To date, there’s not any known increased risk for birth defects or learning problems associated with opioid use, says Lori Wolfe, a certified genetic counselor who advises women about the risks of medication use in pregnancy and while breastfeeding. (Wolfe is also the president of of MotherToBaby, a free, national informational service of the non-profit Organization of Teratology Information Specialists). “The concern for opioids is that the fetus will get dependent on them, the baby will get dependent on them, and the withdrawal can be quite significant for several weeks after delivery,” she says. She advises pregnant women taking narcotic painkillers to talk to their doctor about weaning off these drugs entirely. Opioids have become a common prescription after cesarean delivery. However, it is often a woman’s first exposure to opioids and it is unknown if the opioid gets into breastmilk. Considering the now acknowledged high risk of addiction, a study tracking how much opioid was used when it was not offered automatically, but only of the patient complained of pain after using OTC drugs. Before the new policy 84% of post cesarean moms got opioids, after on 34% needed opioids for pain relief. And those moms in the non-opioid group were able to go home an average of half a day sooner.If you have a cesarean and are offered opioids, remember you can refuse them and, if you need them later, still get them. The safety data with opioids and other pain killers continues to be a topic of discussion. A U.S. National Birth Defects Prevention Study (1997-2005) found associations between early pregnancy use of codeine and other opioids with birth defects, including atrial and ventricular septal defects, hypoplastic left heart syndrome, spina bifida, and gastroschisis in newborns. And yet, the FDA’s recent Drug Safety Communication on the use of pain drugs in pregnancy reviewed and found limitations in the design of the studies on opioids, acetaminophen and NSAIDS. As a result, no new guidelines or restrictions were issued. The FDA continues to stress that pregnant women should consult with their doctor about taking any pain medication, and notes that untreated severe and persistent pain during pregnancy can result in depression, anxiety and high blood pressure for the mother.