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

December 10, 2025

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#310 Moisture Matters In Anesthesia Circuits
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Welcome to the next instalment of the Anesthesia Patient Safety podcast hosted by Alli Bechtel.  This podcast will be an exciting journey towards improved anesthesia patient safety.

Dr. Ruth Landau joined me for a great conversation all about keeping patients safe and comfortable throughout the peripartum period and especially when it comes to pain management during and after caesarean delivery. Dr. Landau is the Virginia Apgar Professor of Anesthesiology and Director of the Division of Obstetric Anesthesia at Columbia University. She also serves as the editor-in-chief of the International Journal of Obstetric Anesthesia. Dr. Landau is truly an expert in the field and her dedication to research, clinical, care, education, leadership, and mentoring really shines through our discussion.

Thank you so much to Dr. Landau for joining us on the show today.

We have a lot of resources for you to check out that we talked about on the show today.

One of the APSF Patient Safety Priorities is Opioid-Related Harm with a focus on prevention and mitigation of opioid-related harm for surgical patients.

  • Some important considerations include: Setting expectations, remember that not all patients’ experiences are the same, that there are differences between intraoperative and postoperative pain, not all caesarean sections are the same.
  • Landau highlights that anesthesia professionals have a tremendous opportunity and responsibility.
  • You may consider asking: “Is it uncomfortable? And would you like me to give you something?”

American Society of Anesthesiologists Statements

  1. Statement on Pain During Cesarean Delivery. Developed by: Committee on Obstetric Anesthesia. Original Approval: October 18, 2023
    1. https://www.asahq.org/standards-and-practice-parameters/statement-on-pain-during-cesarean-delivery
  2. Statement on the Use of Adjuvant Medications and Management of Intraoperative Pain During Cesarean Delivery. Developed by: Committee on Obstetric Anesthesia. Original Approval: October 23, 2024
    1. https://www.asahq.org/standards-and-practice-parameters/statement-on-the-use-of-adjuvant-medications-and-management-of-intraoperative-pain-during-cesarean-delivery
  3. Statement on Providing Psychological Support for Obstetric Patients. Developed by: Committee on Obstetric Anesthesia. Original Approval: October 23, 2024
    1. https://www.asahq.org/standards-and-practice-parameters/statement-on-providing-psychological-support-for-obstetric-patients

Recent article on Dexmedetomidine:

M.S. Douglas, L.J. Soloniuk, J. Jones, et al.
Intravenous dexmedetomidine use in obstetric anesthesia: a focused review
Int. J. Obstet. Anesth., 62 (2025), Article 104345, 10.1016/j.ijoa.2025.104345

SOAP Consensus Statement:

Bauchat JR, Weiniger CF, Sultan P, Habib AS, Ando K, Kowalczyk JJ, Kato R, George RB, Palmer CM, Carvalho B. Society for Obstetric Anesthesia and Perinatology Consensus Statement: Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia. Anesth Analg. 2019 Aug;129(2):458-474. doi: 10.1213/ANE.0000000000004195. PMID: 31082964.

Recommended resources for pain management protocols and considerations for caesarean delivery:

  1. ACOG Postoperative Pain Management Statement from 2019:
    1. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. (2019). ACOG Practice Bulletin No. 209: Obstetric Analgesia and Anesthesia. Obstetrics & Gynecology, 133(3), e208-e225. https://doi.org/10.1097/AOG.0000000000003132
  2. AJOG Neuraxial Anesthesia and Pain Management for Cesarean Delivery
    1. Landau R, Sultan P. Neuraxial anesthesia and pain management for cesarean delivery. Am J Obstet Gynecol. 2025 Jul 16:S0002-9378(25)00334-5. doi: 10.1016/j.ajog.2025.05.018. Epub ahead of print. PMID: 40888444.

Another important article to check out!

Gonzalez-Fiol A, Fardelmann KL, Landau R. Shedding more light on the management of intraoperative pain during cesarean delivery: a review of the American Society of Anesthesiologists statements. Int J Obstet Anesth. 2025 May;62:104360. doi: 10.1016/j.ijoa.2025.104360. Epub 2025 Apr 1. PMID: 40199022.

This episode was edited and produced by Mike Chan.
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© 2025, The Anesthesia Patient Safety Foundation

Hello and welcome back to the Anesthesia Patient Safety Podcast. My name is Alli Bechtel, and I am your host. Thank you for joining us for another show. We have a very special show for you today. Dr. Ruth Landau joined me for a great conversation all about keeping patients safe and comfortable throughout the peripartum period and especially when it comes to pain management during and after caesarean delivery. Dr. Landau is the Virginia Apgar Professor of Anesthesiology and Director of the Division of Obstetric Anesthesia at Columbia University. She also serves as the editor-in-chief of the International Journal of Obstetric Anesthesia. Dr. Landau is truly an expert in the field and her dedication to research, clinical, care, education, leadership, and mentoring really shines through our discussion. So, stay tuned.

Before we dive further into the episode today, we’d like to recognize Eagle, a major corporate supporter of APSF. Eagle has generously provided unrestricted support to further our vision that “no one shall be harmed by anesthesia care”. Thank you, Eagle – we wouldn’t be able to do all that we do without you!”

And now, my conversation with Dr. Ruth Landau.

[Interview Show]

Interview:

  1. Can you introduce yourself? Tell us about your anaesthesia training, career, and current role? How did you become interested in Obstetric Anaesthesia as the focus for your practice?
  2. Since this is the Anesthesia Patient Safety podcast, we like to start the conversation off about patient safety. What got you interested in patient safety in your practice? (personal story or de-identified patient story?)
  3. Can you tell us about your research and work on pain management during caesarean delivery? Can you tell us more about traditional pain management during and after caesarean delivery and how this has evolved over the years?
  4. One of the APSF Patient Safety Priorities is Opioid-Related Harm with a focus on prevention and mitigation of opioid-related harm for surgical patients. Should we be using opioid-sparing protocols for caesarean delivery and postoperative pain management? What do you see as the most important consideration when it comes to pain management during caesarean delivery and postoperative pain management? What is the role for anaesthesia professionals to prevent and mitigate opioid related harm for patients undergoing caesarean delivery?
  5. What can anaesthesia professionals do to ensure safe and effective pain management throughout the peripartum time period? Are there any longer-term effects for patients after discharge from the hospital related to the anaesthetic management? (i.e. chronic opioid use and chronic pain)
  6. How does your pain management protocol differ for patients undergoing caesarean delivery under spinal anaesthesia, epidural anaesthesia, and general anaesthesia?
  7. What resources do you recommend when it comes to pain management protocols and considerations for caesarean delivery?
  8. What do you hope to see going forward when it comes to safe maternal anaesthesia care as well as safe and effective pain management during and after caesarean delivery?
  9. What’s next for your research or projects?
  10. Is there anything else that you want to share that we have not talked about already?

[Bechtel] Thank you so much to Ruth for joining us on the show today and sharing your expertise. We covered a lot of information today. We hope that you will check out the show notes for links and citations to the resources that we talked about on the show today. Before our next podcast drops, you can check out the three ASA statements or the August 2025 expert review article in the American Journal of Obstetrics and Gynecology, “Neuraxial anesthesia and pain management for cesarean delivery.” Are there any changes that you need to make in your OB anesthesia practice to help keep your patients safe and comfortable?

If you have any questions or comments from today’s show, please email us at [email protected]. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.

Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

© 2025, The Anesthesia Patient Safety Foundation