The use of anesthesia during Cesarean delivery remains a critical component of obstetric care, shaping both maternal outcomes and the overall birth experience. As C-section rates continue to be closely examined—balancing concerns of underuse in some settings and overuse in others—understanding the role of analgesia, patient decision-making, and postoperative recovery has become increasingly important for clinicians. From regional anesthesia techniques to considerations around general anesthesia in emergent situations, providers must navigate a range of clinical and patient-centered factoros to ensure safe and effective care.
At the same time, evolving conversations around pain management, patient expectations, and postpartum recovery are influencing how obstetricians counsel patients approaching delivery. Greater emphasis is being placed on shared decision-making, preparation for potential delivery outcomes, and the use of multimodal, opioid-sparing approaches to improve recovery and early maternal-infant bonding.
In this Q&A, Nicole Sparks, MD, a board-certified ob-gyn and clinical partner at Wellstar North Douglas OB/GYN in Douglas, Georgia, discusses key considerations surrounding anesthesia use in Cesarean delivery, current trends in C-section rates, patient concerns, and opportunities to enhance postpartum care and recovery.
Discussing C-section deliveries with Nicole Sparks, MD
Contemporary OB/GYN:
What associations are there with anesthesia during C-sections, and what would you like to highlight as baseline?
Nicole Sparks, MD:
There are many options for analgesia for patients in labor and during Cesarean (C-section) deliveries. According to the American College of Obstetricians and Gynecologists, none of the methods currently used are associated with an increase in Cesarean delivery.1 The decision for which type of analgesia to use is a shared decision between the patient, the patient’s provider, and the anesthesiologist based on obstetric and fetal risk factors.
Most patients undergoing Cesarean delivery will receive regional anesthesia via either epidural or spinal techniques, and these usually have a low risk for maternal morbidity and mortality. General anesthesia is usually reserved for emergency Cesarean deliveries or if regional anesthesia has failed. There are known increased risks while using general anesthesia, including aspiration and airway management, especially with the anatomical changes that take place during pregnancy. It is important to recognize that anesthesia can impact patients differently.
Common adverse effects include maternal hypotension, post-dural puncture headache, and pruritus (which is usually self-limited). In my practice, my priority is keeping patients stable and comfortable throughout the procedure and in the early stages of recovery, so they can stay alert, initiate bonding, and breastfeed as early as possible.
Contemporary OB/GYN:
What types of trends are currently going on concerning the frequency of c-sections, whether these numbers are concerning or not, and how anesthesia plays a role?
Sparks:
There are concerns about underuse in resource-poor settings and overuse of Cesarean deliveries without clear medical indications, especially in higher-income countries. Non medically indicated Cesarean deliveries contribute to rising costs and impact maternal morbidity, recovery, and future deliveries.2
Contemporary OB/GYN:
For those ob-gyns or midwives taking care of pregnant persons who may have questions about c-sections, what is important to remind them as the pregnancy gets closer to term?
Sparks:
As my patients get closer to their due date, I always remind them that while we hope for a safe, vaginal delivery, it’s important to stay flexible and prepare for a possible C-section depending on how labor progresses. Labor can change quickly, and the safety of mom and baby is always our top priority, so I want my patients to feel prepared for varied outcomes.
When having these conversations, it’s important to discuss postoperative recovery expectations and pain management pathways in advance. Historically, opioids have been commonly used to manage pain following C-sections, but we are increasingly focused on multimodal and opioid-sparing approaches.
This is an area where my personal experience informed my practice. After my first C-section, I was prescribed opioids. The side effects left me feeling foggy and disconnected from my baby and the rest of my family. For my following deliveries, my ob-gyn discussed non-opioid options with me, like EXPAREL (bupivacaine liposome injectable suspension; Pacira BioSciences), which was injected during surgery and helped me manage my pain for the first few days after delivery. I noticed a significant difference in my recovery and my pain control.
Since then, I’ve been recommending EXPAREL for my own patients when appropriate.
Having a clear, individualized plan in place can help ease some of the anxiety for patients as their pregnancy comes closer to term. It’s why these conversations are so important.
Contemporary OB/GYN:
How are elected c-sections handled, and what do you often hear from patients about their concerns with c-sections?
Sparks:
We always aim to help patients deliver vaginally, but there are instances where a patient will come in asking for a C-section. Sometimes this might be because of medical issues or past trauma from a previous birth. Every patient can choose this option, but it’s important for us as providers to explain what they can expect and what risks are associated, so that they are fully educated on the procedure ahead of delivery.
The most common concerns I hear are related to pain, recovery time, and how a C-section might impact future pregnancies. I take the time to talk through these concerns so there are no surprises. My goal is to make sure every patient feels informed and confident in their decisions.
Contemporary OB/GYN:
In this awareness month, what else would you like to highlight about c-sections? What areas of improvement in postpartum c-section care would you like to see?
Sparks:
C-Section Awareness Month is an important time to highlight how imperative postpartum care truly is, as C-sections are considered major surgeries and come with a recovery time much longer than a vaginal delivery.
C-sections are an alternative way we’re able to help mothers deliver comfortably and, in some cases, more safely, so it’s important to talk about this procedure in an informative and positive light.
One area I’d like to see continued improvement in is postpartum care, especially better pain control with fewer opioids, earlier mobility, and more support once the patient gets home, which is where most of the recovery happens.3 At the end of the day, my focus is not just on a safe delivery, but on making sure my patients feel supported and recover as smoothly as possible.
Contemporary OB/GYN:
Is there anything else you would like to include?
Sparks:
As both an ob-gyn and a mother of 4, I’ve experienced firsthand how easy it is for patients to deprioritize their own recovery in the postpartum period.
That’s why I strongly encourage clinicians to initiate proactive, evidence-based conversations about pain management during prenatal care, not just at the time of delivery. When patients understand their options, including multimodal and non-opioid approaches, they are better equipped to advocate for themselves and engage in their recovery.
Ultimately, our goal extends beyond a safe delivery. We want to support a recovery that allows patients to be present, functional, and confident in those early postpartum days.