PainRelief.com: What are the main findings?

Response: We found that caesarean delivery was associated with greater incidence of sleep disorders in the year after childbirth compared to vaginal delivery. This was based on analysis of a nationwide insurance claims database of >1.5 million mothers in the United States. After into account other factors that can impact sleep including clinical and sociodemographic factors, mothers who delivered by caesarean delivery had 16% higher odds of developing a sleep disorder within 1 year after delivery.

We also used interviews with 41 mothers within 1 year after delivery to explore experiences of sleep in the postpartum period. We found that a significantly greater proportion of patients who had delivered by caesarean delivery had experienced severe pain that impacted their sleep and/or their function during the day compared to vaginal delivery. Forty-four percent of the patients also expected worse pain and worse sleep after caesarean delivery compared to vaginal delivery. Those who had experienced both cesarean and vaginal delivery reported experienced worse pain and worse sleep after caesarean delivery. This is consistent with previous findings that caesarean delivery is associated with increased risk of severe acute pain and chronic pain, as well as outpatient opioid analgesia use compared to vaginal delivery.^9–13

This suggests that pain may explain part of the observed differences in postpartum sleep experiences and sleep disorders between caesarean and vaginal deliveries.

PainRelief.com: What should readers take away from your report?

Response: The key takeaways are that caesarean delivery is associated with increased odds of sleep disorders compared to vaginal delivery, and that pain may play a role. For those who are considering a caesarean delivery, it would be important to keep in mind that there is an association between caesarean delivery and sleep disorders. This would be particularly important for people who already struggle with their sleep, or those who are at risk of sleep disorders. Given that pain may play a role in this association, it is important that clinicians manage pain adequately, especially after caesarean delivery.

Finally, I would encourage people to have discussions with their obstetricians and primary care physicians if they have concerns about their sleep. We know that sleep disorders in the postpartum period are common. Take for example, insomnia disorder. Estimates vary but we have seen from our studies at least 1 in 10 people have insomnia disorder by 2 months after delivery. However, less than 10% of these patients get help from clinicians for their sleep. Part of it is because people expect sleep to be bad after having a baby, and do not realize that they may have a sleep disorder. We have treatments for insomnia that are proven to work. Given that there are 3.6 million people each year that deliver a baby in the US, you can only imagine the number of people who need treatment and do not have access to the appropriate support. I would encourage people to speak to their clinicians if they are concerned about their sleep; mothers need all the help that they can.

PainRelief.com: What recommendations do you have for future research as a result of this study?

Response: Future studies are needed to explore the reasons for the increased incidence of sleep disorders after caesarean delivery. This could help to develop strategies to identify patients who are at risk, inform decisions regarding delivery mode, and the management of sleep in the postpartum period. Ultimately, it will help us to improve postpartum recovery for mothers.

PainRelief.com: Is there anything else you would like to add? Any disclosures?

Response: I would like to give a huge thank you to my mentor, Professor Pervez Sultan. None of this work would have been possible without his guidance and invaluable mentorship. The work he is doing is inspiring and I am grateful to be part of his mission.

I have no disclosures.

Citations:

References:

1. Sultan P, Sadana N, Sharawi N, et al. Evaluation of Domains of Patient-Reported Outcome Measures for Recovery After Childbirth. JAMA Netw Open. 2020;3(5):e205540-e205540. doi:10.1001/jamanetworkopen.2020.5540
2. Nowakowski S, Meers J, Heimbach E. Sleep and Women’s Health. Sleep Med Res. 2013;4(1):1-22. doi:10.17241/smr.2013.4.1.1
3. Lillis TA, Hamilton NA, Pressman SD, et al. Sleep quality buffers the effects of negative social interactions on maternal mood in the 3–6 month postpartum period: a daily diary study. J Behav Med. 2018;41(5):733-746. doi:10.1007/s10865-018-9967-y
4. Lin X, Zhai R, Mo J, Sun J, Chen P, Huang Y. How do maternal emotion and sleep conditions affect infant sleep: a prospective cohort study. BMC Pregnancy Childbirth. 2022;22(1):237. doi:10.1186/s12884-022-04504-6
5. Dørheim SK, Bondevik GT, Eberhard-Gran M, Bjorvatn B. Sleep and Depression in Postpartum Women: A Population-Based Study. Sleep. 2009;32(7):847-855. doi:10.1093/sleep/32.7.847
6. Bekemeyer Z, Takenoshita M, Michel G, et al. Proposed domains of postpartum sleep: a concept elicitation study using qualitative interviews (in press). SLEEP Advances.
7. Spaeth AM, Khetarpal R, Yu D, Pien GW, Herring SJ. Determinants of postpartum sleep duration and sleep efficiency in minority women. Sleep. 2021;44(4). doi:10.1093/sleep/zsaa246
8. Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6(6):e005671. doi:10.1136/bmjgh-2021-005671
9. Li WY, Liabsuetrakul T, Stray-Pedersen B, Li YJ, Guo LJ, Qin WZ. The effects of mode of delivery and time since birth on chronic pelvic pain and health-related quality of life. International Journal of Gynecology & Obstetrics. 2014;124(2):139-142. doi:10.1016/j.ijgo.2013.07.029
10. Wang B shun, Zhou L feng, Coulter D, et al. Effects of caesarean section on maternal health in low risk nulliparous women: a prospective matched cohort study in Shanghai, China. BMC Pregnancy Childbirth. 2010;10(1):78. doi:10.1186/1471-2393-10-78
11. Kainu JP, Sarvela J, Tiippana E, Halmesmäki E, Korttila KT. Persistent pain after caesarean section and vaginal birth: a cohort study. Int J Obstet Anesth. 2010;19(1):4-9. doi:10.1016/j.ijoa.2009.03.013
12. Hardy‐Fairbanks AJ, Lauria MR, Mackenzie T, Mccarthy M. Intensity and Unpleasantness of Pain Following Vaginal and Cesarean Delivery: A Prospective Evaluation. Birth. 2013;40(2):125-133. doi:10.1111/birt.12039
13. Peahl AF, Dalton VK, Montgomery JR, Lai YL, Hu HM, Waljee JF. Rates of New Persistent Opioid Use After Vaginal or Cesarean Birth Among US Women. JAMA Netw Open. 2019;2(7):e197863. doi:10.1001/jamanetworkopen.2019.786

“Certain data were supplied by Merative as part of one or more Merative™ Marketscan® Commercial Database Research Databases. Any analysis, interpretation, or conclusion based on these data is solely that of the authors and not Merative. Data for this project were accessed using the Stanford Center for Population Health Sciences Data Core. The PHS Data Core is supported by a National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1TR003142) and from Internal Stanford funding. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.”

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Last Updated on October 21, 2025 by PainRelief.com