{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:26:27Z","timestamp":1792686387403,"version":"4.5.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis evaluated whether multimodal intervention bundles improve recovery after cesarean section compared with routine care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA 2020, we searched PubMed, Embase, Scopus, Web of Science, and major Chinese databases (CNKI, Wanfang, VIP) from inception to July 2025 without language restrictions. Eligible randomized controlled trials enrolled postpartum women undergoing cesarean section and implemented bundles comprising \u22652 distinct domains (e.g., opioid-sparing analgesia, early mobilization, early oral intake\/nutrition or breastfeeding support, structured nursing, psychological education). The primary endpoint was pain intensity at 24\u202fh (VAS); secondary endpoints included pain at other time points, analgesic consumption, time to first ambulation and first flatus, adverse events, length of stay, breastfeeding initiation\/time, and maternal psychological recovery. Relative risks were pooled for dichotomous outcomes and mean (or standardized mean) differences for continuous outcomes, using random effects when heterogeneity was substantial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twelve RCTs (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f1,497), all conducted in China, met inclusion. Multimodal care reduced 24\u202fh pain versus routine care (MD\u202f\u2212\u202f0.96 on a 0\u201310 VAS; 95% CI\u202f\u2212\u202f1.28 to \u22120.64; I\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f97%), shortened time to first ambulation (MD\u202f\u2212\u202f4.58\u202fh; 95% CI\u202f\u2212\u202f6.32 to \u22122.84; I\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f95%) and to first flatus (MD\u202f\u2212\u202f2.28\u202fh; 95% CI\u202f\u2212\u202f2.57 to \u22121.98; I\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f97%), and lowered overall adverse events (RR 0.28; 95% CI 0.19\u20130.41; I\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f0%). No significant difference was observed for time to first breastfeeding (MD 1.39\u202fh; 95% CI\u202f\u2212\u202f3.86 to 6.64; I\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f99%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.60). Risk of bias was generally moderate to high owing to limited blinding; Egger\u2019s test for the primary outcome did not suggest publication bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Collectively, the current evidence suggests that multimodal, ERAS-oriented care pathways may facilitate safer and more rapid early recovery following cesarean section, particularly by enhancing analgesic efficacy, mobilization, and gastrointestinal function. Nevertheless, the marked heterogeneity in bundle composition, implementation intensity, and outcome definitions, together with the single-country evidence base and moderate risk of bias, substantially limits the certainty and generalizability of these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1690139","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T06:45:22Z","timestamp":1765953922000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["A meta-analysis of the effects of multimodal intervention measures on the recovery of postpartum women after cesarean section"],"prefix":"10.3389","volume":"12","author":[{"given":"Zhi-Min","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia-Qi","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gui-Xian","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-Jing","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"41","DOI":"10.3831\/KPI.2021.24.2.41","article-title":"Effect of complementary medicine on pain relief and wound healing after cesarean section: a systematic review","volume":"24","author":"Niazi","year":"2021","journal-title":"J Pharmacopuncture"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1186\/s12884-025-07363-z","article-title":"Prevalence and associated factors of intraoperative nausea and vomiting of mothers who gave birth with cesarean section under regional anesthesia: a systematic review and meta-analysis; 2023","volume":"25","author":"Demilew","year":"2025","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"397","DOI":"10.3390\/life14030397","article-title":"Humanizing birth in a third-level hospital: revealing the benefits of natural cesarean sections","volume":"14","author":"Recacha-Ponce","year":"2024","journal-title":"Life (Basel)"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1302\/2633-1462.61.BJO-2024-0076.R1","article-title":"Is the rate of early mobilization in hip fracture patients using Alfentanil better than standard opioid analgesia (REHAB)? A protocol for a prospective cohort study","volume":"6","author":"Agarwal","year":"2025","journal-title":"Bone Jt Open"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"103117","DOI":"10.1016\/j.midw.2021.103117","article-title":"Breastfeeding after a cesarean section: a literature review","volume":"103","author":"Li","year":"2021","journal-title":"Midwifery"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1016\/j.ejso.2020.10.030","article-title":"Enhanced recovery after surgery (ERAS) in gynecology oncology","volume":"47","author":"Bogani","year":"2021","journal-title":"Eur J Surg Oncol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.ygyno.2023.04.009","article-title":"Enhanced recovery after surgery (ERAS\u00ae) society guidelines for gynecologic oncology: addressing implementation challenges - 2023 update","volume":"173","author":"Nelson","year":"2023","journal-title":"Gynecol Oncol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"212","DOI":"10.3969\/j.issn.1008-9993.2018.20.011","article-title":"The effect of multimodal preventive analgesic care on early uterine contraction pain after cesarean section","volume":"52","author":"Kuang","year":"2023","journal-title":"Heilongjiang Tradit Chin Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"54","DOI":"10.3969\/j.issn.1008-9993.2018.20.011","article-title":"Effect of multi-mode preventive analgesia on the early contractive pain of postoperative nursing","volume":"35","author":"Lu","year":"2018","journal-title":"Nurs J Chin PLA"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"84","DOI":"10.19791\/j.cnki.1006-6411.2022.16.024","article-title":"The application of multimodal preventive analgesia combined with emotional intervention in early uterine contractions among parturients undergoing cesarean section after surgery","volume":"29","author":"Lu","year":"2022","journal-title":"Mod Nurs"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e49448","DOI":"10.7759\/cureus.49448","article-title":"Enhanced recovery after surgery (ERAS) in Saudi Arabian surgical practice: a comprehensive analysis of surgical outcomes, patient satisfaction, and cost-effectiveness","volume":"15","author":"Aleid","year":"2023","journal-title":"Cureus"},{"key":"ref12","first-page":"156","article-title":"Effect of multimodal analgesia nursing intervention on postoperative rehabilitation of puerpera with second cesarean section","volume":"57","author":"Sun","year":"2019","journal-title":"China Mod Doctor"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"3014","DOI":"10.3969\/j.issn.1004-0412.2023.10.104","article-title":"The effect of multimodal preventive analgesic care on VAS, NRS and stress indicators of postpartum women after cesarean section","volume":"44","author":"Wang","year":"2023","journal-title":"Jilin Yi Yao"},{"key":"ref14","first-page":"161","article-title":"Evaluation of the effect of multimodal pain management intervention on reducing postoperative pain in parturients undergoing cesarean section","volume":"19","author":"Wang","year":"2021","journal-title":"Med Diet Ther Health"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"157","DOI":"10.11997\/nitcwm.202410048","article-title":"The influence of multimodal analgesia management on the analgesic effect and psychological state of parturients undergoing cesarean section","volume":"10","author":"Yang","year":"2024","journal-title":"J Clin Nurs Pract"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"18","DOI":"10.3969\/j.issn.1674-9316.2023.17.005","article-title":"Effect of multimode comprehensive insulation intervention on cesarean section patients","volume":"14","author":"Yang","year":"2023","journal-title":"China Health Stand Manag"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"58","DOI":"10.19335\/j.cnki.2096-1219.2022.11.018","article-title":"Effect of multimodal preventive analgesia on the degree of acute contractile pain in pregnant women after cesarean section","volume":"8","author":"Ye","year":"2022","journal-title":"Smart Healthc"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"3","DOI":"10.19829\/j.zgfybj.issn.1001-4411.2021.20.019","article-title":"The impact of multimodal comprehensive thermal protection intervention on the prevention of hypothermia and shivering in cesarean section patients and their postpartum recovery","volume":"36","author":"Zheng","year":"2021","journal-title":"Matern Child Health Care China"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"309","DOI":"10.19381\/j.issn.1001-7585.2024.02.049","article-title":"Postpartum body position management and multi-modal hierarchical psychological intervention on the postoperative outcomes of women undergoing a second cesarean section","volume":"37","author":"Zhu","year":"2024","journal-title":"J Med Theor Pract"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"710","DOI":"10.3969\/j.issn.1004-8189.2025.03.040","article-title":"Nursing effect of the multi-mode intervention based on fast-track surgery concept for pregnant women with hypertensive disorders of pregnancy after cesarean section","volume":"33","author":"Zhu","year":"2025","journal-title":"Chin J Fam Plann"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"E832","DOI":"10.9778\/cmajo.20200003","article-title":"Effectiveness of ambulation to prevent venous thromboembolism in patients admitted to hospital: a systematic review","volume":"8","author":"Lau","year":"2020","journal-title":"CMAJ Open"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1577094","DOI":"10.3389\/fped.2025.1577094","article-title":"The impact of mother-infant rooming-in and continuous skin-to-skin contact on newborns","volume":"13","author":"Chu","year":"2025","journal-title":"Front Pediatr"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1016\/j.jopan.2022.12.006","article-title":"Sustainability of an operating room to pediatric Postanesthesia care unit handoff tool","volume":"38","author":"Green","year":"2023","journal-title":"J Perianesth Nurs"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.1038\/s41372-024-02129-5","article-title":"Variation in NICU utilization: a narrative review and path forward","volume":"45","author":"Paul","year":"2024","journal-title":"J Perinatol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1690139\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T06:45:31Z","timestamp":1765953931000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1690139\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,17]]},"references-count":24,"alternative-id":["10.3389\/fmed.2025.1690139"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1690139","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,17]]},"article-number":"1690139"}}