11 Cesarean Birth Nursing Care Plans

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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.

Here are 11 nursing diagnoses and nursing care plans for cesarean birth: 

  1. Deficient Knowledge UPDATED!
  2. Acute Pain UPDATED!
  3. Risk for Infection UPDATED!
  4. Risk for Deficient Fluid Volume UPDATED!
  5. Risk for Disturbed Maternal-Fetal Dyad UPDATED!
  6. Risk for Injury UPDATED!
  7. Anxiety or Fear UPDATED!
  8. Risk for Situational Low Self-Esteem UPDATED!
  9. Powerlessness UPDATED!
  10. Risk for Ineffective Self Health Management UPDATED!
  11. Risk for Impaired Parenting UPDATED!
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Acute Pain

The experience of pain during childbirth is complex and subjective. Several factors can affect the client’s perception of labor pain, making each experience unique. Consistently, pain during childbirth is ranked high on the pain rating scale compared to other painful life experiences (Labor & Maguire, 2008). Cesarean birth is among surgery procedures that induce pain, and surgery threatens the body’s integrity. Increased serum catecholamines and cortisol may lead to decreased pelvic blood flow and increased pain during labor while disrupting normal labor and delivery, prolonged deliveries, emergency cesarean birth, medical and surgical interventions, and increased dissatisfaction with childbirth experiences (Ahmadi, 2020).

Nursing Diagnosis

  • Increased muscle contractions
  • Psychological reactions
  • Surgical trauma
  • Bladder or abdominal distention

May be evidenced by

  • Reports of pain
  • Guarding/distraction behaviors
  • Irritability, crying, shouting, restlessness
  • Facial mask of pain
  • Tachycardia
  • Tachypnea
  • Increase in blood pressure
  • Self-focusing, narrowed focus

Desired outcomes and goals

  • The client verbalizes reduced discomfort or pain.
  • The client appears relaxed, can rest or sleep, and participates appropriately.
  • The client verbalizes methods that provide relief.
  • The client demonstrates relaxation skills and diversional activities as indicated for the situation.

Nursing Assessment and Rationales

1. Assess location, characteristics, frequency, severity, and onset/duration of pain, especially related to the indication for cesarean birth.
Data can help indicate the suitable choice of treatment and guide interventions. The client awaiting imminent cesarean birth may encounter varying degrees of discomfort, depending on the indication for the procedure, e.g., failed induction, dystocia. A study determined that the reasons for performing cesarean birth were the above-normal baby’s weight, fetal distress, dystocia, placenta previa, placenta abruption, decreased fetal percentage, and malposition (Solehati & Rustina, 2015).

2. Assess the client’s perceptions, along with behavioral and physiological responses.
Research shows that experiencing pain during labor and early puerperium is higher in women after a cesarean birth. However, many clients opt to deliver via cesarean for fear of pain (Ilska et al., 2020). According to research conducted in Iran, over 70% of pregnant women demand cesarean without medical necessity, 92% of which are due to fear of labor pain and normal delivery complications. Correcting false client perceptions may help them prepare adequately in dealing with childbirth pain.

3. Note the client’s attitude toward pain and use of specific pain medications. 
Fear of labor pain is the most common fear of childbirth (Ahmadi, 2020). According to previous studies, fear of pain increases the amount of pain and stress during labor. Additionally, the pain intensity is influenced by cultural factors. Culture has a role in pain tolerance and psychological perception of pain (Solehati & Rustina, 2015). Some clients may avoid pharmacological pain relief because of cultural and religious beliefs.

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Nursing Interventions and Rationales

During labor and delivery

1. Perform pain assessment every time the client reports pain.
Note, compare, and investigate changes from previous reports to identify labor progress or rule out worsening of the client’s condition or development of complications. Always rate the client’s pain using a rating scale and identify its characteristics (frequency, duration, severity, intervals).

2. Monitor the client’s vital signs. 
Note for signs of tachycardia, hypertension, and increased respirations. Changes in these vital signs often indicate acute pain and discomfort.

3. Observe nonverbal cues of pain, especially in clients who cannot communicate.
The nurse’s observations may not always be congruent with verbal reports indicating the need for further evaluation, especially in clients who cannot communicate verbally or clients who strictly adhere to their birth plan, which strictly prohibits the use of pharmacologic agents for pain relief. Nevertheless, these women should be assured that pain relief is available at any time during labor.

4. Avoid anxiety-producing circumstances (e.g., loss of control) and encourage the presence of a partner.
Levels of pain tolerance are individual and are affected by various factors. Extreme anxiety following an emergency may develop discomfort due to fear, tension, and pain affecting the client’s ability to cope. Providing social and professional support to the client creates comfort and reassurance and reduces pain (Ahmadi, 2020).

5. Encourage the client to verbalize feelings about pain.
Allow the client to verbalize her perceptions about pain and acknowledge the pain experience. Pain is a subjective experience and cannot be felt by others. Convey acceptance of the client’s response to pain.

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6. Teach and demonstrate proper relaxation techniques—position for comfort as possible. Use therapeutic touch, as appropriate.
Relaxation techniques such as deep breathing exercises, music therapy, massages, etc., can help decrease anxiety and tension, promote comfort, and enhance a sense of well-being. Excessive fear and worry increase the release of catecholamines such as adrenaline and potentiate painkiller stimuli, increase the perception of pain in the cerebral cortex and decrease pain tolerance (Ahmadi, 2020).

7. Review client’s knowledge of and expectations about pain management and previous experiences with pain and methods used.
Antenatal childbirth preparation has a role in increasing maternal satisfaction and may reduce pain scores. Antenatal education is also essential when obtaining consent from the client; the aim is to provide good information to facilitate mothers to form realistic expectations about pain management during childbirth (Labor & Maguire, 2008).

Postpartum care and interventions

8. Encourage adequate rest periods after cesarean birth.
The period after cesarean birth includes recovery from surgery and adapting to motherhood. The client needs to rest adequately to prevent fatigue and recover appropriately before assuming the new role of being a mother. Parents may appreciate early discharge, as it provides the family, including older siblings, an opportunity to be together in the home environment (Kruse et al., 2020). Additionally, it provides adequate social and moral support for the woman.

9. Discuss with family ways to assist the client and reduce the pain.
Emotional and psychological support provided by the family can help in recovery and reduce postpartum pain.

10. If indicated, administer sedatives, narcotics, or preoperative drugs.
Promotes comfort by blocking pain impulses. Potentiates the action of anesthetic agents. Most women report pain and require opioid analgesia following cesarean birth—approximately 20% of women who undergo a cesarean birth experience severe acute postoperative pain. Individualized or stratified post-discharge opioid prescribing practices have been shown to reduce unnecessary opioid analgesic prescription and consumption, so they should be implemented routinely (Carvalho & Habib, 2019).

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Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

Other care plans related to the care of the pregnant mother and her infant:

References and Sources

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With contributions by Marianne Belleza RN.

Gil Wayne graduated in 2008 with a bachelor of science in nursing. He earned his license to practice as a registered nurse during the same year. His drive for educating people stemmed from working as a community health nurse. He conducted first aid training and health seminars and workshops for teachers, community members, and local groups. Wanting to reach a bigger audience in teaching, he is now a writer and contributor for Nurseslabs since 2012 while working part-time as a nurse instructor. His goal is to expand his horizon in nursing-related topics. He wants to guide the next generation of nurses to achieve their goals and empower the nursing profession.
  • This one is valuable for nurse-midwifery trainees. It’s good for to us make an advanced care plan and easy to work in the OB ward.

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