We made it! Thank you so much to everyone for following along with my pregnancy and providing me so much support along the way.
My stubborn trouble-maker decided to stay breech throughout the pregnancy, therefore I had a scheduled C Section at 39 weeks for breech presentation. When preparing for my C Section, I knew that I was preparing for major abdominal surgery so I put into motion the things that I always counsel my patients on, the principles of Enhanced Recovery After Surgery.
Enhanced Recovery After Surgery, or ERAS, is a surgical pathway designed to help patients recover more quickly after surgery, including C Sections. Through this pathway, the patient and the surgeon are actively involved in the recovery process which leads to decreased stress response, improved physiologic function, and decreased narcotics use. In summary, a faster recovery so that I can be present and active with my newborn!
ERAS consists of three phases: pre-operative, inpatient, and post-discharge.
During the pre- operative phase, I used the following principles of ERAS:
- Stay active. I was active by walking 2-3 miles every day leading up to my delivery, which helped with my CS recovery as I was conditioned and able to walk immediately after surgery.
- Bowel regimen. I started taking a bowel regimen one week prior to surgery so that I didn’t go into my CS with constipation. My bowel regimen consisted of Colace which is a stool softener, Miralax which is a laxative, and of course LW Sparkle Fiber and Good Girl Probiotics!
- Carbohydrate loading. The days of not eating or drinking any after midnight are over! Carbohydrate loading on the day of surgery has been shown to decrease the stress response associated with surgery. Since my surgery was in the afternoon, I was able to drink tea and a 12oz Gatorade up until three hours prior to my CS.
- Prepare your house. This component is huge! Make sure you have all of your post-operative meds ready and accessible on the counter. Get a few clothes out and keep them in a place where you don’t have to bed. I took off the soft mattress topper on my bed so that it was easier to get into and out when I came home. Meal prep and keep things handy in the freezer. All these little things add up to recovery success.
During the inpatient phase, I used the following principles of ERAS:
- Goal directed fluid therapy. This means trying to keep your fluid balance for the hospital stay as close to 0 as possible. Often during delivery, you become overloaded with fluid, which adds a ton of unnecessary water weight. I opted to have my IV fluids discontinued after surgery and stayed hydrated by drinking large amounts of water on my own!
- Decreased narcotic intake. During my CS, my anesthesiologist used a type of regional anesthesia known as spinal anesthesia. This type of anesthesia decreases the amount of narcotics needed during the surgery. Post-operatively, I used scheduled Toradol, which is an IV form of ibuprofen, and scheduled oral Tylenol in the first 24 hours after surgery. After that, my pain was controlled with just oral Ibuprofen and Tylenol around the clock. However, I learned that CS recovery pain is no joke, and I definitely needed a few narcotic pills here and there for pain but did not need them regularly.
- Early removal of catheter. This helps prevent UTI’s and encouraged be to move, move, move.
- Early ambulation. Although it wasn’t easy, I knew that the sooner I moved, the better my pain control would be and the sooner my bowels would start working. Therefore, I forced myself to get up and move around as soon as I had feeling back in my legs from anesthesia, which was about 6 hours after surgery. I made sure that every few hours I was at least walking around my room, and even took my baby for a stroll in the hallways less than 24 hours after my surgery!
- Early return to regular diet. I never had to suffer through clear liquids! The sooner you can tolerate regular food, the better. Luckily, I had minimal nausea and was able to eat a regular dinner on the night of surgery.
- Bowel regimen. You’ll see a bowel regimen as part of each phase of recovery because it is so important for pain control! I continued my same bowel regimen while in the hospital to keep my bowels moving.
During the post-discharge phase, I used the following principles of ERAS:
- Decreased narcotics intake. When I was discharged, for one week I continued to take Tylenol and Ibuprofen around the clock, whether I had pain or not. By doing this, I was “staying ahead of the pain” and proactive so that I didn’t wait for the pain to creep up and become severe before doing something about it. I still needed a few narcotics pills during the first two days at home, but overall was feeling relatively back to normal by the 5-6 day after surgery.
- Bowel regimen. I continued with my daily Colace, Miralax, GGP, and SF daily with the addition of Milk of Magnesia when I needed a little extra help going. I noticed that if I was having regular bowel movements, my pain was so much better!
- Ambulation. My body was so sore, but I kept moving! This was really the hardest part of my recovery because it was difficult to even get in and out of bed the first few days after the CS. But I really pushed myself to take small walks each day and found that each day things became easier and easier. Walking also helps prevent blood clots!
- Using support. This is also a huge part of ERAS and any recovery process. Use the support around you! I had my husband and parents there to help me so I could rest and sleep.
By using these tools, I was feeling so much better within a week of surgery. If you’re not able to do all of the above things, that’s ok! Everyone’s recovery is unique and on their own timeline! Recovering from a CS is recovering from major abdominal surgery, plus adding in taking care of a newborn and lack of sleep, it is so challenging. ERAS has been proven to work across all types of surgical subspecialties. Applying as many components of the ERAS pathway as you can, will help you get back to your baseline faster.
I hope these tools can help those of you preparing for delivery!
Dr. Shweta Desai
*Follow my pregnancy journey here!