Town Hall Explores Pain During Cesarean Delivery and Strategies to Improve Patient Care

On Thursday, June 18, 2026, the UCSF Department of Anesthesia and Perioperative Care hosted a joint Town Hall with the Department of Obstetrics and Gynecology to discuss pain during cesarean delivery. The hybrid event featured Chief of Obstetric Anesthesia Alexander Butwick, MBBS, FRCA, MS; maternal-fetal medicine specialist Arianna Cassidy, MD; and Professor of Clinical Radiology Vickie Feldstein, MD. Faculty, trainees, nurses, and administrative and clinical staff attended the interdisciplinary discussion, which focused on one of the most important quality-of-care issues facing obstetric anesthesia. 

The topic has gained national attention following Season 2 of The New York Times podcast The Retrievals, which highlighted patients’ experiences of pain during cesarean delivery. Dr. Butwick recently addressed the issue in an Anesthesiology op-ed, and a growing body of research has expanded understanding of how frequently pain occurs during cesarean delivery and its impact on patients. Earlier this year, Dr. Butwick also participated in a keynote panel at the 2026 Society for Obstetric Anesthesia and Perinatology (SOAP) annual meeting, where experts discussed current evidence and management strategies. 

During the Town Hall, Dr. Butwick presented data showing that, based upon data from a recent prospective population-based study of 3,693 patients, approximately 7.6% of patients experience pain during cesarean delivery, with higher rates occurring among patients receiving epidural “top-ups" (13%).¹ Panelists discussed the historical reluctance to convert from regional to general anesthesia because of concerns about airway management and maternal mortality, while acknowledging that advances in technology and clinical practice have changed the risk-benefit landscape. 

The discussion also explored barriers to improving patient care, including communication gaps between anesthesia and surgical teams, workplace dynamics that may discourage staff from speaking up when patients report pain, and the need for better preoperative counseling so patients understand their anesthesia options before surgery. 

The panel emphasized the importance of trauma-informed care when discussing anesthesia choices with patients. Speakers recommended regular pain assessments every 10 to 15 minutes throughout the procedure and highlighted the psychological consequences of inadequately treated pain, including the risk of post-traumatic stress disorder for some patients. 

Dr. Butwick also shared patient communication scripts presented at the 2026 SOAP meeting by Tracey M. Vogel, MD, Director of the Perinatal Trauma-informed Care Clinic. The scripts are designed to help clinicians have candid preoperative conversations about the possibility of pain during cesarean delivery and how it would be addressed if it occurred. 

Throughout the discussion, the panel members emphasized that effective communication—both among members of the care team and with patients—is essential to recognizing and treating pain during cesarean delivery. 

"The key thing to remember here is, you don't know: the only person that knows whether the patient has pain is the patient. It’s not us." 

¹ O’Carroll JE. Anesthesiology 2026; 144: 784-95.