#284 Safer C-Section Pain Control with Ruth Landau, MD

The fastest way to improve post-cesarean recovery is to start before the first incision—by setting expectations, testing the block, and validating what patients feel. We sit down with Dr. Ruth Landau, Virginia Apgar Professor and Chief of Obstetric Anesthesia at Columbia University, to map a safer path from the OR to the nursery: neuraxial-first analgesia, scheduled non-opioids, and small, truly PRN opioid prescriptions at discharge. She explains how intrapartum cesareans carry higher risk for discomfort and why simple shifts—active epidural management, timely redosing, and clear, compassionate communication—reduce pain, opioid exposure, and the chance of a traumatic birth experience.We break down practical steps that clinicians can apply today. Learn the difference between systemic and neuraxial opioids for breastfeeding safety, when to use ultrasound-guided TAP or QL blocks after general anesthesia, and how micro-boluses of IV dexmedetomidine can blunt visceral sensations, anxiety, and shivering. Dr. Landau also shares the latest from ASA statements and SOAP guidance, including dose-dependent monitoring strategies that make neuraxial opioids feasible even in resource-constrained settings.The conversation moves beyond pharmacology to focus on outcomes that matter to families: fewer leftovers at home, less persistent opioid use, and birth memories grounded in trust instead of fear. We talk debriefs, trauma-informed care, and patient-reported experience measures, plus new research on sensation profiles and intrathecal adjuvants like dexmedetomidine and clonidine. If you’re building an opioid-sparing cesarean pathway—or refining the one you have—this is a clear, evidence-informed playbook.If this resonates with you, follow the show, share it with your OB and nursing teams, and leave a review with one change you plan to make next shift. Your feedback helps more clinicians find these strategies and keeps more parents safe and comfortable.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/284-safer-c-section-pain-control-with-ruth-landau-md/© 2025, The Anesthesia Patient Safety Foundation

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