After Delivery: Recovery, Pain Relief and Breastfeeding After Anesthesia

After a vaginal birth with an epidural, the catheter is removed and sensation and leg strength typically return over the next few hours. After a cesarean under spinal or epidural anesthesia, numbness fades gradually, and you are monitored in a recovery area until your condition is stable.

Pain relief after a cesarean

Pain is usually managed with a combination of approaches: a long-acting opioid given with the spinal or epidural, and regular non-opioid medication such as acetaminophen and anti-inflammatory drugs. ACOG recommends a stepwise, multimodal approach to postpartum pain that limits opioid use where possible.¹ Itching and nausea from neuraxial opioids are common and treatable.

Can I breastfeed?

Yes. The Academy of Breastfeeding Medicine's protocol on anesthesia for the breastfeeding mother notes that most anesthetic and pain medications pass into breast milk only in very small amounts, and that breastfeeding can generally resume as soon as the mother is awake, stable and alert after general anesthesia; there is usually no need to "pump and dump."² Regional anesthesia, with less medication reaching the bloodstream, is especially compatible with early skin-to-skin contact and feeding.

Headache after a spinal or epidural

A small number of patients develop a headache that is worse when sitting or standing and better when lying flat, usually appearing within a few days of a spinal or epidural. This happens when the membrane around the spinal fluid leaks a little, and it is treatable — options range from fluids, caffeine and pain medication to an epidural blood patch, in which a small amount of your own blood is placed at the leak.^3,4 It is worth reporting rather than enduring.

What about backache?

Back pain after childbirth is common whether or not an epidural was used — pregnancy and delivery strain the back on their own. Studies have not shown that epidurals cause long-term back pain.⁴

When to call

Contact your providers if you develop a severe headache that worsens when you sit or stand, new weakness or numbness in your legs, back pain with fever, or pain that is not controlled by your medication.

Sources

1. American College of Obstetricians and Gynecologists. ACOG Clinical Consensus No. 1: Pharmacologic Stepwise Multimodal Approach for Postpartum Pain Management. Obstet Gynecol. 2021;138(3):507–517.
2. Reece-Stremtan S, Campos M, Kokajko L; Academy of Breastfeeding Medicine. ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeed Med. 2017;12(9):500–506.
3. Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2016;124(2):270–300.
4. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 209: Obstetric Analgesia and Anesthesia. Obstet Gynecol. 2019;133(3):e208–e225.