Chronic postsurgical pain following cesarean delivery can have a lasting impact on women's quality of life, daily activities, sleep and emotional well-being, according to a new review of evidence published in Anaesthesia, the journal of the Association of Anaesthetists.
The systematic review, led by researchers from University College London Hospitals and Florida Atlantic University, included 30 studies involving 28,295 women from 22 countries. The researchers examined evidence on pain that persisted for at least three months after cesarean delivery and its effects on maternal functioning and quality of life.
The analysis found that chronic postsurgical pain was linked to difficulties with everyday activities, including walking and normal work, as well as problems with sleep, mood and fatigue. Some women also experienced pain during sexual activity.
Chronic postsurgical pain is estimated to affect around 15–17% of women three to six months after cesarean delivery. Until now, however, there has been no comprehensive assessment of its broader effects on women's health and daily functioning.
Because the studies used different definitions and tools to measure quality of life, the researchers summarized the findings rather than calculating a single overall estimate.
Pain can interfere with everyday activities and sleepAmong four studies assessing pain-related interference during the first three months after childbirth, 55% of women with chronic postsurgical pain said it affected their general activity. Pain also interfered with mood in 54% of women, walking in 44%, normal work in 43% and sleep in 43%.
The effects persisted at later follow-ups. At six months postpartum, 53% of women reported that pain affected their mood and 31% said it interfered with sleep. By 12 months, mood-related interference was reported by 69% of women, while 53% reported problems with sleep.
Fatigue was also common. In one large cohort study, approximately two-thirds of women reported extreme tiredness at both six and 12 months after childbirth, with little improvement during that period.
Depressive symptoms were reported in nine studies, with rates of postpartum depression ranging from 7% to 46% during the first year. One large study found that women experiencing chronic postsurgical pain had approximately five times higher odds of significant depressive symptoms at three and six months after delivery.
The effects could continue beyond the first year. Across the studies, 5–24% of women with chronic pain said sexual intercourse worsened their pain, with approximately 5–6% still reporting this problem three to four years after childbirth.
The researchers said the findings highlight the need to view chronic postsurgical pain as more than a problem involving pain intensity alone. Early identification of women at higher risk, together with routine assessment of how pain affects daily activities and mental health, could help improve long-term recovery.
The authors also noted that prolonged recovery, reduced ability to work and repeated healthcare visits may create a significant socioeconomic burden for women affected by chronic pain.
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