Healthcare Providers' Experiences With and Perspective on Delivering the Enhanced Recovery After Elective Caesarean Birth Pathway With Next-Day Discharge: Qualitative Analysis

Aims: To understand the perspectives and experiences of healthcare providers who have experience working with an enhanced recovery care after elective caesarean birth pathway with next-day discharge and home midwifery.

Design: This study applies a qualitative study design with a pragmatic realist approach. The realist framework was used while also taking a post-positivist philosophy.

Methods: The work was conducted in South Australia, Australia between May and October 2019. Twenty-three semi-structured interviews were completed with 5 doctors and 18 midwives who had occupational experience working with the pathway. Interviews were analysed using following the six-phase qualitative thematic analysis process outlined by Braun and Clarke. COREQ guidelines were followed.

Results: Four main themes and 11 sub-themes were identified. Main themes identified were as follows: The pathway is more than just early discharge; experiences with the process; staff engagement with the pathway; and the impact of the pathway within the health system.

Conclusion: Healthcare providers generally accepted the pathway and found enhanced recovery care to be a positive and beneficial model of care. Staff identified five main challenges with implementing the pathway: early discharge; eligible women's automatic inclusion on the pathway; engaging women; change for staff and organisational constraints and procedures. Elements that support integration include the following: education for women; reassurance and communication with women and families; prepared care and supports including home midwifery; staff education and communication of the evidence; clear guidelines and protocols; defined staff roles; enough clinical time and clinical flexibility.

Impact: Knowledge from staff in this study would be useful for other health services to consider when looking to deliver similar models of care.

Patient or public contribution: The health service and health providers were involved with the initiation and development of the research aims and design.