3. Cesarean birth, also known as a C-section, is a surgical delivery method
where the baby is delivered through an incision made in the mother’s
abdomen and uterus. This procedure is performed when vaginal delivery is
unsafe or not feasible for the mother or the baby, either due to specific
medical conditions or during labor complications. Cesarean birth can be
planned in advance or performed as an emergency intervention, and it has
become a common and important aspect of modern maternity care.
2 types of CS : Classical and Lower Segment
3
4. Cesarean Section Types
1.Traditional Cesarean section
The classic Cesarean section (C-section) involves a long, vertical incision being
made in the midline of the abdomen. Once the skin is incised, the uterus is also
incised vertically, and the baby is delivered. Due to the size of the incision, this
type of C-section allows a large amount of space for delivering the baby. However,
the procedure is associated with post-surgical complications and is not commonly
used today. The long incision weakens the abdominal muscles and increases the
risk of hernia for years after surgery. Furthermore, once this type of C-section is
performed, a vaginal birth is not safe for the delivery of future pregnancies.
4
5. 2. The lower uterine segment Cesarean section (LUCS)
For this type of C-section, an incision is made just above the pubic hairline just
above the bladder. This is a horizontal incision that cuts through the underlying
uterus as well as the skin. The baby is delivered by inserting a hand into the
uterus and pulling the baby out. This is one of the most common methods of C-
section delivery used today. After the surgery, the risk of bleeding and other
complications such as hernia are minimal, and the surgical wound repairs more
easily than the wound that is left after a traditional C-section. Furthermore, a
woman may still choose a vaginal delivery for any future births. A C-section that
is performed due to complications such as non-progress of labor or severe pre-
eclampsia, is an emergency C-section which is usually performed as a LUSCS
procedure.
5
6. ◈ Cesarean hysterectomy
A Cesarean hysterectomy involves removing the uterus during the same
procedure as the C-section delivery. This may be needed in cases of severe post-
delivery bleeding from the placenta or when the placenta cannot be separated
from the uterus walls.
Indications
◈ A planned or ‘elective’ Caesarean section is performed for a variety of
indications. The following are the most common, but this is not an
exhaustive list:
• Breech presentation (at term) – planned Caesarean sections for breech
presentation at term have increased significantly since the ‘Term Breech
Trial’ [Lancet, 2000].
• Other malpresentations – e.g. unstable lie (a presentation that fluctuates
from oblique, cephalic, transverse etc.), transverse lie or oblique lie. 6
7. • Twin pregnancy – when the first twin is not a cephalic presentation.
• Maternal medical conditions (e.g. cardiomyopathy) – where labour would
be dangerous for the mother.
• Fetal compromise (such as early onset growth restriction and/or
abnormal fetal Dopplers) – where it is thought the fetus would not cope
with labour.
• Transmissible disease (e.g. poorly controlled HIV).
• Primary genital herpes (herpes simplex virus) in the third trimester – as
there has been no time for the development and transmission of
maternal antibodies to HSV to cross the placenta and protect the baby.
• Placenta praevia – ‘Low-lying placenta’ where the placenta covers, or
reaches the internal os of the cervix.
• Maternal diabetes with a baby estimated to have a fetal weight >4.5 kg.
• Previous major shoulder dystocia.
• Previous 3rd/4th degree perineal tear where the patient is symptomatic –
after discussion with the patient and appropriate assessment. 7
8. • Maternal request – this covers a variety of reasons from previous traumatic
birth to ‘maternal choice’. This decision is after a multidisciplinary approach
including counselling by a specialist midwife.
◈ Elective Caesarean sections are usually planned after 39 weeks of pregnancy
to reduce respiratory distress in the neonate – known as Transient
Tachypnoea of the Newborn (TTN).
8
11. POST-PARTUM CARE
The postpartum care period of a woman who has undergone emergent
cesarean birth is divided into two: an immediate recovery period and
an extended postpartum period.
After surgery, the woman would be transferred by stretcher to the
post-anesthesia care unit.
If spinal anesthesia was used, the woman’s legs are fully anesthetized
so she cannot move them.
Routine postoperative evaluation
Vital signs, urine production, and vaginal bleeding are all monitored.
Palpation of fundus postpartum
If necessary, administer IV fluids; after that, progress to an oral diet
as suitable; early feeding has been demonstrated to reduce
hospitalization.
11
12. 12
• Allow the patient to rate her pain using a pain rating scale. Some women may
require patient-controlled analgesics or continual epidural injections to ease
discomfort. On the other hand, supplemental analgesics with comfort measures
include changing positions or arranging bed linen.
•During the extended postpartum period, the woman most commonly experiences
gastrointestinal function interference,Instruct the woman to ambulate because this
is the most effective method to relieve gas pain and to prevent complications such
as pneumonia or thrombophlebitis.
•Inform the woman that she should not take acetylsalicylic acid or aspirin because
this can interfere with blood clotting and healing.
•Instruct the woman to place a pillow on her lap as she feeds the infant to deflect
the weight of the infant from the suture line and lessen the pain.
•Football hold for breastfeeding is a way to keep the infant’s weight off the mother’s
incision.
13. 13
Unless the patient has Long-Acting Reversible Contraception (LARC) inserted
at the time of the procedure, discuss contraception along with abstaining
from intercourse for 4-six weeks after cesarean birth.
Example of LARC :
Teach the woman to eat a diet high in roughage and fluid and to attempt to
move her bowels at least every other day to avoid constipation.
Incisional pain may interfere with the woman’s ability to use her abdominal
muscles effectively, so the physician may prescribe a stool softener.
Caution the woman not to strain to pass stools because this puts pressure on
their incision.
Advise the woman to keep their water pitcher full as a reminder for her to
drink fluids.
Reassure the woman that it is normal not to have bowel movements for 3 to 4
days postoperatively, especially if there is enema administered before surgery.
14. 14
• Take special note of the patient’s first bowel movement following surgery,
since if no bowel movement is noticed, the doctor may prescribe a stool
softener, suppository, or enema to aid with stool discharge.
•If the patient has recovered well after surgery, she can be securely
discharged 2 to 4 days later. The doctor will eliminate any staples used to
approximate the skin prior to discharge. Moreover, if the patient has had a
vertical skin incision or is at risk of poor healing due to diabetes or long-term
steroid usage, the doctor may leave the staples in for an additional 2 to 3 days
and have the patient come to the clinic at that time.
15. NURSING CARE PLANS POST-OP
15
Nursing Diagnosis: Deficient Knowledge related to inadequate exposure,
unawareness of the illness and information resources, and information
misunderstanding secondary to C-section or cesarean birth as evidenced by
confusion about narrative, improper behaviors, and insufficient
comprehension of guidelines.
Desired Outcome: The client will articulate her awareness of the reasons for
cesarean birth and postoperative expectations and will identify this as an
alternate childbirth procedure in order to obtain the greatest possible
outcome in the end.
NURSING INTERVENTION
Discuss and create a postoperative pain
management strategy, and go over how
to utilize the pain scale.
RATIONALE
Creating a pain management strategy with the
patient increases the probability of pain
control effectiveness. Some patients may
believe that a cesarean birth will be less
painful than a vaginal birth, or they may be
afraid of becoming dependent on opioids.
16. 16
Risk for Ineffective Self-Health Management
Nursing Diagnosis: Risk for Ineffective Self Health Management related to
inadequate individual coping secondary to the post-C-section procedure, a
complicated therapeutic regimen, and conflicts with spiritual principles or cultural
influences.
Desired Outcome: The patient will determine objectives for optimal health
management related to post-C-section. She will exhibit positive behaviors to adopt
a therapy regimen into daily life and express understanding of the treatment
protocol.
C Section Nursing Interventions Rationale
Give positive reinforcement for the
patient’s efforts.
Positive reinforcement fosters the
persistence of desired behavior.
Maintain an optimistic attitude toward
the patient’s talents and possibility for
progress by emphasizing positive
attributes of the circumstance.
Helping the patient embrace herself
and her distinct qualities will foster
growth and improve her self-care
skills.
17. 17
2.Acute Pain
Nursing Diagnosis: Acute Pain related to intensified muscle contractions,
psychological responses, surgical injury, and distention of the bladder or abdomen
related to C-section or cesarean birth as evidenced by reports of discomfort,
protective or distracting behaviors, nervousness, sobbing, yelling, agitation,
arrhythmia, and tachypnea.
Desired Outcome: The patient will verbally express diminished discomfort or pain,
seem tranquil, be able to rest or sleep, and interact adequately.
C Section Nursing Interventions Rationale
Every time a patient complains of pain,
conduct a pain assessment.
Developments from earlier reports should
be noted, compared, and investigated to
determine labor progress or rule out any
worsening of the patient’s case or the
severity of the condition. Always use a
rating scale to assess the client’s pain and
identify its attributes (frequency, duration,
severity, intervals).
Observe the patient’s vital signs regularly.
Keep an eye out for arrhythmia, high blood
pressure, and accelerated respiration.
Alteration in these vital signs is frequently
associated with severe pain and distress.
18. 18
Encourage proper rest periods following
cesarean delivery.
Following a C-section is spent recovering from
surgery and adjusting to parenthood. Before
taking on the mother’s new position, the patient
must rest well to avoid weariness and recover
properly. Mothers may appreciate early
discharge because it allows the family, including
older siblings, to spend time together at home. It
also provides the woman with enough moral and
social assistance.
Motivate the patient to articulate her suffering feelings
verbally.
Allow the patient to express her pain perceptions and
acknowledge her suffering experienced in a cesarean
birth. Others cannot feel pain since it is a subjective
sensation. Demonstrate acceptance of the patient’s pain
response.
Instruct and promote effective relaxation techniques.
Utilize alternative therapies as needed. Deep breathing
techniques, music education, massages, and other
relaxation treatments can help ease anxiety and stress,
increase comfort, and boost a sense of well-being.
Excessive anxiety and worry enhance catecholamine
production, such as adrenaline, intensify painkiller
impulses, stimulate pain perception in the cerebral cortex,
and diminish pain threshold.
Results of laboratory tests on pleural fluid alone do not establish a diagnosis
Exudative effusions indicate a local etiology (e.g., pulmonary embolus, infection),
Transudative effusions usually are associated with systemic etiologies (e.g., heart failure).
