Surgical Interventions at Birth.pdf

Nursing Care of a Family
During a Surgical Intervention for
Birth

Copyright © 2018 Wolters Kluwer · All Rights Reserved
Common Indications for Surgical
Interventions for Birth
Amniotomy: artificial rupture of membranes during
labor
Indications:
o Insertion of internal electronic fetal monitoring
o Obtaining fetal blood samples
o Ascertaining evidence of meconium staining

Episiotomy: surgical incision of perineum
Indications:
o Prevention of perineal tearing
o Lessening of pressure on fetal head during birth
o Potentially shortening the last portion of second stage of
labor

Internal electric monitoring: passage of a pressure-
sensitive catheter into the uterine cavity between
uterine wall and fetus and a placement of an
electrode on fetal scalp
Indications:
o When more accurate readings of uterine contractions and
fetal heart rate are needed than external monitoring can
provide

Cesarean birth: birth accomplished through
abdominal incision into uterus
Indications:
o Cephalopelvic disproportion
o Breech presentation
o Multiple gestation
o Failure of labor progression

2020 National Health Goals Related to a
Family Experiencing a Surgical Intervention
for Birth
Reduce the rate of cesarean births among low-risk
(full-term, singleton, vertex presentation) women
having their first child to 23.9% of live births from
a baseline of 26.5%.
Reduce the rate of cesarean births among women
who have had a prior cesarean birth to 81.7% of
live births from a baseline of 90.8%.

Assessment of a Family Experiencing a
Surgical Intervention for Birth
Preintervention assessment
o Psychological
 Is woman and family emotionally prepared for
procedure?
 Does woman and family know what to expect related to
the procedure?
o Physical
 Present fetal status, presentation, and maturity
 Maternal circulatory and renal function
 For amniotomy: station and presentation of fetus

Intraoperative assessment
o Amniotomy
 Unexpected decrease in fetal rate
 Presence of meconium staining of amniotic
fluid
 Presence of umbilical cord in vaginal canal

Intraoperative assessment
o Cesarean delivery
 Maternal monitoring as per any surgical procedure
 Fetal heart monitoring
 Neonatal assessment and Apgar scoring (immediate
postdelivery)

Postintervention assessment
o Episiotomy: Assess for signs of hemorrhage and extension
of incision line and assess suture line for infection.
o Amniotomy: Monitor temperature and check subsequent
amniotic fluid discharge for signs/symptoms of infection
(in membrane rupture followed by prolonged labor).
o Internal FHR monitoring/fetal blood sampling: Check
incision on infant’s head for signs/symptoms of infection.

Postintervention assessment: cesarean birth
o Maternal assessment
 Assess incision for signs of bleeding, dehiscence, and infection
 Pain
 Uterine atony and hemorrhage
 Peritonitis
 Urinary output, bladder function, and hydration
 Bowel function
 Thrombophlebitis
 Bonding with infant and breastfeeding

Postintervention assessment: cesarean birth—
(cont.)
o Newborn assessment
 Oxygenation and circulation
 Temperature
 Apgar scoring
 Scalp incision (if internal monitoring is used)
 Watch for transient tachypnea

Examples of Nursing Diagnoses for a Family
Experiencing a Surgical Intervention for Birth
Fear related to impending surgical procedure
Pain related to surgical incision
Deficient fluid volume related to procedural blood
loss
Risk for infection related to surgical procedure
Risk for hemorrhage related to surgical procedure
Risk for impaired parent–infant bonding related to
unplanned surgical procedure

Examples of Nursing Diagnoses and Related
Outcomes in a Family Experiencing a Surgical
Intervention for Birth
Nursing Diagnosis Outcome
Pain related to surgical incision Pain will be managed to woman’s
satisfaction.
Diminished urine output related to
deficient fluid volume
Urine output will be appropriate;
bladder will not be distended.
Risk for hemorrhage related to
surgical procedure
Blood loss will be within expected
limits.
Risk for infection related to surgical
procedure
Maternal and newborn infant
infection will be avoided.

Interventions for a Family Experiencing a
Surgical Intervention for Birth: Cesarean
Birth
Nursing Diagnosis Possible Nursing Interventions
Fear related to impending surgical
procedure
Allow woman and support person
to discuss fears, explain that this is
a normal reaction, and answer
questions.
Knowledge deficit related to
cesarean birth procedure
Acquaint woman and support
person with procedure and
equipment. Include what might be
felt, heard, and seen.
Diminished urine output related to
deficient fluid volume
Monitor urine output; check for
bladder distension.

Birth
Nursing Diagnosis Possible Nursing Interventions
Risk for hemorrhage related to
surgical procedure
Blood pressure, pulse rate, fundus
check, and pad count at
appropriate intervals.
Risk for pain related to surgical
incision
Educate woman related to her
mode of patient-controlled
analgesia; monitor equipment
function and medication cartridges.
Risk for thromboembolism related
to abdominal surgery and venous
stasis
While in bed, have woman change
position frequently; encourage
early and frequent ambulation; and
correct placement of TED
stockings.

Birth

Evaluating Outcomes in a Family
Experiencing a Surgical Intervention for Birth
Outcome Outcome Evaluation
Pain will be managed to woman’s
satisfaction.
Woman will express that pain is
tolerable (use of a pain scale
according to institutional policy).
Urine output will be appropriate;
bladder will not be distended.
Urine output is within normal limits
compared to intake; bladder is not
distended.
Blood loss will be within expected
limits. ?
Maternal and newborn infant
infection will be avoided. ?

Question #1
Internal uterine and fetal monitoring are needed in an
obese laboring woman. What assessment immediately
after an amniotomy would be your primary concern?
A. Checking for meconium-stained amniotic fluid
B. Checking maternal blood pressure
C. Recording the amount of amniotic fluid released
D. Immediate monitoring of fetal heart rate

Answer #1
D. Immediate monitoring of fetal heart rate
Rationale: Although meconium staining is a possible sign of
past fetal distress, amniotomy always places the fetus at
immediate risk for a prolapsed cord, and a decreased FHR is
a sign that this may have occurred.

Question #2
Pain control is an important outcome for a woman
after a cesarean delivery because it impacts attaining
every other outcome except
A.Adequate production of breast milk
B.Prevention of pneumonia and thrombophlebitis
C.Maintenance of bowel function
D.Continuation of maternal–infant bonding process

Answer #2
A. Adequate production of breast milk
Rationale: Pain can prevent postoperative women from
turning in bed and in early ambulation, which assists in
prevention of pneumonia and thrombophlebitis and in
maintaining bowel function. Pain can also interrupt the
maternal–infant bonding process. There is little evidence
that pain affects production of breast milk.

Question #3
Which of the following is the primary reason that the
cesarean birth rate is so high in the United States?
A.Premature labor
B.Fetal malpresentation
C.History of previous cesarean delivery
D.Labor dystocia

Answer #4
C. History of previous cesarean delivery
Rationale: Neither labor dystocia nor fetal malpresentation is
the most prevalent reason for performing a cesarean
delivery. History of a prior cesarean birth is the most
common reason for performing a subsequent cesarean
delivery.

Surgical Interventions at Birth.pdf

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Surgical Interventions at Birth.pdf