Early Ambulation Post-Lower Segment Caesarean Section Improves Women's Outcomes

Abstract

Background: Early ambulation is considered as one of the post-operative interventions in Enhanced Recovery After Surgery protocol and women could be ambulated anytime from 6-8 hours post-surgery.1 Early ambulation benefits patients by reducing the risk of deep vein thrombosis, improving breastfeeding rate, promoting better diet and nutrition, and improving their satisfaction.2 A retrospective baseline data collection from December 2019 to February 2020 showed that only 6-7% of women were ambulated within 24 hours of surgery in the Obstetrics and Gynecology inpatient unit of Al Khor Hospital. Methods: A Quality Improvement (QI) project was conducted to deliver early ambulation in post-cesarean women using QI methodology from the 1st of March, 2020 to the 31st of July, 2021 with the aim to ambulate 100% of the women who underwent Lower Segment Caesarean Section (LSCS) within 12 hours of surgery. Patients received pre-and post-operative patient education, were reassessed by a physician within 6 hours post-surgery, and started oral intake. Women were assisted for post-surgery ambulation as required. They were offered multimodal analgesia to minimize the use of opioids and to enable them to mobilize without falling. Results: Results have suggested that 96% of women were ambulated within 12 hours of surgery at the end of the improvement cycle 1 and 100% of the women were ambulated by the 31st of December, 2020 (Figure 1). Using opioids for pain relief during this period was reduced (Figure 2). Early oral intake increased from 17% to 92% and breastfeeding rate within 24 hours post-surgery increased from 25% to 85% by December, 2020. No fall incidences during ambulation were reported. The QI project is still under monitoring for evaluation of its sustainability. Conclusion: Early ambulation enables new mothers to mobilize within 12 hours of surgery and helps reduce the use of opioid drugs for pain, and increases compliance to breastfeeding and early oral intake.