Enhanced Recovery Programme (ERP) for Caesarean Birth 

What is ERP? 

The Enhanced Recovery Programme (ERP) is a program designed to improve recovery by using evidence-based practices to help you recover quicker after your caesarean birth. It focuses on your wellbeing, comfort, and getting you home sooner by optimising your health before surgery, minimising stress during the procedure and promoting quicker recovery through co-ordinated care and your involvement. 

If you want more detailed information about Caesarean birth, please look at these links: 

If you want more information specifically about your mode of birth and Caesarean birth, please discuss with your midwife and obstetrician.  

Key benefits of ERP  

  • Faster recovery and return to normal activities
  • Reduced risk of complications
  • Shorter hospital stay
  • Improved pain management

Who is eligible for ERP for Caesarean Birth? 

All women scheduled for Caesarean birth can participate in the ERP for Caesarean Birth. Some medical conditions or major anaesthetic or surgical risks might delay the discharge after the operation but the principles of ERP to optimise recovery will still be applied and encouraged.

Antenatal Clinic 

Your Caesarean section is usually booked for 37-41 weeks depending on the reason you are having the procedure. It is commonly booked in Antenatal clinic at around 34-36 weeks. Your signed consent (where you sign that you agree to go ahead with the procedure) tends to be taken within a month of the Caesarean Birth. Sometimes, the consent is taken on the day of the operation.  If your Caesarean Birth is planned earlier than usual, you might be offered steroids to help maturation of your baby's lung. For more information, please read: co-opt-corticosteroids-infographic.jpg (847×599) 

In this visit, ask as many questions as you want, including your choices and options. Go through the benefits and risks with your doctor. You can also ask about the option of contraception that can be done at the time of Caesarean Birth. 

Pre-Operative Care 

Antenatal Clinic/ Day Care Clinic 

You will be given an appointment two days before the Caesarean Birth where:  

  • A blood sample will be taken to check for anaemia and to determine your blood group. This ensures that, in the unlikely event of an emergency, compatible blood can be provided quickly if needed.
  • You will be given two Omeprazole (anti-acid) tablets to take before your Caesarean.
  • You will be asked to read and follow the instructions below. 

This appointment is another good time to ask questions about your birth and postnatal care.  

What you can do before surgery 

Preparing for a caesarean birth involves taking steps to ensure your health and comfort before, during, and after the procedure. Here are some instructions and advice that we recommend: 

  • Prepare a bag for you and your baby. We recommend that you bring one overnight bag with you on the day of your surgery. This should include for you: 
  • Loose nightwear (e.g. nightie)
  • Maternity pads
  • High-waisted underwear (to go over your wound)
  • Your own pillow (optional)
  • Light snacks for after your surgery
  • Pack of nappies
  • Baby vests
  • Baby sleep suits
  • Baby hat
  • Cotton balls 

What to bring to hospital

More information: What to bring to hospital 

  • We will ask you to bring a nappy, a vest, a sleep suit and a baby hat in theatre. From our experience, we advise you to put these in a separate bag so you and your birth partner can find them quickly when you are taken to theatre. 
  • Please do not bring valuables, cooked food that needs reheating and cigarettes (including vapes) or tobacco. Do not wear any jewellery on the day. Try not to bring in any valuables with you. You are responsible for your belongings at all times, and you need to leave them outside theatre unattended. Your birth partner will be able to carry a phone (and possibly, keys and money in their scrub pockets).   
  • Arrange childcare and support at home. You need to arrange childcare for any other children while you are in hospital. You will stay in hospital for at least one night. We do not provide childcare. The hospital birthing unit is not a suitable environment for children. You can have ONE birth partner with you in the operating theatre and whilst on Labour Ward (no changeovers). 
  • Skin preparation has been shown to reduce infection. We encourage you to shave your bikini line at least one week before surgery. You need to stop shaving or waxing your pubic area or bikini line within the week before your caesarean birth. This is to prevent any skin irritation or damage which could lead to an infection. Continue to wash / shower or bathe with your regular products at home. On the day of surgery, wash your pubic area (the area above your genitals and below your stomach) and bikini line (the skin around your genitals) with soap and water. Do not use any lotions, creams or talcum powder on your skin. 
  • Avoid nail polish or false nails, as these will prevent staff monitoring your wellbeing effectively. They might need to be removed on the day if you have not done it beforehand.  
  • Make sure you have arranged support for after surgery, whether from family, friends, or your partner, as you'll need help with daily tasks and caring for your baby while you recover.  

Planning ahead is important for your recovery and can help you feel more confident and supported throughout your caesarean birth experience. 

On the day before your operation  

If your operation is scheduled in the morning: 

  • You are allowed to eat until 2AM
  • Have a carbohydrate-rich dinner the evening before your operation
  • You may have a light meal (such as toast or cereal) before 2AM on the morning of surgery
  • Please avoid heavy or fatty foods, as these can stay in your stomach for longer than 6 hours and may not be suitable before surgery
  • You may drink a high-energy still/non-fizzy drink (such as Lucozade Sport) at 10PM, unless you are diabetic when we suggest a clear drink such as water
  • Take your Omeprazole (anti-acid) at 10PM as prescribed

If your operation is scheduled in the afternoon:  

  • You are allowed to eat until 7AM
  • Have a carbohydrate-rich dinner the evening before your operation
  • You may have a light meal (such as toast or cereal) before 7AM on the morning of surgery
  • Please avoid heavy or fatty foods, as these can stay in your stomach for longer than 6 hours and may not be suitable before surgery.
  • You may drink a high-energy drink (such as Lucozade Sport) at 7AM, unless you are diabetic when we suggest a clear drink such as water. 
  • Take your Omeprazole (anti-acid) at 10PM as prescribed. 

On the day of surgery 

If your operation is scheduled in the morning 

  • You may have a sugar/high-energy drink (no bits, no fizz, no milk) until 6AM (unless you are diabetic).
  • After 6AM, do not eat or drink anything unless instructed otherwise.
  • Take your Omeprazole (anti-acid) at 6AM on the morning of surgery, as prescribed. 

If your operation is scheduled in the afternoon: 

  • You are allowed to eat until 7AM (light breakfast)
  • You may have a sugar/high-energy drink (no bits, no fizz, no milk) until 11AM (unless you are diabetic when we suggest a clear drink such as water)
  • After 11AM, do not eat or drink anything unless instructed otherwise
  • Take your Omeprazole (anti-acid) at 11 AM on the morning of surgery, as prescribed

Admission times: 

  • If you are scheduled for a morning operation, please arrive at 7:30am
  • If you are scheduled for an afternoon operation, please arrive at 11:30am

What to expect on the day when you arrive in hospital:

  • A midwife will greet you and help you get ready
  • You will be given a gown to wear
  • We will check your observations and blood results
  • You are recommended not to have nail polish. We might need to remove it on the day
  • You will be taken to the labour ward with your partner and your belongings
  • Clinicians will discuss with you any concerns and confirm the consent of your operation
  • Very rarely, your caesarean birth might be cancelled. More than 95% of our elective Caesarean Births are done on their scheduled day. However unfortunately if the unit is very busy, we will have to make the difficult choice of postponing your operation. Your procedure will be taken as a priority for the next elective list.  

Intra-operative care 

  • Anaesthesia will be given, usually a spinal or combined spinal epidural, so you'll be awake but won't feel pain. Please look at the anaesthetic section for more information.  
  • A thin, flexible tube called a catheter will be inserted into your bladder to empty it while you're under the anaesthetic, and a small area of pubic hair may be trimmed if necessary. 
  • A screen is placed across your tummy so you won't see the operation, but your birth partner may be able to sit with you. 
  • The surgeon makes a horizontal cut (about 15cm) just above your pubic area. 
  • The womb is opened and your baby is gently lifted out. 
  • You may feel some pressure, pulling/tugging sensations or movement, but not pain. 
  • We encourage delayed cord clamping which takes about 1 minute. After this minute, unless any concerns the baby will be handed to you or your birth partner as soon as possible. We encourage skin to skin with your baby as soon as your baby is born. 
  • The surgeon will remove the placenta and close the incisions with stitches. The suture material is usually absorbed by your body so does not need removal, however in some instances other suture material are used (or staples) - in this case, you will have them removed after some days following surgery.  
  • The whole procedure takes about 40 to 50 minutes.  
  • We recommend a vitamin K injection for your baby. This injection is given in theatre. Please read the information sheet provided as your consent is needed before administration. For more information, look at this link:  https://thh.nhs.uk/vitamin-k-for-your-new-born-baby 

Anaesthesia and pain relief for Caesarean Birth 

  • You will be seen by an anaesthetist on the day of your Caesarean, who will discuss the anaesthetic options, gain verbal consent for anaesthesia and discuss what to expect during the surgery. 
  • A regional anaesthetic where you are awake and comfortable for your Caesarean is usually the preferred method of anaesthesia, of which there are three types: spinal, combined spinal-epidural and epidural. 
  • In all of these, local anaesthetic is given into your back to numb your tummy and lower body. 
  • Different types of anaesthetic are more suitable for different situations, and your anaesthetist will discuss with you the options that are most appropriate for your caesarean birth. 
  • In certain circumstances a general anaesthetic (where you are unconscious and do not feel anything during the procedure) may be more appropriate. This will be discussed in detail with you by your anaesthetist. 

After surgery 

  • You will go to the Recovery Unit where you will be monitored closely. During this time, which can be from two to four hours, no visitors are allowed. No visitors apart from one birth partner are allowed during your stay on Labour Ward. Unfortunately, swapping partner is not allowed. Take this time to rest and bond with your baby.  
  • You will then be transferred to the Alexandra Postnatal Ward.  
  • Your catheter will be removed at about six hours after your surgery. We will try our best not to disturb you if you are having a rest between caring and feeding your baby.  
  • Early Movement: You'll be encouraged to move and walk as soon as possible. 
  • Eating and Drinking: You can usually eat and drink soon after surgery. 
  • Pain Relief: Regular pain relief will be provided. Tell staff if you need more. 
  • Feeding Your Baby: Support is available for breastfeeding or bottle feeding. Do not hesitate to ask.  
  • Your bladder: After your catheter is removed you will be asked you measure your first wee by your midwife. It is important that when you go for your first wee all your urine comes out, without pushing it out forcefully and you are feeling your usual sensation of needing to pass urine. Your midwife will help you monitor this.  

Alexandra Postnatal Ward visiting times  

  • One birth partner is permitted to stay 24 hours a day (no swapping of this named partner)
  • Other visitors, including siblings of the baby, are allowed from 2pm until 7pm.
  • Only 2 visitors at the bedside at one time (children under the age of 16 are counted as 1 and must be always accompanied by an adult other than you).  

Going home 

  • Most people go home within 24-48 hours after surgery
  • You will be given pain relief tablets and other medications (such as blood thinners) that are specific to your care. 
  • You'll be given advice on caring for yourself and your baby, pain relief, wound care, and signs to watch for.
  • Please tell the midwife if you will be going to a different address when you are discharged from hospital.
  • Your telephone number will be checked to ensure the community midwives can contact you after you go home.
  • If your address is difficult to find or if parking is limited, please let your midwife know in advance.
  • Please ask your partner or support person to bring in a car seat for your baby on the morning of your expected discharge.
  • You will be given an information pack before you leave. 

Tips for recovery at home 

  • Rest and accept help from family or friends.
  • Take pain relief as advised.
  • Keep your wound clean and dry.
  • Watch for signs of infection (redness, swelling, fever).
  • Gradually increase your activity. 

Contact your midwife or GP if you have concerns. Your community Midwife will contact you either face to face (home visit) or by phone depending on your needs.   

If you have questions or concern, contact your midwife, GP, or Triage. 

Triage Number 01895 279 054 

 

If your Casesarean Birth surgery is in the MORNING 

Planning your Caesarean Birth 

  • Your Caesarean section is usually scheduled at the Antenatal clinic, typically around 36 weeks.
  • Attend your pre-operative appointment.
  • Pack an overnight bag for yourself and your baby.
  • Arrange support from family and friends for help after the operation, including childcare if required.
  • Ensure your baby's car seat is ready for use.
  • Stop shaving or waxing your pubic area (the area above your genitals and below your stomach) and bikini line at least one week before surgery to reduce infection risk. 

The day before the operation 

  • Take omeprazole at 22:00 as advised
  • Prepare your skin as instructed by the hospital
  • Double-check that your bag is packed
  • Eat a carbohydrate-rich meal before bedtime
  • If your surgery is in the morning, do not eat anything after 02:00 

The day of the operation 

  • On the morning of your caesarean birth, wash your pubic area and bikini line with soap and water.
  • Avoid using lotions, creams or talcum powder on your skin.
  • Remove all jewellery and piercings (you may keep on your wedding ring if you have one).
  • Do not wear makeup and remove false nails.
  • You can drink clear fluids such as sports drink and clear juice till 6am (no milk, no fizzy drinks, no bits in your juice and no chewing gum)
  • Take your second omeprazole at 6am
  • Come to Labour Ward at 7.30am 

The day after the operation 

  • Your healthcare team will provide care instructions and recovery advice for the day following your caesarean birth. 

At home 

  • You will receive further guidance and support for your recovery at home from your midwives and healthcare team, helping you transition smoothly from hospital to home life. 

 

If your Casesarean Birth surgery is in the AFTERNOON 

Planning your Caesarean Birth 

  • Your Caesarean section is usually scheduled at the Antenatal clinic, typically around 36 weeks.
  • Attend your pre-operative appointment. 
  • Pack an overnight bag for yourself and your baby. 
  • Arrange support from family and friends for help after the operation, including childcare if required. 
  • Ensure your baby's car seat is ready for use. 
  • Stop shaving or waxing your pubic area (the area above your genitals and below your stomach) and bikini line at least one week before surgery to reduce infection risk. 

The day before the operation 

  • Take omeprazole at 22:00 as advised
  • Prepare your skin as instructed by the hospital
  • Double-check that your bag is packed
  • Eat a carbohydrate-rich meal before bedtime 

The day of the operation 

  • On the morning of your caesarean birth, wash your pubic area and bikini line with soap and water.
  • Avoid using lotions, creams or talcum powder on your skin.
  • Remove all jewellery and piercings (you may keep on your wedding ring if you have one).
  • Do not wear makeup and remove false nails.
  • Do not eat anything after 7am. 
  • You can drink clear fluids such as sports drink and clear juice till 11am (no milk, no fizzy drinks, no bits in your juice and no chewing gum)
  • Take your second omeprazole at 11am
  • Come to Labour Ward at 11.30am
  • The Day After the Operation
  • Your healthcare team will provide care instructions and recovery advice for the day following your caesarean birth. 

At home 

  • You will receive further guidance and support for your recovery at home from your midwives and healthcare team, helping you transition smoothly from hospital to home life.