By Dr. Cynthia English, consultant of Pacira BioSciences, Inc.
Sponsored by Pacira BioSciences, Inc., manufacturer of EXPAREL®

Despite 1 in 3 babies being born via cesarean section, or C-section, most labor & birth classes don’t talk about them, leaving parents in the dark about what the process is actually like. Dr. Cynthia English, OB/GYN, wants to change that. Here, she shares what she believes every parent should know regarding C-sections, to help reduce anxiety and increase feelings of empowerment regarding their birth decisions.


Preparing for a C-Section (Whether Planned or Not)

The biggest thing I want patients to know when it comes to C-sections is that they have time to ask questions, whether that C-section is planned or unplanned.

If you and your doctor are planning on a C-section, bring a list of questions to your prenatal appointments. Some good questions to ask are:

  •     What will the setup in the room be like?
  •     What does the step-by-step process of the procedure actually look like?
  •     What role can my partner play? Can they cut the cord? Can I do skin-to-skin?
  •     How will my pain be managed after the procedure (e.g., are non-opioid options available)? 
  •     How can I plan for a healthy recovery?

If you are planning for a vaginal delivery, these are also really great questions to ask your provider during one of your final prenatal appointments. You can factor these answers into your birth plan, so you can account for any birth experience. 

If you don’t discuss these questions before going into labor and your doctor proposes an unplanned cesarean birth, don’t feel like it’s too late. You should still feel empowered to ask these same questions and initiate an open dialogue, even if they happen a few days before going into labor or hours before the delivery. 

These discussions not only prepare you mentally and emotionally for what’s to come, but they help you get the most out of the experience. For instance, I’ll chat with my patients about whether they want a see-through curtain to watch the birth, what kind of music they’d like to hear, and if they want a partner to cut the cord or to have immediate skin-to-skin contact. All of these choices can add up and make what can otherwise be a cold and clinical procedure be a personal experience for your growing family.


Navigating C-Section Recovery

When it comes to the recovery following a C-section, I reinforce to my patients that even though cesarean births are incredibly common, they’re still considered a major surgery that requires weeks of recovery. After leaving the hospital, you should plan for a great deal of rest, and lean on your support systems as much as possible to take care of day-to-day responsibilities. Take chores off your to-do list, and instead focus on things like resting, moving a little every day, meeting the immediate needs of your baby, monitoring your incision, getting good nutrition, and staying hydrated. 


Tips for Managing Pain Post-Procedure

When it comes to pain management, opioids are commonly prescribed following the procedure, and while they can effectively relieve pain, they can also come with a lot of side effects, like itchy skin, nausea, vomiting, or brain fog — not to mention concerns around addiction or dependence. 

I want patients to know they have options. Before going in for your procedure, whether it’s planned or unplanned, you can ask your OB/GYN what non-opioid pain management options are available. One non-opioid I’ve found encouraging success within my personal practice is EXPAREL® (bupivacaine liposome injectable suspension). EXPAREL is a long-acting numbing medication that is injected into the surgical site after the baby is delivered. It provides pain relief at the site of pain for the first few days following surgery when pain is at its worst and patients need it most. In my personal experience, incorporating EXPAREL into an overall non-opioid approach to pain management has allowed my patients to experience an enhanced recovery. They are up and moving sooner – which is key to recovery – getting home sooner, reporting less pain, and having an overall optimized recovery that allows them to better enjoy those first few days with their precious newborn.


Where to Go to Learn More

C-sections are something that I believe every pregnant person needs to learn about, and while I hope this post is helpful, there’s so much more to cover. I encourage you to check out Tinyhood’s class, C-Section Births & Recovery: What Every Pregnant Person Needs to Know. In it, Ashley Sousa, a labor and delivery nurse, and I arm you with all of the information you need to know regarding a planned or unplanned C-section, such as what the procedure entails; the decisions you can make, including non-opioid pain management options; what the recovery process is like; and so much more.

For more information on EXPAREL, please visit


EXPAREL® (bupivacaine liposome injectable suspension) is indicated for single-dose infiltration in patients aged 6 years and older to produce postsurgical local analgesia and in adults as an interscalene brachial plexus nerve block to produce postsurgical regional analgesia. Safety and efficacy have not been established in other nerve blocks.


Important Safety Information
EXPAREL should not be used in obstetrical paracervical block anesthesia.

In studies in adults where EXPAREL was injected into a wound, the most common side effects were nausea, constipation, and vomiting.

In studies in adults where EXPAREL was injected near a nerve, the most common side effects were nausea, fever, and constipation.

In the study where EXPAREL was given to children, the most common side effects were nausea, vomiting, constipation, low blood pressure, low number of red blood cells, muscle twitching, blurred vision, itching, and rapid heartbeat.

EXPAREL can cause a temporary loss of feeling and/or loss of muscle movement. How much and how long the loss of feeling and/or muscle movement depends on where and how much of EXPAREL was injected and may last for up to 5 days.

EXPAREL is not recommended to be used in patients younger than 6 years old for injection into the wound, for patients younger than 18 years old for injection near a nerve, and/or in pregnant women.

Tell your health care provider if you or your child has liver disease, since this may affect how the active ingredient (bupivacaine) in EXPAREL is eliminated from the body.

EXPAREL should not be injected into the spine, joints, or veins.

The active ingredient in EXPAREL can affect the nervous system and the cardiovascular system; may cause an allergic reaction; may cause damage if injected into the joints; and can cause a rare blood disorder.

FOR MORE INFORMATION, PLEASE VISIT or CALL 1-855-793-9727. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit or call 1-800-FDA-1088.



                                                                                            PP-EX-US-8503        6/23