Paracetamol for relief of perineal pain after birth

The birth of a baby should be a very special time for every woman, but perineal pain can sometimes interfere and cause problems. The perineum is a diamond-shaped area between the vagina and the anus. Perineal pain can arise from bruising or tearing that sometimes occurs as the baby is born. Pain can also arise from a cut which may be used to enlarge the perineal outlet for the baby to be born (episiotomy). Episiotomies require stitches (also called sutures), and natural tears also may need stitches. Any trauma and stitches can cause discomfort and pain. In addition, there is often pain if forceps or ventouse have been used to help the baby into the world. Reducing the chance of perineal trauma and thus perineal pain is clearly important for women. However, this review is part of a series of reviews looking at drugs to help relieve perineal pain once it is there in the early days after the birth. This review identified 10 studies, involving 1367 women, looking at how effective paracetamol might be in helping with this pain. The studies were quite old and thus not of high quality. However, they showed that paracetamol (either in a single 500 mg to 600 mg or a single 1000 mg dose) was effective at reducing the perineal pain, mostly caused by episiotomies. The studies did not look carefully at potential adverse effects but generally paracetamol at these doses causes few problems. There are also generally no identified problems for breastfed babies when mothers take paracetamol, but these outcomes were not specifically assessed in any of the included studies. The comparison of how effective paracetamol is compared with other drugs is being assessed in the other reviews in the series.