Midwifery 83 (2020) 102632 Contents lists available at ScienceDirect Midwifery journal homepage: www.elsevier.com/locate/midw Women’s experiences with enhanced recovery after elective caesarean section with next day discharge: A qualitative study Lynette Cusack a,b,* , Christianna Digenis b , Tim Schultz b , Bronwen Klaer a , Meredith Hobbs a a Northern Adelaide Local Health Network, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, 5112 South Australia, Australia b The University of Adelaide, North Terrace, Adelaide 5005, South Australia, Australia a r t i c l e i n f o Article history: Received 30 August 2019 Revised 14 January 2020 Accepted 15 January 2020 Keywords: Women Qualitative study Elective caesarean section Early discharge Enhanced recovery a b s t r a c t Background: A maternity service in Australia recently implemented an ‘Enhanced recovery after Elective Caesarean’ pathway, which includes antenatal preparation and facilitates an active role in postnatal recov- ery such as encouraging mobility and early cessation of fasting. The pathway includes next day discharge for women and their babies after elective caesarean section and safely transitions maternity care from hospital to home with community midwifery care. While enhanced recovery has been implemented in a number of surgical procedures to reduce hospital stay and to improve patient outcomes it has only been considered for elective caesarean sections in more recent years. Given this, enhanced recovery is not well established or researched in obstetric contexts. Furthermore, women’s experiences with reduced hospi- tal stays post-caesarean, particularly next day discharge, is limited. A qualitative explorative descriptive study of women’s experiences with the pathway and the associated early transition home will help to inform clinical practice and the research evidence base. Methods: Eleven interviews were conducted with women who had experienced the pathway and next day discharge. Thematic analysis was conducted. Findings: Three major themes and twelve sub-themes emerged from the data. Major themes identified were women’s general experience of an enhanced recovery pathway, their experiences following arrival at home and support at home. All women interviewed were satisfied with the pathway and home recovery. However, there are a number of aspects of care that are essential to a positive experience. This includes excellent support from social networks, healthcare staff and home midwifery care; well managed pain relief; and adequate and timely information, including reassurance that they or their baby could remain in hospital if required. Conclusion: This study takes a woman-centred perspective adding to both literature and practice. © 2020 Elsevier Ltd. All rights reserved. Introduction The Australian Institute of Health and Welfare (AIHW) indi- cates that 35% of women gave birth by caesarean section in 2017 (AIHW, 2019). The rate of caesarean birth has increased by 4% over the last 10 years (AIHW, 2019). With an increasing caesarean sec- tion rate, in 2015 a maternity service within South Australia intro- duced a practice development initiative called ‘Enhanced recovery after Elective Caesarean (EREC)’. EREC is a criterion led discharge * Correspondence to: The University of Adelaide, Faculty of Health and Medical Sciences. E-mail addresses: Lynette.cusack@adelaide.edu.au (L. Cusack), Christianna.digenis@adelaied.edu.au (C. Digenis), Tim.schultz@adelaide.edu.au (T. Schultz), Bronwen.Klaer@sa.gov.au (B. Klaer), Meredith.Hobbs@sa.gov.au (M. Hobbs). pathway that includes next day discharge between 24–36 h, for women and their babies after elective caesarean section (ECS), and safely transitions maternity care from hospital to home. This path- way includes antenatal preparation and improved postnatal care such as encouraging mobility and early cessation of fasting. To be eligible for this pathway, women must meet all of the follow- ing criteria: multiparous, living within the community midwifery catchment area, no major comorbidities, singleton foetus and social supports available in the community. Women on the pathway re- ceive additional support at home from a visiting midwifery service and the option for the mothercarer service. Most women did not choose to make use of the Mothercarer Service. Mothercarers are employed by the health service to assist women postnatally with emotional and practical support in the home such as household duties, transport, care of children, and referral to ongoing services. They can offer up to 4 days of care for 5–6 h. https://doi.org/10.1016/j.midw.2020.102632 0266-6138/© 2020 Elsevier Ltd. All rights reserved.