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!
Risk for Situational Low Self-Esteem
Society currently perceives childbirth as a natural process. Therefore, women who give birth through cesarean section are stigmatized because they are seen as having avoided something difficult- the rite of motherhood- going through hours of agonizing labor- for not having their babies the “natural way” (Cripe, 2017). Following a cesarean birth, women were more likely to experience loss of self-esteem and report struggling with body image (Burcher et al., 2016).
- Risk for Situational Low Self-Esteem
Risk factors may include
- Perceived “failure” at a life event
- Behavior inconsistent with a belief system
- Fear of stigma
Possibly evidenced by
A risk diagnosis is not evidenced by signs and symptoms, the presence of signs and symptoms establishes an actual/problem diagnosis. Nursing interventions are directed at prevention.
Desired outcomes and goals
- The client identifies and discusses negative feelings.
- The client verbalizes confidence in herself and her abilities.
- The client identifies coping strategies for the present situation.
Nursing Assessment and Rationales
1. Assess the client’s unusual feelings about self and pregnancy. Note cultural influences.
Diagnosis of a shift in the self-concept is based on past perceptions and experiences. Cesarean birth can change how the client feels about herself, even if planned or not. The client sees that the birth plan has been changed and that surgical intervention is needed to deliver the infant, while most women can deliver without any such intervention.
2. Assess for grief, depression, and ineffective coping.
Grief can result from not being able to follow a birthing plan or going against a cultural belief can lead the woman to question the decisions made and may increase the risk for depression in the postpartum period. Women who undergo cesarean birth have higher risks of postpartum depression (Shen et a., 2020). The nurse should provide comprehensive education about the fear of childbirth.
Nursing Interventions and Rationales
1. Allow the client to verbalize feelings and thoughts.
Determines areas to be discussed. Clients’ feedback varies and may be hard to diagnose in the preoperative stage. Feelings of negative self-image related to disappointment in the birth experience may interfere with postpartum activities related to successful breastfeeding and infant care.
2. Encourage questions and give facts. Reinforce previous learning.
Improves understanding and clarifies misconceptions. Women who do not have a spontaneous vaginal delivery at first childbirth may have mixed feelings after the delivery: happy about their new baby but sad or disappointed about the labor and delivery process. Family and friends may have difficulty understanding a new mother’s feelings after a cesarean or instrumental vaginal childbirth (Kjerulff & Brubaker, 2017).
3. Associate cesarean birth as an alternative method of childbirth.
Terms like “C-section” and “normal delivery” may bolster the client’s thought that the cesarean birth is unusual and abnormal, and the client may look at herself as inadequate, flawed, or weak. Women who had unplanned cesarean were considerably more likely to feel like a failure (Kjerulff & Brubaker, 2017). Therefore, the nurse needs to reinforce cesarean birth as another delivery method instead of surgical intervention or a treatment method.
4. Provide verbal communication of assessment and interventions. Written information can be given at a later time.
When a self-esteem problem arises for the client, it may become more critical postpartum. During the preoperative period, the client focuses on the here and now and may not be ready to read or deal with additional information.
5. Recognize other couples or resources to refer the situation to after delivery.
At this significant time, the view of the situation usually does not provide a chance to communicate with others who have shared the same experience. However, these activities may help with the resolution of feelings and perceptions.
6. Allow a partner’s presence at the delivery as desired.
Provides support for the client, encourages parental bonding, and gives additional input to the client’s recall of the birth experience because memory lapses are more common during periods of crisis. Some cultures may prevent the father’s presence during delivery, necessitating a female family member instead.
7. Encourage the client or couple to participate in room bonding activities (e.g., breastfeeding and holding the infant) as able.
Reinforces the birth experience and deemphasizes the surgical nature of the delivery. Women who underwent cesarean birth may feel disappointed or fail because of their birthing process. However, maternal bonding and breastfeeding may reinforce the feeling of purposefulness.
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
- Cesarean Birth | 10 Care Plans UPDATED!
- Cleft Palate and Cleft Lip | 6 Care Plans
- Dysfunctional Labor (Dystocia) | 4 Care Plans
- Elective Termination | 6 Care Plans
- Gestational Diabetes Mellitus | 8 Care Plans UPDATED!
- Hyperbilirubinemia | 4 Care Plans
- 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 Infection | 4 Care Plans
- 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!
References and Sources
- 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
- 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
- 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
- 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
- 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
- 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/
- Boushra, M., & Rahman, O. (2021, July 15). Postpartum Infection – StatPearls. NCBI. Retrieved January 9, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK560804/
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Cripe, E. T. (2017, March 29). “The Scarlet C”: Exploring Caesarean Section Stigma. Health Communication, 33(6), 782-785. 10.1080/10410236.2017.1298953
- 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
- Fawole, B., & Hofmeyr, G. (2012, December 12). Maternal oxygen administration for fetal distress. Cochrane Database of Systematic Reviews, (12). 10.1002/14651858.CD000136.pub2
- 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.
- 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/
- 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
- 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
- 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
- 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
- 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.
- 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
- 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
- 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
- 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
- Labor, S., & Maguire, S. (2008, December). The Pain of Labour. Reviews in Pain, 2(2), 15-19. 10.1177/204946370800200205
- Leifer, G. (2018). Introduction to Maternity and Pediatric Nursing (8th ed.). Elsevier.
- 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
- 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
- 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/
- 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
- 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.
- Pillitteri, A., & Silbert-Flagg, J. (2018). Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family (8th ed.). Wolters Kluwer.
- 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
- 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
- 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
- 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
- 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
- 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
- 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/
- 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
- 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.