Enhanced Recovery after Caesarean Delivery

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Pre-admission visit:
Caesarean delivery date:
Predicted date for discharge:

Ranitidine 150mg at 10pm the day before surgery

Ranitidine 150mg at 6am on the day of surgery

What is enhanced recovery?
Enhanced recovery is about making sure people receive the best possible care before, during and after surgery to help them get back to full health as quickly as possible. Research has shown that the earlier a person gets out of bed and starts walking, eating and drinking after having an operation, the shorter their recovery time will be. By taking part, you will usually be able to go home the day after your caesarean delivery. If you feel you are not comfortable with being discharged after 24 hours, please feel free to speak to one of our staff. We will also tell you as soon as possible if you are no longer suitable to participate.

Pre-admission visit
At this visit, you will meet a midwife to discuss the process and ask any questions. You will have an MRSA swab and blood tests taken and will be given ranitidine tablets; these tablets neutralise the acid in your stomach and should be taken the night before and on the morning of your caesarean.

Eating and drinking
The night before your operation, you should eat normally until 3am. You may drink clear, non-fizzy fluids (water, apple juice, black tea/coffee and non-fizzy isotonic sports drinks) up until 7am. You should not chew gum. You will be encouraged to eat after your surgery.

On arrival in hospital
Arriving at 07:30am on the day of your caesarean will allow time to meet the midwife, obstetrician and anaesthetist. The midwife will give you a hospital gown to change into and special tight stockings. You should bring slippers and a dressing gown to wear when you walk to theatre. Your birth partner will be given theatre clothes (scrubs). You may bring a camera or smartphone to theatre for taking photos only. You may wear glasses if you are staying awake but remove any contact lenses, piercings and jewellery. If you cannot remove your jewellery, it can be taped up. You may have a long wait, depending on where you are on the theatre list.

Your anaesthetic
You will meet your anaesthetist on the morning of the surgery, and they will discuss the type of anaesthetic that is best for you. This is usually a spinal anaesthetic, allowing you to be awake and your birth partner present during the caesarean. This is a good opportunity to ask any questions or tell the anaesthetist about any worries you may have. Information about anaesthesia for caesarean deliveries can be found on the website www.labourpains.com

Obstetric review
You will see an obstetrician before the surgery to go through the procedure again and confirm your consent, please feel free to ask questions.

On arrival in theatre
You may be surprised how many people are in the operating theatre. There will be a midwife with you, an anaesthetist and an ODP (Operating Department Practitioner) who assists the anaesthetist. There will be two doctors to perform the operation, a scrub nurse to assist them and a theatre assistant. There may also be a doctor to check the baby after delivery and there may be students.

After your operation
You will go to the recovery area for further monitoring, accompanied by your baby. You will be able to drink water and feed your baby. On the post-natal ward, you will be able to eat and drink. Six hours after your anaesthetic, the spinal has usually worn off enough to mobilise. Once you can move your legs easily, the catheter can be removed, making it easier to get out of bed. Early
mobilisation is a key feature of the enhanced recovery pathway and most patients will be able to walk on the day of surgery. If you feel dizzy or faint when you get out of bed, sit down again and ask for help. When you need to pass urine, please ask for a measuring jug so the volume of urine can be monitored.

Pain relief Good pain relief is important to help you recover quickly. You will be given a long-acting painkiller with the spinal and you will usually receive a suppository to relieve pain at the end of the operation. You will need regular tablets, such as paracetamol and ibuprofen, for about a week after the operation. Stronger painkillers such as Dihydrocodeine and Oramorph are available while in hospital if you need them. These have been found to cause drowsiness, poor feeding and breathing problems in breastfed babies so they should be used at the lowest effective dose for the shortest possible duration. If your baby has any of these side effects, seek medical advice. If you are breastfeeding the baby should have a breast-feeding assessment by the midwife before your discharge.

Discharge from hospital
You will be discharged home the day after your caesarean, if you and the team looking after you agree that you are safe to go home. You will be visited by the community midwife on the day after discharge. Please make sure that you have paracetamol and ibuprofen at home, stored in a safe place away from children. These can be bought beforehand. You can take two paracetamol tablets (1g) four times a day and ibuprofen (400mg) three times a day. You will also be given dihydrocodeine tablets to take home.

When you first go home, you will not be fully mobile and will need someone to assist you with tasks that involve bending and heavy lifting. You will need someone to drive you home from the hospital. Please check with your car insurance company about when you can drive.

Caring for your wound
Please have a shower or bath on the morning of surgery. You will be given an antibiotic into your cannula before the surgery starts. These actions help to prevent wound infections.

The sutures will need to be removed about 5 days after the surgery, unless they are dissolvable sutures. You will be given dressing advice before leaving hospital. If you develop a high temperature or the wound becomes more painful, swollen, red, weepy or smelly, please contact your midwife or GP. Wound infections can be treated successfully with antibiotics.

Preventing Venous Thrombosis
After surgery, you are at risk of developing blood clots in your leg veins which can travel to the lungs. Wearing the tight stockings and staying mobile helps prevent this. Most women will also need a course of self-administered Dalteparin injections, a drug which prevents clot formation. The midwife will explain and demonstrate how to do this.

Useful Contact Numbers
Milton Keynes University Hospital
Standing Way, Eaglestone, Milton Keynes MK65LD

Main Switchboard: 01908 660033
Labour Ward: 01908 243 478
Patient Advice and Liaison Service (PALS): 01908 995 954
Community Midwives: 01895 279 472