A. DESCRIPTION
1.In this surgical procedure, the newborn is delivered through the abdomen from an incision made through the maternal abdomen and the uterine myometrium.
2. The surgery maybe preplanned (elective) or arise form an unanticipated problem.
3. Types of cesarean birth include the following:
a. Classical or vertical. A vertical midline incision is made in the skin and the body of the uterus, permitting easier access to the fetus. This is indicated in emergency situations, where there are abdominal adhesions for previous surgeries, or when the fetus is in transverse lie. Blood loss increased because large vessels of the myometrium are involved. Because the uterine musculature is weakened, there is greater possibility of rupture of the uterine scar subsequent pregnancies.
b. Transverse low segment. In this, the most common type, the incision is low (“bikini” or “Pfannenstiel’s incision), and the uterine incision is horizontal in the lower uterine segment. Blood loss is minimal, fewer post delivery complication occur, and the incision is easy to repair, with less chance of rupture of uterine scar during the future deliveries. The procedure takes longer to perform than the classic incision; therefore, it is not often used in emergencies.
4. In subsequent pregnancies and delivery, a trial of labor and vaginal birth is increasing regarded as safe and appropriate as long as cephalopelvic disproportion does not exist and the previous incision was low transverse.
5. Elective, repeat cesarean birth may be performed in the absence of specific indication for operative delivery when either the physician or the client is unwilling to attempt vaginal delivery.
6. Anesthesia may be general, spinal, or epidural; preoperative or postoperative care will vary accordingly.
B.REASONS FOR PERFORMING A CESARIAN BIRTH
1.Maternal factors
a. Cephalopelvic disproportion
b. Active genital herpes or papilloma
c. Previous cesarian birth by classic incision
d. Presence of severe disabling hypertension or heart disease
2. Placental factors
a. Placenta previa
b. Abruptio placentae
3. Fetal factors
a. Transverse fetal lie
b. Extreme low birth weight
c. Fetal distress
d. Compound conditions, such as macrosomia, transverse lie
C. NURSING MANAGEMENT
1. Perform complete maternal and fetal assessment.
a. Obtain a complete obstetric history.
b. If the client presents with labor, determine frequency, duration and intensity of contractions.
c. Determine the condition of the fetus through FHR, fetal scalp blood sample, fetal activity changes, and presence of meconium in amniotic fluid.
2.Prepare the client for cesarean birth in the same way whether the surgery is elective or emergency. Depending on hospital policy:
a. Shave or clip pubic hair.
b. Insert a retention catheter to empty the bladder continuously.
c. As prescribed, insert intravenous lines, collect specimens for laboratory analysis, and administer preoperative medications.
d. Also as prescribed, provide an antacid (to prevent vomiting and possible aspiration of gastric secretions) and prophylactic antibiotics (to prevent endometritis)
e.Assist the client to remove jewelry, dentures, and nail polish, as appropriate.
f. As needed, reinforce the obstetrician’s explanation of the surgery, the expected outcome, and the anesthesiologist’s explanation of the kind of anesthetics to be used (depending on the client’s cardiopulmonary status).
g. Make sure the client’s signed the informed const is on file.
h. Continue assessing maternal and fetal vital signs in accordance with the hospital policy until the client is transported to the operating room.
i. Notify other health care team members of the pending delivery.
j. Modify preoperative teaching to meet the needs of planned versus emergency cesarean birth; depth and breadth of instruction will depend on the circumstances and time available.
k. If there is time, begin explaining what the client can expect postoperatively. Discuss pain relief, turning, coughing, deep breathing and ambulation.
l. Inform the client that intraoperative and immediate postpartum care will be performed by the surgical and obstetric team, and the newborn will receive care by the pediatrician and a nurse skilled in neonatal care procedures (resuscitation).
3. Facilitate a family-centered cesarean birth by including, when possible, such activities as:
a. Preparing the partner for participation in the delivery.
b. Reuniting the family as soon as possible following delivery.
c. Providing for family time alone in the critical first hours after the mother and the newborn stabilized.
d. Including the father and siblings (as possible) when demonstrating care of the newborn.
e. Encouraging the mother’s support person to remain with her as much as possible. In some cases, this person may accompany the client to the surgical suit and stay with her throughout the birth.
4. Provide physical and emotional support.
a. Anticipate parental feelings of “failure” related to cesarean rather than “normal” birth. In such a situation, provide time for the client to relieve and talk through the experience. Offer reassurance and support.
b. Assist the family in planning for care of mother and newborn at home.
