Breakthrough pain during cesarean delivery refers to a patient reporting significant pain or intense uncomfortable pressure; it is a patient-reported outcome that occurs in up to one-third of patients, depending on anesthetic risk factors (eg, epidural anesthesia) and obstetric scenarios (eg, intrapartum cesarean delivery, prolonged surgery). In this review, important considerations to better understand what breakthrough pain during cesarean delivery under neuraxial anesthesia is, how to measure and report it, and strategies to prevent, mitigate and manage its occurrence and associated consequences are discussed. Experiencing breakthrough pain during cesarean delivery is associated with childbirth-related post-traumatic stress disorder.