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depression. In the absence of contra-indications, women should be prescribed regular oral analgesia
postoperatively. Pain scores on movement and sedation scores should be kept for all women
postoperatively, and additional analgesia should be offered without delay when required.
Recovery care
Local guidelines (based on relevant national standards) for standards of care in recovery should be
regularly updated, audited and monitored.
The following are recommendations of the AAGBI [16]:
• No fewer than two members of staff (of whom at least one must be a registered practitioner)
should be present when there is a patient in recovery who does not fulfil the criteria for discharge
to the ward
• All registered practitioners should be appropriately trained in accordance with the standards and
competencies detailed in the UK National Core Competencies for Post-anaesthesia Care [31].
All women leaving obstetric recovery areas should continue to receive appropriate post-operative
care. Staff caring for post-operative patients on post-natal wards must be trained to do so, and should
carry out post-surgical care as set out in local guidelines.
There should be a ratio of two recovery beds to one operating theatre [31]. It should be noted that
more space is required per bed area for obstetric theatre recovery, compared with general postoperative
recovery areas. This is because there is a need to accommodate birth partners, cots etc as
well as the patient in the same area.
To ensure privacy and dignity are maintained and that infection risk is reduced there should be
adequate space between beds, and the facility to have private conversations with mothers and to
conduct physical examinations (for example to check vaginal blood loss) [29].
Postnatal care
Following operative delivery, women need continuing care [29]. Any woman who has received
neuraxial opioids should have respiratory rate, pain and sedation scores monitored for a period
appropriate to the clinical situation.
Women who have received anaesthetic care (whether analgesia for labour or anaesthesia) should be
followed up routinely to obtain feedback and exclude complications. With early discharge following
delivery, it may be logistically impossible to achieve this, and significant complications may not
become manifest until after women have been discharged. Therefore, all women who have received
regional analgesia or anaesthesia should receive written information about when and how to seek
help if complications should arise; this is particularly important for women who are discharged within
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