Abstract Enhanced Recovery After Cesarean (ERAC) protocols represent a significant advance in standardizing perioperative care to improve maternal outcomes. This narrative review synthesizes current evidence through a critical lens, arguing that the translation of ERAC principles into equitable, global practice is hindered by a predominant focus on high-resource contexts and a lack of integration with local cultural paradigms of postpartum recovery. We conducted a targeted literature search to identify major international ERAC guidelines and patient-reported outcome measures (PROMs). We then propose and apply an analytical "Framework for Contextualized ERAC Implementation" to evaluate this literature. Our analysis reveals that while guidelines from societies like Enhanced Recovery After Surgery (ERAS), Society for Obstetric Anesthesia and Perinatology (SOAP), and National Institute for Health and Care Excellence (NICE) provide robust evidence-based recommendations, their development processes and implicit assumptions often limit direct applicability worldwide. Similarly, PROMs like Obstetric Quality of Recovery (ObsQoR) and Stanford Obstetric Recovery Checklist (STORK), though validated, may not capture recovery domains prioritized in diverse cultural settings, such as those influenced by traditions like zuo yuezi (a traditional period of postpartum confinement and rest in Chinese culture). Successful implementation depends on moving beyond direct translation of protocols to active adaptation across two spectra: resource stratification (from low to high) and cultural integration (from translation to adaptation). Future efforts must prioritize the co-design of tiered, resource-sensitive protocols and the development of culturally competent metrics to ensure ERAC fulfills its promise of optimized, patient-centered recovery for all postpartum individuals.
Du et al. (Thu,) studied this question.