Enhanced recovery programme for patients requiring elective caesarean section

The aim of the Enhanced Recovery Programme (ERP) is to get you back to full health as quickly as possible after your caesarean. Research indicates that after surgery, the earlier you get out of bed and start eating and drinking the better. This will speed your recovery making it less likely that complications will develop. For example, the benefits of getting up and about are

• Returning to eating and drinking much sooner.
• Reduced risk of hospital acquired infection.
• Less tiredness.
• Reduced risk of developing blood clots.

To achieve this, however, we need you to be a partner with us so that we can work together to speed your recovery. This article will increase your understanding of the programme and ensure you play an active role in the preparation for your operation and your recovery.

Before you come into hospital your obstetrician/midwife will see you and explain the programme to you, where you will be given the opportunity to ask questions.

Below is a picture of your female anatomy while pregnant. Your obstetrician will explain your operation to you.

Elective caesarian section

If you optimise your health in the weeks before your operation then you will recover more quickly and have fewer complications.

Try to eat as healthily as possible and you may consider taking a multivitamin every day to make sure you have a good level of essential nutrients. Do not diet in the weeks before an operation but also avoid putting on a lot of weight. Ensure adequate exercise and walk whenever you can. If you are a smoker it is advisable for you to stop. You may wish to speak to your Community Midwife, GP or contact the National Stop Smoking helpline on 0800 022 4332.

Also, think about how you can cope in the weeks after surgery when you are convalescing. Can you arrange help from family or friends? If you think that you will have problems at home after your operation then seek help early so a suitable solution can be found before your operation.

Make sure that you raise any concerns that you have in the preassessment clinic. If you look after your health in the weeks before your operation then you will recover quicker and have fewer complications.

The day before your admission date you will be seen in the pre-assessment clinic. The clinic is run by experienced midwives and maternity care assistants, where you will be given your pre-operation medication; you will also need to have blood taken in the phlebotomy department.

You will also have a thromboprophylaxis risk assessment to prevent Deep Vein Thrombosis. A copy of the leaflet Prevent Deep Vein Thrombosis (DVT) whilst in hospital, will be given to you.

Please bring into hospital any medication that you usually take on prescription in their original boxes. The midwife in pre-assessment will tell you which of these should be taken before and on the day of your surgery.

You can have 500mls of Lucozade sport two hours prior to you admission or until 7am and then you will need to fast (be Nil by Mouth).

If you are a type one diabetic or gestational diabetic on insulin or diet controlled you can have clear fluids only.

If my operation is in the morning:

10pm and 6am.

If my operation is in the afternoon:

10pm and 10am

Hand hygiene is the best way to prevent germs spreading. It may feel awkward to question staff when someone is looking after you, but you are entitled to ask/remind health care staff to wash their hands.

To help reduce the risk of getting an infection in hospital, please read the following advice.

• Keep your hands and body clean.
• Always wash your hands before and after using the toilet.
• Always wash your hands or use a moist wipe before you eat your meal.
• If a member of staff needs to examine you or perform a procedure, do not be afraid to ask if they have first washed their hands or used a hygienic hand rub. Staff should gloves for procedures such as taking blood, undertaking dressings etc.
• Keep your locker and bedside table tidy and free from clutter and ensure none of your possessions are on the floor. This will make it easier for staff to clean properly.
• Ask your visitors to use the hand gel provided on entering and leaving the ward.
• Please remember flowers are not permitted throughout the hospital.

Before you come into hospital for your operation, you will have a pre assessment appointment. During this appointment two painless swabs will be taken, one from inside the nose and one from the groin these are the areas of the body where MRSA is most likely to be found in carriers.

MRSA stands for Methicillin Resistant Staphylococcus Aureus. This is a form of Staphylococcus Aureus (SA). SA is the commonest type of bacteria which can infect humans. About a third of the population are colonised with SA. Colonised means the organism lives harmlessly on skin or in the nose. SA causes problems when it enters the body and this is most likely when patients are unwell. MRSA is a variety of SA that tends to spread easily.

If you are unable to do your own perineum swabs a midwife or maternity care assistant will assist you. The swabs will be sent to the hospital laboratory to see if the MRSA germ is present – it can take up to five days to get the results. If your swabs come back positive we will inform you straight away and let you know what treatment is needed. For example, if your nasal swab is positive you will need to use an antibacterial spray which is applied to your nostrils three times a day for five days.

If you have any questions with regard to infection control, please speak to a midwife or maternity care assistant.