The Attitude of Health Care Workers on Enhanced Recovery After Surgery for Cesarean Delivery: A Scoping Review

Published:March 27, 2021DOI:



      Previous systematic reviews have found that the enhanced recovery after surgery (ERAS) protocol for cesarean delivery can vary from one study to another, and the attitudes of health care professionals regarding ERAS methods and the implementation of the ERAS for cesarean delivery remain unclear. We aimed to identify the attitudes of health professionals toward ERAS in the context of cesarean delivery.

      Data Sources

      Systematic searches were conducted in 6 databases: PubMed, ScienceDirect, EBSCO, Scopus, the Cochrane Library, and Sage Journals from September 2010 to September 2020.

      Study Selection

      A total of 4 articles were selected for analysis. All articles use survey methods and present health professional attitudes toward ERAS for cesarean delivery.

      Data Extraction and Synthesis

      Data were extracted using Excel spreadsheets. The results obtained are presented descriptively.


      This review illustrates that there are many ERAS protocols that health care professionals have not yet implemented for cesarean delivery. Policymakers can use this knowledge to inform the promotion of the ERAS protocol for cesarean delivery.



      Les revues systématiques précédentes ont montré que les programmes de récupération rapide après une intervention chirurgicale (ERAS) en contexte post-césarienne peuvent varier d'une étude à l'autre et que leur utilisation, y compris leur mise en œuvre, par les professionnels de la santé demeure vague. Notre objectif était de connaître l'utilisation qu'en font les professionnels de la santé en contexte de césarienne.

      Sources de données

      Des recherches systématiques ont été effectuées dans six bases de données, en l'occurrence PubMed, ScienceDirect, EBSCO, Scopus, Cochrane Library et Sage Journals, pour la période de septembre 2010 à septembre 2020.

      Sélection des études

      Au total, quatre articles ont été sélectionnés pour analyse. Tous les articles s'appuient sur des méthodes de sondage et indiquent comment les professionnels de la santé utilisent les programmes ERAS en contexte de césarienne.

      Extraction des données et synthèse

      Les données ont été extraites au moyen de feuilles de calcul Excel. Les résultats obtenus sont présentés de façon descriptive.


      Cet examen montre qu'il existe de nombreux programmes ERAS que les professionnels de la santé n'ont pas encore mis en œuvre pour la césarienne. Les décideurs peuvent utiliser ces connaissances pour orienter la promotion des programmes ERAS en contexte de césarienne.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Obstetrics and Gynaecology Canada
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ituk U
        • Habib AS.
        Enhanced recovery after cesarean delivery.
        F1000Res. 2018; 7 (Faculty Rev-513. Published 2018 Apr 27): F1000
        • Laronche A
        • Popescu L
        • Benhamou D.
        An enhanced recovery programme after caesarean delivery increases maternal satisfaction and improves maternal-neonatal bonding: a case control study.
        Eur J Obstet Gynecol Reprod Biol. 2017; 210: 212-216
        • Peahl AF
        • Smith R
        • Johnson TR
        • et al.
        Better late than never: why obstetricians must implement enhanced recovery after cesarean.
        Am J Obstet Gynecol. 2019; 221 (117.e1–e7)
        • Coates E
        • Fuller G
        • Hind D
        • et al.
        Enhanced recovery pathway for elective caesarean section.
        Int J Obstet Anesth. 2016; 27: 94-95
        • Conn LG
        • McKenzie M
        • Pearsall EA
        • et al.
        Successful implementation of an enhanced recovery after surgery programme for elective colorectal surgery: a process evaluation of champions’ experiences.
        Implement Sci. 2015; 10: 1-11
        • Brown D
        • Xhaja A.
        Nursing perspectives on enhanced recovery after surgery.
        Surg Clin North Am. 2018; 98: 1-11
        • Lyon A
        • Solomon MJ
        • Harrison JD.
        A qualitative study assessing the barriers to implementation of enhanced recovery after surgery.
        World J Surg. 2014; 38: 1374-1380
        • Arksey H
        • O'Malley L
        Scoping studies: towards a methodological framework.
        Int J Soc Res Method. 2005; 8: 19-32
        • Moher D
        • Liberati A
        • Tetzlaff J
        • et al.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Plos Med. 2009; 7e1000097
        • Altman AD
        • Helpman L
        • McGee J
        • et al.
        Enhanced recovery after surgery: implementing a new standard of surgical care.
        CMAJ. 2019; 191: E469-E475
        • Jarraya A
        • Boujelbene M
        • Zghal J
        • et al.
        Early recovery after a cesarean delivery: survey of practice at some maternity hospitals in the region of sfax in tunisia.
        Pan African Med J. 2016; 23
        • Jacques V
        • Vial F
        • Lerintiu M
        • et al.
        Enhanced recovery following uncomplicated elective caesarean section in France: a survey of national practice.
        Ann Fr Anesth Reanim. 2013; 32: 142-148
        • Aluri S
        • Wrench IJ.
        Enhanced recovery from obstetric surgery: a U.K. survey of practice.
        Int J Obstet Anesth. 2014; 23: 157-160
        • Pujic B
        • Kendrisic M
        • Shotwell M
        • et al.
        A survey of enhanced recovery after surgery protocols for cesarean delivery in Serbia.
        Front Med. 2018; 5: 100
        • Kratzing C.
        Pre-operative nutrition and carbohydrate loading.
        Proc Nutr Soc. 2011; 70: 311-315
        • Herbert G
        • Sutton E
        • Burden S
        • et al.
        Healthcare professionals’ views of the enhanced recovery after surgery programme: a qualitative investigation.
        BMC Health Serv Res. 2017; 17: 1-14
        • Wilson RD
        • Caughey AB
        • Wood SL
        • et al.
        Guidelines for antenatal and preoperative care in cesarean delivery: enhanced recovery after surgery society recommendations (part 1).
        Am J Obstet Gynecol. 2018; 219 (523.e1–15)
        • Cawich SO
        • Mohammed F
        • Spence R
        • et al.
        Surgeons' attitudes toward mechanical bowel preparation in the 21st century: a survey of the Caribbean college of surgeons.
        Curr Med Res Pract. 2019; 9: 53-57
        • Echeverry-Marín PC
        • Rincón-Valenzuela DA
        • Monroy-Charry AG
        • et al.
        Survey about attitudes on perioperative temperature monitoring and thermal protection in colombia.
        Rev Colomb Anestesiol. 2016; 44: 282-291
        • Thorneloe B
        • Carvalho J
        • Downey K
        • et al.
        Uterotonic drug usage in canada: a snapshot of the practice in obstetric units of university-affiliated hospitals.
        Int J Obstet Anesth. 2019; 37: 45-51
        • Liabsuetrakul T
        • Chongsuvivatwong V
        • Lumbiganon P
        • et al.
        Obstetricians’ attitudes, subjective norms, perceived controls, and intentions on antibiotic prophylaxis in caesarean section.
        Sos Sci Med. 2003; 57: 1665-1674
        • Jiaming L
        • Mai JLJ.
        Ponv attitudes, knowledge and antiemetic prescibing practices amongst surgeons in a pediatric hospital.
        J Macro Trends Health Med. 2015; 3: 9-25
        • Dharmalingam T
        • Muniandy R.
        Doctors' knowledge and attitudes on pain assessment and management in Queen Elizabeth Hospital, Kota Kinabalu, Sabah.
        Med J Malaysia. 2020; 75: 68-73
        • Leffert L
        • Butwick A
        • Carvalho B
        • et al.
        The society for obstetric anesthesia and perinatology consensus statement on the anesthetic management of pregnant and postpartum women receiving thromboprophylaxis or higher dose anticoagulants.
        Anesth Analg. 2018; 126: 928-944
        • Elias KM.
        Understanding enhanced recovery after surgery guidelines: an introductory approach.
        J Laparoendosc Adv Surg Tech A. 2017; 27: 871-875
        • Kaur H
        • Kaur S
        • Sikka P.
        A quasi-experimental study to assess the effectiveness of early ambulation in post-operative recovery among post-caesarean mothers admitted in selected areas of Nehru Hospital, Pgimer, Chandigarh.
        Nurs Midwife Res. 2015; 11: 33
        • Teoh W
        • Shah M
        • Mah C.
        A randomised controlled trial on beneficial effects of early feeding post-caesarean delivery under regional anaesthesia.
        Singapore Med J. 2007; 48: 152
        • Mangesi L
        • Hofmeyr GJ.
        Early compared with delayed oral fluids and food after caesarean section.
        Cochrane Database Syst Rev. 2002; CD003516
        • Tran HT
        • Nippita T
        • Nguyen PTK
        • et al.
        Knowledge, experience and attitudes towards skin-to-skin contact following caesarean sections among health professionals in Vietnam.
        Acta Paediatr. 2018; 107: 1917-1923
        • Kahokehr A
        • Sammour T
        • Zargar-Shoshtari K
        • et al.
        Implementation of ERAS and how to overcome the barriers.
        Int J Surg. 2009; 7: 16-19