Why Do Thousands of Women Feel the Pain of Their C-sections?

Factors like the type of anesthesia used, the circumstances of the procedure, and even medical bias can lead to an excruciating experience.
woman with pregnant belly in hospital bed about to undergo a csection
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Emily had a bad feeling about her Caesarian section before it started. The epidural had numbed her legs, but she could sense the catheter in her bladder, which seemed wrong to her as a labor and delivery nurse. Sure enough, when the anesthesiologist pricked her belly with something sharp to test whether the anesthesia had set in, she felt a sting. It’s normal to feel some touching, they told her. But what happened next was outright pain: The visceral sensation of a scalpel slicing her skin and tearing across her abdomen.

It’s so hard to fathom, it might seem like it must be a singular experience—a terrible one-off. That’s what Susan Burton, host of the podcast The Retrievals, figured when she received a letter sharing an equally horrifying C-section experience from a listener. This person had reached out because she’d resonated with the stories of the women featured in the first season, whose severe pain during egg retrieval procedures went dismissed and untreated. But before long, Burton had received an influx of similar notes about C-sections, which inspired the podcast’s newest season, The Retrievals, Season 2: The C-sections, released July 10.

Though it isn’t often discussed, pain during C-section is a major issue, so much so that the American Society of Anesthesiologists (ASA) released a statement in 2023 to raise awareness and guide clinicians toward recognizing and treating it. A review of studies published this month suggests about 11% of people undergoing a C-section feel pain during it (despite getting the routine anesthetic). Of course, that means a great majority of people are totally numb. But considering that there are 1.2 million C-sections annually in the US, 11% translates to more than 100,000 people in pain every year. And the actual number may be even higher; studies don’t often track self-reported pain itself, but instead look at whether patients were put on extra IV pain meds or anesthesia during C-sections as a proxy for it.

As Burton points out in the first episode of The Retrievals, Season 2, there’s no other surgery where it would be acceptable for this number of people to feel the pain of it in action. To show the magnitude of the issue, the season follows Clara, a nurse at a hospital in Chicago who, while being operated on by coworkers, felt all of her C-section—every cut, pull, tug, even the sealing of blood vessels with a red-hot instrument.

Below, experts share why C-sections can turn painful or sometimes agonizing, even with the standard anesthesia in place, and what can be done to soften the blow.

There are three main ways pain can be managed during C-sections: epidural, spinal block, and in rare cases, general anesthesia.

Splitting open your belly to extract a baby from your uterus is clearly an intense surgery, so you might assume you’d be fully knocked out for it (and therefore feel nothing). And prior to the 1980s, use of general anesthesia during C-section was pretty typical, Jamie Murphy, MD, chief of the obstetric, gynecologic, and fetal anesthesiology division at Johns Hopkins, tells SELF. But there are a few safety-related reasons why we’ve gotten away from that, she says.

For one, pregnant people about to give birth aren’t ideal candidates for intubation—an essential step to ensure a patient can keep breathing while under general anesthesia—because certain hormone changes can cause swelling around the airway, Dr. Murphy points out. They’re also more likely than nonpregnant folks to experience aspiration under general anesthesia, which is when food reverses course from your stomach and spills into your lungs. That’s because when you’re pregnant, your stomach is shoved upward in your abdomen, and food may not move through it as quickly, Dr. Murphy notes. (Plus, the band of muscle that keeps stomach contents from backing up into your esophagus is more relaxed.) Aspiration can be life-threatening, so it’s not a risk that’s taken lightly.

There’s also some potential danger for the baby in getting put to sleep for a C-section. Most of the drugs used “enter the systemic vasculature of the patient and cross the placenta,” Shannon Clark, MD, a board-certified ob-gyn and maternal fetal medicine specialist in Galveston, Texas, tells SELF. If enough of the meds reach the baby in utero (based on things like the length of the surgery and placental blood flow), they could be born anesthetized, Dr. Murphy says, which could limit their ability to breathe and require them to get intubated in the NICU until they wake up.

All to say, there are valid reasons why general anesthesia isn’t the default for C-sections like it is for other major surgeries (though it is still sometimes used, particularly in emergency C-sections—more on this below). What’s typically offered instead is a form of neuraxial anesthesia, which numbs out a large swath of your body by blocking nerve signals in your spine. That’s either an epidural, which involves receiving anesthetic meds via a catheter (a.k.a. tiny tube) inserted next to your spinal cord, or a spinal block, which is a single shot of numbing drugs directly into your cerebrospinal fluid.

More than half of C-sections in the US are unexpected, which means the plans for anesthesia may develop or change quickly.

The type of anesthesia you get will depend on the circumstances surrounding your C-section. According to 2023 data, 39% of C-sections in the US are unplanned and occur after labor has started, and another 15% are also unexpected but happen before labor has begun. Generally, if you had an epidural placed while laboring, the docs will pump more meds into the tube that’s already in your back, whereas if you didn’t (or hadn’t yet gone into labor), you’ll probably get a spinal because it’s quicker to do and sparks numbness faster, Dr. Murphy says.

However, the level of urgency can also factor into the decision. While some unplanned C-sections occur because of scenarios that could make vaginal birth challenging but aren’t urgent (like a baby that isn’t positioned head-down or a cervix that stops dilating), others are the result of emergencies (for instance, the baby’s heart rate is dropping or your uterus ruptures). For the latter, an ob-gyn might suggest general anesthesia from the jump, Dr. Clark says, despite the risks above. (While only 6% of total C-sections involve general, that number may be as high as 20% for emergency ones.) Dr. Clark notes that there are techniques doctors can use to avoid intubation issues and keep stomach fluids down, like raising the head of your bed, applying a certain type of pressure to your throat, and dosing meds rapidly to protect your airway ASAP after you lose consciousness.

The remaining minority of C-sections are planned because of a medical reason, like having had a C-section previously, or personal choice; in these situations, you’d probably get a spinal since it’s more direct than an epidural (no tube) and only lasts for about two hours.

With either an epidural or a spinal, you should be wholly numb from about your nipple line all the way down to your feet, Dr. Murphy says. (To be clear, this means feeling less than you would with an epidural that’s just for labor—that involves fewer meds, so you can still feel some of the cramping and pressure of contractions and move your legs, Dr. Murphy points out.) To make sure the block is working, your anesthesiologist will do some testing, usually with something cold first and then with a sharp object like a needle. If you can’t feel it, then they know the drugs are likely doing their job to zap pain signals. What you still will feel during a C-section, Dr. Clark says, is some sense of pressure. That occurs when the surgeon goes to deliver the baby and needs to push on the top of the uterus, she explains. This also might include the unnerving sensation of your organs being moved around—but it shouldn’t hurt.

So why do a sizable portion of people still feel outright pain during a C-section?

If you aren’t one of the select folks who receives general anesthesia, a few factors can cause pain to rear its head despite getting an epidural or a spinal. A big one is that the meds just haven’t totally nullified those pain signals—so even if you were fine with the pinprick test, a full-fledged incision could be another story. To Kate, who had to get a C-section six weeks before her due date when her placenta partially detached, it felt like “someone stabbing me in my stomach,” she tells SELF. (She had received an epidural when she initially went into early labor.) This can happen when the drugs don’t fully bathe your spinal cord—because they weren’t injected into the exact right spot or something’s off with the epidural tube, for instance—or they haven’t had enough time to penetrate your nerves. While a spinal shot typically kicks in within a few minutes, with adding meds to an epidural, it could take upwards of 20 to 25 minutes for the extra drugs to soak into your nerves from the space where they’re inserted. (And your doc can’t just pump in a ton of them at once because too much, too fast could tank your blood pressure.)

In this scenario, the proper protocol is for your doctor to pause what they’re doing and reassess with the anesthesiology crew, Dr. Clark says. The good news is, there’s plenty they can do to help—namely, topping off an epidural with anesthetics and painkillers (and allowing more time for the meds to kick in); administering IV pain meds and hypnotics or sedating gas; or all of the above. For Kate, an extra hit of drugs via her epidural squashed the pain. This kind of additional support can also relieve pain that crops up near the end of an unexpectedly long C-section, when anesthesia might wear off—which is likely what happened to Kathryn, who had a C-section after 50 hours of laboring and a failed induction. Once she told the doctors she felt sharp pain, she remembers drifting off into a “dreamlike state” and being pain-free for the rest of the surgery, she tells SELF.

But in the case of an emergency C-section, there may not be any time to stop, reevaluate, and dose extra meds. As Dr. Murphy points out, urgency is a prime reason for pain in the first place: The spinal anesthetic has had a limited chance to totally bathe your nerves. Not to mention, the rushed movements of a surgeon who’s (sorry) ripping through tissue to access the baby can also worsen any experience of discomfort, she adds. As noted above, this is why some ob-gyns opt for general anesthesia in emergency cases.

If you weren’t knocked out for an urgent C-section and wind up in pain—or if you’re hurting during a nonurgent C-section, and the supplemental drugs don’t cut it—the anesthesiology team can usually still put you to sleep mid-surgery to bring relief. But that involves additional risk, and even though certain precautions can help prevent issues, some providers might shy away from it, Dr. Murphy notes. They may think, I don’t have the optimal conditions to put a tube in while they’re being operated on—what if I lose the airway? Or, It’s not that much longer, maybe I can just sedate her through. Perhaps they’ve had a bad experience with general anesthesia during a C-section in the past. So rather than take on extra risk, they choose to deny the problem—say, by insisting that a patient is just feeling pressure, not pain, or that it’s the normal “touching” of the procedure, as in Emily’s case.

Some of that resistance can also spring from provider ego and bias. Certain anesthesiologists might be convinced that they’re above a failed spinal or epidural. Maybe it seemed like a perfect placement to them, and there’s no obvious reason it shouldn’t be working, Dr. Clark says. And let’s not forget the long history of doctors simply dismissing women’s pain or blaming it on anxiety. It’s what seemingly happened to Clara, the woman in The Retrievals: As she was crying out in pain, an attending physician in the room told a nurse to let her know that it was “okay,” that this was all normal. Unconscious bias against people of a particular race or socioeconomic status could also lead a provider to more readily downplay certain patients’ claims of pain, Dr. Murphy says. “I’m ashamed that this happens in our profession, but we have to at least acknowledge that it does.”

Recognizing C-section pain as a legitimate issue is a key step toward resolving it.

Two things can be true: Doctors are responsible for keeping mom and baby safe during a C-section and also for not subjecting any patient to avoidable torment. Sometimes those things might seem at odds—the most effective pain control, general anesthesia, comes with real risks. “Would I rather my patient not go to sleep? For sure,” Dr. Clark says. “But that doesn’t mean I’m going to sit there and let her scream and cry and feel it.”

The recent ASA guidance pushes doctors to be open about the possibility of pain and lay out the options available for managing it during a pre-op convo—so you should feel empowered to bring up the topic if they don’t beat you to it. That chat should also include what the ASA calls “shared decision-making,” which means you get to weigh in on the plan for what happens if you do wind up hurting mid-procedure. Of course, you might not always know you’re going to have a C-section before it’s about to happen. So it may be worth consulting with your doc about that hypothetical scenario and weighing the what-ifs in advance, as part of determining your ideal birth plan.

Both Dr. Clark and Dr. Murphy also emphasize the importance of doctors trusting their patients when they say they’re feeling pain. “We should never automatically assume it’s pressure,” Dr. Murphy says. Or that it’s an anxiety attack, for instance, when they’re writhing “every time I put a scalpel in their skin,” Dr. Clark says. To the same end, she adds, doctors shouldn’t be too proud to acknowledge a spinal or epidural that isn’t working and embrace a plan B—like topping off an epidural or giving it more time to work, or supplementing with IV meds. And they should be equally willing to switch a patient to general anesthesia if they’re still suffering (while taking care to minimize risks).

The point isn’t just to resolve in-the-moment agony. It’s also to reduce the risk of postnatal trauma, which research shows is more likely in folks who have a negative birth experience and particularly a painful C-section.

Emily, for one, has post-traumatic stress disorder (PTSD) from her C-section. After letting out a panicked yelp when she felt the surgeon slicing into her, she received additional meds via her epidural, which helped for a short bit. But the pain returned once they were pulling out her baby and maneuvering her uterus thereafter. Though she cried out again, she felt written off, told she would feel “‘something,’ when in reality, it was terrible pain,” she says. Even today, her daughter nearly five years old, she can still feel the scalpel crossing her abdomen. If a patient of hers is the least bit distressed during a C-section, “it brings me back to mine,” she says. “My stomach just drops, and I feel instantly frozen.”

It’s made her all the more attuned to ensuring her patients feel heard, seen, and taken care of during this vulnerable period of their lives. As she notes, pain functions like a fifth vital sign, “and it should always be treated by providers.”

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