Maternal Perceptions of Cesarean Delivery Care: A Qualitative Study to inform ERAS Guideline Development

Abstract

INTRODUCTION: Cesarean delivery (CD) is the most common inpatient surgical procedure; however, there are no internationally-accepted, standardized clinical guidelines. The Enhanced Recovery After Surgery (ERAS®) program aims to improve outcomes through the development of international guidelines (IG). The purpose of this study is to obtain and consolidate women’s experiences with CD to inform the development of an ERAS international guideline (IG). METHODS: Qualitative methods were used to assess the patient experience with current evidence-based CD protocols across operative phases. Twelve women who experienced CD were interviewed using an open-ended, semi-structured interview guide at six-weeks post-partum. Two researchers coded the emerging themes separately and compared findings. RESULTS: Women described feeling informed, but felt they did not have a choice. Pre-surgery, women wanted more information about the risks of CD. Pre-operatively, women expressed confusion with the procedures, but felt informed about local anaesthesia and thermoregulation. Post-CD, women felt informed about pain and nausea control; however, urinary catheter removal was delayed when compared to the ERAS recommendations. Information about post-partum infant care was not well communicated, as many women were uninformed about delayed cord-clamping and infant thermoregulation. DISCUSSION: This qualitative study provides opportunities to improve communication, the patient-provider relationship, and the overall satisfaction throughout the CD process. The findings support the implementation of patient decision aids and training with the shared decision model. The improved procedures recommended in the ERAS IG for CD have the potential to deliver significant improvements to patient satisfaction, mother-infant bonding and mental wellness.