When Anesthesia Fails and the Patient Is Cut Open

Summary of When Anesthesia Fails and the Patient Is Cut Open

by The New York Times

31m•February 6, 2026
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Overview of When Anesthesia Fails and the Patient Is Cut Open

This episode of The Daily (The New York Times) features reporter Susan Burton discussing investigative reporting into a disturbing and under‑recognized problem: some women undergoing cesarean deliveries (C‑sections) experience significant pain — even feeling surgeons cut and manipulate their organs — because neuraxial anesthesia (epidurals or spinals) fails or is inadequate. Burton recounts patient stories, including a detailed case (Vanessa), traces the limited medical literature on the topic, and summarizes a recent large multicenter study quantifying how often this occurs and what factors increase risk. The episode then explores systemic causes, clinician perspectives, and possible medical and communication‑based solutions.

Key takeaways

  • A recent multicenter study (15 hospitals, ~4,000 patients) asked C‑section patients directly about intraoperative pain and found about 8% reported significant pain (≥6/10).
  • Pain incidence differed by anesthetic technique: ~13% of patients who had labor epidurals topped up for a C‑section reported significant pain versus ~4% of patients who received spinals.
  • Because the U.S. performs roughly one million C‑sections a year, an 8% incidence suggests on the order of tens of thousands of women annually may experience substantial pain during the operation.
  • Causes are multifactorial: technical failures of epidurals (misplacement, catheter migration), rushed care/shift changes, inadequate testing or dosing, staffing pressures, OR power dynamics (surgeon vs anesthesiologist, trainees vs attendings), and a cultural expectation that women should tolerate birth‑related pain.
  • Solutions being discussed: lower threshold to replace ineffective epidurals, consider converting to spinal or (when appropriate) general anesthesia, standardized intraoperative pain checks, better communication and protocols, and post‑op acknowledgment and support for affected patients.

Case study: Vanessa (illustrative patient)

  • Background: Late‑30s first‑time mother, induced labor, had an epidural that felt inadequate (she could move her legs), then required an unplanned C‑section.
  • What happened: Anesthesia providers debated replacing the epidural but ultimately decided there wasn’t time; during the C‑section she reports feeling excruciating pain (described as burning/searing), heard surgeons talking about cutting and moving tissues, screamed and pleaded, and was told repeatedly that she was only feeling “pressure.”
  • Aftermath: She received medications after delivery but felt robbed of the joyful birth moment, experienced PTSD symptoms and flashbacks, and struggled with whether to have more children. Her social and clinical responses included minimization and lack of formal explanation or apology.

The research and evidence

  • Historical context: Little formal literature existed until recent years; patient accounts began to appear around 2016 and interest grew after editorials and smaller studies.
  • Multicenter study details: Conducted at 15 hospitals in the U.S. and Canada with nearly 4,000 enrolled patients; patients were asked directly about intraoperative pain rather than relying only on clinician assessment.
  • Main quantitative findings:
    • Overall ~8% of patients reported significant pain (≥6/10) during C‑section.
    • Stratified by anesthetic type: ~13% for topped‑up labor epidurals vs ~4% for primary spinals.
  • Qualitative findings: Word‑cloud descriptors included “searing,” “blinding,” “wretched,” “tearing,” “grueling,” underscoring the severity of experiences for many.

Causes and contributing factors

  • Technical/anesthetic reasons:
    • Epidural catheter misplacement or migration.
    • Inadequate dose or failure to convert a labor epidural into a dense surgical block.
    • Differences between epidurals (more variable, used for labor then topped up) and spinals (denser, faster, often used for scheduled C‑sections).
  • System and workflow issues:
    • Shift changes and staffing shortages; anesthesiologists stretched across floors.
    • Teaching environments where resident training and operative speed may complicate responsiveness.
    • Pressure to proceed quickly in perceived emergencies.
  • Cultural and communication factors:
    • Expectation that childbirth is painful and that women will tolerate it.
    • Clinician messages normalizing “pressure” and discouraging escalation.
    • Patients’ fear of slowing a needed intervention for the baby or being labeled “hysterical.”

Solutions discussed

  • Clinical/practice changes:
    • Pre‑op verification of epidural effectiveness and a lower threshold to replace a poorly functioning labor epidural before proceeding to surgery.
    • When appropriate, converting to a spinal or using general anesthesia rather than persisting with an inadequate neuraxial block.
    • Develop and follow protocols for intra‑operative pain assessment and rapid escalation (e.g., scheduled checks and pain scores during the procedure).
  • Communication and culture:
    • Train OR teams to listen to patients, validate reports of pain, and empower nurses and staff to speak up.
    • Reduce stigma around using general anesthesia when needed.
    • Postoperative acknowledgement, explanation, and psychological follow‑up for patients who experienced pain or trauma.
  • Research and measurement:
    • More multicenter, patient‑reported outcome research to quantify incidence, risk factors, and effectiveness of mitigation strategies.

Notable quotes and vivid language from the episode

  • Patient descriptions of the sensation: “It was like someone took a hot piece of metal and put it against my stomach.”
  • Common clinician/teaching phrase that can normalize pain: “Pressure’s normal.”
  • Word cloud descriptors from study participants: “searing,” “blinding,” “wretched,” “tearing,” “grueling,” “drilling,” “vicious.”

Practical recommendations (for different audiences)

  • For clinicians and hospitals:
    • Implement routine intraoperative pain checks and clear escalation pathways.
    • Audit C‑section anesthesia failures to identify system fixes (staffing, protocols, training).
    • Encourage debriefs and standardized post‑op communication and support.
  • For patients (discussion, not medical advice):
    • Discuss anesthesia plans early in labor and ask how an existing epidural will be tested or managed if a C‑section becomes necessary.
    • Ask who will be responsible for assessing pain intraoperatively and how you can signal distress.
    • If you experience traumatic pain during delivery, seek follow‑up medical and mental‑health care and document the experience.

Final takeaway

Feeling significant pain during C‑section is not rare and has been historically underreported and normalized. The combination of new patient‑reported research and investigative reporting is prompting medical teams to examine technical, systemic, and cultural causes and to pursue both medical and communication reforms to prevent and respond to intraoperative pain and its long‑term consequences.