The Obstetrics Initiative (OBI), a Collaborative Quality Initiative (CQI) dedicated to improving childbirth care in Michigan, works with more than 70 hospital teams to help maternity clinicians improve postpartum pain control, reduce harmful opioid prescribing, and promote more equitable, respectful care.
Opioid prescribing after childbirth is excessive, risky, and variable. According to national data, one in 75 people who are exposed to opioids during their postpartum recovery will develop a new, persistent opioid use disorder. In addition, there are wide variations in opioid prescribing postpartum across Michigan, with hospital averages ranging from 32-100 percent of patients receiving an opioid prescription post-childbirth. With these statistics in mind, the team at OBI has developed a new pain management plan focused on reducing opioid use postpartum, resulting in a dramatic reduction in opioid prescribing postpartum.
Creating COMFORT
OBI launched the COMFORT Initiative (Creating Optimal pain Management FOR Tailoring interventions after childbirth) in mid-2023 with a toolkit of recommendations from a national panel of experts to support specific protocols in response to an overwhelming problem of postpartum opioid stewardship. OBI hospitals are widely adopting the COMFORT initiative, and compliance in scheduled non-opioids rose from 51.8% percent average compliance in January 2024, to 71.5 percent through September 2024 cases. By December 2025, more than 70 percent of participating hospitals will offer COMFORT clinical practice guidelines (CPGs) concordant care.
The COMFORT CPGs aim to promote more respectful, equitable postpartum pain management experiences through evidence-based care tailored to individual risk factors, preferences, and values. COMFORT recommendations for prescribers include providing robust education and counseling about pain management, risks of opioid prescribing, and risk education, using scheduled non-opioid medications (acetaminophen and NSAIDs) as the first choice for postpartum pain, offering non-pharmacologic strategies (e.g., heat/ice, abdominal binder, aromatherapy) to augment pain management after birth, considering inpatient strategies, particularly for patients with more complex postpartum pain or who are unable to receive standard treatments, considering tailored opioid prescribing through a shared decision-making process, and using a principles-based approach to postpartum pain management for patients with opioid use disorder, chronic pain, and other complex pain.
OBI collects two sets of data points around COMFORT: First, the rate of opioid prescribing postpartum, and second, scheduled NSAID and acetaminophen. A facilitation process was also launched in October 2024 to continue to improve both areas of care delivery.
COMFORT at Work
As COMFORT CPGs have rolled out to Michigan practitioners, feedback has been positive, and as one nurse points out, eye-opening to care standards:
“As a nurse with over 20 years of experience and a strong advocate for high-quality care, I’ve always sought to protect my team from unnecessary workflow changes. One COMFORT measure I hesitated to implement was scheduled Motrin and Tylenol after birth, believing PRN orders were more efficient on vaginal deliveries. That changed when I watched my own daughter give birth and struggle to advocate for herself in managing her pain. Seeing firsthand how scheduled order sets empower patients to receive timely care without having to ask, was eye-opening. This experience reinforced that COMFORT protocols truly prioritize the patient experience. I am confident that the Obstetrics Initiative and our Birthing Center are providing a progressive evidence-based approach to managing our patients’ postpartum pain for all births.”
OBI will continue their work with COMFORT in 2025, with a goal that by December more than 70 percent of OBI-affiliated hospitals in Michigan will offer COMFORT CPG-concordant care, measured by an aim to get more than 70 percent of clinicians trained on COMFORT guideline, and more than 90 percentage of eligible births receive opioid-sparing postpartum pain management.
For More Information
- Learn more about the Bringing Our Patients COMFORT initiative.
- To learn about the Collaborative Quality Initiatives, visit cqis.org.