31-07-2025
What Are the Solutions?
By Susan Burton
Hi, 'Retrievals' listeners. Episode 4, our final episode of this season, drops today.
In Episode 4, we learn about some of the changes that Dr. Heather Nixon and her colleagues made at UI Health to manage patient pain during cesarean.
I took this photo of Heather on a reporting trip in December. That day, she gave an educational session for anesthesia residents on communicating with patients.
In this series about solutions to pain during C-sections, communication is the one we examine closely. In this week's episode, for example, we learn that it may not always be enough to tell health care providers to 'listen to patients'; you need to give them a system to do so. But of course a lot of medical factors are at play here, too. What are those medical 'problems' and possible solutions? What are the myths and the realities? The medicine of the C-section is a massive topic for a single newsletter. When I considered what I could offer today, a note from a listener named Kate Davis came to mind. Kate, who underwent a painful C-section in New York City, said that her pain had never been acknowledged by her doctor or any hospital staff, and that the first episode left her teary and breathless. But 'I still have questions,' she wrote. 'Why did Clara 'pass' the block test and then feel pain?'
This week I put a version of this question to Heather.
HEATHER: Once you get into the abdomen, those internal organs are not covered by the same exact nerve endings that the skin is. So my test of the skin is not a perfect metric for the internal organs. And that's unfortunate. I wish I had a better way to test internally, but I just don't. So when they start moving those organs around, often patients will feel discomfort. And some women, most women, if you are giving enough adjuncts and enough medicine through the epidural will say: 'I feel it moving. It's a weird sensation.' And I'll say, 'But is it painful?' And they'll say: 'No, it's not. It's just weird.' But then we have women who are like, 'No, it is painful.' And that's where we need to start thinking about how to change the script in those scenarios.
SUSAN: Is there a world where there's another kind of test that allows you to make this determination before the patient is opened up?
HEATHER: I would say before they're opened up, probably not.
And this is why, Heather adds, knowing what puts a patient at higher risk for intraoperative pain is important. For example, in her experience, patients with an infection called chorioamnionitis, or Triple I, are likely to feel more pain. A longer surgery can increase the risk of pain. An epidural that consistently did not offer enough pain management during labor is another red flag.
HEATHER: And so when I have those patients, I have every single thing in my arsenal right up front because they're probably going to need it. And I'm also having discussions with them. I'm like, This may not be enough. We may need to go to sleep. Those are the conversations that you need to have — the proactive, We think you're at high risk.
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