Is It Safe to Use Morphine During Pregnancy?

Healthcare professionals sometimes use morphine to treat severe pain during pregnancy.

This is because there are limited options for pharmaceutical pain relief during pregnancy. Research has shown that even ibuprofen use in pregnancy may cause birth defects, according to the Centers for Disease Control and Prevention (CDC).

In general, public health groups and maternal and fetal health experts do not recommend the use of morphine during pregnancy if other options are available. If an individual is already taking morphine or must take it, they should take it for only short periods of time.

The American College of Obstetricians and Gynecologists (ACOG) says that alternative treatments like physical therapy and non-opioid medications are preferred when treating chronic pain during pregnancy.

The organization also suggests using a class of medications known as opioid agonists to treat opioid addiction or dependence experienced by a pregnant person.

The CDC warns that taking morphine during pregnancy can put your baby at greater risk of having a birth defect than if you take non-opioid pain relievers like acetaminophen.

The Food and Drug Administration (FDA) puts morphine — as a short-term option for severe pain — into category C on its pregnancy category scale.

The scale includes categories A (studies have demonstrated no fetal risk) through D (evidence of fetal risk but potential benefits may warrant use), plus a category X (evidence of risk that outweighs the benefits of use).

So, category C means that pregnant people and their doctors should weigh the benefits of using this medication against the potential risk.

With long-term or chronic use, however, morphine moves from category C to category D. This means there is evidence of definite risks to a fetus with use.

With morphine, it can be difficult to determine dosages and lengths of usage. This is because few clinical studies have really investigated opioid safety during pregnancy. Ultimately, more research is needed in this area.

Morphine is a natural narcotic made from the opium plant. A number of other opioids are created using this plant as well, including the prescription pain medication MS-Contin and drugs like heroin. Morphine and other opioids are habit-forming and can lead to addiction.

Morphine and other opioids work by attaching to opioid receptors throughout your body — like in the spinal cord, digestive tract, and brain — to slow or prevent the sending of pain signals to your brain.

These medications and drugs can create feelings of euphoria and offer pain relief, but they also have dangerous side effects that include:

• oversedation
• cough suppression
• breathing difficulties
• mood changes
• allergic reactions

As a medication, morphine is mostly used for treating severe pain that isn’t relieved by other medications or therapies. It’s a powerful and effective analgesic that healthcare professionals can prescribe as:

• an oral medication in a pill or liquid form
• a muscular injection
• an intravenous drug

When used intravenously — a common option during labor and delivery — morphine can provide pain relief in as little as 2 minutes. It reaches peak effectiveness in 5 to 15 minutes and can provide relief for about 4 hours in total.

Besides pain, morphine may also be used to treat:

• opioid dependency
• chronic cough
• breathlessness
• sores or ulcers on mucous membranes
• diarrhea

Morphine and other opioids cross the placenta from your bloodstream to your baby during pregnancy. There are clear risks to the baby in any situation where a pregnant person uses morphine, and these risks increase with long-term or chronic use.

Pregnant individuals who use morphine may experience any of the typical side effects of this medication, plus complications of pregnancy. These can include:

• drowsiness
• sedation
• breathing difficulty
• high blood pressure
• constipation
• problems with the placenta
• preeclampsia
• miscarriage
• stillbirth
• premature delivery

All types of medications come with risks if you use them during pregnancy.

There’s not a lot of data on specific dosages and times frames when it comes to using morphine, since few researchers have examined opioid safety during pregnancy. Instead, most research has focused on what happens after opioid use.

What experts do know is the timeline of fetal development:

• First trimester. It’s clear that congenital birth defects (like neural tube defects) and structural changes (such as gastroschisis) typically occur early in pregnancy when the baby’s most basic systems are being formed.
• Second trimester. In mid-pregnancy, fewer birth defects occur. However, concerns with fetal growth are more likely.
• Third trimester. By the final trimester in late pregnancy, babies are almost fully formed, and morphine use could cause concerns like growth delays, breathing difficulties, or drug dependency at birth.

Below are some of the most common concerns observed in babies born to people who used morphine during pregnancy:

• Cleft lip and cleft palate. Cleft lip and cleft palate are changes in the structure of the lip and mouth that can lead to speech, feeding, or even breathing concerns.
• Clubfoot. Clubfoot causes the baby’s foot to turn sideways or upward, and it can result in mobility concerns.
• Congenital heart defects. There are many types of congenital heart defects, which can range from mild to severe. They may involve either heart function or structure. Some may go undetected and last a lifetime. Other might require emergency treatment at birth.
• Drug dependency. Babies who are exposed to morphine and other opioids throughout pregnancy — especially in late pregnancy — may be born with an addiction to these drugs or medications. This causes a condition called neonatal abstinence syndrome (NAS), explained in more detail below.
• Gastroschisis. Gastroschisis occurs as the baby’s digestive system and abdominal wall are forming in early pregnancy. The abdominal muscles and organs don’t connect properly, so babies with this condition are born with intestines and sometimes other organs on the outside of their body. Immediate surgery is required after birth to correct this condition.
• Glaucoma. Glaucoma can occur as vision develops and can cause permanent vision concerns or even blindness.
• Growth delays and low birth weight. Babies spend much of middle to late pregnancy growing larger and putting on weight. Low birth weight and growth delays are common complications when a baby is exposed to morphine during pregnancy.
• Hearing loss. Hearing loss and other communication conditions usually develop in the second or third trimester and can require ongoing treatment after birth.
• Microcephaly. This happens when the baby’s head does not form appropriately or is damaged during the pregnancy. Microcephaly can result in small head circumference and a number of neurological delays.
• Neural tube defects. Neural tube defects refer to changes to the brain and spinal cord. These usually occur early in pregnancy as the baby’s nervous system is forming. A common neural tube defect is spina bifida. In this condition, the spinal cord doesn’t form correctly, leaving portions exposed on the outside of the body. These types of conditions can cause mild to serious neurological concerns for babies.
• Prematurity. Morphine or opioid use can also trigger concerns for the pregnant person. It may lead to premature or early delivery. Depending on how early birth occurs, this can create a wide range of complications.
• Sudden infant death syndrome (SIDS). Babies born to people who used morphine or opioids during pregnancy are at a higher risk of SIDS.

NAS occurs in newborns who were exposed to certain substances in the womb. Though this condition can develop from exposure to all types of substances and medications, opioid exposure is a common cause.

When a baby has been exposed to opioids during pregnancy and possibly developed a dependence, this condition is specifically called neonatal opioid withdrawal syndrome (NOWS).

NAS and NOWS can cause uncomfortable, painful, and even dangerous symptoms in newborns as they withdraw from opioids and other substances they were exposed to during the pregnancy. These symptoms can include:

• irritability
• feeding difficulties
• breathing trouble
• seizures
• mottling of the skin
• fever
• sweating
• hyperactive reflexes
• poor muscle tone
• vomiting
• diarrhea
• sleep concerns

Treatment of newborn withdrawal from opioids and other substances can be difficult. Ideally, non-pharmacologic treatments are used, such as:

• baby staying in the room with the birthing parent
• breastfeeding or chestfeeding baby
• swaddling baby
• having skin-to-skin contact with baby
• exposing baby to low stimulation

The treatment strategy will depend in part on:

• which medication or drug the baby was exposed to during pregnancy
• how much of the substance they were exposed to
• how long they were exposed to the substance
• how close to delivery the last exposure occurred

When babies are born with severe dependency, healthcare professionals must sometimes prescribe medications, including opioids. These are necessary to wean the newborn from their dependency gradually.

Can you nurse your newborn if you are taking morphine?

Opioids can be passed to your baby through breast milk. However, short-term use of medications like morphine to manage delivery pain in the first 2 to 3 days after birth is both common and considered “compatible” with breastfeeding or chestfeeding.

When morphine is used for long-term therapy or pain relief — especially in infants who were not exposed to these medications during pregnancy — close monitoring is required.

With the use of other opioid drugs or medications, including medications (like buprenorphine) used to treat dependency, a healthcare must closely monitor baby if you’re breastfeeding or chestfeeding.

Nursing is possible while you’re taking these medications. However, the long-term use of opioid medications, including morphine, can cause complications. These complications may include:

• trouble gaining weight
• sleepiness
• feeding difficulties
• breathing concerns

For babies born without NAS or NOWS who are exposed to short-term doses of morphine during pregnancy, the outlook is good. These infants should not experience long-term effects as long as they do not have any other conditions or complications.

When babies are born dependent on morphine or other drugs or medications, the treatment process for NAS can take months. Even after treatment is complete, these babies can experience long-term effects like:

• congenital health defects
• low birth weight
• premature birth
• small head circumference
• SIDS
• developmental, cognitive, and behavioral concerns

A healthcare professional may sometimes prescribe morphine during pregnancy and after delivery to help you manage severe pain.

However, this should be considered only after you have tried other methods of pain relief. This is because morphine may present several risks to both you and baby. Risks include miscarriage, premature delivery, and birth defects.

Morphine use for limited periods of time — like right after delivery — is generally safe, but long-term use comes with a greater risk of complications.

Talk with your doctor if you are having difficulty managing your pain during pregnancy or while nursing. A healthcare professional can help you weigh the benefits of using morphine against the risks.