About one in three US births is a cesarean, yet the possibility of long-lasting pain rarely comes up in the prenatal conversation.
A systematic review published in Anaesthesia in September 2026 pulled together 30 studies covering 28,295 women in 22 countries.
It found that chronic postsurgical pain after a C-section shapes everyday life for months, and in some cases years.
Between 15 and 17 percent of women still had persistent surgical pain three to six months after delivery, the review found.
Also read: What your blood pressure does while you sleep may matter more than your daytime reading
In the first three months, more than half said the pain interfered with general activity (55%) or mood (54%).
Walking was disrupted in 44% of women, work in 43%, and sleep in another 43%.
The picture did not simply fade with time. At 12 months, 69% of women with chronic postsurgical pain reported mood interference and 53% reported disrupted sleep.
Around two-thirds still had extreme fatigue at both 6 and 12 months.
Also read: A daily probiotic may lower the risk of death for babies born too early
Sexual intercourse aggravated pain for between 5% and 24% of women early on, and 5-6% still reported this three to four years later.
Postpartum depression rates in the included studies ranged from 7% to 46% during the first year.
Women with chronic postsurgical pain had roughly five times higher odds of significant depressive symptoms at 3-6 months, the review found.
Where the pain comes from
A cesarean is a major abdominal operation, and chronic pain can stem from several sources at once.
Also read: How drinking too much water can affect your kidneys
Nerves in the lower abdominal wall can be cut, tied or trapped in scar tissue.
The ilioinguinal, iliohypogastric and genitofemoral nerves sit right in the path of the Pfannenstiel incision, the low horizontal cut used in most C-sections.
That can leave lasting nerve pain, numbness or hypersensitivity along the scar.
Adhesions add another layer. Any abdominal surgery can trigger internal scarring, and after one cesarean, studies estimate 12-46% of women develop peritoneal adhesions. After multiple cesareans, that rises to 26-75%.
Also read: New study: The brain responds to every single breath
Adhesions can pull on tissue and organs and drive persistent pain long after the incision has healed.
What raises the risk
Not every woman is at equal risk. Severe acute pain in the first days after surgery is one of the strongest predictors of pain that becomes chronic.
Early sleep disruption, depressive symptoms and higher anxiety scores in the first weeks are also independent risk markers.
General anesthesia without regional pain relief (a spinal or epidural block) has been linked to a higher chance of chronic pain.
Also read: 7 signs you may not be getting enough omega-3
Longer surgery times and existing pain conditions such as back pain or headaches raise the odds too.
The review's authors say those signals should be used to identify at-risk women earlier.
They also urge routine checks on pain, mood and function after birth, not only at the six-week postnatal visit.
What the numbers mean in practice
The US cesarean delivery rate was 32.4% in 2024, according to CDC provisional birth data, essentially unchanged from 32.3% in 2023.
With about one in three US births now delivered surgically, the review's 15-17% estimate points to a very large group of US women affected each year. Most were never told this was a possible outcome.
"Our findings support a broader understanding of chronic postsurgical pain after cesarean delivery that recognises its substantial impact on physical, psychological and everyday functioning, rather than focusing solely on the sensation and intensity of pain," lead researcher Dr. Sarah Ciechanowicz said.
The review has real limits. Most included studies were observational, definitions of chronic pain varied, and quality-of-life scales were mixed, so the authors could not combine every number into a single pooled estimate.
The authors call for multidisciplinary care for women whose pain lasts beyond three months.
That means combining pain specialists, physiotherapy and mental-health support, rather than treating persistent post-cesarean pain as a normal part of recovery.
This article is made and published by Mie Hermansen, who may have used AI in the preparation.