How often it happens, and who it happens to

Between one in fifty and one in three, depending on the technique and who is counting.

There is no single number, and the reason is the definition. Reported rates run from 2% to 36% depending on the group studied and what was counted.

The pooled figure from a systematic review of 34 studies and 11,351 patients is 17% under regional anesthesia: 14% with a fresh spinal, and 33% where a labor epidural was topped up for the operation. The current reviews put it at up to a third of patients in the higher-risk situations.

14%

With a fresh spinal

Pooled, 34 studies

33%

With a labor epidural topped up

Same review

2–36%

Range across studies

Depends on the definition used

The risk is higher when a labor epidural is extended for surgery rather than a fresh spinal being placed, when the cesarean happens during labor rather than as a planned operation, and when surgery runs long.

Read the 33% againAn unplanned cesarean after a labor epidural is the commonest cesarean there is. It is also the one with the highest reported rate of pain, and it is almost never mentioned beforehand.

Where this comes from

Landau R. Breakthrough pain during cesarean delivery. Anesthesiol Clin. 2026;44(3):453-476. doi:10.1016/j.anclin.2026.02.017
Sharpe EE, Landau R. Pain during cesarean delivery: risk factors, mitigation, and current approaches. Curr Opin Anaesthesiol. 2025;38(3):169-178. doi:10.1097/ACO.0000000000001488
Charles EA, Carter H, Stanford S, Blake L, Eley V, Carvalho B, et al. Intraoperative pain during cesarean delivery under neuraxial anesthesia: a systematic review and meta-analysis. Anesthesiology. 2025;143(1):156-167.

Covered in the class

6Module 6. Pain during a cesareanPressure and pulling are expected. Pain is not, and it must not be relabelled as pressure.

Continue

Read this inside the full program, with the questions to take to your next visit and a record of what you have covered.

Obstetric Anesthesia Preparedness →

More from What it is

Breakthrough pain is what you report, not what they do about itThe definition matters, because the wrong one makes the problem disappear.

This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you.