INTRODUCTION: Postoperative opioid use presents pain management dilemmas because mothers should be alert and engaged with their neonates. Mothers with neonates in intensive care (NICU) have additional stresses and may desire “round the clock” vs “prn” pain management. We compared post-operative opioid usage in mothers with neonates in regular nursery (“regular”) vs. NICU. METHODS: From January 1, 2013 through December 12, 2018, postoperative opioid use for days 0 until discharge was retrospectively reviewed. Mothers with “regular” neonates constituted Group 1, and NICU neonates were Group 2. Perioperative substance abusers or chronic opioid users were excluded. RESULTS: All the 8136 charts reviewed had orders for narcotic and non-narcotic analgesics. Both agents were used by 84% and only non-narcotic analgesics by 16% of mothers. None used narcotics exclusively. All received narcotic prescriptions at discharge, regardless of postoperative opioid use. Group 1 had 6509 and Group 2 had 1627 mothers. Group 2 diagnoses included prematurity (12%), sepsis (4%), neonates with life threatening anomalies requiring major surgery (3%). No differences occurred in opioid usage between the 2 Groups (43% vs 45%, POD1; 81% vs 80%, POD2; 72% vs 70%, POD3; 20% vs 23%, POD4). Significantly more opioid usage occurred in mothers of neonates with life threatening anomalies. CONCLUSION: Mothers with NICU neonates did not demonstrate increased postoperative opioid usage, in spite of the perceived added stresses. However, mothers with neonates having life threatening diagnoses utilized larger amounts of narcotics post-operatively. These findings may have future implications for post discharge pain management.