A new synthesis of global evidence, published in Anaesthesia (the journal of the Association of Anaesthetists), finds that chronic postsurgical pain after cesarean delivery is associated with substantial impairment in women's quality of life and everyday functioning in the months and years after giving birth. The study was led by Dr Sarah Ciechanowicz of University College London Hospitals NHS Foundation Trust, London, UK, with first author Samira Alwahabi of Florida Atlantic University, USA, and co-authors from Stanford University, USA.
The systematic review of 30 studies involving 28,295 women found that chronic postsurgical pain was associated with persistent disruption to everyday functioning, including general activity, walking and normal work, as well as sleep, mood, fatigue, and, in some cases, sexual function.
The authors say that the findings underscore the importance of identifying at-risk women at an earlier stage, as well as the routine assessment of the impact of pain on daily life and mental health after cesarean delivery.
Chronic postsurgical pain is increasingly recognised as a complication of cesarean delivery and an important cause of health problems after childbirth, affecting an estimated 15-17% of women three to six months after giving birth. However, until now, there has been no comprehensive synthesis of the available evidence examining its broader impact on new mothers' health-related quality of life.
To find out more, researchers conducted a systematic review combining results from randomised controlled trials and observational studies, including cohort and cross-sectional studies published up to November 2025, examining how persistent pain lasting three months or longer after cesarean delivery is associated with maternal quality of life and functioning in the months and years following surgery.
Because the studies used different definitions and measures of quality of life, the researchers compared and summarised the findings rather than combining them into a single overall estimate. Data were analysed from 30 studies involving 28,295 women across 22 countries.
Persistent impact on daily life, mood, sleep and fatigue
Across four studies measuring pain-related interference in the first three months after giving birth, more than half (55%) of women with chronic postsurgical pain reported that pain interfered with general activity. Pain also interfered with mood (54%), walking (44%), normal work (43%) and sleep (43%).
Pain-related interference was also evident at later follow-up. At six months postpartum, 53% of women reported that pain interfered with their mood and 31% reported interference with sleep. At 12 months, mood-related interference affected around two-thirds of women (69%), while more than half (53%) reported that pain interfered with sleep.
Persistent fatigue was also common. In one large cohort, around two-thirds of women reported extreme tiredness at both six and 12 months after giving birth, showing little improvement over this period.
Additionally, across nine studies reporting depressive symptoms, rates of postpartum depression ranged from 7% to 46% during the first year after giving birth. One large study also found that women with chronic postsurgical pain after cesarean delivery had around five times higher odds of significant depressive symptoms at both three and six months after giving birth.
Beyond one year postpartum, chronic pain continued to interfere with activities, sleep and mood in some women. Across studies, around 5% to 24% of women with chronic pain reported that sexual intercourse aggravated their pain, with rates of around 5% to 6% still reported three to four years after giving birth.
"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," said Dr Ciechanowicz.
"In the early months after childbirth, the impact of chronic pain appears to be more strongly characterised by limitations in physical function, while emotional and psychological effects may become more prominent over time. It is therefore crucial that we develop multidisciplinary strategies to support women and improve longer-term recovery after giving birth."
She added, "The burden of chronic postsurgical pain extends beyond its impact on quality of life, with prolonged recovery, reduced capacity to work and repeated healthcare visits potentially placing a considerable socioeconomic burden on affected women. This reinforces the importance of early identification of at-risk women and effective management of chronic pain."
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