“Sleep is often overlooked in postpartum recovery, but it is central to a mother’s physical and mental health,” said Moe Takenoshita, M.B.B.Ch., lead author of the study and a postdoctoral scholar in the department of anesthesia at Stanford University Center for Academic Medicine, Palo Alto, California. “Cesarean delivery in particular appears to increase the risk for severe pain and sleep disorders, which can lead to postpartum depression, thinking and memory problems, and fatigue, as well as disrupt bonding with their babies and relationships with family and friends.”

The research team used both qualitative and quantitative methods. In the qualitative portion, they interviewed 41 mothers about their pain and sleep experiences after childbirth. Among them, 24 had vaginal deliveries, 11 had planned C-sections, and six had unplanned C-sections. Severe pain that affected sleep and everyday activities was reported by more than two-thirds of those who underwent C-sections (73% of planned and 67% of unplanned), compared to just 8% of mothers who had vaginal births.

The quantitative analysis drew from a national insurance database of more than 1.5 million mothers who gave birth between 2008 and 2021. The findings showed that mothers who had C-sections were 16% more likely to receive a new diagnosis of a sleep disorder (such as insomnia, sleep deprivation, or obstructive sleep apnea) within one month to one year after delivery, compared with those who gave birth vaginally.

Dr. Takenoshita advised that new mothers, particularly those recovering from C-sections, should take steps to manage pain effectively, since untreated pain can further disturb sleep. Additional strategies to support better rest include engaging in light physical activity when possible, sleeping when the baby sleeps, avoiding caffeine and alcohol later in the day, and winding down before bed through activities such as taking a bath or practicing deep breathing.

“About one-third of U.S. births are C-sections,” said Dr. Takenoshita. “Those who are planning a C-section should understand that the procedure is linked to more severe pain after delivery and a higher risk of sleep disorders. Anyone having sleep problems during pregnancy or after childbirth should discuss their concerns with their physician, who can evaluate the issue, make recommendations and refer them to a specialist if necessary.”