#317 Setting Expectations For Safer Cesarean Anesthesia with Dr. Ruthi Landau Revisited, PART 2

Many patients walk into labor and delivery picturing a birth day, not an operating room, and that mismatch is where preventable suffering can start. We sit down with Dr. Ruthi Landau to get practical about cesarean delivery anesthesia, with a focus on patient safety, respectful communication, and what to do when a patient says, “This isn’t comfortable.”We dig into why setting expectations during neuraxial consent matters, and why active management of labor epidurals is not optional when an urgent intrapartum C-section may be around the corner. We also unpack what the literature keeps showing: epidural top-ups for intrapartum cesarean delivery are a common pathway to intraoperative discomfort. From re-dosing to adjuvants to real-time reassurance, we talk through concrete ways to prevent pain from being brushed off as “normal.”The conversation goes beyond the OR. A traumatic cesarean experience can shape the next pregnancy, fuel avoidance, and contribute to childbirth-related PTSD. We discuss trauma-informed care, offering debriefs, connecting patients to maternal mental health services, and using patient-reported experience measures to learn where systems fail. On the technical side, we cover pain management for general anesthesia cases, when to keep using an existing epidural, how neuraxial opioids fit with SOAP consensus monitoring guidance, and what a solid multimodal plan looks like when there is no neuraxial option including TAP or QL blocks, acetaminophen, NSAIDs, and opioid stewardship.Subscribe for more obstetric anesthesia and anesthesia patient safety conversations, share this with an anesthesia or OB colleague, and leave a review to help others find the show. What change are you most ready to make in your C-section anesthesia practice?For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/317-setting-expectations-for-safer-cesarean-anesthesia-with-dr-ruthi-landau-revisited-part-2/© 2026, The Anesthesia Patient Safety Foundation