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When Taylor Buckley gave birth to her first baby in September 2018, she spent several agonizing days in labor before doctors at Wheat Ridge’s Lutheran Medical Center decided to perform a cesarean section. (Her son, Parker, weighed more than nine pounds and was stuck in the birth canal, so doctors had no other choice.) In addition to being groggy and exhausted after the procedure, Buckley remembers feeling a lot of pain. Doctors had just made an incision in her abdomen, after all—the same one that had been stretched out for months.
After she gave birth to her daughter, Lucy, three years later—also via C-section at the same hospital—a nurse handed Buckley an abdominal binder. The stretchy, elastic band helped support and compress her midsection while she healed. “I really liked it,” says Buckley, who is 40 and works as a project manager for a technical training company. “It just felt more comfortable having it on.”
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Since last fall, the binder Buckley received has been a standard element of post-operative care for parents who undergo C-sections at Lutheran Medical Center and seven other SCL Health hospitals in Colorado and Montana—because of research conducted by the nonprofit health care organization’s very own medical staffers. The study, which was published in the journal Nursing for Women’s Health in February, found that patients who wore abdominal binders after C-sections needed smaller doses of opioid painkillers and experienced less pain than those who didn’t wear the binders.
The results are a promising step toward reducing opioid use—and potential opioid addiction—among mothers in Colorado and beyond. Patients leave the hospital within four days of their C-section, but the opioids prescribed after the procedure could stay in their lives a lot longer. A 2019 study of “opioid-naive” women in the U.S. (women who had not filled an opioid prescription within the last year) found that, when doctors prescribed opioids, 1.7 percent of patients who delivered vaginally and 2.2 percent of C-section patients continued to fill those prescriptions for months afterward. Researchers described this behavior as “new persistent use” of opioids, a sign of addiction.
In the Centennial State, unintentional drug overdose is the second-leading cause of pregnancy-related death, according to the most recent statistics from the Colorado Department of Public Health and Environment. Between 2014 and 2016, 13 pregnant or postpartum women died of drug overdoses, which represented 14 percent of all maternal deaths in that time period. “We knew [opioid addiction] was a big problem nationally. And then to see it as the number two reason for maternal deaths in the state of Colorado, we thought this was a really worthwhile topic to pursue,” says Corie Hoskins, the study’s lead author and a mom/baby nurse at Lutheran Medical Center.
Hoskins has spent the last seven years tending to mothers and their newborns at Lutheran. In 2017, she also participated in a nursing research fellowship through SCL Health, a year-long program that teaches nurses how to plan and execute scientific research. After she completed the fellowship, Hoskins began brainstorming potential research projects. With the nation’s opioid crisis top of mind, she decided to focus on pain management. She wondered if it would be possible to decrease—or even eliminate—opioid use among postpartum moms.
“Quite often, women’s first exposure to opioids is after a surgery, and C-sections are the most common surgery in the United States,” Hoskins says. (Nationally, about one-third of pregnant women deliver their babies via C-section. In Colorado, that number is around 24 percent.) “It seemed like the perfect opportunity to find some alternative pain management options.”
Reading up on past pain management research led Hoskins to the binders; studies showed they benefited abdominal surgery patients in the general population.
She also called around to other hospitals and found that several routinely provided binders to patients after C-sections. “When we asked about it (‘can we see your evidence, why did you come to this decision?’) really the responses we got were, ‘Well, the moms seem to like it,’ ” Hoskins says. “Which makes sense. We do a lot of things for our patients based on anecdotal evidence.”
Hoskins wanted more than anecdotal evidence, though, before recommending the change at Lutheran. For 25 months between August 2018 and September 2020, nurses at Lutheran Medical Center randomly assigned 220 women to one of two groups: one group wore abdominal binders after their surgeries and the other did not; oxycodone, a common opioid painkiller, was also given to women in both groups. Nurses monitored oxycodone use for the first 48 hours after the surgery, and also asked the women to rate their levels of pain at 24 and 48 hours after birth; 196 women completed the study.
Women who wore the binders reported roughly 30 percent less pain on average than those who did not 48 hours after the surgery. Women in the binder group also used 21.5 percent less oxycodone on average, a number that was not statistically significant but still encouraging to Hoskins (“not statistically significant” means the difference could be due to random chance or other factors).
In addition, 96 percent of women who wore the binder and answered questions about their experience said they would recommend the support belt to someone else. Hoskins presented the study’s findings to the system-wide leadership team at SCL Health late last summer, who found the research compelling. “They reviewed it and determined it was powerful enough to implement as standard protocol for all of our post C-section patients at hospitals along the Front Range,” she says. “It made a huge impact.”
Since the binders are around $20, they’re an easy, low-cost way to help ease pain and potentially reduce opioid use among new moms, Hoskins says. She is already planning her next research project: a study exploring the optimal time to remove urinary catheters after C-sections.
“Within the nursing profession, we should always be striving to do what we can for our patients while keeping in mind that opioids are not the only method we have to mitigate pain,” Hoskins says. “Just because we’ve done it one way forever doesn’t mean we can’t look at something with fresh eyes. And the basis of that is research. Evidence-based practice is what nurses work from, and more research means more evidence, which means better care for patients.”