If you’ve ever heard “it’s just pressure” during a C-section and felt your gut twist, you’re not alone, and it may be a patient safety issue hiding in plain sight. We sit down with Dr. Ruthi Landau, the Virginia Apgar Professor of Anesthesiology and Director of Obstetric Anesthesiology at Columbia University, to get practical about what patients actually feel during cesarean delivery anesthesia and what we can do when those sensations become uncomfortable.We talk through why labeling sensations as pressure versus pain misses the point, and why the better clinical question is simple: “Is it uncomfortable?” From there, we unpack a safer communication loop that invites patients to speak up and gives them real choices for relief, whether that means dosing through an epidural, using IV medication, or escalating plans when neuraxial techniques are not working. We also dig into opioid-sparing strategies for C-section pain management, including multimodal non-opioid analgesia, the risks of cookie-cutter discharge prescriptions, and how shared decision-making can reduce leftover opioids at home. Finally, Dr. Landau shares current practice insights on dexmedetomidine for shivering, anxiety, and visceral discomfort, along with the evolving evidence base and dosing approaches being used today.If you care about safer cesarean delivery, obstetric anesthesia best practices, and preventing opioid-related harm, subscribe, share this with a colleague, and leave a review so more clinicians can find the conversation.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/316-safer-c-section-pain-control-revisited-part-1/© 2026, The Anesthesia Patient Safety Foundation

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