COMFORT Trial: Complex Obstetric Management With Focused Regional Transversus Abdominis Plane Block

Inclusion criteria: Patient has a history of a least one of the following: * Prior exploratory laparotomy * History of non-obstetric open intra-abdominal surgery * History of three or more prior cesarean deliveries * History of intra-abdominal or pelvic adhesive disease * History of abdominal re-exploration surgery Exclusion Criteria: * Planned general anesthesia * Supraumbilical skin incision * History of less than 3 cesarean deliveries if do not meet other inclusion criteria * History of chronic opioid use * History of substance abuse (i.e. alcohol, methamphetamine/amphetamine, abuse of prescription opioid medication, or heroin use) * History of chronic kidney disease * Allergies to bupivacaine or oral analgesics * Patient preference * Planned cesarean hysterectomy * Administration of \>4mg morphine to epidural