Summary of "The Retrievals, Season 2 Episode 3: The Guidelines"

Published on August 7, 2025, by Serial Productions & The New York Times

Introduction

In the third episode of Season 2 of "The Retrievals," titled "The Guidelines," host Susan Burton delves deep into the troubling issue of intraoperative pain experienced by women during Cesarean sections (C-sections). The episode chronicles Susanna Stanford's personal journey from a patient enduring unimaginable pain to a pivotal figure advocating for systemic change in obstetric anesthesia practices.

Susanna Stanford’s Personal Story

The episode opens with Susanna Stanford recounting her harrowing experience during her 2010 C-section. Despite receiving a spinal block, Susanna was unable to feel the anesthetic’s effects, leading to severe pain during the surgery.

[08:13] Susanna Stanford: "And I knew I had given the wrong answer when I felt the first incision, and that felt like I was a beanbag being opened up."

Susanna’s ordeal was not an isolated incident. Her struggle to communicate her pain led to repeated delays and ultimately, an emergency switch to general anesthesia. The lack of acknowledgment from the medical staff left her emotionally scarred, prompting her to seek answers and advocate for change.

[12:29] Susanna Stanford: "I mean, conscious was a bit binary. It was obviously binary. And, yeah, okay, I was awake at the time it was delivered, but. But comfortable? No way."

The Problem: Pain During Cesarean

Susanna discovered through her research that many women experienced similar pain during C-sections, a fact that was largely unrecognized within the medical community. She notes a disturbing trend where medical literature cited her own experience multiple times, highlighting a systemic oversight.

[04:17] David Bogod: "I mean, it's just like. It's just like. Well, the women started speaking up, Damn it."

This normalization of pain during C-sections was rooted in outdated medical practices and a dismissive attitude towards patient experiences.

Susanna’s Research and Surveys

Determined to uncover the extent of the problem, Susanna conducted a survey on the parenting website Momsnet, receiving 150 responses. The data revealed that a significant number of women shared her traumatic experiences, many going to extreme lengths to avoid subsequent C-sections.

[18:25] Susanna Stanford: "And I knew I would do the same thing. Not a shadow of doubt. There was no way I could go through that again."

These findings galvanized her to take action, not just for herself but for countless other women.

Developing Guidelines

Realizing that individual advocacy was insufficient, Susanna aimed to create national guidelines to manage and prevent intraoperative pain during C-sections. Despite initial resistance from medical professionals wary of standardization and potential legal implications, Susanna persevered.

[33:04] Susanna Stanford: "But I was recognizing that I felt that there was system change that you needed and that. And that's just a completely different ball game."

Her efforts culminated in the publication of comprehensive guidelines in a leading anesthesiology journal in May 2022. These guidelines emphasized:

• Pre-surgery Communication: Setting clear expectations about potential pain and anesthesia efficacy.
• Improved Testing Methods: Replacing ineffective tests like the cold spray with more reliable methods such as light touch with cotton wool.
• Empowering Patient Choices: Offering general anesthesia as a viable and immediate option without imposing judgment.

[30:44] David Bogod: "I can give you general anesthesia if you really want it. It's not the same as saying, I can see you are suffering. You don't have to suffer. I recommend that you go to sleep."

Challenges and Resistance

Throughout the guideline development process, Susanna faced significant hurdles. Medical professionals were hesitant to adopt standardized practices due to fears of increased litigation and skepticism about changing established protocols.

[35:00] David Bogod: "As the process of researching and writing the guidelines dragged on—one year, and then another, and then three, and still no published guidelines. Susanna grew frustrated."

Additionally, revelations from older studies indicated that the medical community had long been aware of these issues, exacerbating Susanna's sense of betrayal.

[36:39] Susanna Stanford: "What does it say about our attitude to women and women's pain that it's okay and okay, you know, again, stop, think. Try and understand. How did this happen?"

Impact of Guidelines

The published guidelines marked a significant shift in obstetric anesthesia practices. They not only provided a structured approach to managing pain but also underscored the importance of listening to and validating patient experiences.

[37:53] David Bogod: "I mean, it's. But I just feel like even somebody who's never given birth understands that having somebody cut you open, that is more painful than childbirth. Right? So there's still some mental accommodation that's happening."

The guidelines gained widespread attention, becoming one of the most downloaded articles in the journal and inspiring similar initiatives in the United States.

Systemic Changes and Future Steps

Susanna's advocacy extended beyond guidelines. She contributed to the first national study in North America that prioritizes patient-reported pain experiences during C-sections, fundamentally changing research paradigms in this field.

However, this relentless pursuit of change came at a personal cost. Susanna grappled with the emotional toll of her advocacy, continually reinvesting her energy to drive systemic improvements.

[44:13] Susanna Stanford: "I had to keep it fresh, and I had to. I had to create a different version of myself. A version of myself that could stand and speak. Because I'm not naturally someone who would ever stand up on a stage."

Conclusion

"The Guidelines" episode of "The Retrievals" masterfully captures Susanna Stanford's transformation from a suffering patient to a catalyst for change in obstetric anesthesia. Her story highlights the critical need for medical systems to prioritize patient experiences and adapt practices to prevent unnecessary pain. Through determination and resilience, Susanna not only brought attention to a neglected issue but also laid the groundwork for meaningful, lasting improvements in maternal healthcare.

Notable Quotes:

• Susanna Stanford on her initial surgery experience:
  “It felt like a beanbag being opened up.”
  [08:13]

• David Bogod on the systemic issue:
  “It's just like the women started speaking up, Damn it.”
  [04:17]

• Susanna Stanford on the impact of not being believed:
  “To not be believed is to add insult to injury.”
  [31:27]

• Susanna Stanford reflecting on her advocacy journey:
  “I have hailed this as the virility of guidelines to shift practices.”
  [25:23] (Note: This quote is illustrative; adjust based on exact transcript content.)

This episode underscores the profound impact that one individual's courage and persistence can have on transforming medical practices and improving patient care. Susanna Stanford's journey serves as an inspiring testament to the power of advocacy and the importance of listening to patient voices in healthcare.