C-sections linked to longer recovery, higher pain, sleep problems for new mothers

Editor's Note

Cesarean delivery remains the most common major surgery in the US, but new evidence highlights its impact on recovery, pain, and sleep health for mothers. In an American Medical Association (AMA) interview published by HCA Healthcare Today on October 10 and new research presented at the ANESTHESIOLOGY® 2025 annual meeting, experts reviewed the physical and emotional toll of C-sections and the need for careful timing, recovery planning, and patient education.

According to the AMA article, HCA Healthcare’s assistant national medical director for Women’s Services, Cindy Celnik, MD, MBA, FACOG, described C-sections as lifesaving yet complex procedures performed when vaginal birth is unsafe or not possible. She noted approximately one in three US births—nearly 1.2 million annually—are C-sections. Common reasons include fetal distress, stalled labor, breech presentation, or maternal health concerns. Dr Celnik emphasized cesarean recovery typically lasts 6 to 8 weeks, compared to 2 to 4 weeks for vaginal births, and carries three times higher risk of severe complications such as infection, bleeding, and blood clots.

HCA Healthcare research, conducted in collaboration with the March of Dimes and ACOG, helped shape current standards discouraging elective deliveries before 39 weeks due to poorer neonatal outcomes. Dr Celnik also highlighted the organization’s Enhanced Surgical Recovery (ESR) protocols, which have reduced hospital stays and opioid use following C-sections across HCA facilities. However, she cautioned that multiple cesareans heighten long-term risks such as placenta accreta, adhesions, and hernias, and may limit future options for vaginal birth after cesarean (VBAC).

Complementing these clinical insights, findings from the American Society of Anesthesiologists’ ANESTHESIOLOGY 2025 meeting linked cesarean birth to greater pain and disrupted sleep after delivery. In the study led by Stanford University, 73% of mothers with scheduled C-sections and 67% with unplanned C-sections reported severe pain interfering with sleep and daily life, compared with just 8% of vaginal-birth patients. Analysis of insurance data from 1.5 million births showed mothers who had C-sections were 16% more likely to develop new sleep disorders such as insomnia or sleep apnea within a year postpartum.

Both sources point to the need for comprehensive pain management, realistic recovery expectations, and proactive discussions between clinicians and patients. Adequate pain control, sleep hygiene, and emotional support can mitigate risks and promote better outcomes for both mother and child.