Indications for possible cesarean birth’
Intro
What is cesarean birth?
- Cesarean birth is accomplished through an
abdominal incision in uterus. It is one of the oldest
types of surgical procedures known. It is always
slightly more hazardous than vaginal birth, but
compared to other surgical procedures, it is one
of the safest types of surgeries and one with few
complications.
Types of cesarean birth
- There are two types of cesarean birth:
- Scheduled c-section: there is time for thorough
preparation for the experience throughout the
antepartal period. Some women even take a
childbirth preparation class specifically for
cesarean birth.
- Emergent c-section: emergent cesarean births
are done for reasons such as placenta previa,
premature separation of the placenta, fetal
distress, or failure to progress in labor.
Nursing Process Overview
- Assessment – assess whether a woman will be a
good candidate for surgery. Check for both
physiologic and psychological status and
preparedness.
- Nursing Diagnosis – nursing diagnosis to
cesarean birth are often related to prevention of
common complications from surgery
patient/family concerns about surgical birth.
- Ex) risk for infection related to a surgical incision,
fear related to impending surgery, etc.
- Outcome Identification and Planning – the same
important outcome applies to a woman giving
birth by cesarean as a woman giving birth
vaginally: a healthy mother and a healthy child.
- Implementation ¬– an important intervention
includes coordination of health care team
members such as anesthesiologist, surgeon,
pediatricians, or neonatologist, and recovery
room or nursery personnel.
- Outcome Evaluation – evaluation of expected
outcome is important in the care of a woman after
cesarean birth to ensure she is not developing a
complication.
Indications for Possible Cesarean Birth
 Maternal Factor
- Active genital or perhaps human papillomavirus
- AIDS or HIV-positive status
- Cephalopelvic disproportion
- Cervical cerclage
- Disabling conditions, such as severe
hypertension of pregnancy, that prevent pushing
to accomplish the pelvic division of labor
- Failed induction or failure to progress in labor
- Obstructive benign or malignant tumor
- Previous cesarean birth by classic incision
- Elective – no indicated risks
 Placenta Factors
- Placenta previa
- Premature separation of the placenta
- Umbilical cord prolapse
 Fetal Factors
- Compound conditions such as macrosomic fetus
in a breech lie
- Extreme low birth weight
- Fetal distress
- Major fetal anomalies, such as hydrocephalus
- Multigestation or conjoined twins
- Transverse fetal lie
Effects of Surgery on a Woman.
a. Stress Response – whenever the body is
subjected to stress, it responds with
measures to preserve the function of major
body systems. This results in release of
epinephrine and norepinephrine from the
adrenal medulla. Epinephrine causes an
increased heart rate, bronchial dilation, and
elevation of the blood glucose level.
b. Interference with Body Defenses – when skin
is incised for a surgical procedure, this
important line of defense is lost. If cesarean
birth is performed hours after the membranes
ruptured, a woman’s risk for infection will be
higher than if the membranes were intact.
c. Interference with Circulatory Function –
extensive blood loss can lead to hypovolemia
and lowered blood pressure.
d. Interference with Body Organ Function –
when any organ is handled, cut, or repaired
in surgery, it may respond with a temporary
or disruption in function.
e. Interference with Self-image or Self-esteem –
surgery always leaves an incisional scar that
will be noticeable to some extent afterward.
1. Risk factors for a woman and a newborn
A. Operative Risk for a Woman
a. Poor Nutritional Status – a woman who is
obese because of poor nutrition is at risk
because such a condition interferes with
wound healing. A woman with a protein and
vitamins deficiency is also at risk for poorer
healing.
b. Age Variation – age affects surgical risk
because it can cause decreased circulatory
and renal function.
c. Altered General Health – a woman who has
a secondary illness such as cardiac disease,
diabetes mellitus, anemia, or kidney or liver
disease is at greater than usual surgical risk
may interfere with her ability to adjust
physically to the demands of surgery.
d. Fluid and Electrolyte Imbalance – a woman
who enters surgery with a lower than normal
blood volume will feel the effect of surgical
blood loss more than woman who has a
normal blood volume.
e. Fear – woman who are extremely worried
need a very detailed explanation of the
procedure before they can enter surgery
without intense fear.
B. Operative Risk to the Newborn
- More infants born by cesarean birth develop
some degree of respiratory difficulty for a day or
two after birth than those born vaginally.