Learn about the Eracs Method: Comfortable and Modern Labor for Moms

Background and Definition

Based on data from the World Health Organization in 2018, it was stated that 21% of births worldwide occurred through caesarean section procedures, and this is expected to increase to 29% by 2030. Like other surgical procedures, caesarean sections have postoperative risks. The postoperative problem most complained about and feared by patients undergoing cesarean sections is acute postoperative pain, which often causes discomfort for the mother.

The Enhanced Recovery After Caesarean Surgery (ERACS) protocol is a caesarean section method that includes the principles of multimodal perioperative management to minimize pain so that it will speed up patient recovery, reduce the duration of hospitalization, and increase maternal and family satisfaction rates.

This protocol allows patients to move more quickly, namely around 2 hours after a caesarean section, with minimal pain. Giving birth using this method involves collaboration between obstetricians as operators, anesthesiologists, and pediatricians.

Distinctions from a standard caesarean section

ERACS is essentially a development of the "sectio caesarean" section delivery method, with an emphasis on recovery, pain management, and patient comfort both before, during, and after surgery. The following are some of the ways that ERACS and cesarean section delivery differ from one another:

1. Fasting time

   Patients undergoing ERACS have a shorter fasting time (6 hours) than those undergoing sectio caesaria (about 8 hours). The patient will even get water or juice two hours prior to the operation starting. 

2. Postoperative pain

   Postoperative pain is a major problem that makes patients hesitant to undergo surgical procedures. But ERACS can be a solution to this problem because it has been proven to be effective in reducing postoperative pain in patients. This can be caused by several factors, including: 

   • Injecting anesthesia using a smaller needle
   • Scheduled administration of pain medication
   • Administration of low-dose, long-acting pain relievers to the spine during surgery
      
3. Postoperative recovery time

   In addition to making preparations generally simpler for patients, post-ERACS treatment promotes quicker patient recovery because: 

   • Patients can be given food and drink more quickly (immediately).
   • Catheters can be removed 2 hours after surgery so that patients can move more freely.
   • The infusion is removed 12 hours after surgery so that the patient can fully mobilize.
   • Patients can return home sooner in order to provide the mother's body with the strength and fitness it needs to start the early breastfeeding process (IMD) right away and have skin-to-skin contact with the child as soon as feasible.
      
4. Surgical scar

   ERACS surgery will use a small, very sharp scalpel so that the first incision can directly penetrate the muscle and connective tissue. As a result, tissue damage is minimized, and wound healing tends to be faster.
    

The Benefits of the ERACS Operations

1. Shorter fasting duration
2. A significant reduction in the use of opioid analgesics
3. Reduced pain after surgery
4. Less postoperative nausea
5. Increased early mobilization
6. Shortening of hospital stay duration

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Reference

1. Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: Global and regional estimates. BMJ Global Health. 2021 Jun 15;6(6).
2. Habib AS, Ituk U. Enhanced recovery after cesarean delivery [version 1; referees: 2 approved]. Vol. 7, F1000Research. F1000 Research Ltd; 2018.
3. Bollag L, Nelson G. Enhanced Recovery After Cesarean (ERAC) – Beyond The Pain Scores. International Journal of Obstetric Anesthesia. 2020;43:36–8.