11 Cesarean Birth Nursing Care Plans

ADVERTISEMENTS

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!
ADVERTISEMENTS

Anxiety or Fear

Women who have cesarean births need greater emotional support than women having vaginal births. They are usually happy and excited about the newborn, but they may also feel fear, guilt, grief, or anger because the expected birth course did not occur (Leifer, 2018). They may feel anxious about what is to come and the consequences of a cesarean birth; how it may affect themselves and the fetus. If not accepted, expressed, and intervened with, these feelings may cause emotional consequences during the intrapartum and postpartum periods. Additionally, women who request an elective cesarean birth have higher antepartum depression and anxiety levels than women who had planned to deliver vaginally (Olieman et al., 2017). 

Nursing Diagnoses

  • Fear
  • Anxiety
  • Perceived/actual threat of maternal and fetal well-being
  • Situational crisis
  • Threat to self-concept
  • Development of complications

Possibly evidenced by

  • Apprehension
  • Distress
  • Feelings of inadequacy
  • Increased tension
  • Restlessness
  • Sympathetic stimulation
  • Expressed concerns regarding consequences

Desired Outcomes

  • The client and her partner discuss feelings about cesarean birth.
  • The client appears relaxed and comfortable.
  • The client and her partner verbalize fears for the safety of herself and the infant.
  • The client and her partner will express decreased anxiety after explaining cesarean birth.

Nursing Assessment and Rationales

1. Assess psychological response to events and availability of support systems.
The greater the client perceives the threat, the greater her anxiety level. Women who are extremely worried about the cesarean birth may need a detailed explanation of the procedure to reduce their anxiety to a tolerable level.

2. Determine stress level and learning needs. 
Provides a database to build on to provide information that will decrease anxiety. Overwhelming or persistent fears result in excessive stress reactions.

ADVERTISEMENTS

Nursing Interventions and Rationales

1. Consider cultural influences or expectations.
Some cultures (e.g., Latin, Mexican/Arab-American) may view surgical intervention as detrimental to the client’s well-being or may believe the client will be stigmatized as a “weak woman” (e.g., Puerto Rican). Women who have a cesarean birth might be stigmatized because they are seen as having avoided something difficult, the rite of passage into motherhood of going through hours of agonizing labor (Cripe, 2017).

2. Know whether the procedure is planned or not.
If the procedure is unplanned, the client or couple usually has limited physiological or psychological preparation time. Cesarean birth can still create apprehension even if planned due to the perceived physical threat to the mother and infant.

3. Note and validate expressions of fear, distress, or feelings of helplessness. 
Validation helps the nurse and the client deal realistically with fear. Numerous fears surrounding childbirth have been reported, and these include fear of losing control, emergency cesarean birth, death or injury to themselves or the baby, inadequate support/care from care providers, not having a voice in decision making, pain, epidural anesthesia, episiotomies or perineal tears, and the unknown (Bryanton et al., 2021).

4. Remain with the client, and stay calm. Speak slowly and convey empathy.
Therapeutic communication helps to reduce interpersonal transmission anxiety and shows care for the client or couple. Studies, such as the Akbarzadeh et al., have proved that nurse companionship with the client positively reduces maternal anxiety during and after cesarean birth (Mostafayi et al., 2021).

5. Reinforce positive aspects of maternal and fetal condition.
It focuses on the likelihood of a desirable outcome and helps bring perceived or actual threats into perspective.

6. Let the client or couple verbalize their inner thoughts and feelings.
Helps to distinguish negative feelings and concerns and provides a chance to cope with uncertain or unresolved feelings of grief. The client may also feel emotional intimidation to her self-esteem, owing to her feelings that she has failed, that she is weak as a woman, and that her expectations have not been met. The partner may question their abilities in assisting the client and providing needed support.

ADVERTISEMENTS

7. Support or redirect expressed coping mechanisms.
Improves fundamental and automatic coping mechanisms, increases self-confidence and acceptance and reduces anxiety. Note: Some actions by the client may be viewed as ineffective (e.g., screaming and throwing things) and need to be redirected to enhance the client’s sense of control. Participants of a research study voiced that gaining control and developing a plan for their birth helped them cope with their fears (Bryanton et al., 2021).

8. Allow the client to discuss and elaborate past childbirth experiences or expectations, as appropriate.
The client may have twisted thoughts of past delivery or unrealistic perceptions of abnormality of cesarean birth that will increase anxiety.

9. Allot time for privacy.
Allows the client or couple to process information, organize resources, and cope effectively.

10. Guide the client through preoperative nursing care. 
Familiarization with preoperative nursing care can significantly reduce the client’s anxiety, heart rate, respiratory rate, and blood pressure (Mostafayi et al., 2021).

ADVERTISEMENTS

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.

ADVERTISEMENTS

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

  1. Abdelraheim, A. R., Gomaa, K., Ibrahim, E. M., Mohammed, M. M., Khalifa, E. M., Youssef, A. M., Abdelhakeem, A. K., Hassan, H., Alghany, A. A., & Gelany, S. E. (2019, July 8). Intra-abdominal infection (IAI) following cesarean section: a retrospective study in a tertiary referral hospital in Egypt. BMC Pregnancy and Childbirth, 19(234). https://doi.org/10.1186/s12884-019-2394-4
  2. Ahmadi, Z. (2020, 03 20). Identifying and explaining experiences of fear of childbirth and coping strategies: A qualitative study. Journal of Qualitative Research in Health Sciences, 9(1), 47-58. 10.22062/JQR.2020.90993
  3. Ahmed, W. A. S., & Hamdy, M. A. (2018, August 21). Optimal management of umbilical cord prolapse. International Journal of Women’s Health, 10, 459-465. 10.2147/IJWH.S130879
  4. Akalpler, O., & Okumus, H. (2018, Sept-Oct). Gum chewing and bowel function after Caesarean section under spinal anesthesia. Pakistan Journal of Medical Sciences, 34(5), 1242-1247. 10.12669/pjms.345.15772
  5. Asim, M., Alkadi, M. M., Asim, H., & Ghaffar, A. (2019, January 21). Dehydration and volume depletion: How to handle the misconceptions. World Journal of Nephrology, 8(1), 23-32. 10.5527/wjn.v8.i1.23
  6. Bonnet, M. P., & Benhamou, D. (2016, June 27). Management of postpartum haemorrhage. NCBI. Retrieved January 12, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926727/
  7. Boushra, M., & Rahman, O. (2021, July 15). Postpartum Infection – StatPearls. NCBI. Retrieved January 9, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK560804/
  8. Bryanton, J., Beck, C. T., & Morrison, S. (2021, April 22). When Fear Surrounding Childbirth Leads Women to Request a Planned Cesarean Birth. Western Journal of Nursing Research. 10.1177/01939459211010192
  9. Burke, C., & Allen, R. (2020, March/April). Complications of Cesarean Birth Clinical Recommendations for Prevention and Management. The American Journal of Maternal/Child Nursing, 45(2), 92-99. 10.1097/NMC.0000000000000598
  10. Carvalho, B., & Habib, A.S. (2019). Personalized analgesic management for cesarean delivery. International Journal of Obstetric Anesthesia, 40, 91-100. https://doi.org/10.1016/j.ijoa.2019.02.124
  11. Caughey, A. B., Wood, S. L., Macones, G. A., Wrench, I. J., Huang, J., Norman, M., Pettersson, K., Fawcett, W. J., Shalabi, M. M., Metcalfe, A., Gramlich, L., Nelson, G., & Wilson, D. (2018, December). Guidelines for intraoperative care in cesarean delivery: Enhanced Recovery After Surgery Society Recommendations (Part 2). American Journal of Obstetrics and Gynecology, 219(6), 533-544. https://doi.org/10.1016/j.ajog.2018.08.006
  12. Chen, H., & Tan, D. (2019, February 21). Cesarean Section or Natural Childbirth? Cesarean Birth May Damage Your Health. frontiers in Psychology, 10(351). https://doi.org/10.3389/fpsyg.2019.00351
  13. Chokshi, A., Sifri, Z., Cennimo, D., & Horng, H. (2019, Jan-Mar). Global Contributors to Antibiotic Resistance. Journal of Global Infectious Diseases, 11(1), 36-42. 10.4103/jgid.jgid_110_18
  14. Chung, F.-F., Wan, G.-H., Kuo, S.-C., Lin, K.-C., & Liu, H.-E. (2018, September 6). Mother-infant interaction quality and sense of parenting competence at six months postpartum for first-time mothers in Taiwan: a multiple time-series design. BMC Pregnancy and Childbirth, 18(365). https://doi.org/10.1186/s12884-018-1979-7
  15. Cripe, E. T. (2017, March 29). “The Scarlet C”: Exploring Caesarean Section Stigma. Health Communication, 33(6), 782-785. 10.1080/10410236.2017.1298953 
  16. Damanabad, Z. H., Valizadeh, L., Hosseini, M., Abdolalipour, M., & Jafarabadi, M. A. (2021, July 23). Comparing the Effects of Face‑to‑Face and Video‑Based Educations on Hand Hygiene Knowledge and Performance among Mothers in Neonatal Intensive Care Unit: A Randomized Controlled Trial. Nursing and Midwifery Studies, 10(3), 158-164. 10.4103/NMS.nms_18_20
  17. Fawole, B., & Hofmeyr, G. (2012, December 12). Maternal oxygen administration for fetal distress. Cochrane Database of Systematic Reviews, (12). 10.1002/14651858.CD000136.pub2
  18. Fernández, V. R., y Cajal, C. N. L. R., Ortiz, E. M., & Naveira, E. C. (2018). Intrapartum and perinatal results associated with different degrees of staining of meconium-stained amniotic fluid. European Journal of Obstetrics & Gynecology and Reproductive Biology, 228, 65-70.
  19. Fowler, J. R., & Simon, L. V. (2021, September 8). Chorioamnionitis – StatPearls. NCBI. Retrieved January 9, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK532251/
  20. Galante, D. (2010, March 10). Considerations on labor analgesia and drug complications. British Journal of Anaesthesia, 105(eLetters Supplement). https://doi.org/10.1093/bja/el_5617
  21. Ghi, T., Pasquo, E. D., Dall’Asta, A., Commare, A., Melandri, E., Casciaro, A., Fieni, S., & Frusca, T. (2020, October 13). Intrapartum fetal heart rate between 150 and 160 bpm at or after 40 weeks and labor outcome. Acta Obstetricia et Gynecologica Scandinavica, 100(3), 548=554. https://doi.org/10.1111/aogs.14024
  22. Gibbs, B. G., Forste, R., & Lybbert, E. (2018, January 31). Breastfeeding, Parenting, and Infant Attachment Behaviors. Maternal and Child Health Journal, 22, 579-588. https://doi.org/10.1007/s10995-018-2427-z
  23. Grant, E. K., Gattamorta, K. A., & Foronda, C. L. (2020, March 21). Reducing the risk of unintended retained surgical sponges: A quality improvement project. Perioperative Care and Operating Room Management, 21. https://doi.org/10.1016/j.pcorm.2020.100099
  24. Hasan, F., Ahmed, N., Jamil, R., Ali, L., & Khan, F. A. (2021, 06 30). Frequency and Indications of Primary Cesarean Section. Journal of Surgery Pakistan, 26(1). 10.21699/jsp.26.1.2.
  25. Ilska, M., Banas, E., Gregor, K., Salmeri, A. B., Ilski, A., & Cnota, W. (2020, August). Vaginal delivery or cesarean section – Severity of early symptoms of postpartum depression and assessment of pain in Polish women in the early puerperium. Midwifery, 87. https://doi.org/10.1016/j.midw.2020.102731
  26. Kim, D. R., & Wang, E. (2015, August 15). Prevention of supine hypotensive syndrome in pregnant women treated with transcranial magnetic stimulation. Psychiatry Research, 218, 1-2. 10.1016/j.psychres.2014.04.001
  27. Kjerulff, K. H., & Brubaker, L. H. (2017, October 20). New mothers’ feelings of disappointment and failure after cesarean delivery. Birth, 45(1), 19-27. https://doi.org/10.1111/birt.12315
  28. Kruse, A. R., Lauszus, F. F., Forman, A., Kesmodel, U. S., Rugaard, M. B., Knudsen, R. K., Persson, E.-K., Uldbjerg, N., & Sundtoft, I. B. (2020, November 11). Effect of early discharge after planned cesarean section on recovery and parental sense of security. A randomized clinical trial. Acta Obstetricia et Gynecologica Scandinavica, 100(5), 955-963. https://doi.org/10.1111/aogs.14041
  29. Labor, S., & Maguire, S. (2008, December). The Pain of Labour. Reviews in Pain, 2(2), 15-19. 10.1177/204946370800200205
  30. Leifer, G. (2018). Introduction to Maternity and Pediatric Nursing (8th ed.). Elsevier.
  31. Li, L., Wen, J., Li, Y., & Li, Y. (2010, December 23). Is routine indwelling catheterization of the bladder for cesarean section necessary? A systematic review. BJOG: An /International Journal of Obstetrics and Gynecology, 118(4), 400-409. https://doi.org/10.1111/j.1471-0528.2010.02802.x
  32. Macones, G. A., Caughey, A. B., Wood, S. L., Wrench, I. J., Huang, J., Norman, M., Pettersson, K., Fawcett, W. J., Shalabi, M. M., Metcalfe, A., Gramlich, L., Nelson, G., & Wilson, D. (2019, September). Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3). American Journal of Obstetrics and Gynecology, 221(3), 247. https://doi.org/10.1016/j.ajog.2019.04.012
  33. Miovech, S. M., Knapp, H., Borucki, L., Roncoli, M., Arnold, L., & Dorothy Brooten. (n.d.). Major Concerns of Women After Cesarean Delivery. NCBI. Retrieved January 14, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3694506/
  34. Mostafayi, M., Imani, B., Zandi, S., & Jongi, F. (2021, June). The effect of familiarization with preoperative care on anxiety and vital signs in the patient’s cesarean section: A randomized controlled trial. European Journal of Midwifery, 5, 1-7. https://doi.org/10.18332/ejm/137366
  35. Nanthiphatthanachai, A., & Insin, P. (2020). Effect of chewing gum on gastrointestinal function recovery after surgery of gynecological cancer patients at Rajavithi Hospital: a randomized controlled trial. Asian Pacific journal of cancer prevention: APJCP, 21(3), 761.
  36. Pillitteri, A., & Silbert-Flagg, J. (2018). Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family (8th ed.). Wolters Kluwer.
  37. Puia, D. (2018, Winter). First-Time Mothers’ Experiences of a Planned Cesarean Birth. The Journal of Perinatal Education, 27(1), 50-60. 10.1891/1058-1243.27.1.50 
  38. Rookesh, Z., Kaviani, M., Zarshenas, M., & Akbarzadeh, M. (2021, October 22). Comparison of Maternal-Infant Attachment in Cesarean Delivery Based on Robson Classification: A Cross-Sectional Study. Iranian Journal of Nursing and Midwifery Research, 26(6), 500-507. 10.4103/ijnmr.IJNMR_230_19
  39. Salam Ramadan, S. A. E., & Farrag, R. E. (2018, October). UTILIZATION OF SELF CARE GUIDELINE TO PROMOTE QUALITY OF LIFE AMONG WOMEN UNDERGOING CESAREAN SECTION. The Malaysian Journal of Nursing, 10(2). :10.31674/mjn.2018.v10i02.007
  40. Sentilhes, L., Senat, M. V., Le Lous, M., Winer, N., Rozenberg, P., Kayem, G., Verspyck, E., Fuchs, F., Azria, E., Gallot, D., Korb, D., & Desbriere, R. (2021, April 29). Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery. The New England Journal of Medicine, 384(17). 10.1056/NEJMoa2028788
  41. Shen, D., Moriyama, M. H., Ishida, K., Fuseya, S., Tanaka, S., & Kawamata, M. (2020, May 12). Acute postoperative pain is correlated with the early onset of postpartum depression after cesarean section: a retrospective cohort study. Journal of Anesthesia, 34, 607-612. https://doi.org/10.1007/s00540-020-02789-5
  42. Solehati, T., & Rustina, Y. (2015, June 22). Benson Relaxation Technique in Reducing Pain Intensity in Women After Cesarean Section. Anesthesiology and Pain Medicine, 5(3). 10.5812/aapm.22236v2
  43. Tennant, K., & Rivers, C. L. (2021, September 21). Sterile Technique – StatPearls. NCBI. Retrieved January 9, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK459175/
  44. Vafaeenejad, Z., Elyasi, F., Moosazadeh, M., & Shahhosseini, Z. (2019, April 9). Psychological factors contributing to parenting styles: A systematic review. F1000Research, 7(906). https://doi.org/10.12688/f1000research.14978.2
  45. Wilson, R. D., Caughey, A. B., Wood, S. L., Macones, G. A., Wrench, I. J., Huang, J., Norman, M., Pettersson, K., Fawcett, W. J., Shalabi, M. M., Metcalfe, A., Gramlich, L., & Nelson, G. (2018, December). Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery (ERAS) Society Recommendations (Part 1). American Journal of Obstetrics and Gynecology, 219(6), 523.e1-523.e15. https://doi.org/10.1016/j.ajog.2018.09.015

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.

  • >