CEASAREAN

SECTION

WMSU

1
WESTERN MINDANAO STATE UNIVERSITY
• Cesarean delivery is the surgical removal
of the infant from the uterus through an
incision made in the abdominal wall and
an incision made in the uterus.
• The surgery may be preplanned (elective)
or arise from an unanticipated problem.
• The surgery may be preplanned (elective)
or arise from an unanticipated problem.

2
Skin incision
1. a midline vertical 2. Pfannenstiel incision
incision between the just above the
umbilicus and the symphysis 
symphysis
Three types of uterine incisions
are possible
1) low transverse
2) low vertical
3) classic, a vertical incision into the
upper uterus
• The low transverse uterine incision is preferred
unless a very large fetus or placenta previa in the
lower uterus prevents its use. The uterine incision
does not always match the skin incision. For
example, a woman may have a vertical skin
incision and a low transverse uterine incision,
particularly if she is very obese.
• In subsequent pregnancies and delivery, a trial of
labor and vaginal birth is increasingly regarded as
safe and appropriate as long as cephalopelvic
disproportion does not exist and the previous
incision was low transverse.
• Elective, repeat cesarean may be
performed in the absence of a specific
indication for operative delivery when
either the physician or the client is
unwilling to attempt vaginal delivery.
• Anesthesia may be general, spinal, or
epidural; preoperative and postoperative
care will vary accordingly.
 Reasons For Performing A Cesarean Delivery
1. Maternal factors
a. Cephalopelvic disproportion (CPD)
b. Active genital herpes or papilloma
c. Previous cesarean birth by classic incision
d. Presence of severe disabling hypertension or heart disease

2. Placental factors
e. Placenta previa
f. Abruptio placental

3. Fetal factors
g. Transverse fetal lie
h. Extreme low birth weight
i. Fetal distress
j. Compound conditions, such as macrosomia and transverse lie.
Nursing Management

1. Perform a complete maternal and fetal

assessment.
• Obtain a complete obstetric history.
• If he client presents with labor determine frequency,
duration, and intensity of contractions.
• Determine the condition of the fetus through fetal
heart tones, fetal monitoring strips, fetal scalp blood
sample, fetal activity changes, and presence of
meconium in amniotic fluid.
2. Prepare the client for cesarean delivery in the same way
whether the surgery is elective or emergency. Depending on
hospital policy:
• Shave or clip pubic hair.
• Insert a retention catheter to empty the bladder continuously.
• As prescribed, insert intravenous lines, collect specimens for
laboratory analysis, and administer preoperative medications.
• Also as prescribed, provide an antacid (to prevent vomiting and
possible aspiration of gastric secretions) and prophylactic
antibiotics (to prevent endometritis).
• Assist the client to remove jewelry, dentures, and nail polish, as
appropriate.
• 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).
• Make sure the client’s signed informed consent is on file.
• Continue assessing maternal and fetal vital signs in accordance with
hospital policy until the client is transported to the operating room.
• Notify other health care team members of the pending delivery.
• 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.
• If there is time, begin explaining what the client can expect postoperatively.
Discuss pain relief, turning, coughing, deep breathing, and ambulation.
• Inform the client that intraoperative and postpartum care will be performed
by the surgical and obstetric team, and that the newborn will receive care
by the pediatrician and a nurse skilled in neonatal care procedures (ie,
resuscitation).

3. Facilitate a family- centered cesarean birth by including , when

possible, such activities as:

• Preparing the partner for participation in the delivery.

• Providing for family time alone in the critical first hours after
the mother and newborn are stabilized.
• Including the father and siblings (as possible) when
demonstrating care of the newborn.
• 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 suite and stay with her
throughout the birth.
4. Provide physical and emotional support.
• Anticipate parental feelings of “failure” related to cesarean
rather than “normal” birth. In such a situation, provide time
for them to relive and talk through the experience. Offer
reassurance and support.
• Assist the family in planning for care of mother and
newborn at home
Client and Family Teaching

• Explain to the mother, her partner, and other family members that recovery
from a surgical cesarean delivery is slower, and often more painful, when
compared with recovery from a normal vaginal delivery. The following
considerations must be taken into account:
• Need for increased rest (influenced by type of anesthesia, length of labor,
and the type of abdominal or uterine incision)
• Need for increased pain medication and other pain-relieving techniques
• Inability to climb the stairs
• Inability to drive a car
• Difficulty with breast feeding the newborn in certain positions (e.g., cradle
hold).teach the mother the best positions to use and how to use pillows to
cushion the incision site.
• Difficulty with normal ADLs (e.g., dressing, bathing, toileting, and so on).
Difficulty with providing normal newborn care (e.g., lifting, carrying, bathing,
and dressing the newborn) and the need for assistance in caring for the
newborn.
 Ref:
https://www.rnpedia.com/nursing-notes/ma
ternal-and-child-nursing-notes/cesarean-d
elivery/

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