Opinion Piece on C-sections and Pain Management

Notes of caution on ‘toughing it out’

How to recover quickly and avoid chronic pain after a C-section

Women are miraculous providers of life – going through the challenging phases of pregnancy, the remarkable birthing process, and the important years of nurturing their children. These are tough endeavors that are a testament to the strength and resiliency of mothers. But my message is a simple one – don’t be afraid to take your pain medications after a C-section! A mother’s ability to “tough it out” can be more harmful to her long term recovery and comfort.

C-sections have become increasingly common, with over a third of pregnant women having one – they can be both planned and unplanned. The procedure is rising in popularity, with an increasing number of women choosing C-sections over vaginal delivery. The U.S. rate has increased by more than half over the last decade; the national average is now over 30 percent, and 40 percent in many major institutions.

So my desire is to quiet the fears of pregnancy by helping you know what to expect after your big day. Whether you are planning a C-section, or understand that sometimes it becomes medically necessary for the health of you or your baby, you should know that C-sections can be successful and safe, and recovery can be fast and smooth as well. Understanding this process will help minimize fear and stress, which is good for you, and good for the baby.

One thing that is important to understand is why pain management for C-section recovery is important – there is definitely a correlation between the pain you experience in the postpartum room and chronic pain that may develop later on. Part of how chronic pain develops has to do with the spinal cord “wind up,” meaning that once certain neural tracts in the spinal cord have been sensitized to the presence of pain, the pain gets “remembered,” setting up a continuing cycle.

Working with a physician anesthesiologist to understand pain management for your surgery and recovery process should be taken seriously. Less pain early on also means less likelihood of developing chronic pain. The studies are conclusive: if you have severe pain immediately after your cesarean, you are more likely to develop chronic pain down the line. While 36 percent of women had pain two months after a cesarean, a whopping 10-18 percent still had pain one year later.

Pain has been noted to be woefully undertreated in the USA, and the postpartum period is a prime example. Most doctors are not trained as pain specialists the way physician anesthesiologists are. So let me give you a few tips that they may unintentionally forget to give you. First and foremost: treat the pain well! The net result of taking pain medication is that you will recover faster. Since long-term pain is to a large extent ‘learned’, “toughing it out” doesn’t make physiological sense. Post-cesarean pain should not be severe for more than one week; you won’t get addicted in that time frame. After that, you should be able to cut back on medication.

By far the most common mainstay of pain relief after a C-section is epidural or spinal morphine. Given into your back, the morphine enters the spinal fluid and works for up to 24 hours, providing better quality pain relief than IV narcotics. After that, medications like Ibuprofen and even Hydrocodone/acetaminophen (e.g. Vicodin) are used to reduce pain, allowing you to get out of bed and move around more, which paves the way toward a faster recovery.

Don’t be afraid to take your pain medications. Toughing it out is not the way to go anymore. By having good pain relief and employing preemptive analgesia, thereby preventing pain before it occurs, you can prevent spinal cord wind-up and drastically reduce your chances for chronic pain. It’s better for you, both in the short term and the long term. Your body will thank you in the months to come.

So as you think about your recovery process, understand the following:

• Preemptive measures are a good thing:  treat the pain before it starts so that your spinal cord never has the chance to become sensitized to it. In other words, avoiding pain in the short term helps prevents pain in the long term.
• Appropriately prescribed pain medications are safe for you and your baby: by taking your pain medicine, you will be more comfortable, enjoy and bond with your baby, and be able to move around more.
• Feeling comfortable quickens your recovery: pain medicine will help you move around and do your routine – the perfect launching pad to a complete recovery.

Birthing a baby, whether vaginally or by C-section, is a lot of work for you, the mother. Just remember you have a team of doctors, nurses and other healthcare providers that are there to have your back. Don’t be afraid to ask questions. You’ve already gone through a lot in pregnancy, and delivery is a challenge as well. So view your pain medications as an important tool in your arsenal to put yourself on the path toward a fast and successful recovery.

Dr. Mark Zakowski, California Society of Anesthesiologists

Chair, Legislation and Practice Affairs Division

Author of: C-sections: how to avoid, prepare for and recover from your cesarean