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To describe nationwide patterns in outpatient opioid dispensing after vaginal delivery.Using the Truven Health Analytics MarketScan database, we performed a large, nationwide retrospective cohort study of commercially insured beneficiaries who underwent vaginal delivery between 2003 and 2015 and who were opioid-naive for 12 weeks before the delivery admission. We assessed the proportion of women dispensed an oral opioid within 1 week of discharge, the associated median oral morphine milligram equivalent dose dispensed, and the frequency of opioid refills during the 6 weeks after discharge. We evaluated predictors of opioid dispensing using multivariable logistic regression.Among 1,345,244 women undergoing vaginal delivery, 28.5% were dispensed an opioid within 1 week of discharge. The most commonly dispensed opioids were hydrocodone (44.7%), oxycodone (34.6%), and codeine (13.1%). The odds of filling an opioid were higher among those using benzodiazepines (adjusted odds ratio [OR] 1.87, 95% CI 1.73–2.02) and antidepressants (adjusted OR 1.63, 95% CI 1.59–1.66), smokers (adjusted OR 1.44, 95% CI 1.38–1.51), and among those undergoing tubal ligation (adjusted OR 3.77, 95% CI 3.67–3.87), operative vaginal delivery (adjusted OR 1.52, 95% CI 1.49–1.54), and higher order perineal laceration (adjusted OR 2.15, 95% CI 2.11–2.18). The median (interquartile range, 10th–90th percentile) dose of opioids dispensed was 150 (113–225, 80–345) morphine milligram equivalents, equivalent to 20 tablets (interquartile range 15–30, 10th–90th percentile 11–46) of 5 mg oxycodone. Six weeks after discharge, 8.5% of women filled one or more additional opioid prescriptions.Opioid dispensing after vaginal delivery is common and often occurs at high doses. Given the frequency of vaginal delivery, this may represent an important source of overprescription of opioids in the United States.