January 13, 2020
Helping moms after surgery
Innovative surgical care provides a better experience — and improves recovery — after a cesarean birth.
Eating and getting moving sooner after a C-section can improve recovery for new moms. Pictured, Kaiser Permanente nurse Vanessa Bell with her newborn.
Vanessa Bell, 34, a labor and delivery nurse at the Kaiser Permanente Santa Clara Medical Center, always knew that she would need a cesarean section due to a medical condition, even before she became pregnant.
Back in 2015, she recalls, “My doctors told me that I’d have a high-risk pregnancy, and to prepare for a C-section.”
When Bell did get pregnant and her water broke early, at almost 34 weeks, she delivered her baby by C-section. Her baby girl required a stay at the neonatal intensive care unit, or NICU.
As a nurse, Bell had helped countless other women use ERAS, or the Enhanced Recovery After Surgery program, to recover more quickly after a C-section. And now it was her turn to benefit from it.
Less medication, more movement
ERAS includes innovations such as allowing a high-carbohydrate drink 2- 4 hours before surgery (rather than the traditional fast); pain management that reduces opioids in favor of local anesthetics and acetaminophen; getting patients up and walking soon after surgery; and educating patients about what to expect in recovery.
The ERAS program reduces mortality, post-operative complications and readmissions, and opioid prescriptions for some surgeries. A Kaiser Permanente study in Northern California found that ERAS protocols can allow women undergoing elective C-sections to recover more quickly and care more rapidly for themselves and their newborns.
“The study found that implementing the ERAS program was associated with a decrease in opioid exposure, yet women did not report greater pain,” said Monique Hedderson, PhD, a research scientist with the Kaiser Permanente Division of Research. Opioid exposure was cut nearly in half. In addition, patients in the study were up and walking 2.7 hours sooner and ate 11 hours sooner after the surgery than those patients offered traditional recovery.
Up and moving
“They knew I had to get up and go to the NICU,” Bell recalled, referencing the nurses, “and the ERAS program helped me do that even quicker, without relying too much on opioids, which, even after one dose, left me feeling awful.” She was reminded by her nurses to take acetaminophen before she had to make her NICU journey, and to take a wheelchair with her, so she wouldn’t overexert herself.
Kaiser Permanente uses ERAS protocols to improve the patient experience and shorten hospital stays for a wide range of surgeries. Most recently, 2 Kaiser Permanente programs in Northern California were honored with the inaugural NCQA Innovation Award for reducing surgical patient hospital stays by nearly 50%.
“I personally benefited from this program in one of the hardest moments of life,” Bell said of ERAS. “Not only was I able to recover well from a major surgery, but I could also be there physically for my daughter.”
