How ERACS protocols ensure a safe, improved childbirth experience: 3 Qs with Maimonides Medical Center’s Dr. Gary Schwartz

In today’s healthcare environment, it’s more important than ever to make sure childbirth is a safe, pleasant experience. Maimonides Medical Center in Brooklyn, N.Y., has adopted enhanced recovery after cesarean section protocols, or ERACS, to ensure a safe and positive experience for the mother, baby and family.

ERACS can allow mothers to spend more time with their baby early on and shorten their overall length of stay. By using techniques such as multimodal analgesia, fluid optimization and giving antibiotics before a C-section, ERACS helps providers deliver an optimal childbirth experience.

Here, Gary Schwartz, MD, an interventional pain physician and director of acute pain management at Maimonides, discusses how the hospital has utilized ERACS protocols to improve care for women undergoing C-sections.

Editor’s note: Responses have been edited for length and clarity.

Question: What is the current status of enhanced recovery after surgery and multimodal protocols in the world of obstetrics? Where are we in the continuum of evolution?

Dr. Gary Schwartz: Most obstetric providers are either early in their enhanced recovery protocols or just starting them. It’s becoming the standard of care in this current environment. Not every department has accepted it, but the Society for Obstetric Anesthesia and Perinatology has a consensus statement about it.

In the continuum of evolution, we’re learning different things about our ERACS protocol. It’s a collaboration between obstetrics, anesthesia, administration and nursing. It could be a continuum of care really from preconception to antepartum to postpartum.

Q: Why did Maimonides adopt enhanced recovery after c-sections? Have you changed anything about the program recently?

GS: We started it a couple years ago and it has gone through many different changes. But number one, we think it’s really the best thing for the safety and comfort of the mother. Fast forward to present day, we have also had to free up beds for the hospital’s sake to manage patient flow.

We recently started doing transversus abdominis plane (TAP) blocks with liposomal bupivacaine. The main reason we did that was to improve postoperative pain control with fewer opioids. The TAP blocks mean less pain, more movement, and earlier recovery after surgery for mom.

We know that after a C-section, unfortunately, postoperative pain is one of the main factors that keeps women in the hospital. With the introduction of these TAP blocks with liposomal bupivacaine, we were able to better manage pain for new mothers.

Prior to our ERACS protocol, a lot of women received opiates postoperatively, which can delay recovery due to nausea, constipation, among other challenges. By using these protocols, including the TAP blocks with liposomal bupivacaine, women were able to walk, take fewer opiates and advance towards activities of daily living with less pain.

Q: Why are enhanced recovery protocols in obstetrics relevant now more than ever?

GS: Enhanced recovery protocols in Obstetrics are relevant now more than ever because women’s health is at the forefront of medical research, and the data is showing that ERACS has improved outcomes. With multimodal analgesia, which is one of the cornerstones of ERACS, we’re able to get patients eating faster, moving faster. We’re also able to promote breastfeeding and maternal-infant bonding.

Especially now, our ERACS protocols are key to better manage hospital resources, improve patient outcomes and to make the birth experience positive for mom, baby and family members.

I
n today’s healthcare environment, it’s more important than
ever to make sure childbirth is a safe, pleasant experience.
Maimonides Medical Center in Brooklyn, N.Y., has adopted
enhanced recovery after cesarean section protocols, or ERACS, to
ensure a safe and positive experience for the mother, baby and
family.
ERACS can allow mothers to spend more time with their baby early
on and shorten their overall length of stay. By using techniques
such as multimodal analgesia, fluid optimization and giving
antibiotics before a C-section, ERACS helps providers deliver an
optimal childbirth experience.
Here, Gary Schwartz, MD, an interventional pain physician and
director of acute pain management at Maimonides, discusses
how the hospital has utilized ERACS protocols to improve care for
women undergoing C-sections.
Editor’s note: Responses have been edited for length and clarity.
Question: What is the current status of enhanced recovery after
surgery and multimodal protocols in the world of obstetrics?
Where are we in the continuum of evolution?
Dr. Gary Schwartz: Most obstetric providers are either early
in their enhanced recovery protocols or just starting them. It’s
becoming the standard of care in this current environment. Not
every department has accepted it, but the Society for Obstetric
Anesthesia and Perinatology has a consensus statement about it.
In the continuum of evolution, we’re learning different things
about our ERACS protocol. It’s a collaboration between obstetrics,
anesthesia, administration and nursing. It could be a continuum of
care really from preconception to antepartum to postpartum.
Q: Why did Maimonides adopt enhanced recovery after
c-sections? Have you changed anything about the program
recently?
GS: We started it a couple years ago and it has gone through
many different changes. But number one, we think it’s really the
best thing for the safety and comfort of the mother. Fast forward
to present day, we have also had to free up beds for the hospital’s
sake to manage patient flow.
We recently started doing transversus abdominis plane (TAP)
blocks with liposomal bupivacaine. The main reason we did that
was to improve postoperative pain control with fewer opioids. The
TAP blocks mean less pain, more movement, and earlier recovery
after surgery for mom.
We know that after a C-section, unfortunately, postoperative pain is
one of the main factors that keeps women in the hospital. With the
introduction of these TAP blocks with liposomal bupivacaine, we
were able to better manage pain for new mothers.
Prior to our ERACS protocol, a lot of women received opiates
postoperatively, which can delay recovery due to nausea,
constipation, among other challenges. By using these protocols,
including the TAP blocks with liposomal bupivacaine, women were
able to walk, take fewer opiates and advance towards activities of
daily living with less pain.
Q: Why are enhanced recovery protocols in obstetrics relevant
now more than ever?

GS: Enhanced recovery protocols in Obstetrics are relevant
now more than ever because women’s health is at the forefront
of medical research, and the data is showing that ERACS has
improved outcomes. With multimodal analgesia, which is one of
the cornerstones of ERACS, we’re able to get patients eating faster,
moving faster. We’re also able to promote breastfeeding and
maternal-infant bonding.
Especially now, our ERACS protocols are key to better manage
hospital resources, improve patient outcomes and to make the
birth experience positive for mom, baby and family members.

© Copyright ASC COMMUNICATIONS 2020. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

Featured Webinars

Featured Whitepapers