Cesarean

Birth

Larumbe, Lee Lorraine T.

BSN 2 -E
Cesarean birth of the infant through an abdominal and uterine incision. It is one of
the oldest surgical procedures known. Until the 20th century, cesarean procedures
were primarily used in an attempt to save the fetus of a dying woman. As the
maternal and perinatal mobidity and mortality rates associated with cesarean birth
steadily decreased throught 20th century, the proportion of cesarean births
increased.

INDICATIONS
Complete Placenta Previa Failure to progress labor

Cephalopelvic disproportion Nonreassuring fetus

Placental abruption Benign and malignant tumors that

obstruct the birth canal
Active genital herpes
Cervical cerclage
Umbilical cord prolapse

CONTROVERSIAL INDICATIONS

Breech presentation

Prevoius cesarean birth

Major congenital anomalies

Severe Rh alloimmunization

MATERNAL MORTALITY AND MORBIDITY

Cesarean birth have a higher maternal mortality rate than vaginal births. Whereas
approximately 2.1 per 100,000 women die during vaginal birth, mrtality is 5.9 per
100,000 fore women who undergo an elective cesarean birth. Women who undergo
an emergency cesarean birth face an significantly higher incidence of death, 18.2
per 100,000 (Hannah, 2004). Perinatal morbidity is often associated with infection,
reaction to anesthesia,blood clots and bleeding problems. In addition to
complications associated with cesarean birth, there are risks tht incerase maternal
mortality and morbidity in subsequent pregnancies.

• Risk for placenta previa

• Abruptio placenta

• Increase in fetal demise and in neonatal respiratory distress and the need for
oxygen administration in fetuses whose mothers have previously given birth
via cesearean.
SKIN INCISIONS
The skin incision for a cesarean birth ie either tranverse(Pfannenstiel) or vertical
and is ni=ot indicarive of the type of incision made into the uterus. The tranverse
incision is made across the lowest and narrowest part of the abdomen. Since the
incision is made below the pubic hairline, it is almost invisible after healing. The
limitation of this type of os skin incision is that it does not allow for extension of the
incision if needed.

Vertcal incsion is made between the navel and the symphysis pubis. The type of
incision is quicker and is therefore preferred in cases of nonreassuring fetal status
when rapid birth is indicated, with preterm pr macrosomic infants, or when the
woman is significanty obese. Time factors, client preference, previous vertical
incision, or physician preference determine the type of skin incision.

UTERINE INCISIONS
The type of uterine incision depends on the need for the cesarean. The choice of
incision affects the woman’s opportuity for a subsequent vaginal birth and her risks
of a ruptured uterine sacr with a subsequrnt pregnancy.

The two major locations of uterine incisions are in the lower uterine segment and in
the upper uterine segment of the uterine corpus. The lower uterine segment
incision most commonly used is a tranverse incision. The lower uterine segment
incision is preferred for the following reasons:

• The lower segment is the thinnest portion of the uterus and involves less
blood loss

• It requires only moderate dissection of the bladder from underlying myo

metrium.

• It is easier to repair, although repair takes longer

• The site is less likely to rupture during subsequent pregnancies.

The lower uterine segment vertical incision is preferred for multiple gestation,
abnormal presentation, placenta previa, nonreassuring fetal status, and preterm
and macrosomic fetuses. One other incision, the classic incision, was the method of
choice for many years but is used infrequently now. This vertical incision was made
into the upper uterine segment. More blood loss resulted and it was more difficult to
repair. More importantly, it carried an increased risk of uterine rupture with
subsequent pregnancy,labor and birth because the upper uterine segment is the
most contractille portion of the uterus.

ANALGESIA AND ANESTHESIA

There is no perfect anesthesia for cesarean birth. Each has its advantages,
disadvantages, possible risks, and side effects. Goals foe analgesia and anesthesia
administration include safety,comfort, and emotional satisfaction for the client.

NURSING CARE MANAGEMENT

Pregnant women and their partners should be encuraged to discuss the possibility
of a cesarean birth with their physician or CNM and the same time discuss their
specific needs and desires under those circumstances. Their preferences may
include the ff.

• Participating in the choice of anesthetic

• Father being present during the procedures and birth

• Audio recording and/or taking pictures of birth

• Delayed instillation of eyedrops to promote eye contact between parent and

infant in the first hours after birth

• Physical contact or holding the infant while in the operating room

• Breastfeeding in the recovery area within the first hour of birth

Information that couples need about cesarean birth includes the following:

• What prepatayory procedures to expect

• Description or viewing of the operating room

• Types of anesthesia for birth and analgesia available postpartum

• Sensations that may be experienced

• Roles f significant others

• Interaction with newborn

• Immediate recovery phase

• Pospartum phase

Preparations

• Establishing IV line
 • Instilling urinary indwelling catheter

• Performing an abdominal prep.

• Use of therapeutic touch and direct eye contact assist the woman in
maintaining a sense of control and lessen anxiety.

• Woman is given nothing by mouth (NPO).

• Monitor blood pressure of mother

• Fetal heart rate is assessed before surgery and during preparation because
fetal hypoxia can result from supine position.

• Uterus is placed 15 degrees from the midline. This helps relieve the pressure
of the heavy uterus on the vena cava and lessens the incidence of vena cava
compression and maternal supine hypotension.

IMMEDIATE POSTPARTUM RECOVERY PERIOD

• Assess APGAR score and completes the sam initial assessment and
identification procedures used for vaginal birth.

• Infant identification bands must be placed on the infant and the mother prior
to removing the infant from the operating room.

• Assess the mother’s vital signs every 5 minutes until they are stable, then 15
minutes for at least an hour.

• If the woman has been under general anesthesia, she should be positioned
on her side to facilitate drainage of secretions, turned, and assisted with
coughing and deep breathing every two hours for at least 24 hours.

• If she received a spinal or epidural anesthetic, the level of anesthesia is

checked every 15 minutes until full sensation has returned.

• It is important for the nurse to monitor intake and output and to observe the
urine bloody tinge, which could mean surgical trauma to the bladder.

• The physician describes medication to relieve the mother’s pain and nausea,
and it is administered as needed.

SOURCES:

Fundamentals of Maternal and Child Nursing Care by Marcia L. London

Volume 1 ( pages 554-558)