Pain during the operation

The single most under-disclosed fact in cesarean consent.

Women are told they will feel pressure and pulling but not pain. That is not what the data show.

A 2025 systematic review of 34 studies and 11,351 patients found intraoperative pain in a pooled 17% of cesareans under regional anesthesia. Broken down by technique: 14% with a spinal, and 33% when a labor epidural was topped up for surgery.

17%

Pooled rate of pain during cesarean under regional anesthesia

34 studies, 11,351 patients

14%

With spinal anesthesia

Same review

33%

With a labor epidural topped up for surgery

Same review

Read the 33% againIf your cesarean follows a labor epidural, roughly one woman in three reports pain during the operation. This is exactly the scenario most women are in when they have an unplanned cesarean, and it is almost never mentioned beforehand.

Where this comes from

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 Anesthesia

How cesareans are anesthetizedAlmost all are awake. A minority are not. Side effects of a spinal during the operationLow blood pressure, nausea, shivering and itching are all common. General anesthesia: the breathing tube and the stomachTwo specific risks that make obstetric general anesthesia harder. General anesthesia: awarenessObstetrics carries the highest awareness risk of any surgery.

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