Hi Retrievals listeners, Episode 2 drops today! If you missed the Episode 1 newsletter, about what led me to report on the problem of severe pain during C-sections and the people trying to solve it, you can find it here. Episode 2 takes up the question of “why?” Why are patients feeling everything during C-sections? It’s not an easy question to answer, and in this episode, we hear what happens when a doctor gets up onstage and asks a ballroom full of anesthesiologists to wrestle with it. Last week, when we announced the new season on Instagram, hundreds of readers responded in the comments, often with personal stories of painful C-sections. Others questioned whether it was even a good idea to put this type of content out there on Instagram.
Personally what I find scary is that 100,000 U.S. patients a year are feeling significant pain during major abdominal surgery and that hardly anyone knows about it. Yes, it would be great if everyone could have a one-on-one consultation with an anesthesiologist before they even go into labor. It’s not such a pie-in-the-sky idea: People are thinking about how to make this a reality. (Search this report for “prenatal anesthesia consultations.”) But right now that’s not how our system works. So now that you know that this can happen during a C-section, what do you do with that information? Often the answer to this question is: Advocate for yourself! And, yes, but that should not be the only answer. The responsibility should not be on patients to fix this problem. Yesterday a listener sent me an email saying that when the doctors tested her spinal block before her C-section, she could tell the block wasn’t working. Initially she was met with disbelief, and so, lying exposed on the operating table she had to, she wrote, “project manage” the OR in order to get the care she needed. You should not have to project manage your own C-section. The doctor at the center of this episode is named Heather Nixon. She thinks about patient education like this: “My goal is not to freak people out, but to make them ask the questions that are gonna make their providers do the best thing for them.” In that spirit, here’s some information, not to freak you out, or to saddle you with the burden of addressing this problem, but to help you get the care you deserve. 1. You need a birth plan not just to avoid a C-section, but to anticipate one. Lots of patients have a firewall about C-sections. That’s not going to happen to me. It might. One in three women who give birth in the U.S. this year will do so by cesarean. You need to be as prepared for a C-section as you are for a vaginal birth. 2. When you meet your anesthesiologist, ask questions. Most of the time you don’t meet your anesthesiologist until they’re walking into your room with their equipment on a tray. There will be a lot of information coming at you at once. Ideally your anesthesiologist will set expectations for what you’ll feel during a C-section — you are likely to feel some sensation, even if your anesthesia is working properly — and talk through your pain management options, including your options if the anesthesia fails. If your anesthesiologist is not forthcoming on these matters, something like, “I’ve heard that blocks can fail. If that happens, what are my choices?” is a perfectly reasonable question. General anesthesia should be discussed as one of those choices. 3. Don’t be pressured into saying you’re ready for the surgery to start. When you’re in the OR, the doctors will test to make sure your anesthesia is working, typically by touching your body and asking whether you can feel it. If you’re not sure whether your anesthesia is working, it probably isn’t. Do not be afraid to say so. Even in an emergency, there is enough time for an anesthesiologist to make sure that you are not in pain and that you and your baby are safe. 4. It is absolutely OK to speak up about pain during the surgery. If you begin to feel pain once the surgery has already started, speak up. You are the only one who knows what you feel, which is why speaking up is important. It’s not a criticism of the doctor if you are in pain. It doesn’t necessarily mean someone made a mistake. Do not be embarrassed. If you feel pain, it is very likely to get worse. Do not hold on hoping the pain will pass. Again, even in an emergency, there are options to address pain without putting either you or your baby at risk. 5. Anticipate sensation, but not severe pain. A doctor may tell you that you’ll feel “just pressure.” Be alert to “just,” which can indicate a culture where pressure is not yet taken seriously. Pressure can be extremely painful. And if it is painful, again, you don’t have to endure this. There are options to treat your pain. There are certain parts of a C-section you might feel more strongly than others. For example, when the baby is delivered, a doctor will press with all their might on your abdomen to push the baby out. It might feel like it’s hard to breathe. The doctor we get to know in Episode 2, Heather Nixon, tells her patients that it will feel like there’s an elephant on their chest, but to take a deep breath, and blow it out, and then the baby will be there. (I’ve written these tips with input from Heather and with someone you’ll meet in Episode 3, Susanna Stanford.) Finally, most of the time you don’t choose your hospital based on the anesthesiologist you might get. But it’s worth seeing if your hospital is staffed with obstetric anesthesia specialists who’ve done advanced training in the field. (Right now the website of their professional society, SOAP, features information for patients and providers on C-section pain.) Obstetric anesthesiologists have taken the lead on bringing the problem of pain during cesarean to light and finding solutions to it. Which is what we get into in Episode 2. All four episodes are out now for New York Times subscribers. Thank you for your notes and please keep writing to us. You can find me here or email serialshows@nytimes.com.
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