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!
Women who underwent cesarean birth reported a sense of loss, powerlessness, and lack of control during the birth, and many used the word “traumatic” to describe their experience. Many women view childbirth as a “landmark event,” and cesarean birth may be perceived as a loss of this experience. Loss of control is significant, as women with the lowest perceived control have the least satisfaction and the greatest risk for postpartum depression (Burcher et al., 2016).
May be related to
- Interpersonal interaction
- Illness-related regimen
- Lifestyle of helplessness
May be evidenced by
- Verbal expressions of loss of control over the situation
- Lack of participation in the care and decision-making
- Passivity or anger
Desired outcomes and goals
- The client verbalizes fears and feelings of vulnerability.
- The client expresses individual needs and desires.
- The client participates in the decision-making process whenever possible.
Nursing Assessment and Rationales
1. Appraise circumstances contributing to a sense of powerlessness.
Powerlessness becomes a major stress factor for clients experiencing their first hospitalization, including fear of the unknown. Unplanned (and sometimes planned) cesarean birth may be characterized by the client’s or couple’s sense of loss of control over the birth experience (Burcher et al., 2016).
2. Identify the client’s strengths and past successful coping strategies.
Helps the client to recognize their ability to deal with a difficult situation. One of the most important strategies for coping with the fear of childbirth is the feeling of confidence. Maternal confidence can be derived from four important factors, according to a qualitative study by Ahmadi (2020): faith in God, receiving support, raising awareness, and positive thinking.
Nursing Interventions and Rationales
1. Encourage the client to consider options in care when possible (e.g., IV placement, choice of anesthesia, and use of the mirror).
Provide client opportunities to control as many events (e.g., choice of food, placement of IV cannula, choice of anesthesia type, etc.) as care restrictions may permit the client to have some sense of control over the situation.
2. Recognize client or couple’s expectations and desires concerning the delivery experience.
Provides an opportunity to accommodate needs and encourage a positive experience. Increasing awareness and preparation for childbirth is an important strategy for coping with the fear of childbirth. Well-prepared women have higher confidence which translates to reduced fear of losing control of the situation (Ahmadi, 2020).
3. Allot personal time and space for the couple before the surgery, if possible. Stay with the client if the partner is absent.
Provide an opportunity to let the couple talk about the situation through their means. Leaving the client alone may result in feelings of abandonment and adds anxiety. Providing ongoing emotional and psychological support to the mother creates comfort and reassurance and reduces fear and pain (Ahmadi, 2020).
4. Provide information, and talk about the client or couple’s perceptions.
Providing information diminishes stress brought by misconceptions and unfounded fear. By receiving correct information, well-prepared women for pregnancy and childbirth have greater expectations of actual pain levels and are less likely to experience inability and loss of control (Ahmadi, 2020).
5. Develop a care plan with the client specifying goals agreed on.
Enhances commitment to the plan and optimizing outcomes. Shared decision-making before and during labor and delivery is critical for developing and preserving a client-provider relationship characterized by trust, mutual respect, multidirectional communication, and shared power/control (Ahmadi, 2020).
6. Facilitate return to a productive role in whatever capacity possible for the client.
The extent of recovery following a cesarean birth varies among clients. For some women, emotional recovery is much more difficult than physical recovery. Difficulties with infant care, particularly breastfeeding, also influence the client’s productive role. The presence of support and social interaction can positively impact the client’s emotional and physical recovery. Education about infant care and breastfeeding also increases the client’s control of the situation and her new role as a mother (Puia, 2018).
7. Encourage the client to think productively and positively and take responsibility for their thoughts.
Having positive attitudes such as paying attention to positive aspects like becoming a mother and others’ positive experiences and using positive visualization such as imagining the pleasing results of childbirth and having beautiful perceptions about the moment of mother and child visit creates positive thinking. It ultimately reduces the fear of childbirth (Ahmadi, 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
- 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!
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With contributions by Marianne Belleza RN.