a laxative is required to treat constipation during breastfeeding, osmotic or bulk laxatives are initially preferable to stimulant laxatives.
- Bulk-forming laxatives- Are not absorbed by the body and they can all be used during breastfeeding. No infant monitoring is usually required.
- Osmotic laxatives- Passage into breastmilk is low and can all be used during breastfeeding. As a precaution monitor the infant for diarrhoea, vomiting or irritability.
- Stimulant laxative - Are safe during breastfeeding but can lead to reliance on their action. As a precaution monitor the infant for diarrhoea, vomiting or irritability.
What side effects shall I expect with the laxatives I have been advised to take?
The side effect depends on the laxative you have been prescribed/advised to take by your doctor. Some include the following:
- Lactulose- Abdominal pain, diarrhoea, flatulence, nausea, vomiting.
- Macrogol- Flatulence, gastrointestinal discomfort, nausea, vomiting.
- Ispaghula husk- Abdominal distention, difficulty in breathing, wheezing, skin rash, itching and a sudden life-threatening allergic reaction.
- Senna- Diarrhoea, fluid imbalance, gastrointestinal discomfort.
If you experience any of these contact your doctor, midwife, or 999 for severe allergic reactions or difficulty breathing
The doses in this information are recommended doses for adults and adolescents (>12 years of age).
If you have any further questions regarding the ingredients of your medication, check with your midwife, doctor or pharmacist.