Background: Buprenorphine and methadone are common medications for opioid use disorder (MOUD) in pregnancy. Buprenorphine’s high affinity to the mu-receptor may impact postoperative analgesia and increase opioid needs after cesarean delivery. We assessed whether parturients receiving buprenorphine, compared with methadone, experience higher postoperative opioid requirements or pain scores after cesarean delivery. Methods: Patients with documented opioid use disorder receiving buprenorphine or methadone MOUD who underwent cesarean delivery at a single institution (2017-2019) were identified. Outcomes included total postpartum supplemental opioid milligram morphine equivalents (MME) and maximum postpartum pain scores. Primary analyses compared total postpartum opioid consumption (MME) and maximum postpartum pain scores between MOUD groups using univariable and multivariable regression, while exploratory analyses evaluated clinical, obstetric, and anesthetic predictors of opioid use and pain severity. Statistical significance was defined as P<0.05 for primary analyses and P<0.1 for exploratory analyses. Results: A total of 177 patients were included, 59 (33%) receiving methadone and 118 (67%) buprenorphine. Postpartum opioid requirements and maximum pain scores were similar between MOUD groups. In exploratory analyses, MOUD did not predict postpartum maximum pain score. Obstetric and anesthetic factors including estimated gestational age, labor prior to cesarean, conversion to general anesthesia, neuraxial morphine, emergency cesarean delivery, duration of surgery, and postoperative parenteral opioid patient-controlled analgesia, were associated with higher pain scores and opioid use. Conclusion: After cesarean delivery, patients receiving buprenorphine and methadone for MOUD had similar postpartum opioid requirements and pain scores. Additional risk factors for postpartum pain and total opioid dose are identified as opportunities for future research and clinical improvement efforts. Key Points Question: Do pregnant patients receiving buprenorphine for opioid use disorder (OUD) experience worse postoperative pain or higher opioid use after cesarean delivery compared with those receiving methadone? Findings: After cesarean delivery, patients receiving buprenorphine and methadone for MOUD had similar postpartum opioid requirements and pain scores. Meaning: These findings suggest that postoperative analgesic needs among patients receiving MOUD may be driven more by obstetric urgency, anesthetic course, and perioperative management, rather than MOUD choice.