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We appreciate Dr Fullin’s interest in our work.1Badreldin N. Grobman W.A. Yee L.M. Inpatient opioid use after vaginal delivery.Am J Obstet Gynecol. 2018; 219: 608.e1-608.e7Abstract Full Text Full Text PDF Scopus (24) Google Scholar We enthusiastically agree that there is a need to improve postpartum pain management and this remains a pivotal goal of our research. In this study of more than 9000 women who underwent a vaginal delivery, we showed that greater use of acetaminophen and analgesia orders written by an advanced practitioner were independently associated with decreased odds of opioid use in the 24 hours prior to hospital. As Dr Fullin highlights, intrapartum regional analgesia was associated with increased odds of opioid use during this time frame. Dr Fullin correctly points out that regional analgesia can include a wide range of anesthetic techniques. For the purposes of our analyses, the term regional analgesia was used to encompass epidural, spinal, and combined spinal and epidural analgesia. Our data are compiled from a single center that is serviced by 1 obstetrical anesthesia group with unified practices. Laboring patients who opt for neuraxial analgesia typically receive a combined spinal and epidural dosed with fentanyl and bupivacaine. Intrathecal morphine is not routinely used for laboring patients. Unaccounted factors for opioid use after vaginal deliveryAmerican Journal of Obstetrics & GynecologyVol. 220Issue 6PreviewI read with great interest the article of Badreldin et al1 in a recent issue of the journal. The authors performed a retrospective study of 9038 women after a vaginal delivery and concluded that both the use of acetaminophen and having had postpartum orders written by an advanced practitioner were independently associated with lower odds of inpatient opioid use. The authors should be applauded for performing a well-designed study in an important topic (ie, opioid consumption) in patients undergoing vaginal delivery. Full-Text PDF