Chapter 1: What is the main topic discussed in this episode?
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From The New York Times, I'm Rachel Abrams, and this is The Daily. C-sections are the most common surgery in the United States. But it turns out, in a shocking number of them, the anesthesia is failing. And that's leaving women to feel a major surgery as it is being performed. Writer Susan Burton made a series about this phenomenon for our colleagues at Serial Productions.
And today, she tells us about some of the women she spoke to and the new research on how common their experiences are.
C-sections
It's Friday, February 6th. Susan, thank you so much for being here.
Of course. Thank you for having me.
You have done so much tremendous reporting on something really horrific, which is all of these women who have gotten C-sections and could actually feel them, which sounds like something literally out of a nightmare, out of a horror movie. And recently, there was a study that came out that actually backed up some of these anecdotes that you had been collecting.
So how did you even get started talking to these women in the first place?
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Chapter 2: What alarming issue is highlighted about anesthesia during C-sections?
I thought, was this maybe a one-off? I wrote back to the listener. And then within 24 or maybe 48 hours, I had opened two more emails describing something really similar. And that was the point where I was like, okay, is this a thing? So I started talking to people about it, and I came to recognize that there were patterns in these experiences.
I was rushed into the C-section. My husband was there, and I could feel them starting the operation. I could feel the incision.
So, for example, feeling the surgery in a way that was just totally shocking.
It was burning. It was like someone took a hot piece of metal and put it against my stomach. There was this nurse on my right side. I just remember holding her hand and telling her over and over again that I can feel everything, that I still feel it, I still feel it.
Speaking up and after you've spoken up, being told that what you're feeling is just pressure. So having your pain mischaracterized is something else.
And he said, well, that's not possible. You know, if you were feeling it, you would pass out from the pain. And I was like, I wish I could pass out from the pain. When they took my son out, I was shaking and I was so much in pain that I could not hold him. It was, I'm shaking just talking about it. It was major abdominal surgery without full anesthesia.
And some of the really unsettling things were happening in the aftermath of the surgery, like experiences never being acknowledged, nobody apologizing, nobody explaining what had happened.
So you're hearing the same horrifying through line in a lot of these different stories. Tell us about one person who maybe stood out to you.
Sure. So one of the women I spoke to, her name is Vanessa Lenner. She was in her late 30s when she got pregnant. She lives in Florida. She works as a physician's assistant. And her husband is an engineer who works in aerospace.
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Chapter 3: How did Susan Burton start her investigation into women's pain during C-sections?
She's in pain. She gets an epidural. And, you know, when you get an epidural during labor, right, that's to reduce your discomfort. But for Vanessa, the epidural, like, isn't really working right. She's in the hospital overnight. She's a lot of discomfort, kind of, you know, moving around in the bed. It's the next day. It's been 24 hours since this all started.
Vanessa's heart rate is rising a little bit. The baby's heart rate is rising a little bit. The baby's not moving down. And the doctors are like, well, you know, I think it's time to do a C-section.
And I was pretty much okay with that. You know, I just wanted a healthy baby. And I was very tired at that point.
And... Vanessa isn't that nervous about the surgery. She told me, you know, she's a health care provider. She works in a hospital. She trusted her medical team. The thing she is concerned about is her epidural. It just hadn't been working that well during her labor.
I personally was concerned because I could move my legs with the epidural. And, you know, even before we went into the C-section, I told the anesthesia, I said, you know, I can move my legs. I don't think this is normal. And he's like, no, no, no, it has nothing to do with the pain management.
And I think a lot of us know in general what an epidural is, right? It's the thing that controls pain. But what an epidural actually is, it's a little plastic tube, a catheter that goes into your back. And doctors push medicine through that tube. So during labor, the medicine is lighter to allow you to move around. During surgery, the medicine is more potent.
The idea is to numb your midsection, but to allow you to remain awake for the birth of your child. And so, as she tells it, she'd asked two different anesthesia providers about this epidural. One of them had been like, huh, should I change it? Maybe I should change it. I'm not sure if I should change it.
And then they had to change shift. And then by the time he came back, he's like, no, we don't have time to change it.
Ultimately, it's decided there's not enough time to change it. And Vanessa goes into the operating room. So Vanessa's in the OR and the anesthesiologist needs to test that she's numb. Often this test is something like putting a broken tongue depressor on a patient's body and seeing whether the patient can feel it. So it's like kind of sharp, but they're not cutting into you. Correct.
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Chapter 4: What disturbing experiences did women report during their C-sections?
Doctors told me this is a really physical surgery. You know, sometimes you see the doctors kind of leaning back like in tug-of-war, right, to separate the muscles. That's what happens at the beginning of the surgery, right? And, you know, then as the surgery goes on, the baby is eventually separated. pressed out of sort of this hole in the patient's body.
After that, there's still a lot of the surgery left. Seven layers of muscle and skin need to be sewn back up. And as Vanessa says, she feels everything. She feels way too much.
I remember like this intense, like severe pain and screaming and telling them to stop. And the anesthesia guy was like, it's okay, it's just pressure. And I remember the doctor saying, what's going on? And he's like, I'm just pushing more meds and they're not working. And the anesthesia doctor was telling me, you know, just hold on and I can't give you anything else.
We need to wait to get the baby out and then I'll give you anything that you can. Just hold on, hold on.
For some reason, her husband is outside the OR. He's not in the surgery from the very beginning. And once he comes in, what he sees, he sees Vanessa strapped to the table and she's screaming and crying. So Vanessa's husband, he comes to her side and she says, talk to me.
And he's like, talk to you about what? I'm like, I don't know. Talk to me about your work. Like, just talk to me about anything.
And part of the reason she's asked him to talk to her, it's to distract her from the pain, but it's also because this is a teaching hospital, and she can overhear the obstetrician teaching the resident.
You know, I could hear the whole time, you know, cut here, move here, do this, do that, move this over, let me show you how to do this.
She hears him say, I'm cutting through fascia. Right, so just imagine this, right? You're lying open on an operating table, and... You feel what's going on and you hear somebody describing what they're doing to your insides. Like it's frightening. It's scary.
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Chapter 5: What role does communication play in addressing pain during surgery?
You know, so it sort of gets at this question. hush-hush quality of this thing, kind of unspoken, and now are we finally paying attention to it. But just recently, just last month, there was a really important study released. It was published in the journal Anesthesiology, and it tries to measure how often patients are feeling pain during C-sections.
Right, because by now we know this is happening, but there's been no real effort to quantify it.
So there have been efforts, but they've been smaller scale efforts. They've been efforts to measure it within one institution, for example. And they have most often been efforts that rely on doctors' assessments of patient pain. So this study is important because it was a big study. It was at 15 hospitals in the U.S. and Canada.
It enrolled almost 4,000 patients, and it asked patients whether they were in pain during C-section. Which seems pretty crucial to understanding if women are feeling pain, to ask them directly.
Exactly.
And the study found a couple of really important things. So it found that 8% of patients experience significant pain. So there are 1.2 million C-sections in the U.S. a year. So 8% means that 100,000 women a year experience significant pain. And by significant pain, we mean what exactly? So as the study defined it, this was when women report a pain score of 6 or above. Out of 10. Correct. Correct.
and actually the study's lead author, his name is James O'Carroll, he told me that the incidence of pain, that 8% number, that was sort of what he expected. But what was surprising to him was the level of pain reported. I saw the research presented at a medical conference, and one of the really striking pieces of it is this kind of word cloud that the researchers made
The word cloud shows the words that women used to describe the pain they felt. So some of those words, searing, blinding, wretched, tearing, cramping, grueling, radiating, vicious, cruel, drilling, smarting.
I can't believe we're talking about 21st century medicine right now.
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