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Wollny K, Metcalfe A, Corrigan C, Drobot A, Gilmour L, Wood S, Wilson RD, Gramlich L, Nelson G. Maternal perceptions of cesarean birth care: A qualitative study to inform ERAS guideline development. Birth 2021; 48:550-557. [PMID: 34137470 DOI: 10.1111/birt.12561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 05/11/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cesarean birth (CB) is the most common inpatient surgical procedure, and until recently, there were no internationally accepted, standardized clinical guidelines available. The Enhanced Recovery After Surgery (ERAS® ) program aims to improve outcomes through the development of international guidelines (IGs). As an ERAS IG for CB was being developed, this qualitative study was conducted to explore and consolidate women's experiences with CB. METHODS Qualitative methods were used to assess the patient experience with current evidence-based CB protocols across operative phases. Twelve women who experienced CB at a single center in Canada were interviewed using an open-ended, semi-structured interview guide at six weeks postpartum. Two researchers coded the emerging themes separately and compared findings. RESULTS Women described feeling informed, but felt they did not have a choice. Presurgery, women wanted more information about the risks of CB. Preoperatively, women expressed confusion with the procedures, but felt informed about local anesthesia and thermoregulation. Post-CB, women felt informed about pain and nausea control; however, urinary catheter removal was delayed when compared to the ERAS recommendations. Information about postpartum infant care was not well communicated, as many women were uninformed about delayed cord clamping and infant thermoregulation. CONCLUSIONS This qualitative study provides opportunities to improve communication, the patient-practitioner relationship, and the overall satisfaction throughout the CB 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 CB have the potential to deliver significant improvements to patient care and patient satisfaction.
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Affiliation(s)
- Krista Wollny
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Crystal Corrigan
- Health Systems Evaluation and Evidence, Alberta Health Services, Edmonton, AB, Canada
| | - Ashley Drobot
- Health Systems Evaluation and Evidence, Alberta Health Services, Edmonton, AB, Canada
| | - Loreen Gilmour
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Stephen Wood
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - R Douglas Wilson
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Gregg Nelson
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
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