therapy throughout the intrapartum and postpartum periods
because they have a heightened sensitivity to pain and greater
tolerance to pain medications. Risk of relapse is greatest in the
natal period (Unger et al. 2012). Goodman (2011) re.
ported that women maintained on methadone (70 percent
of
women) and ine (47 percent of women) required
more analgeia after surgical birth than did
cesarean
naive women.
Because pain management for women with opiate addic-
tion using maintenance therapy has not been well-studied.
Goodman (2011) recommends buprenorphine over metha-
done on the basis of anecdotal clinical experience. Nonopioid
pain management may be adequate for women who undergo
a routine spontaneous vaginal delivery. The literature recom-
mends a multimodal approach using nonsteroidal anti-inflam-
matory drugs with opioids if needed. An epidural can be left in