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Enhanced Recovery After Cesarean (ERAC) Protocol

Some moms who deliver their babies at the Fetal Health Center have a Cesarean section (C-section), or surgical delivery. If you and your care team decide that a surgical delivery is the safest option for you and your baby, the Enhanced Recovery After Cesarean (ERAC) protocol can help you feel better faster so you can spend more time with your baby.

If you’ve had a C-section in the past, you probably were asked to stop eating and drinking at midnight before your surgery. But that’s changing. Two well-respected national medical organizations, the American College of Obstetrics and Gynecology and the Society for Obstetric Anesthesiology and Perinatology, have approved this new protocol because it’s been shown to improve outcomes for moms and babies.

What to expect from the new ERAC protocol

Generally, this protocol has proven to result in:

  • Shorter fasting times before surgery (stop eating 6 hours before surgery; stop drinking 2 hours before)
  • Better pain management (cuts opioid use by 30-50%) without nausea
  • Getting you up and moving around faster after surgery
  • Fewer blood clots
  • Reduced need for IV fluids
  • Improved bonding between you and your baby

Key differences from traditional C-section protocol

Children’s Mercy is one of the first hospitals in the region to implement the ERAC protocol. Here are some of the key differences you may notice if you’ve delivered via a C-section before:

Eating and drinking

With this new protocol, we will encourage you to eat and drink before and after your C-section. You may have a light meal up to 6 hours before your scheduled arrival time. You may drink clear liquids up until 2 hours before your surgery time.

If you are diabetic, we will have you drink G2 or a similar diabetic drink before surgery. We will check your blood sugars when you arrive. Our nurses will discuss the details of your plan closer to your delivery date.

You will be provided with chewing gum during your stay before and after surgery at your choosing. Chewing gum has been proven to decrease nausea and improve return of normal bowel function faster after surgery.

Preventing nausea

No one wants to feel nauseated after surgery. The ERAC protocol uses IV fluid therapies, including a proven combination of anti-nausea medicines, to keep you comfortable. Eating and drinking as directed also can help prevent nausea.

Get moving earlier

Most babies born in the Fetal Health Center also need to stay in the hospital’s Neonatal Intensive Care Unit (NICU). This new protocol will help you get up and moving faster by getting your IV fluids and urinary catheter discontinued earlier.

Eating and drinking as instructed also will help you get up and moving quicker, help you heal faster, prevent blood clots from forming, and make getting to the NICU easier so you can visit your baby.

Preventative pain management for more effective relief

From the moment you arrive, we will start your preventive pain management plan with scheduled Tylenol and ibuprofen or other non-steroidal anti-inflammatory medications (NSAIDs). You will receive these medications by IV or by mouth.

We also will provide a small dose of long-acting pain medicine in your spinal or epidural in the operating room. This helps maximize pain relief while minimizing side effects, like itching and nausea.

Combining these medications into one plan can help decrease the amount of opioid medications needed after surgery by 30- 50%. Decreasing opioids after surgery will help you feel less tired, less nauseated, less constipated, and will help you get up and moving sooner.

If you have questions about the ERAC protocol or your specific birth plan, talk with your Fetal Health Center care team.