CEASAREAN

SECTION
DELIVERY
Prepared by:
AM VYELLICA MARICOR CO MAGUYON, RN
 CEASAREAN SECTION DELIVERY
“C-SECTION”
• surgical delivery method where the baby is
delivered through an incision made in the mother’s
abdomen and uterus.
• elective or arise from an unanticipated problem
(emergency)
• anesthesia may be general, spinal, or epidural
anesthesia.
• types of uterine incisions are possible (1) low
transverse; (2) low vertical; and (3) classic,
 TYPES OF C-SECTION
1.Emergency C-section: sudden, unexpected
complication that requires immediate delivery of the
baby. Examples of emergency situations may include
fetal distress, placental abruption, or uterine rupture.

2.Planned C-section: scheduled in advance and may

be recommended for various reasons, such as previous
C-sections, multiple pregnancies, certain medical
conditions, or fetal abnormalities.
3. Repeat C-section: for previous C-section
delivery and is recommended to have another C-
section for a subsequent pregnancy.

4. Classical C-section: a vertical incision made

in the uterus and is rarely performed due to
higher risks of complications, such as bleeding
and future uterine rupture.
5. Low-transverse C-section: most common type of C-
section performed.
• horizontal incision made in the lower part of the
uterus, which is less likely to cause complications
and allows for future vaginal births after a C-section
(VBAC).

6. T-shaped C-section:
• horizontal incision across the lower uterus, as well as
a vertical incision extending down the uterus, and is
typically performed in cases of abnormal fetal
positioning or certain medical conditions.
 INDICATIONS IN PERFORMING A
CESAREAN DELIVERY
Maternal factors
1.Cephalopelvic disproportion
(CPD)
2.Active genital herpes or Fetal factors
papilloma 1.Transverse fetal lie
3.Previous cesarean birth by 2.Extreme low birth weight
classic incision 3.Fetal distress
4.Presence of severe disabling 4.Compound conditions, such
hypertension or heart disease as macrosomia and transverse
lie.
Placental factors
5.Placenta previa
6.Abruptio placental
 PREOPERATIVE ASSESSMENT
• Maternal history, allergies for foods, medications and
anesthesia.
• Physical and psychological state.
• For obese woman:
poor nutritional status - slow wound healing
early ambulation – pneumonia and thrombophlebitis
• Protein and vitamin deficiency – poor wound healing
• Comorbidities – greater surgical risk
• NPO for 8 hours for elective C-section deliveries.
• Initiated IVF replacement – to prevent fluid and electrolyte
imbalance.
PREOPERATIVE DIAGNOSTIC PROCEDURES

• Circulatory and renal function assessments

and fetal heart rate
• Complete blood count and PT and PTT
• Urinalysis for renal function
• Vital sign determination, serum electrolyte and pH,
blood typing and cross-matching, and ultrasound to
determine fetal presentation and maturity.
• For prolonged labor – increase in WBC – risk for
infection
 PREOPERATIVE MEASURES
• Secure consent
• No jewelries, no nail polish (capillary refill), no
dentures (obstruction)
• Gastric emptying agents (metoclopramide) – to
decrease stomach secretions
• Foley catheter insertion – reduce bladder size and to
keep away the bladder to the surgical field
• Ringer’s for IVF – for hydration
• Minimum preoperative medications (premeds,
anesthesia meds)
• Left lateral position to prevent supine hypotension
 INTRAOPERATIVE MEASURES
• Transferred to OR theatre / transferred to OR bed
• Hooked to cardiac monitor for vital signs
• Oxygen administration
• Anesthesia of choice – regional block/spinal/epidural
• For skin preparation, shaving the surgical site, use Povidone Iodine
10% and Povidone Iodine 7% as antiseptic
• Place towel under her right hip to move abdominal contents away
from the surgical field and lift her uterus away from the vena cava.
• Placing sterile drapes. Setting up sterile field.
• Ensures accurate count of instruments, sponges and sutures
• Vaginal evacuation of blood, assessing urine output (color)
• Application of wound dressing and antiseptic
• Place abdominal binder
• Transfer to recovery room safely.
 POSTPARTAL CARE/MEASURES
• PAIN control is a major problem after delivery. – use pain scale rating
• Postoperative medications.
• Encourage ambulate because this is the most effective method to relieve
gas pain.
• Encourage breastfeeding.
• Instruct proper diet and increase fluid intake- to prevent constipation. It is
normal not to have bowel movements for 3 to 4 days postoperatively.
• Daily wound care of the incision site.
• Urine output postoperative.
• Anesthesia wise: Flat on bed if s/p spinal/epidural anesthesia. Anesthesia
wear off – able to move and bend both lower extremities (if s/p spinal
anesthesia)
• Maintaining a well-contracted uterus. (massage uterus)
• Assessing vaginal blood discharge prior to transout.
 NURSING CARE PLAN AND
MANAGEMENT

1. RISK FOR BLEEDING

• Risk for bleeding associated with Cesarean delivery
can be caused by severe blood loss after delivery (
postpartum hemorrhage) and pregnancy-related
complications.
Nursing Diagnosis: Risk for Bleeding
Related to:
 Increasing maternal age
 Obesity or high body mass index
 Previous uterine scar
 Pregnancy-related conditions such as
preeclampsia
 Placenta previa
 Placental abruption
 Multiple fetuses
Expected outcomes:
 Patient will not experience heavy post-
surgical bleeding
 Patient will demonstrate an expected amount
of lochia daily after delivery
 Patient will be able to manifest signs of
uterine involution
RISK FOR BLEEDING ASSESSMENT

1. Determine risk factors for bleeding.

2. Assess coagulation factors.
3. Assess the uterus.
4. Assess for signs and symptoms of bleeding.
5. Assess the patient’s intake and output.
6. Monitor blood pressure.
7. Assess lochia characteristics.
RISK FOR BLEEDING INTERVENTIONS

1. Perform fundal assessment.

2. Evaluate the incision.
3. Advise early ambulation.
4. Count the pads.
 NURSING CARE PLAN AND
MANAGEMENT

2. ACUTE PAIN R/T SURGICAL INCISION

Assessment: The patient reports pain at the incision

site that is sharp and stabbing in nature, with a pain
rating of 8 out of 10.
Evidenced by:

• The patient reports pain at the incision site

• Pain is described as sharp and stabbing,
the pain rating is 8 out of 10
• The patient has limited movement due to pain
• The patient is anxious and restless due to pain
Expected Outcome:

• patient will experience a reduction in pain intensity

and improved comfort levels. The patient will be
able to move more freely without pain and will be
able to participate in activities of daily living
without discomfort.
ACUTE PAIN INTERVENTIONS:
1. Administer pain medication as prescribed.
2. Encourage the patient to use relaxation techniques, such as
deep breathing and progressive muscle relaxation.
3. Position the patient in a comfortable position that promotes
healing and reduces pressure on the incision site
4. Educate the patient about the importance of wound care and
hygiene, including how to properly clean and dress the incision
site
5. Encourage the patient to engage in distractions, such as
reading, listening to music, or watching TV, to take their mind
off the pain
 EVALUATION:
• This can be done by assessing the patient’s pain levels and
comfort levels, as well as their ability to move and participate
in activities of daily living without discomfort.

• If the patient reports a reduction in pain intensity, improved

comfort levels, and increased ability to move and participate in
activities of daily living without discomfort, then the nursing
interventions have been successful. If the patient continues to
experience high levels of pain or discomfort, then the nursing
interventions should be re-evaluated and revised as needed.
 NURSING CARE PLAN AND
MANAGEMENT
3. IMPAIRED PHYSICAL MOBILITY R/T PAIN
Assessment:

• inability to move freely and independently. The patient is experiencing

impaired physical mobility related to pain following a Cesarean section (C-
section). The patient reports pain at the incision site that is limiting their
ability to move, walk and perform activities of daily living.
Evidenced by:

• The patient reports pain at the incision site

• Pain is described as severe and sharp in nature
• The patient reports difficulty moving, walking, and
performing activities of daily living due to pain
• The patient is using a wheelchair or assistive device
for mobility
• The patient reports feeling anxious and depressed
due to their limited mobility.
Expected Outcome:

• The expected outcome of the nursing diagnosis of

Impaired Physical Mobility is for the patient to
experience improved mobility and independence.
The patient will be able to walk and perform
activities of daily living without significant pain
or assistance.
 IMPAIRED MOBILITY
INTERVENTIONS:
1. Administer pain medication as prescribed.
2. Encourage the patient to use a pillow or abdominal binder to
support the incision site while moving or walking, which can
reduce pain levels and improve mobility.
3. Assess the patient’s environment for safety hazards and make
modifications as needed to reduce the risk of falls and injuries.
4. Educate the patient and family members about proper body
mechanics and techniques for lifting and transferring, which can
reduce the risk of injury and pain.
5. Encourage the patient to engage in regular physical therapy and
exercise programs to improve strength and flexibility, which can
reduce pain levels and improve mobility.
EVALUATION:
• This can be done by assessing the patient’s ability to move
and participate in activities of daily living without
significant pain or assistance, as well as their use of
assistive devices.

• If the patient reports improved mobility and independence,

reduced pain levels, and appropriate use of assistive
devices, then the nursing interventions have been
successful. If the patient continues to experience impaired
physical mobility or high levels of pain, then the nursing
interventions should be re-evaluated and revised as needed.
 NURSING CARE PLAN AND
MANAGEMENT

4. FEARR/T PERCEIVED THREAT TO OWN WELL-

BEING, THE OUTCOME OF BIRTH

Assessment:
The patient reports feeling anxious and fearful about the
procedure, as well as concerned about their own well-being and
the well-being of their baby.
Evidenced by:

• The patient reports feeling anxious and fearful

about the C-section procedure
• Patient expresses concerns about their own well-
being and the well-being of their baby
• The patient is tearful and appears agitated
• The patient’s vital signs are elevated, including
heart rate and blood pressure
• The patient has difficulty sleeping and eating due
to anxiety.
Expected Outcome:

• The expected outcome for the nursing diagnosis of

Fear is for the patient to experience a reduction in
anxiety and fear related to the C-section and the
outcome of their birth. The patient will be able to
verbalize their concerns and fears, as well as
identify coping strategies to manage their anxiety.
Evaluation:

This can be done by assessing the patient’s anxiety

levels, vital signs, and ability to verbalize their concerns and
fears. If the patient reports a reduction in anxiety and fear, as
well as the ability to identify coping strategies to manage their
anxiety, then the nursing interventions have been successful. If
the patient continues to experience high levels of anxiety and
fear, then the nursing interventions should be re-evaluated and
revised as needed.
 NURSING CARE PLAN AND
MANAGEMENT

1. DISTURBED BODY IMAGE R/T SURGERY, UNMET

EXPECTATIONS FOR CHILDBIRTH

Assessment:

Refers to an individual’s negative perception of their physical

appearance, which can lead to emotional distress, decreased self-esteem,
and social isolation.
The patient expresses dissatisfaction with her physical appearance
due to scarring from surgery and changes to her body following childbirth.
Evidenced by:

• Patient expresses dissatisfaction with physical appearance and negative

feelings towards their body
• The patient avoids looking in the mirror or engaging in activities that
involve physical appearance
• Patient reports feeling embarrassed or self-conscious in public due to their
physical appearance
• The patient is experiencing anxiety and depression related to their negative
body image
• The patient is experiencing difficulty with sexual relationships due to their
negative body image.
Expected Outcome:

• The patient to develop a more positive perception of their

physical appearance and improved self-esteem. The patient will
feel comfortable engaging in social activities that involve their
physical appearance and will have improved sexual
relationships.
DISTURBED BODY IMAGE – NURSING
INTERVENTIONS

1. Develop a therapeutic relationship with the patient to create a supportive

environment where they can express their concerns and fears without judgment.
2. Encourage the patient to verbalize their feelings and concerns related to their
negative body image.
3. Provide education to the patient about the normal physical changes that occur
after surgery and childbirth.
4. Collaborate with the healthcare team to develop a plan for scar management
and/or other interventions to improve the patient’s physical appearance
5. Encourage the patient to engage in activities that promote positive body images,
such as exercise or self-care.
Evaluation:

• This can be done by assessing the patient’s verbalization of their feelings

related to their body image, as well as observing their behavior related to
social activities and sexual relationships.

• If the patient reports feeling more positive about their physical

appearance, engaging in social activities, and having improved sexual
relationships, then the nursing interventions have been successful. If the
patient continues to express negative feelings about their body image,
then the nursing interventions should be re-evaluated and revised as
needed
THANK YOU VERY MUCH FUTURE NURSES!!!