CESAREAN BIRTH

also termed as cesarean section

s the delivery of a neonate by surgical incision
through the abdomen and uterus.
This method can be done as elective surgery or as
an emergency procedure when conditions
impede a vaginal or normal delivery. 
 A nursing assessment of a pregnant
woman about to undergo cesarean birth
is also important to obtain health history
that would become essential later on.

PREOPERATIVE •Assess the woman about past surgeries,

ASSESSMENT
secondary illnesses, allergies to foods or
drugs, reaction to anesthesia, and
medications that could increase any
surgical risk.
•The woman should be in the best
possible physical and psychological state
before undergoing any surgery.
•An obese woman with poor nutritional
status is at risk for a slow wound healing.
• Tissue that contains extra fatty cells would be difficult
to suture and the incision will heal much slower and
predispose the woman to infection and dehiscence.
• An obese woman would also have difficulty in initiating
ambulation and turning after surgery as it will increase
the risk for pneumonia or thrombophlebitis.
• A woman with protein or vitamin deficiency is also at
risk for poorer healing because these are needed for
new cell formation at the incision site.
• Age can also affect surgical risk because it can cause
decreased circulatory and renal function.
• A woman who has secondary illness is also at greater
surgical risk depending on the extent of the disease
because the secondary illness may affect the woman’s
ability to adapt to the demands of the surgery.
• the general medication history of the woman must also be assessed because there are
drugs that could increase the surgical risk by interfering with the effects of anesthesia.
• A woman with lower than normal blood volume might feel the effects of surgery more
than a woman with normal blood volume.
• An example of this is a woman who began labor and was told later on that she should
undergo cesarean birth instead because she may not have had anything to eat or drink
for almost 24 hours.
• To prevent fluid and electrolyte imbalance, intravenous fluid replacement is initiated
preoperatively and postoperatively.
• There are women who are very worried about the procedure, so they need a very
detailed explanation of the procedure before they can enter surgery without intense
fear.
•A woman who is frightened is at greater risk for cardiac arrest during
anesthesia administration.
•Acknowledge that the woman’s fear of surgery is normal so that she
can view her feelings as expected which could increase her self-
esteem.
•The newborn is also at greater risk than those newborn born
through vaginal delivery.
•Infants born through cesarean delivery develop a degree of
respiratory difficulty because when a fetus is pushed through the
birth canal, pressure on the chest helps to rid the newborn lungs of
fluid.
PREOPERATIVE DIAGNOSTIC
PROCEDURES

Before undergoing surgery, the woman must subject herself to the diagnostic procedures
as recommended by her physician.

• Diagnostic procedures that a woman must undergo before surgery include circulatory
and renal function assessments and fetal heart rate.
• For the circulatory system, diagnostic procedures include complete blood count, and PT
and PTT.
• For the renal function, assessment of urine is necessary.

• Other diagnostic procedures include vital sign determination, serum electrolyte and pH,
blood typing and cross matching, and ultrasound to determine the fetal presentation and
maturity.
• When a woman experiences prolonged labor, she may have an elevated leukocyte count
of up to 20, 000/mm3, so this finding would not be a good indicator of infection.
PREOPERATIVE MEASURES

Preoperatively, there are measures that should be taken to ensure the woman’s safety during
surgery.

• The most important responsibility of the surgeon is securing the informed consent from the patient.
• It is everyone’s responsibility to see to it that the consent is obtained, and witnesses might be asked
to witness the woman’s signature.
• The consent must be informed, and the risks and benefits of the procedure must be explained in a
language that the woman understands.
• Upon admission, the woman is provided with a clean hospital gown and her hair is pulled into a
ponytail.
• The woman’s nails should be free from nail polish or any acrylic fingernails because nails
are used to assess capillary refill.
• To decrease stomach secretions, a gastric emptying agent is used before surgery,
because the woman would be lying on her back during surgery which makes esophageal
reflux and aspiration highly possible.
• An indwelling catheter is prescribed before or after the surgery to reduce bladder size
and keep the bladder away from the surgical field.
• Make sure that you have good lighting when inserting a catheter on a pregnant woman
to clearly reveal the perineum.
• The urine should be draining freely, and the drainage bag should be kept below the level
of the bladder during transport to prevent backflow and the introduction of
microorganisms into the bladder.
• To ensure that the woman is fully hydrated, an
intravenous solution such as Ringer’s can be started as
prescribed.
• Only a minimum of preoperative medications is given
to prevent compromising the fetal blood supply and
make sure that the newborn is wide awake at birth and
respirations are initiated spontaneously.
• Documentation of nursing care up until the woman
leaves the hospital must be complete and factual.
• Upon transport to surgery, ensure that the woman is
lying on her left side to prevent supine hypotension.
• Ensure that the side rails are up, and the woman is
covered with a blanket.
• A support person may be needed during cesarean
birth, and they also need encouragement to watch the
birth live.
While anesthesia is being administered, a surgical nurse will
assist the woman first to move from the transport stretcher to
the operating table.

The anesthesia of choice is usually a regional block.

Encourage the woman to remain on her side or insert a pillow INTRAOPERATIVE

under her right hip to keep her body slightly tilted to the side MEASURES
to prevent supine hypotension.

In emergency cases, a spinal anesthesia is administered while

the woman is sitting up.

It would be difficult for a woman in labor to remain in a

curved position during administration of the anesthetic, so talk
to her gently and let her lean on you while you gently restrain
her.
• pidural anesthesia is administered while the woman is
lying on her side, and it has an effect that lasts for 24
hours, so continuous pulse oximetry must be used 24
hours post surgery to detect respiratory depression.
• For the skin preparation, shaving away abdominal hair
and washing the skin over the incision site with soap
and water could reduce the bacteria on the skin.
• The woman is then positioned with a towel under her
right hip to move abdominal contents away from the
surgical field and lift her uterus away from the vena
cava.
• The woman would be covered by a sterile drape to
block the flow of the bacteria from her respiratory tract
to the incision site and also block the woman’s and
support person’s lines of sight from the incision site.
• The incision area is scrubbed by an antiseptic, and additional drapes are placed around
the area so that only a small area of the skin is exposed.
• Prepare the woman and the support person for the sights they might see.

• A classic incision is made vertically through both the abdominal skin and the uterus.

• A disadvantage of this type of incision is that it leaves a wide skin scar and also runs
through the active contractile portion of the uterus.
• The woman would not be able to have a subsequent vaginal birth because this type of
scar could rupture during labor.
• A low segment incision or low transverse incision is made horizontally across the
abdomen just over the symphysis pubis and also horizontally across the uterus just over
the cervix.
• This is the most common type of incision and is also referred to as “bikini” incision.
•it is less likely that this type of incision
would rupture during labor, so it is
possible for the woman to have VBAC in
the future.
•It results in less blood loss, easier to
suture, decreases puerperal infections and
less likely to cause postpartum
gastrointestinal complications.
•The disadvantage of this incision is that it
takes longer to perform, making it
inappropriate for an emergent cesarean
birth.
POSTPARTAL CARE

•The postpartal care period of a woman who has undergone

emergent cesarean birth is divided into two: immediate recovery
period and extended postpartal period.
•After surgery, the woman would be transferred by stretcher to
the postanesthesia care unit.
•If spinal anesthesia was used, the woman’s legs are fully
anesthetized so she cannot move them.
•Pain control is a major problem after birth because it was so
intense that it interfered with the woman’s ability to move and
deep breathe.
•This may lead to complications such as pneumonia or
thrombophlebitis.
•Use a pain rating scale to allow a woman to rate her pain.
•Some women may need patient controlled analgesia or
continued epidural injections to relieve the pain.
•Supplement the analgesics with comfort measures such as
change in position or straightening of bed linen.
•Instruct the woman to ambulate because this is the most
effective method to relieve gas pain
• 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 breast feeding is a way to keep the infant’s weight off the mother’s incision.

• During the extended postpartal period, the woman most commonly experiences gastrointestinal function
interference.

• Note carefully the woman’s first bowel movement after surgery because if no bowel movement has been observed,
the physician may order a stool softener, a suppository, or an enema to facilitate stool evacuation.
•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.
•Advice 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.