Medications
This is a guide to some of the medications you may be given after the birth of your baby.
Other medication that is not mentioned in this factsheet may also have been prescribed. Always follow your obstetrician (doctor who specialises in the care of pregnant women) or midwife’s advice.
General advice about medication
- Always keep medication out of the reach of children
- Do not let anyone else take your medication.
- Do not take medication that has been prescribed for someone else.
- Keep all your medication in the original containers.
- If you have any unpleasant side effects from your medication, speak to your obstetrician, GP, midwife or pharmacist.
- Ask your midwife, obstetrician, GP or pharmacist for advice before you start any new medication while you are pregnant or breastfeeding.
- Always read the information leaflet provided with each prescribed medication.
- You can take any medications you no longer need to a pharmacist or midwife and they will dispose of them for you. Do not throw your medications away in a general waste bin.
If you have any questions about the medication you are on please speak to your midwife, GP or pharmacist.
Pain relief medications (analgesics)
Everyone experiences pain differently and some people need more pain relief than others. If you experience pain, take your pain relief medications (also known as analgesics) as soon as you have any pain and before it gets too bad. It is easier to relieve pain if you deal with it sooner rather than later.
It’s important to manage your pain effectively after giving birth, particularly if you have had an assisted vaginal birth (forceps or ventouse) or caesarean section, as this will help with your recovery. If you have moderate to severe pain, we may recommend that you take your pain relief medication regularly for the first 24 to 48 hours.
There are three main groups of pain relief medication:
Pain relief medications (analgesics)
Paracetamol
What is paracetamol used for?
Paracetamol is a pain relief medication that is commonly used after birth. Paracetamol works by relieving pain, and reducing high temperature and fever. It can provide effective relief from mild to moderate pain including:
Headache, toothache, sore throat, aches and pains, symptomatic relief of rheumatic aches and pains, influenza symptoms, fever.
How to take paracetamol
You can take paracetamol regularly or when you need to for pain.
Dosage for adults and children over 12 years
Take two tablets up to four times a day, as required. Take the tablets with water. Take only as much as you need to relieve your symptoms and leave at least four hours between each dose. Do not take more than eight tablets in 24 hours.
Side effects
Most people don’t have side effects from taking paracetamol. You can read more about side effects in the patient information leaflet that came with your medication.
Can I take paracetamol while I am breastfeeding?
There are no known safety concerns with using paracetamol while you are breastfeeding. Take the smallest dose you need for effective pain relief.
Ibuprofen (such as Nurofen) and diclofenac (such as Voltarol)
What are ibuprofen and diclofenac used for?
Ibuprofen and diclofenac are non-steroidal anti-inflammatory drugs (NSAIDs) used to treat inflammation and pain in a variety of conditions. They are commonly used after a caesarean section to help ease the pain after the procedure. They may also be used if you have had an assisted vaginal birth or a severe perineal tear.
To begin with, we may give you diclofenac in the form of suppositories (medication that dissolves in your back passage). The suppositories contain 100mg diclofenac and are given 12 hours apart for 24 hours. If your pain is well-controlled after this, we will give you ibuprofen tablets. If your pain is not well-controlled, we may give you further doses of diclofenac suppository and possibly some to take home. You must not take any ibuprofen for at least 12 hours after your last diclofenac dose.
How to take ibuprofen and diclofenac
Swallow ibuprofen tablets whole with a glass of water. If possible, take the tablets with or after food to avoid stomach upset.
Diclofenac suppositories should be inserted into the back passage. Please follow the instructions in the patient information leaflet that comes with the suppositories.
Dosage for adults
Ibuprofen: 400mg tablet three times a day, six to eight hours apart. If you are using your own supply of ibuprofen tablets purchased from a chemist, you may have 200mg tablets. In this case, take two 200mg tablets three times a day.
Diclofenac: 100mg suppository inserted into the back passage, 12 hours apart initially for 24 hours. After this, doses should not exceed 100mg once daily or 50mg two to three times daily if continued and will be given to you either as suppositories to insert into the back passage or oral tablets.
Do not take diclofenac and ibuprofen at the same time. Wait 12 hours after a diclofenac dose before taking ibuprofen or six hours after an ibuprofen dose before taking diclofenac. If you have other medical conditions.
Check with your obstetrician, GP, midwife or pharmacist before taking ibuprofen or diclofenac if you have asthma or breathing problems, a previous stomach ulcer, a previous reaction to aspirin, ibuprofen, diclofenac or another non-steroidal anti-inflammatory drug or other medical conditions, such as kidney disease, heart disease, blood clotting disorders, or liver disease
Side effects
Common side effects include headache, dizziness, feeling sick, diarrhoea
You can read more about side effects in the patient information leaflet that came with your medication.
Can I take ibuprofen and diclofenac medication while I am breastfeeding?
Both ibuprofen and diclofenac are suitable while you are breastfeeding.
Safety information
Stop taking the medication and seek immediate medical help if you:
- pass blood in your faeces (stools or poo)
- pass black tarry stools
- vomit any blood or dark particles that look like coffee grounds
- have an allergic reaction such as itching, dizziness, swelling of the face, lips, tongue, mouth and throat, which may cause shortness of breath or difficulty swallowing
Dihydrocodeine or codeine
What are dihydrocodeine and codeine used for?
Dihydrocodeine is an opioid-based medication used to relieve mild to moderate pain. It is often taken in combination with paracetamol. Occasionally, a similar type of drug called codeine may be used instead. We will prescribe either one or the other, not both.
How to take dihydrocodeine and codeine
You can take dihydrocodeine or codeine regularly, or when required, depending on the level of pain you are experiencing. If paracetamol and ibuprofen have failed to control your pain, we may recommend adding in dihydrocodeine or codeine either regularly or as required. Do not drink alcohol while taking either of these medications.
Dosage for adults and children over 12 years
Dihydrocodeine: 30mg every four hours up to a maximum of 180mg a day
Codeine: 30 to 60mg every four hours up to a maximum of 240mg a day
Side effects
The most common side effects with dihydrocodeine or codeine are dizziness, constipation, feeling sick, dry mouth
You can read more about side effects in the patient information leaflet that came with your medication.
Can I take dihydrocodeine and codeine while I am breastfeeding?
Codeine is not suitable while you are breastfeeding. You can use dihydrocodeine with caution while you are breastfeeding, if it is recommended by your obstetrician. Use the smallest effective dose for the least amount of time possible.
Safety information
If you are taking dihydrocodeine while you are breastfeeding, tell your midwife immediately if your baby is showing signs of:
- increased drowsiness
- difficulty waking up for feeds
- breathing problems
- anything else unusual
Research has shown that some babies may be more susceptible than others to these side effects.
If you would like any further information about taking dihydrocodeine while you are breastfeeding, please discuss it with your midwife, obstetrician or pharmacist.
Taking pain relief medication
The medication you take will depend on your level of pain.
Start by taking paracetamol. This is a very effective pain reliever with few side effects. It may take up to half an hour to work. To get the best effect, paracetamol should be taken regularly (four times a day) if your pain is moderate to severe. Mild pain may be managed with paracetamol taken when required.
If paracetamol is not managing your pain, you should add an anti-inflammatory pain relief medication such as ibuprofen together with your paracetamol. As your pain improves, you may start to reduce the dose of ibuprofen until you are left just with the paracetamol.
If both paracetamol and ibuprofen fail to manage your pain, your obstetrician or GP may recommend that you add in an opioid medication such as codeine (unless you are breastfeeding) or dihydrocodeine. Take these as instructed on the label. No matter how much you take, continue to take your other pain relief medications such as paracetamol and ibuprofen regularly, as these will enhance the pain-relieving effects of the opioid medication.
Can I take more than one pain relief medication at the same time?
It is safe to take one medication from each of the three groups at the same time. For example, paracetamol, ibuprofen and dihydrocodeine can safely be used together at the recommended doses.
Do not take more than one medication from each group. For example, do not take ibuprofen and diclofenac, or dihydrocodeine and codeine together.
If you still have pain
If you have reached the maximum dose of your medications but are still in pain, seek medical advice using the phone numbers at the end of this factsheet or contact your GP, local walk-in centre or emergency department, depending on how bad your pain feels.
Stopping pain relief medications
If you have been taking a combination of paracetamol, anti-inflammatory medications and codeine-based medications, you will need to stop taking them gradually. Do not stop taking all of them suddenly, as your pain may come back and it will then be harder to get back under control.
Gradually stop the codeine-based medication first. Next, stop taking the anti-inflammatory medication. Keep taking paracetamol regularly until your pain and discomfort settles.
Sometimes pain is felt more at certain times of day, often at night time when there is less to distract you from the feeling. If this is the case, stop the daytime doses first and continue to take pain relief medications at night until you feel ready to stop these doses too.
Other Medications
Iron supplements (ferrous sulfate or ferrous fumarate)
What are iron supplements used for?
Iron supplements are used to treat iron deficiency anaemia.
Iron is a mineral the body needs to produce red blood cells. When your body is not getting enough iron, it cannot produce enough red blood cells. This is known as iron deficiency anaemia. It is common for women who are pregnant or who have just given birth to have iron deficiency anaemia.
Iron supplements work by replacing the iron the body needs to produce red blood cells. We will usually offer you iron supplements in the form of ferrous sulfate tablets. If you experience unwanted side effects, please tell your midwife or GP. They may advise you to take your tablets less often (such as every other day) or give you iron supplements in another form, such as ferrous fumarate tablets or liquid.
How to take iron supplements
Some foods and drinks can stop the body absorbing iron supplements. Do not eat or drink any of the following items for two hours before and one hour after taking your iron supplements:
Tea, coffee, milk, eggs or whole grains
Your body will be able to absorb iron supplements best if you take them on an empty stomach, but you can also take them after food to reduce effects on the stomach. Iron supplements are best taken with a glass of orange juice (or another source of vitamin C) as this helps with absorption.
Dosage for iron supplement tablets (ferrous sulfate or ferrous fumarate)
One tablet every day. Swallow your tablet whole with orange juice or water.
Dosage for iron supplement liquid (ferrous fumarate)
5 to 10ml once daily.
Side effects
Like all medications, ferrous sulfate iron supplement tablets can cause side effects, although not everybody gets them. The most common side effects are constipation, diarrhoea, stomach pain, feeling sick, blackened stools (poo)
You can read more about side effects in the patient information leaflet that came with your medication. If you experience unwanted side effects, please discuss them with your midwife or GP. They may advise you to reduce your dose and take one tablet every other day.
Can I take iron supplements while I am breastfeeding?
You can take iron supplements while you are breastfeeding if they are recommended by your obstetrician or GP. Make sure you do not take more than the recommended dose.
Laxatives (Lactulose or ispaghula husk)
What are laxatives used for?
Laxatives are used to treat constipation. We may prescribe laxatives after birth to prevent straining on the toilet, particularly if you have had surgery to repair a tear to your vagina or perineum.
If you feel that you need a laxative, please discuss this with your midwife, obstetrician or GP.
Avoiding constipation
You can avoid constipation by looking after your diet and maintaining regular bowel habits.
- Eat plenty of foods that contain fibre, such as wholegrain bread, fruit and vegetables.
- Drink plenty of liquid.
- Exercise regularly.
Side effects
The common side effects of laxatives include feeling bloated, increased wind and mild abdominal pain
You can read more about side effects in the patient information leaflet that came with your medication.
Gentle laxatives used after birth:
Lactulose
Lactulose is a liquid laxative used to treat and prevent constipation. Lactulose can take two to three days to have an effect.
Dosage: Usually 10 to 15ml twice daily. It must be taken regularly to have an effect.
Ispaghula husk (such as Fybogel)
Ispaghula husk is a high fibre drink that increases the fibre in your diet. This helps to gently relieve constipation. Make sure you drink plenty of liquids while you are taking ispaghula husk.
Dosage: The usual dose is one sachet mixed with a glass of water up to twice daily.
Can I take Lactulose and ispaghula husk while I am breastfeeding?
Lactulose and ispaghula husk are not absorbed into the blood, so they only affect the gut. They are not known to be harmful if it is taken while you are breastfeeding.
Enoxaparin (Inhixa or Clexane)
What is enoxaparin used for?
Enoxaparin is used to prevent and treat blood clots. Blood clots usually take the form of either:
- deep vein thrombosis (DVT) usually in a leg vein, or
- pulmonary embolism (PE), a blood clot in the lung
- you have had a caesarean section
- you have had a large blood loss or blood transfusion
- you are overweight
- pass blood in your faeces (poo)
- pass black tarry stools (poo)
- vomit any blood or dark particles that look like coffee grounds
- have any bleeding that does not stop by itself
- have signs of too much bleeding (possibly internal) such as being very weak, tired, pale or dizzy with a headache or unexplained swelling
- have an allergic reaction such as itching, dizziness, swelling of the face, lips, tongue, mouth and throat, which may cause shortness of breath or difficulty swallowing
Taking enoxaparin after your baby’s birth
Some women are more at risk of developing blood clots after birth than others. Your midwife will assess your individual risk when you go into labour and immediately after your baby’s birth. They will discuss your medical history, weight and lifestyle with you, and may advise you to take additional preventative measures, depending on your risk.
Your midwife or obstetrician may recommend that you start taking enoxaparin or another similar medication if:
If you were on enoxaparin during your pregnancy, your obstetrician may want you to carry on with the same treatment. Your obstetrician or midwife will tell you how long you need to continue taking enoxaparin.
Side effects
Enoxaparin is a blood-thinning medication (also known as an anti-coagulant) and may increase your risk of bleeding. This may mean that you bruise easily or if you cut yourself, your bleeding may take longer to stop.
Other possible side effects include increased liver enzymes, low platelet count, pain or bruising at the injection site and skin rashes
You can read more about side effects in the patient information leaflet that came with your medication.
Can I use enoxaparin while I am breastfeeding?
Enoxaparin is unlikely to cross into breast milk and is not known to be harmful while you are breastfeeding.
Safety information
Stop taking the medication and seek immediate medical help if you:
How to use enoxaparin
Enoxaparin is given as an injection just beneath the skin (subcutaneous). It is usually injected into a skin fold in your abdomen (stomach). If this is not suitable, we may recommend using another area of skin. Enoxaparin should not be injected into your muscles. It may be given either once or twice daily (we will discuss the appropriate dose with you).
Enoxaparin is usually only given in hospital. If you need to have enoxaparin injections at home, please make sure that a midwife has shown you how to use this medication and given you a sharps bin to dispose of needles safely.
There are also written instructions showing you how to give yourself the injection in the patient information leaflet that comes with the medication.
When should you worry?
Newborn
NEWBORN
Contact your health visitor or GP if your baby is newborn and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Don’t have a Grasp Reflex (doesn’t grab your finger or small object when you put it in their hand)
- Are often startling and you cannot understand why
- Move one side of their body more than the other, for example:
- Rarely moves one of their arms compared to the other arm
- Rarely moves one leg compared to the other leg
- When your baby startles, one side moves or looks different from the other
6-8 weeks
6-8 WEEKS
Contact your health visitor or GP if your baby is 6-8 weeks and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
2-3 months
2-3 MONTHS
Contact your health visitor or GP if your baby is 2-3 months and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
3-4 months
3-4 MONTHS
Contact your health visitor or GP if your baby is 3-4 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when awake
- Prefer to keep their arms by their sides. For example, they do not reach for things, or do not bring their hands together over their face or tummy
- Move their arms or legs in repetitive, jerky, or strange ways
- Still need you to support their head, or can’t lift their head when lying on their tummy
- Have very tight fists and it’s hard to open their hand
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
4-6 months
4-6 MONTHS
Contact your health visitor or GP if your baby is 4-6 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
- Are unable to roll, or can roll in one direction but not the other
- Find it difficult to reach their arms out. For example, they do not reach for toys
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back. For example, they do not bring their feet to their chest
- Still need you to support their head
6-9 months
6-9 MONTHS
Contact your health visitor or GP if your baby is 6-9 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys, or eat and drink
- Rarely kick one leg compared to the other
- Can’t sit without support. For example, they lean on their hand, or, when they sit, their back is very curved
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back, for example, do not bring their feet to their chest
- Still need you to support their head
- Still need you to help turn their head when lying on their back
- Can’t crawl, or find it hard, for example, drags one of their legs behind them
- Find it difficult to stand, for example:
- Can’t stand with support
- Doesn’t try to pull themselves up to stand
- Can’t move a toy from one hand to the other
- Doesn’t use both hands to hold larger things
9-12 months
9-12 MONTHS
Contact your health visitor or GP if your baby is 9-12 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms and legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink.
- Rarely kick one leg compared to the other
- Find it difficult to sit, for example:
- Only sit with support
- Lean on their hand when sitting
- When they sit their back is very curved
- Can’t move a toy from one hand to the other
- Don’t use both hands to hold larger things
- Don’t point to objects
- Can’t crawl, or find it hard, for example, drags one leg behind them
- Find it difficult to stand, for example:
- Can’t pull themselves up to stand
- Find it hard to pull themselves up. For example, they only use their arms and don’t push with their legs
- Can’t stand with support
2 months
Your Baby By Two Months
Social/Emotional Milestones
- Calms down when spoken to or picked up
- Looks at your face
- Seems happy to see you when you walk up to her
- Smiles when you talk to or smile at her
Language/Communication Milestones
- Makes sounds other than crying
- Reacts to loud sounds
Cognitive Milestones (learning, thinking, problem-solving)
- Watches you as you move
- Looks at a toy for several seconds
Movement/Physical Development Milestones
- Holds head up when on tummy
- Moves both arms and both legs
- Opens hands briefly
4 months
Your Baby By Four Months
Social/Emotional Milestones
- Smiles on his own to get your attention
- Chuckles (not yet a full laugh) when you try to make him laugh
- Looks at you, moves, or makes sounds to get or keep your attention
Language/Communication Milestones
- Makes sounds like “oooo”, “aahh” (cooing)
- Makes sounds back when you talk to him
- Turns head towards the sound of your voice
Cognitive Milestones (learning, thinking, problem-solving
- If hungry, opens mouth when he sees breast or bottle
- Looks at her hands with interest
Movement/Physical Development Milestones
- Holds head steady without support when you are holding him
- Holds a toy when you put it in his hand
- Uses his arm to swing at toys
- Brings hands to mouth
- Pushes up onto elbows/forearms when on tummy
6 months
Your Baby By Six Months
Social/Emotional Milestones
- Knows familiar people
- Likes to look at self in a mirror
- Laughs
Language/Communication Milestones
- Takes turns making sounds with you
- Blows “raspberries” (sticks tongue out and blows)
- Makes squealing noises
Cognitive Milestones (learning, thinking, problem-solving)
- Puts things in her mouth to explore them
- Reaches to grab a toy she wants
- Closes lips to show she doesn’t want more food
Movement/Physical Development Milestones
- Rolls from tummy to back
- Pushes up with straight arms when on tummy
- Leans on hands to support herself when sitting
9 months
Your Baby By Nine Months
Social/Emotional Milestones
- Is shy, clingy, or fearful around strangers
- Shows several facial expressions, like happy, sad, angry, and surprised
- Looks when you call her name
- Reacts when you leave (looks, reaches for you, or cries)
- Smiles or laughs when you play peek-a-boo
Language/Communication Milestones
- Makes a lot of different sounds like “mamamama” and “bababababa”
- Lifts arms up to be picked up
Cognitive Milestones (learning, thinking, problem-solving)
- Looks for objects when dropped out of sight (like his spoon or toy)
- Bangs two things together
Movement/Physical Development Milestones
- Gets to a sitting position by herself
- Moves things from one hand to her other hand
- Uses fingers to “rake” food towards himself
- Sits without support
1 year
Your Baby By One Year
Social/Emotional Milestones
- Plays games with you, like pat-a-cake
Language/Communication Milestones
- Waves “bye-bye”
- Calls a parent “mama” or “dada” or another special name
- Understands “no” (pauses briefly or stops when you say it)
Cognitive Milestones (learning, thinking, problem-solving)
- Puts something in a container, like a block in a cup
- Looks for things he sees you hide, like a toy under a blanket
Movement/Physical Development Milestones
- Pulls up to stand
- Walks, holding on to furniture
- Drinks from a cup without a lid, as you hold it
- Picks things up between thumb and pointer finger, like small bits of food
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