Background: Post-operative pain management following cesarean section remains a critical determinant of maternal recovery, psychological well-being, and early bonding with the newborn. Nurses, being the frontline caregivers, play an essential role in assessing, managing, and evaluating pain among post-cesarean women. Objective: This study explores the role of nurses in post-operative pain management after cesarean section at Aster Sanad Hospital, Riyadh, with a focus on practices, challenges, and patient-reported outcomes. Methods: A descriptive cross-sectional study was conducted between January and April 2025 among post-cesarean women admitted to Aster Sanad Hospital. A structured questionnaire, including validated patient-reported experience measures (PREMs) and nurse-reported practices, was administered to 450 participants (response rate: 92%). Quantitative data were analyzed using descriptive and inferential statistics, while qualitative narratives were thematically analyzed to capture patient perceptions. Results: Most patients (78%) reported moderate-to-severe pain within the first 24 hours post-surgery. Effective pain relief was strongly associated with timely nurse interventions (p < 0.05). Nurses employed multimodal strategies including pharmacologic management (NSAIDs, opioids, regional anesthesia follow-up) and non-pharmacologic techniques (positioning, breathing exercises, emotional reassurance). Patients rated nurse responsiveness and communication as critical factors in satisfaction with pain relief. However, barriers such as high workload, inconsistent protocols, and limited time for individualized care were identified. Conclusion: Nurses play a pivotal role in ensuring effective pain management after cesarean section. Strengthening nurse-led interventions, standardizing pain assessment protocols, and providing continuous training in pain management strategies can enhance patient outcomes and overall quality of care.