S02 Episode 3: The Guidelines
How One Patient Exposed Pain During Cesarean And Sparked Systemic Change
This episode follows Susanna Stanford, a mother whose traumatic experience of severe pain during a scheduled cesarean led her to investigate, document, and ultimately help write national guidance for managing interoperative pain. What began as a personal wound became research, public speaking, committee work, and a guideline that reframed how clinicians should test, communicate about, and treat anesthesia failures during cesarean delivery.
Why Patients Felt Pain During C-Sections: testing failures and clinician assumptions
The narrative explains that routine sensory checks—like cold spray—left many patients confused and surgeries proceeding despite inadequate spinal or epidural blockade. A cultural dynamic amplified the problem: clinicians’ confidence in their block often prevented them from switching to a mindset of cautious doubt. Susanna crystallized this into the catchphrases, "test the block, not your block" and "assume the block is not adequate until proven otherwise."
From grassroots survey to national obstetric anesthesia guidelines
Susanna used an online survey and personal narratives to show the prevalence and emotional effects of intraoperative pain. Her findings prompted invitations to professional meetings, collaborations with anesthesiologists, and years of committee work. The published guidelines now recommend preoperative counseling about possible sensations, more reliable sensory tests (light touch rather than cold spray), objective checks such as a straight leg raise, clear documentation, and reframing general anesthesia as a legitimate option rather than a last resort.
Practical solutions highlighted by a patient-led campaign
- Better testing: use simple, patient-friendly tests like light touch and ask the patient directly about pain.
- Clear communication: clinicians should acknowledge suffering and recommend timely options, including general anesthesia when appropriate.
- System change: guidelines transform individual fixes into institutional standards that protect future patients.
Culture, research, and the value of listening to patients
The episode interrogates why such harm persisted, introducing the concept of normalization of deviance—how tolerated errors become standard practice. It also shows how patient-reported outcomes corrected a research blindspot: past studies defined anesthesia failure by clinician measures, not by whether patients actually felt pain. Susanna’s work helped create a new research and clinical norm: ask the patient, record their experience, and let those data drive policy.
For clinicians, patients, and hospital leaders, this story is both a model of sustained advocacy and a roadmap for concrete changes in perioperative care during cesarean delivery.
Key points
- Use light-touch cotton-wool testing for spinal blocks instead of cold spray sensory testing methods.
- Require a straight leg raise check before beginning cesarean surgery to confirm adequate anesthesia.
- Frame general anesthesia as an acceptable option early when intraoperative pain is likely to worsen.
- Document intraoperative pain complaints and follow up to ensure transparency and institutional learning.
- Include patient-reported pain outcomes in clinical research on cesarean anesthesia effectiveness.
- Provide preoperative counseling about possible sensations and explicitly discuss pain mitigation options.
- Form multidisciplinary guideline committees to scale local improvements into national obstetric standards.
FAQ
Why do some women feel pain during cesarean delivery?
Pain can occur when spinal or epidural blocks are inadequate and routine sensory checks miss that failure, allowing surgery to proceed while the patient feels sensations or pain.
What testing methods reduce the risk of missed anesthesia failure?
Use patient-friendly tests such as light touch with cotton wool and a straight leg raise demonstration rather than relying on cold spray alone.
How can clinicians better support a patient experiencing pain during cesarean surgery?
Acknowledge suffering, offer clear recommendations including timely general anesthesia, document events, and arrange follow-up to explain what went wrong.
How did Susanna Stanford influence clinical practice?
She collected patient survey data, spoke to professional groups, joined guideline committees, and became a named co-author on published obstetric anesthesia guidance.
