In breastfeeding patients, which analgesic regimen is recommended for postpartum pain relief?

• A. Acetaminophen and ibuprofen; opioids cautiously if needed and monitor the infant.
• B. Aspirin and acetaminophen.
• C. Codeine on a regular schedule.
• D. Naproxen only.

Answer: (C)

Postpartum pain relief in breastfeeding focuses on effective relief with minimal medication transfer to the baby. Start with nonopioid analgesics because they are safe for lactation and work well together. Acetaminophen and ibuprofen provide good pain control and, when used together, can reduce the need for opioids. If additional pain relief is needed after nonopioids, opioids can be considered but only in the smallest amount for the shortest time, with careful watching of the infant for signs of sleepiness, poor feeding, or breathing issues. Avoid regular codeine in breastfeeding due to unpredictable metabolism and potential risk to the infant. Aspirin is generally avoided in lactation, and while naproxen is a NSAID option, the preferred approach emphasizes acetaminophen plus ibuprofen first.