CS

• Cesarean birth


  Birth accomplished through an abdominal incision into the uterus
• Cesarean birth is one of the oldest types of surgical procedures known
• Cesarean birth is always slightly more hazardous than vaginal birth, but compared with other surgical procedures, it is one of the safest types of surgeries and one with few complications
• The word "cesarean"


  Derived from the Latin word "caedore" which means "to cut"
• There was a popular belief that Julius Caesar was born by a cesarean birth and the procedure was named for him, but this is unlikely as Caesar was born before antibiotics and sterile surgical technique
• Cesarean birth


  A birth more than a surgical procedure
• National Health Goals related to cesarean birth

  • Reduce the rate of cesarean births among low-risk women having their first child to 15% of live births
  • Reduce the rate of cesarean births among women who have had a prior cesarean birth to 63% of live births
• Nurses


  • Can help the nation achieve these goals by encouraging women who fulfill the criteria for vaginal birth after cesarean (VBAC) to attempt a vaginal birth with a second child
  • Can conduct additional nursing research on the effect of nursing practice and the cesarean birth rate, effective pain management for cesarean birth, and measures to help the family adjust smoothly from the hospital to the home setting after a cesarean birth
• The same important outcome applies to a woman giving birth by cesarean as a woman giving birth vaginally: a healthy mother and a healthy child
• Because cesarean birth decisions can be made suddenly, planning can be limited to only a few minutes
• Plans must include discharge instructions and home care, because a woman will remain in the health care facility only 2 or 3 days
• For a woman who knows in advance that she will have a cesarean birth, helpful websites to use for referral are the March of Dimes and the International Cesarean Awareness Network
• When giving care to any woman during labor, it is imperative to establish early on a helping relationship with both the woman and her support person
• An important intervention includes coordination of health care team members such as an anesthesiologist, surgeon, pediatrician or neonatologist, and recovery room or nursery personnel
• Many interventions focus on teaching and support, because the more a woman understands about what is happening, the more she can accept and cooperate with procedures
• During surgery, sterile technique is essential as a postpartal infection can be devastating to a woman who already has made many other physical adaptations
• After surgery, it is important to provide adequate "talk time" to allow a woman time to review what has happened and integrate it into what she and her partner expected
• Currently, cesarean birth is used most often as a prophylactic measure, to alleviate problems of birth such as cephalopelvic disproportion or failure to progress in labor
• In 1970, only 5.5% of women in the United States had infants born by cesarean birth, but currently the incidence of primary cesarean births is about 30.2% or one-third of births
• The increased rate of cesarean births results from a combination of the increasing safety of cesarean birth, the use of fetal monitors, an increased incidence in obese women, and elective cesarean births chosen by women for convenience or to prevent potential urinary or anal incontinence later in life
• The increase in rate may also be related to physicians' fears of malpractice suits should a fetus be allowed to be born vaginally and then be discovered to have suffered anoxia
• Although the present incidence of cesarean births is a concern, this concern must be weighed against the potential for the procedure to reduce the incidence of infants who are born cognitively or physically challenged or who die at birth
• Nurse-midwifery birthing services have a lower incidence of cesarean births than hospital services because of the higher incidence of low-risk women in these settings, and continuous support during labor appears to decrease the incidence
• Scheduled cesarean birth


  There is time for thorough preparation for the experience throughout the antepartal period
• Emergent cesarean birth


  Preparation must be done much more rapidly but with the same concern for fully informing a woman and her support person about what circumstances created the need for a cesarean birth and how the birth will proceed
• In the 1950s, cesarean birth became a status symbol when Hollywood stars asked to have cesarean births to save themselves the strain of labor and in some instances to schedule the birth conveniently between movie contracts
• Although many cesarean births are done because the woman had a past cesarean birth, with new surgical techniques, particularly the use of a low cervical incision, "once a cesarean, always a cesarean" no longer applies
• Most women who have had a cesarean birth within the past 10 years are eligible to give birth vaginally in subsequent pregnancies if the circumstances otherwise are appropriate for vaginal birth
• Cesarean birth is mandatory when there is a physical indication such as a transverse presentation, genital herpes, or cephalopelvic disproportion
• Other indications for cesarean birth

  • Active genital herpes or perhaps human papillomavirus
  • AIDS or HIV-positive status
  • Cephalopelvic disproportion
  • Cervical cerclage
  • Disabling conditions, such as severe hypertension of pregnancy, that prevent pushing to accomplish the pelvic division of labor
  • Failed induction or failure to progress in labor
  • Obstructive benign or malignant tumor
  • Previous cesarean birth by classic incision
  • Elective no indicated risks
  • Placenta previa
  • Premature separation of the placenta
  • Umbilical cord prolapse
  • Compound conditions such as macrosomic fetus in a breech lie
  • Extreme low birth weight
  • Fetal distress
  • Major fetal anomalies, such as hydrocephalus
  • Multigestation or conjoined twins
  • Transverse fetal lie
• Emergent cesarean births are done for reasons such as placenta previa, premature separation of the placenta, fetal distress, or failure to progress in labor
• An emergent cesarean birth carries with it the risk of any emergent surgery: the woman may not be a prime candidate for anesthesia and is psychologically unprepared for the experience
• In addition, the woman may have a fluid and electrolyte imbalance and be both physically and emotionally exhausted from a long labor
• Stress response


  Whenever the body is subjected to stress, either physical or psychosocial, it responds with measures to preserve the function of major body systems, resulting in release of epinephrine and norepinephrine from the adrenal medulla
• These normally positive stress responses may antagonize anesthetic action, which is aimed at minimizing body activity, and in the pregnant woman, may minimize blood supply to the lower extremities
• Cesarean birth has systemic effects on the woman's body
• Stress Response


  1. Release of epinephrine and norepinephrine from the adrenal medulla

  2. Increased heart rate, bronchial dilatation, elevation of blood glucose level

  3. Peripheral vasoconstriction, increased blood pressure

  4. May antagonize anesthetic action and minimize blood supply to lower extremities
• Interference with body defenses

  • Skin serves as primary line of defense against bacterial invasion, which is lost during surgery
  • Strict adherence to aseptic technique is necessary to compensate for impaired defense
• Interference with circulatory function

  • Some blood loss always occurs with surgery, which can lead to hypovolemia and lowered blood pressure
  • Amount of blood lost is higher in cesarean birth compared to vaginal birth
• Interference with body organ function

  • Temporary disruption in function of organs handled, cut or repaired during surgery
  • Edema or inflammation can further impair organ function
  • Close assessment of primary organ involved and total body function is necessary