Cesarean birth, also termed cesarean section, is the delivery of a neonate by surgical incision through the abdomen and uterus. The term cesarean birth is used in nursing literature rather than cesarean delivery to accentuate that it is a process of birth rather than a surgical procedure. This method may occur under planned, unplanned, or emergency conditions. Indications for cesarean birth may include abnormal labor, cephalopelvic disproportion, gestational hypertension or diabetes mellitus, active maternal herpes virus infection, fetal compromise, placenta previa, or abruptio placentae.
Nursing Care Plans
Cesarean section is currently the most common major surgical procedure in the United States. However, it carries risks to both the mother and the fetus. It also has a lengthy recovery period than vaginal birth. Some women may have difficulty attempting a vaginal birth later. Yet, many women can have a vaginal birth after a cesarean (VBAC). Hence, mothers need to work with health care providers to make the best decision for themselves and the baby.
- Deficient Knowledge UPDATED!
- Acute Pain UPDATED!
- Risk for Infection UPDATED!
- Risk for Deficient Fluid Volume UPDATED!
- Risk for Disturbed Maternal-Fetal Dyad UPDATED!
- Risk for Injury UPDATED!
- Anxiety or Fear UPDATED!
- Risk for Situational Low Self-Esteem UPDATED!
- Powerlessness UPDATED!
- Risk for Ineffective Self Health Management UPDATED!
- Risk for Impaired Parenting UPDATED!
Cesarean section (CS) is one of the most common major surgical procedures worldwide. Despite being a vital obstetric procedure that saves the lives of women and infants, it is not free of short and long-term adverse events for both. Childbearing women themselves, their relatives, and society might prefer delivery by a CS due to a lack of general knowledge about the advantages of vaginal delivery, fear from pain, widespread misconceptions about urinary and sexual functions after vaginal delivery, and the misbelief that a CS is safer for the baby (Wali et al., 2020).
Related factors may include
- Lack of exposure
- Unfamiliarity with condition and information resources
- Misinterpretation of information
May be evidenced by
- Request for information
- Narrative misconception
- Inappropriate behaviors
- Inaccurate understanding of instructions
Desired outcomes and goals
- The client verbalizes understanding of indications for cesarean birth and postoperative expectations.
- The client states that they feel well prepared for cesarean birth.
- The client recognizes this as an alternative childbirth procedure to achieve the best result possible in the end.
- The client performs or participates in necessary procedures appropriately to understand the rationale behind the actions.
Nursing Assessment and Rationales
1. Assess the client’s or couple’s level of understanding.
Determining the level of understanding facilitates the planning of preoperative teaching and identifies content needs.
2. Appraise knowledge toward the procedure.
Most clients fail to retain the information instilled during childbirth classes. Therefore, clients have difficulty remembering or understanding the details during the entire process.
3. Assess the level of stress and whether the procedure was planned or not.
Defines the client’s or couple’s readiness to incorporate information. Clients who are extremely worried about surgery may need a detailed explanation of the procedure to reduce their anxiety to a tolerable level.
Nursing Interventions and Rationales
1. Provide accurate information in easy-to-understand terms and clarify misconceptions.
The stress of the situation can affect the client’s ability to understand the information required to make informed decisions. They may not process the new information if they do not understand the terminology.
2. Encourage the couple to ask questions and verbalize their understanding of the matter.
Provides an opportunity to assess and evaluate the client’s or couple’s understanding of the situation. Answer all specific questions that the couple has and fill in gaps in knowledge as necessary. Be certain that all information that you offer is correct.
3. Review indications necessitating alternative birth methods.
Cesarean birth should be viewed as an alternative and not an abnormal situation to enhance maternal and fetal safety and well-being.
4. Explain preoperative procedures in advance and present rationale as appropriate.
Explanation of the logical reasons why a particular choice was made is vital in preparation for the procedure. Immediate preoperative procedures such as surgical skin preparation, eating nothing before the time of surgery, premedications, and method of transport to surgery should be clearly explained by the nurse.
5. Review the necessity for postoperative measures.
Educate the client about the rationale behind necessary postoperative measures such as indwelling bladder catheter, IV fluid administration, and placement of an epidural catheter for post-procedure pain relief (if preferred by the client). Knowing the rationale behind the procedures may allow the client to feel a sense of control over her situation.
6. Educate the client preoperatively and reinforce learning postoperatively, including demonstration of leg exercises, proper coughing, deep breathing techniques, incentive spirometry, splinting, and abdominal tightening exercises.
Provides routine to prevent complications associated with venous stasis and hypostatic pneumonia and lessen stress on the operative site. Abdominal tightening reduces distress associated with gas formation and abdominal distension. Periodic deep breathing exercises fully aerate the lungs and help prevent stasis of lung secretions. Preoperative education can help reduce anxiety about the procedure and clients are more likely to comprehend what is being taught.
7. Stress anticipated sensations further during the delivery and recovery period.
Knowing the possible outcomes helps prevent unnecessary anxiety. Preoperative teaching aims to acquaint the client with the cesarean procedure and any special equipment used.
8. Use visual aids during teaching if necessary.
Draw pictures or show illustrations of anatomy, as needed. These materials could enhance the client’s learning experience and make it easier to understand and recall the teachings fully. See the resources section below for a list of teaching aids you can use.
9. Discuss and develop a postoperative pain management plan and review the use of the pain scale.
Developing a pain management plan with the client increases the likelihood of successful pain management. Some clients may expect that cesarean birth produces less pain than a vaginal birth or fear becoming addicted to opioid agents (Wali et al., 2020).
Recommended nursing diagnosis and nursing care plan books and resources.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
- Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
- NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
- Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
- Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
- Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
- Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
- All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other care plans related to the care of the pregnant mother and her infant:
- Abruptio Placenta | 3 Care Plan
- Abortion (Termination of Pregnancy) | 8 Care Plans UPDATED!
- Cesarean Birth | 10 Care Plans UPDATED!
- Cleft Palate and Cleft Lip | 6 Care Plans
- Dysfunctional Labor (Dystocia) | 4 Care Plans
- Gestational Diabetes Mellitus | 8 Care Plans UPDATED!
- Hyperbilirubinemia (Jaundice) | 4 Care Plans UPDATED!
- Labor Stages, Induced and Augmented Labor | 36 Care Plans UPDATED!
- Neonatal Sepsis | 5 Care Plans
- Perinatal Loss | 5 Care Plans
- Placenta Previa | 3 Care Plans
- Postpartum Hemorrhage | 8 Care Plans UPDATED!
- Postpartum Thrombophlebitis | 5 Care Plans UPDATED!
- Prenatal Hemorrhage | 9 Care Plans UPDATED!
- Prenatal Substance Dependence/Abuse | 6 Care Plans
- Precipitous Labor | 3 Care Plans
- Preeclampsia and Gestational Hypertension | 6 Care Plans UPDATED!
- Premature Dilation of the Cervix | 3 Care Plans
- Prenatal Infection | 3 Care Plans
- Preterm Labor | 7 Care Plans UPDATED!
- Puerperal & Postpartum Infections | 5 Care Plans UPDATED!
- Cultural Birthing Practices and Experiences. An eBook that details the different cultural and ethnic practices during childbirth in Australia. A great resource if you want to expand your knowledge about these practices.
- Intrapartum Care for a Positive Childbirth Experience. A resource by the WHO that details what they recommend and what they don’t during intrapartum care. Check out the executive summary!
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With contributions by Marianne Belleza RN.