Implementation Strategies for Standardizing Perinatal Pain Management

Wide variation in pain management practices after childbirth can lead to untreated pain, opioid misuse, and inequities in care. The Creating Optimal Pain Management FOR Tailoring Care (COMFORT) clinical practice guideline (CPG) was developed to address these issues by promoting equitable, evidence-based pain management. A new study identifies key barriers, facilitators, and strategies to implement the guideline effectively in United States maternity care settings.

Peripartum pain management is inconsistent across health care systems, highlighting a need for standardized practices. This study aimed to identify actionable strategies to ensure the adoption of the COMFORT CPG in diverse clinical settings, particularly to improve outcomes for patients and reduce care disparities.

Researchers conducted 57 interviews with patients and clinicians and six focus groups with quality improvement (QI) teams from Michigan hospitals. Using established implementation research frameworks, they identified influential contextual factors and linked them to 32 implementation strategies and 12 supporting tools designed to overcome barriers to CPG adoption.

Participants identified 10 key barriers and facilitators to COMFORT CPG adoption, including perceptions of the guideline’s robustness, challenges in adapting local workflows and electronic health records (EHR) systems, and the need for stronger anticipatory counseling for patients. To address these, researchers developed 27 unit-level strategies and 12 tools aimed at optimizing implementation. Key strategies included forming multidisciplinary teams, engaging champions with clearly defined roles, and securing leadership buy-in. Planning efforts focused on reviewing baseline performance, adapting unit policies, and tailoring EHR tools to simplify CPG adoption. Engagement strategies emphasized dynamic clinician training, peer support, and patient education materials to prepare birthing people for shared decision-making. Reflection and evaluation efforts incorporated data sharing, clinician feedback, and performance monitoring to drive ongoing improvement. Together, these strategies and tools aim to address barriers, standardize pain management practices, and promote equitable care delivery.

Limitations include reliance on self-reported data, focus on Michigan hospitals, and lack of real-world implementation testing. However, the study’s theoretical basis and inclusion of diverse stakeholders strengthen its applicability.

“This work identifies strategies and tools to promote COMFORT CPG adoption, potentially fostering equitable and evidence-based perinatal pain management,” the authors concluded.

Reference

Sharif L, Cocroft S, Smith SN, et al. Development of an implementation intervention to promote adoption of the COMFORT clinical practice guideline for peripartum pain management: a qualitative study. Implement Sci Commun. 2025;6(1):1. doi:10.1186/s43058-024-00687-5