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Emily had a bad feeling about her Caesarian section<\/a> 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\u2019s normal to feel some touching, they told her. But what happened next was outright pain<\/em>: The visceral sensation of a scalpel slicing her skin and tearing across her abdomen.<\/p>\n It\u2019s so hard to fathom, it might seem like it must be a singular experience\u2014a terrible one-off. That\u2019s what Susan Burton<\/a>, host of the podcast The Retrievals<\/em><\/a>, figured when she received a letter sharing an equally horrifying C-section experience from a listener. This person had reached out because she\u2019d resonated with the stories of the women featured in the first season, whose severe pain during egg retrieval procedures went dismissed and untreated<\/a>. But before long, Burton had received an influx of similar notes about C-sections, which inspired the podcast\u2019s newest season, The Retrievals, Season 2: The C-sections<\/em><\/a>, released July 10.<\/p>\n Though it isn\u2019t often discussed, pain during C-section is a major issue, so much so that the American Society of Anesthesiologists (ASA) released a statement<\/a> in 2023 to raise awareness and guide clinicians toward recognizing and treating it. A review of studies<\/a> 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\u2019t 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.<\/p>\n As Burton points out in the first episode of The Retrievals, Season 2<\/em>, there\u2019s 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<\/em> of her C-section\u2014every cut, pull, tug, even the sealing of blood vessels with a red-hot instrument.<\/p>\n 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.<\/p>\n Splitting open your belly to extract a baby from your uterus is clearly an intense surgery, so you might assume you\u2019d 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<\/a>, chief of the obstetric, gynecologic, and fetal anesthesiology division at Johns Hopkins, tells SELF. But there are a few safety-related reasons why we\u2019ve gotten away from that, she says.<\/p>\n<\/div>\n For one, pregnant people about to give birth aren\u2019t ideal candidates for intubation\u2014an essential step to ensure a patient can keep breathing while under general anesthesia\u2014because certain hormone changes can cause swelling around the airway, Dr. Murphy points out. They\u2019re 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\u2019s because when you\u2019re 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\u2019s not a risk that\u2019s taken lightly.<\/p>\n There\u2019s also some potential danger for the baby in getting put to sleep for a C-section. Most of the drugs used \u201center the systemic vasculature of the patient and cross the placenta,\u201d Shannon Clark, MD<\/a>, 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.<\/p>\n All to say, there are valid reasons why general anesthesia isn\u2019t the default for C-sections like it is for other major surgeries (though it is<\/em> still sometimes used, particularly in emergency C-sections<\/a>\u2014more on this below). What\u2019s 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\u2019s 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.<\/p>\n More than half of C-sections in the US are unexpected, which means the plans for anesthesia may develop or change quickly.<\/p>\n The type of anesthesia you get will depend on the circumstances surrounding your C-section. According to 2023 data<\/a>, 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\u2019s already in your back, whereas if you didn\u2019t (or hadn\u2019t yet gone into labor), you\u2019ll probably get a spinal because it\u2019s quicker to do and sparks numbness faster, Dr. Murphy says.<\/p>\n 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\u2019t urgent (like a baby that isn\u2019t positioned head-down or a cervix that stops dilating), others are the result of emergencies (for instance, the baby\u2019s 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%<\/a> 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.<\/p>\n<\/div>\n 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\u2019d probably get a spinal since it\u2019s more direct than an epidural (no tube) and only lasts for about two hours.<\/p>\n 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\u2019s just for labor\u2014that 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\u2019t feel it, then they know the drugs are likely doing their job to zap pain signals. What you still will<\/em> 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<\/a> of your organs being moved around\u2014but it shouldn\u2019t hurt.<\/em><\/p>\n If you aren\u2019t 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\u2019t totally nullified those pain signals\u2014so 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 \u201csomeone stabbing me in my stomach,\u201d she tells SELF. (She had received an epidural when she initially went into early labor.) This can happen when the drugs don\u2019t fully bathe your spinal cord\u2014because they weren\u2019t injected into the exact right spot or something\u2019s off with the epidural tube, for instance\u2014or they haven\u2019t 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\u2019re inserted. (And your doc can\u2019t just pump in a ton of them at once because too much, too fast could tank your blood pressure.)<\/p>\n In this scenario, the proper protocol is for your doctor to pause what they\u2019re doing and reassess with the anesthesiology crew, Dr. Clark says. The good news is, there\u2019s plenty they can do to help\u2014namely, 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\u2014which 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 \u201cdreamlike state\u201d and being pain-free for the rest of the surgery, she tells SELF.<\/p>\n<\/div>\n But in the case of an emergency<\/em> 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\u2019s (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.<\/p>\n If you weren\u2019t<\/em> knocked out for an urgent C-section and wind up in pain\u2014or if you\u2019re hurting during a nonurgent C-section, and the supplemental drugs don\u2019t cut it\u2014the 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\u2019t have the optimal conditions to put a tube in while they\u2019re being operated on\u2014what if I lose the airway?<\/em> Or, It\u2019s not that much longer, maybe I can just sedate her through.<\/em> Perhaps they\u2019ve 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\u2014say, by insisting that a patient is just feeling pressure<\/em>, not pain, or that it\u2019s the normal \u201ctouching\u201d of the procedure, as in Emily\u2019s case.<\/p>\n Some of that resistance can also spring from provider ego and bias. Certain anesthesiologists might be convinced that they\u2019re above a failed spinal or epidural. Maybe it seemed like a perfect placement to them, and there\u2019s no obvious reason<\/em> it shouldn\u2019t be working, Dr. Clark says. And let\u2019s not forget the long history of doctors simply dismissing women\u2019s pain or blaming it on anxiety. It\u2019s what seemingly happened to Clara, the woman in The Retrievals<\/em>: As she was crying out in pain, an attending physician in the room told a nurse to let her know that it was \u201cokay,\u201d 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\u2019 claims of pain, Dr. Murphy says. \u201cI\u2019m ashamed that this happens in our profession, but we have to at least acknowledge that it does.\u201d<\/p>\n Two things can be true: Doctors are responsible for keeping mom and baby safe during a C-section and<\/em> also for not subjecting any patient to avoidable torment. Sometimes those things might seem at odds\u2014the most effective pain control, general anesthesia, comes with real risks. \u201cWould I rather my patient not go to sleep? For sure,\u201d Dr. Clark says. \u201cBut that doesn\u2019t mean I\u2019m going to sit there and let her scream and cry and feel it.\u201d<\/p>\n<\/div>\n 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\u2014so you should feel empowered to bring up the topic if they don\u2019t beat you to it. That chat should also include what the ASA calls \u201cshared decision-making,\u201d 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<\/em> you\u2019re going to have a C-section before it\u2019s 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.<\/p>\n Both Dr. Clark and Dr. Murphy also emphasize the importance of doctors trusting their patients when they say they\u2019re feeling pain. \u201cWe should never automatically assume it\u2019s pressure,\u201d Dr. Murphy says. Or that it\u2019s an anxiety attack, for instance, when they\u2019re writhing \u201cevery time I put a scalpel in their skin,\u201d Dr. Clark says. To the same end, she adds, doctors shouldn\u2019t be too proud to acknowledge a spinal or epidural that isn\u2019t working and embrace a plan B\u2014like 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\u2019re still suffering (while taking care to minimize risks).<\/p>\n The point isn\u2019t just to resolve in-the-moment agony. It\u2019s also to reduce the risk of postnatal trauma, which research<\/a> shows is more likely in folks who have a negative birth experience and particularly a painful C-section.<\/p>\n 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 \u201c\u2018something,\u2019 when in reality, it was terrible pain,\u201d 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, \u201cit brings me back to mine,\u201d she says. \u201cMy stomach just drops, and I feel instantly frozen.\u201d<\/p>\n It\u2019s 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, \u201cand it should always<\/em> be treated by providers.\u201d<\/p>\n Related:<\/strong><\/p>\nBusiness News There are three main ways pain can be managed during C-sections: epidural, spinal block, and in rare cases, general anesthesia.<\/h2>\n
Business News So why do a sizable portion of people still feel outright pain during a C-section?<\/h2>\n
Business News Recognizing C-section pain as a legitimate issue is a key step toward resolving it.<\/h2>\n
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