In the 2010 edition of "Williams' Obstetrics," Dr. F. Gary Cunningham, chief of obstetrics for Encino-Tarzana Medical Center, reports that about 30 percent of births in the United States occur by Cesarean section. Although almost all pregnant women complain of back pain, spinal anesthesia represents a unique risk factor for back pain from Cesarean birth. In fact, according to a 2009 study published in the journal Anesthesia and Critical Care, the risk approaches 40 percent.
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Back pain from Cesarean birth has two causes: The first cause is trauma to the skin, muscle, ligaments or nerves of the back due to insertion of the spinal needle. The second cause is known as a post-dural puncture headache in which a gradual leak of cerebrospinal fluid results in headache and neck pain that worsens when the patient sits or stands, and resolves when she lies flat.
Insertion-site pain presents as soon as the anesthetic begins to wear off—usually about two to six hours, says the American Society of Regional Anesthesia and Pain Medicine. Post-dural puncture headache-related pain presents a little later—between 12 hours and five days after Cesarean birth.
Both types of pain usually resolve over the course of a few days; although, in some cases, they may persist for a few weeks. For severe puncture headache-related pain, patients can undergo a treatment known as a "blood patch," which entails injection of the patient's own blood into the dural space. This provides almost immediate relief. Approximately one in 4,000 to one in 200,000 women may experience longer lasting pain due to nerve injury caused by spinal anesthesia for Cesarean birth, advises the American Society of Regional Anesthesia and Pain Medicine.
Back pain related to the insertion of the spinal needle usually occurs low on the back, around the first lumbar vertebral bone. Back pain related to post-dural puncture headaches seems to radiate down the neck from the head.
Patients usually rate both insertion site and puncture pain as mild and report improvements with over-the-counter acetaminophen. For patients with insertion site pain, alternating hot and cold compresses can help. For patients with puncture pain, it helps to increase fluid intake, especially caffeinated fluids such as coffee, tea and colas.
Emergency Warning Signs
According to obstetric anesthetist Dr. Wayne Kleinman in the 2006 edition of "Clinical Anesthesiology," about one in 220,000 patients develop complications such as bleeding and infections. Warning signs of complications include fever, redness or discharge at the insertion site; severe pain; and pain that progresses to numbness, tingling, muscle weakness or loss of bowel or bladder control. Women who experience warning signs after Cesarean birth should contact their obstetricians or go directly to the emergency department.
- "Williams' Obstetrics, 23rd edition"; F.G. Cunningham, et al.; 2010
- "Anesthesia and Intensive Care;" Incidence and Risk Factors for Chronic Pain after Caesarean Section under Spinal Anaesthesia; B.L. Sng et al.; Sep. 2009
- "Clinical Anesthesiology, 4th edition"; G.E. Morgan et al.; 2006