1. Enhanced Recovery in Obstetrics
Young and fit
Less co-morbidity
Motivated for early discharge
Average hospital stay after delivery:
Vaginal: 1-2 days
Caesarean: 3-4 days
ER CS: 1-2 days?
NICE recommendation: 1 day after uncomplicated CS
NICE Clinical Guideline
Not until 2013 Enhanced Recovery was described and debated in an editorial in relation to obstetric surgery. This is strange as the obstetric population should be suitable for fast recovery: A young and fit population with less co-morbidity and normally motivated for early discharge. The average stay after vaginal delivery is 1-2 days and after CS 3-4 days. National British guidelines recommend discharge after 1 day in uncomplicated cases. 1

2. Strategies for Enhanced Recovery after Caesarean Section
Before Delivery
Information
Education: Analgesia, thromboprophylaxis, breastfeeding
Day of Delivery
Minimise starvation and thirst
Intrathecal opioids
Prophylactic antibiotics
PONV and thrombo-prophylaxis
An editorial in IJOA from 2013 has outlined the startegies for enhanced recovery after caesarean section. Many of the components were already an established part of the perioperative practice in many units and the programme therefore easier to implement. Information and education of the patient before delivery about pain therapy, tromboprophylaxis and breastfeeding.
On the day of delivery starvation and thirst should be minimised. The patient should receive prophylactic antibiotics and prevention against nausea, vomiting and trombosis.
After delivery the patient should be encouraged to early oral intake, and iv cannula and catheters should be removed early to fascilitate mobilisation.
After Delivery
Regular analgesia (multimodal)
Early oral intake
Early removal of catheter and iv cannula
Early mobilisation

3. Enhanced Recovery after Caesarean Section 10 years’ experience
ER programmes are easy to implement in obstetric patients:
Improve maternal satisfaction
Reduce hospital stay
Do not increase maternal or neonatal readmission
May reduce cost and morbidity
Our enhanced programme reduced the postoperative use of morfin, increased patient satisfaction and the readmission rate did not increase.
The programme has been adapted to all CS patients.