1 in 7 mothers experience inadequate pain relief during C-section, new recommendations from anesthesiologists help address the problem

Posted: April 30, 2024 | Word Count: 641

Nearly a third of all births in the U.S. — more than 1.3 million — are delivered by cesarean section (C-section) each year. While their baby’s safety is top of mind, mothers are likely also concerned about the pain they may experience during the procedure. Although epidurals are the most common pain relief used and are highly effective, recent research found that nearly one in seven mothers — almost 200,000 a year — may still experience some level of pain or discomfort, which can significantly affect their mental health.

The American Society of Anesthesiologists (ASA) is helping to address this issue by releasing new recommendations and best practices to help ensure all moms-to-be receive adequate pain management during planned or unexpected C-sections.

Data shows that when a mother’s pain is not adequately controlled during a cesarean delivery they can experience psychological distress and an increased risk of post-traumatic stress disorder,” said ASA President Ronald L. Harter, M.D., FASA. “ASA’s new recommendations will help ensure all expectant mothers receive optimal pain care tailored to their individual needs.”

ASA explains pain management options during C-sections, the new recommendations and what women in labor can expect and should ask their anesthesiologist.

Pain Management During C-sections

The majority of mothers undergoing C-sections receive regional anesthesia, which is proven very safe and quite effective and used in 95% of elective and 80% of emergency cesarean deliveries in the U.S. The two most common are epidurals and spinal blocks, where pain medication is delivered through an injection or a catheter inserted into the lower back.

An epidural or spinal block is often the preferred pain-relief method because the baby is exposed to the lowest amount of medication, and the mother can still actively participate in the baby’s birth. However, general anesthesia may be necessary in some cases.

Many hospitals have historically tracked general anesthesia rates in cesarean delivery, but the frequency of pain associated with epidurals and spinal blocks has largely been unknown until more recently when research found that mothers’ pain was sometimes not adequately controlled through this type of anesthesia, requiring additional anesthesia or pain medications.

New Recommendations and Best Practices for Health Care Teams

ASA’s new recommendations and best practices focus on helping health care professionals identify patients at increased risk for pain before a C-section, maintaining adequate anesthesia throughout the delivery, ensuring effective communication between the mother and her health care team and following up with new moms to ensure quality improvements and disparities are reduced. The importance of shared decision-making with the patient is also discussed.

What Moms-To-Be Should Expect

A cesarean delivery is needed if a baby can’t be born vaginally for reasons such as the positioning of the baby or placenta, or other health risks to the mother or baby. Some C-sections are planned, but many are done when unexpected issues occur during labor for a planned vaginal delivery.

For patients preparing for a C-section, ASA encourages them to talk with their anesthesiologist about their anesthesia plan. Questions moms-to-be should consider asking include:

  • What type of anesthesia will I receive?
  • How will the anesthesia affect my baby?
  • What can I expect to feel during the procedure?
  • How will my pain be managed after the procedure?
  • What are the possible side effects of the anesthesia?
  • How will you monitor me during the procedure?
  • What happens if I require general anesthesia during the procedure?
  • Will an anesthesiologist be involved in my care?

Expecting mothers also are urged to speak up if they experience any pain or discomfort during the procedure, as additional anesthesia options may be available to help control pain while protecting both their health and the baby’s.

Learn more about how anesthesiologists help manage pain during labor and the anesthesia options that are available by visiting: https://www.asahq.org/madeforthismoment/pain-management/types-of-pain/labor/.

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