DRUG LIST H –Health Teachings

-Ranitidine (PREOP) Informed patient to avoid lifting heavy objects for 1-

2 weeks
-Ampicillin(PREOP)
Stressed the importance of perineal cleanliness
Nalbuphine (Nubain)
Encouraged client to have hot sitz bath
Ketorolac (Kortezor)
Instructed patient to increase intake of protein-rich
Methylergonomitrine foods to promote faster wound healing

Instructed to promote adequate fluid intake

PREOP Discouraged patient to participate in strenuous

activities that might precipitate stress and trauma to
Imbalanced Nutrition: More the wound
than body requirements r/t Instructed patient to promote breastfeeding
excessive intake in relation to O –Observable Signs and Symptoms
metabolic need Observe for dehiscence and evisceration
PREOP Instructed patient to report to physician any signs of
infection
Deficient knowledge r/t lack of
Instructed patient to report any case of hemorrhage or
interest in learning abnormal bleeding
POSTOP D – Diet
Acute pain r/t traumatized skin Encouraged client to increase intake of fiber to avoid
constipation
Tissue
Instructed to increase fluid intake
POSTOP
Instructed to increase intake of nutritious foods such
Risk f
as fruits and vegetables
or infection r/t
Low Transverse C-Section 
traumatized skin tissue 2° to In a low transverse C-section (LTCS), the doctor cuts
through the lower uterine segment of the uterus,
cesarean section which typically doesn't involve the same tissue as a
classical C-section. This region of the uterus has less
POSTOP muscular fiber, and is less easy to tear or rupture with
future labors.
Risk for constipation r/t post
There are still risks with a LTCS, but they seem to be
pregnancy 2° to cesarean fewer in nature. The uterine scar will tear less easily,
as we already suggested. However, even though
section many women can deliver subsequent babies vaginally
after this procedure, many doctors still advise going
DISCHARGE PLANNING
the C-section route with subsequent babies, just to be
M – Medication on the safe side.

Take home medication as prescribed by the Physician What Happens During a Planned C-section? 
In a planned C-section (make note of the word
Methylgonometrine 1 tab TID Page 11 "planned" because procedures might work differently
in an emergency), the doctor will review the patient's
E – Environment history, make recommendations, and schedule a
certain day and time for the surgery.
Instructed patient to stay in calm, quiet environment
Pre-Surgery
Home environment must be free from slipping or On the morning of the surgery, the nurse will
accident hazards evaluate the baby's heart rate and mother's
contraction pattern by using external monitors placed
T –Treatment
around the mother's abdomen. In addition, the nurse
Informed patient to have a follow-up check up after will check the mother's vital signs. The nurse, doctor,
1- 2 weeks and anesthesiologist will review the records again to
evaluate any medical complications. Consent forms (otherwise known as a bikini cut), which is a
will be signed and witnessed. The surgeon will ask horizontal incision just above the pubic hairline.
the mother if she has any questions and will explain Several layers of tissue are cut before the surgeon is
what will happen, if that has not already occurred. inside reaching the uterus.

Once everything is set, the patient will be taken to the From the patient's perspective, all she should feel is a
operating room (OR). The nurse may or may not do a little bit of pressure or tugging and pulling, but she
shave of the pubic area, depending on the physician's shouldn't feel any sharpness or pain.
preference. A Foley bladder catheter is inserted to
drain the bladder so that it is not in the way of the After the surgeon reaches the uterus, he will study the
operating field (basically, they deflate it). At this anatomy to decide where the baby is lying and where
point, the anesthesiologist takes over. If the to make the cut to optimize getting the baby out.
indication is not urgent, the patient will receive a There will be some gentle dissection behind the
regional anesthetic (most likely a spinal) so she stays bladder in order to create a space to expose the
awake, but the region being worked on is numb. In incision site on the uterus. The reason the surgeon
this way, the patient does not have to be intubated as takes so much care is that he is trying to preserve the
she is breathing on her own. This is considered to be mother's option of having a baby vaginally in the
much safer than a general anesthetic where the future.
patient is put under and is not conscious. (Much nicer
to be conscious for your baby's birth.) The physician will make a low-transverse uterine
incision. The incision will be large enough to pull the
If the baby has been continuously monitored up to baby out, possibly 8-10 centimeters (the doctor can
this point, the monitors are taken away so that the stretch it more with his hands). The surgeon will go
abdomen can be prepared for surgery. The slowly before the next cut, with the assistant
preparation consists of applying sterilizing solutions suctioning away the blood that obscures the surgeon's
to kill all the germs on the surface of the skin. Many vision. There is lots of blood pouring into the hole he
times it is an iodine solution. If you're allergic to is cutting, so he must trust his tactile feel to reduce
iodine, let the doctor know earlier. Also, let them injury to the baby. Once the doctor feels that he is
know if you're allergic to latex. inside the uterus, he will stretch open the incision and
put one hand inside to protect and deliver the baby's
Before the surgery begins, a hip roll is placed beneath head. Usually, he will be aided by an assistant who is
the patient's right hip, to tilt her slightly to the left. applying pressure on the top of the uterus to push the
They do this for the same reason that the doctors baby forward.
don't want you sleeping on your back during the latter
stages of pregnancy – because the uterus being heavy The baby's head can't be pulled out until it's actually
can rest on the vena cava, which can restrict the peeking out. The surgeon will use a little force to
blood flow to the baby. push the mother's uterus down, thereby squeezing the
baby out of the incision.
The patient is then draped, and the surgeons take
their places on either side of the patient. Often, there From the mother's perspective, she'll feel tugging and
is a second surgeon (who might be a resident) a lot of pressure. She will not be asked to push, but
assisting the primary surgeon (your doctor). she will definitely be aware of the tugging and
Obviously, the primary surgeon will be the person pulling.
performing the operation.
The Baby Delivered by C-Section
At this point, the surgeon will check with the When the baby is delivered, there tends to be a lot of
anesthesiologist to verify that the anesthesia is amniotic fluid that comes out, so the doctor will
adequate – in other words, they will do a test to make suction the baby's mouth and nose to aid the baby's
sure the patient can't feel anything in the appropriate breathing efforts. He'll clamp the umbilical cord, cut
area and therefore is ready for surgery. Now the the cord between two clamps, and one of the doctors
father or significant other is allowed into the will hand the baby to a nurse so that the baby can go
operating room. That person will be draped in a gown immediately to a warmer. (The doctor might show
and facemask to preserve the sterile environment, and you the baby briefly, but don't count on it. The
he (or she) will be positioned at the head of the bed immediate concern is to get the baby evaluated.)
next to you. After the baby is on the warmer, the neonatal
resuscitative team (NNR) will work on the baby and
The drape is elevated above the patient's chest so that make sure that it is progressing as it should.
her face is shielded from the operative field. This is
done for two reasons: Doctors want to keep the The way the staff handles a baby delivered by
patient's face shielded from anything that could Cesarean is different than the way they handle a
splatter on it; they also don't want her seeing the vaginal birth because of the increased risk to both
trauma of her innards coming out. Let's face it – that mother and baby in a C-section. For example, the
would be a disgusting thing to witness. So, it's a baby may have more of an adjustment or transition
combination of emotional and physical safety issues. period from intrauterine to extrauterine life by being
delivered from a C-section. In a vaginal delivery, the
Surgery squeezing of going through the birth canal pushes the
Next, the doctor makes the incision in the skin. fluid in the baby's lungs out and can facilitate
Typically, it's called a Pfannenstiel skin incision breathing of the baby once it's delivered. However, in
a C-section, depending upon whether labor occurred performed. This would be done as a last resort to save
or not, much of this fluid may still remain in the a woman's life. The decision is never taken lightly.
baby's lungs, so the baby is often given oxygen and With any surgery, there is also the risk of scar tissue
the baby's back is massaged (palpation) to increase or adhesions, which could cause pain later.
the expulsion of fluid.
One of the obvious risks for the baby is that the
The Surgery Continues... doctor could cut the baby's skin with the scalpel.
Once the baby is out, the OB will focus his attention Because the baby's head or face is pressed against the
back on the mother (his primary patient) because she uterus, the doctor has to go very slowly and carefully
is still bleeding from the uterus, which must be when incising the uterus, clearing away blood before
controlled immediately. The placenta is delivered making his every cut. That is where experience and
next. The surgeon places his hand inside the uterus touch come into play for the surgeon, who is often
and peels the placenta off the uterine wall. blinded by the extensive amount of blood. Other
Simultaneously, the anesthesiologist administers injuries the baby could suffer might be a neck injury,
Pitocin, which will help the uterus squeeze down as it is being pulled out.
upon itself to cut down on the blood loss. Typically,
if the patient hasn't received antibiotics up to this Post-Op and Recovery
point, she will receive them now. Antibiotics are a After the woman is all stitched up, she is transported
key factor because they will reduce the chances of (referred to as towed in the Navy) to the recovery
infection, since virtually all the contents of the uterus room for at least an hour. There her vital signs are
have spilled into the patient's abdominal cavity , monitored to make sure there are no significant
including lots of bacteria (not to be too graphic here, complications from surgery that would require her to
but yeech – I'm beginning to notice that doctors get a go back to the OR. If the baby is doing fine, she may
kick out of describing gross stuff). see the baby at this point, or she may have to wait
until she goes to her room. Sometimes, it's hard for
Once the placenta is out, the doctor focuses on family members to visit in the recovery room due to
closing the incision he made. There tends to be a lot privacy issues with other patients, so don't expect a
of bleeding at this juncture, so visualization is a lot of visitors.
challenge. The team uses a combination of suction
and gauze sponges to find out where they need to Typically, your OB will sit down and explain how
sew. They start at one end of the uterine incision and the surgery went and answer any questions.
work across to the other side, closing the incision Afterwards, the patient is transferred to a recovery
site. Often, the OB will perform a second layer of room or a postpartum room, where she will stay until
closure on top of the first one. Some doctors feel that she is discharged, which will probably be in two or
this is helpful to prevent a uterine rupture in the three days, barring complications.
future.
The Day of the Surgery
Next, the surgeon will look for any signs of bleeding The day of the surgery, if you're the patient, you will
that haven't been addressed yet and cauterize those feel pretty tired and have some pain issues. You will
areas. The pelvic region may be irrigated with sterile be required to rest a lot. The catheter will stay in
water or saline. The doctor will remove any large place so that you don't have to get out of bed to go to
clots and begin the closure of the various layers of the bathroom. Pain medicines will be administered
incisions that were previously incised, including the through an IV. You will not be allowed to eat at first,
skin. The skin may be closed with suture materials or although fluids are provided. Mostly, you'll just want
staples. to rest (and see your baby, of course).

From the Doctor's Perspective... The First Day Post-Op

Studies show that the healing rates from using either By the first day after surgery (post-operative Day 1),
staples or suture material are the same. Dr. John, the doctor will evaluate you to make sure you're
however, likes sutures better because they are stable. The bandage will be removed so the doctor
dissolvable. "With staples, you have to remove them can look at the incision, and then it will be left
in three days, say the morning of going home. uncovered. The Foley catheter is removed. The
Sutures don't have to be removed since they dissolve patient is asked to begin walking, if she hasn't already
on their own. Some doctors think it's faster to work done so.
with staples, but I still prefer sutures."
Walking will be a little bit challenging at first, but
The Pitfalls of Surgery with effort, the majority of women find they can walk
Compared to a vaginal delivery, the risk for the pretty well by the end of the first day. Dr. John
mother in a C-section is generally twice that of a always asks patients to sit up for a few minutes first
vaginal birth for bleeding, infection, and other to make sure they aren't dizzy, and then stand up with
complications. Having said that, the overall risk of a hand close to the bed to give themselves another
having a complication is one to three percent. minute before they walk around the room.

The mother could also have injury to other organs, You will still have an IV with fluid flowing. You
including the bladder and intestines. In rare cases, the should sit in a chair if you're tired but don't feel like
uterus may continue to bleed despite conservative sleeping. If you're tired, use the bed to sleep, but if
efforts to stop the bleeding. In those situations, it's you're not tired, doctors prefer that you try to use the
possible that a hysterectomy might have to be chair. Sitting and walking not only restores
confidence, but also helps prevent clots from forming Maternal Indications for a C-Section
in the legs. You'll be asked to increase your walking There are several conditions in the mother that would
daily. necessitate a C-section (or in doctor jargon, absolute
indications – in other words, the doctor would always
It's time for food, if you feel like eating. The first suggest or resort to a C-section in these cases). If
meal you will eat will be a soft diet of easily chewed these conditions are noted in advance, chances are
foods. If those are tolerated well, you'll advance to good that you'll be scheduled for a C-section when
eating regular foods. your baby is at term. These health conditions include
the following:
The Second Day Post-Op
On the second day, the hospital staff and your doctor  A woman who cannot labor for various
will evaluate your progress and take a blood test to reasons (for example, she has a serious heart
make sure you haven't lost too much blood. You'll condition).
continue to walk the hallways, obviously more than  A woman who has a small or contracted
the day before. In some instances, patients may pelvis that wouldn't allow the baby to push
recover so well that they can be discharged at the end through (sometimes this is known in
of the day, but this is usually reserved for post-op advance, but not always).
Day 3.  Serious maternal health problems where
a delivery through the vaginal area would
The Third Day Post-Op put the baby at risk (for example, the mother
On post-op Day 3, you'll be examined, the staples has herpes or AIDs).
will be removed if necessary, and you'll be given  If the mother has had a prior classical
instructions on how to take care of yourself at home. C-section in a previous birth.
Things to watch out for include fevers, increased Fetal Indications for a C-Section
vaginal bleeding (more than a period), and pain that In addition, there are conditions related to the baby's
is not responding to pain meds that could indicate health that would prompt the doctor to suggest a C-
complications from surgery. The doctor will section over a vaginal delivery. These conditions may
recommend that you don't lift anything heavier than not be known in advance of the baby's birth. They
your baby. include the following:
 Problems with the umbilical cord; for
Indications for a C-section example, the cord falls into the vagina
(prolapsed cord, which would lead to
Let's start by defining a C-section. A vaginal delivery emergency surgery) or the cord is pinched or
occurs when the baby is delivered through the vagina compressed.
by natural means. In a C-section the baby does not go  Presence of a complete placenta previa
through the birth canal, but rather is pulled out (where the placenta is covering the cervix).
through an incision made in the mother's abdomen  Fetal distress – that is, the baby shows
and uterus. Unlike a vaginal delivery, a C-section signs of distress such as a slowing heart rate
involves a surgical procedure and is performed in an or lactic acid buildup in the baby's
operating room under sterile conditions. bloodstream from lack of oxygen.
 Fetal illness, which might include
In the United States, approximately one in four babies diagnosed prenatally with certain
babies is delivered by C-section, according to the medical conditions, such as a heart condition
American College of Obstetricians and or spina bifida (a hole in the spinal cord).
Gynecologists.
 Multiple babies – that is, twins, triplets,
or more.
When to Perform a C-Section
 What Is a Classical C-Section? 
It's important to note that, in most cases, doctors will
The classical C-section has been used by
opt for a vaginal delivery over a C-section. The
physicians as the standard way of
reason is that a vaginal delivery is almost always
performing a C-section, but recently it has
considered to be safer for the mother and baby unless
been superceded in use by the Low-
extreme health conditions warrant otherwise. C-
Transverse uterine incision (see next
sections may be scheduled in advance if certain
section).
conditions are present and both the mother and doctor
 In a classical C-section, the physician makes
agree that it is necessary.
an incision or cut in the upper or contractile
portion of the uterus. This gives much more
Often, however, C-sections are performed in
access to the baby. It traditionally has been
emergency circumstances because conditions indicate
done under emergency circumstances, so
that the mother or baby is at risk for a potential
many doctors thought this was the quickest
problem. If the mother's or baby's health is at risk,
and easiest way to deliver the baby.
then a c-section might become the immediate
However, as doctors discovered later, this
alternative for saving lives. So, you may go into the
type of incision subjected both the mother
delivery room anticipating a "normal" delivery and
and baby to additional risks, as will be
suddenly find that you're going to have a C-section.
discussed later.
It's impossible to tell when this will occur, but some
 While we're on the subject, don't confuse the
of the circumstances that might precipitate this
way your skin is cut and the way your uterus
decision on the part of your doctor are listed below.
is cut. We're talking about the cutting of the
 uterus here, not the incision in the skin that low-transverse incisions are safer for vaginal
you see – confusing, but important deliveries after C-sections. (Hey, it's a good
differences. Just because a doctor cuts your story whether it's true or not.)
outer skin up and down or a bikini cut
(sideways) doesn't mean that he cuts your Cesarean Birth
uterus that same way. You can't tell from the
outer skin incision how your uterus was cut, Even though most babies are born by the vaginal
and it does matter later if you plan on having route, it is a good idea to familiarize yourself with all
subsequent births. types of deliveries, since unpredictable circumstances
 The old dictum was once a C-section, can arise. Understanding the possibilities can help
always a C-section, which usually applied to you feel more secure and allow you to be a more
the classical Cesarean section and meant that active participant in your own care.
you always had to have C-sections for later
deliveries. However, that dictum does not What is Cesarean Section?
always apply to a low-transverse C-section.
 Risks of a Classical C-Section In cesarean section, also called c-section, the baby is
When a classical C-section is performed, the born through a surgical incision in her mother's
area that is cut tends to be muscular so that abdomen and uterus. For most women and their
when a scar forms, the scar is found to be infants, vaginal birth is a better and safer option than
weaker when laboring with a future cesarean, with a shorter and less painful recovery.
pregnancy. This does not bode well for a There are times, however, when the risks of vaginal
mother's attempt at a vaginal delivery in delivery outweigh the risks of surgery. In these
subsequent births, for fear that the scar situations, a cesarean can be a lifesaving procedure
might tear while in labor. Thus, there is a for the mother or the baby.
risk in future deliveries for the uterus to
rupture. In some situations, the risk of vaginal birth and the
 If a rupture occurs, the mother could bleed risk of cesarean are about equal and the decision can
internally, and the baby could work its way be made based on personal preference. This partially
through the previous incision or scar. In that explains the different rates of cesarean for
case, the placenta would be compromised, different doctors, hospitals and communities.
and the baby could die. The mother could
also die. The overall risk of a uterine rupture The procedure
occurring is less than one percent in women
who have never had surgery of the uterus Cesarean involves two incisions--one into the
(for example, a previous baby born by this abdomen and one into the uterus. The skin incision is
type of C-section). usually a "bikini" incision across the lower abdomen,
 However, in women who have had a but in some circumstances may be an up-and-down
classical C-section in a previous birth, the incision, from the pubic hair to the belly-button. The
risk for rupture elevates to 20-25 percent in uterine incision is usually a "low transverse" incision
subsequent pregnancies and births attempted (across the lower uterus), allowing the woman to
vaginally. For this reason, most doctors labor in the future without great risk of uterine
recommend that subsequent births also be rupture.
delivered via C-section.
 In contrast, the risk for rupture in subsequent The direction of the skin incision does not indicate
pregnancies for a woman with one low- how the uterine incision was done. The surgical note
transverse C-section is less than one percent. or the word of the surgeon is the best judge of what
And that's the real reason that OBs prefer type of cesarean was done and whether a future
the low-transverse C-section procedure. vaginal birth after cesarean (VBAC) would be safe.
 Uncovering Statistics
How did doctors figure this out? Dr. John
said that there is an unfounded story that the
difference between these two types of C- Risks of cesarean
sections in subsequent births was first
noticed in the UCLA parking lot, of all Because it involves surgery, cesarean creates some
risks that are not usually present for vaginal birth.
places! One day the parking lot was literally
full of women having babies at the County Although major complications of cesarean are not
common, there can be injury to other internal organs
Hospital because the hospital was full, and
there weren't enough rooms. Because many such as the bladder, ureters (tubes that come down
from the kidneys), or bowel. Excessive bleeding can
of the women were Hispanic and possibly
there weren't enough interpreters or time to occur, leading to anemia (low blood count) or even
the need for blood transfusion. Very rarely there is an
get full histories or data before the births, it
wasn't until after the births occurred that injury to the fetus during the surgery. In addition,
there can be a complication from the anesthetic,
doctors discovered that many of the women
were having a third or fourth child delivered especially if you need general anesthesia for the
surgery. In most cases it is safer to have anepidural or
vaginally, but they had previously had low-
transverse incisions and C-sections. Bells spinal if possible.
started ringing and people started asking
questions. The result: The discovery that
 What is a cesarean section? do the procedure in the following conditions: the
baby is expected to weigh less than eight pounds; the
A cesarean section (or 'C-section') is a surgical woman has a normal pelvis; and the baby is in a frank
procedure for delivering a baby. It is usually breech with legs extended and head flexed.  
performed when a normal vaginal delivery may be  
risky or impossible. The operation involves an
abdominal and uterine incision. The abdominal Failure of labour
incision may be horizontal, just above the pubic
hairline, or vertical extending down from the Dystocia is the medical term for failure to progress in
bellybutton. The incision in the uterus runs labour. Some women have ineffective uterine
horizontally across the lower part of the uterus (low contractions that lead to prolonged labour. The
transverse or low segment incision). Cesarean woman may be unable to push the baby out under her
sections are usually done under general anaesthesia. own steam. If the contractions are weak and irregular,
The whole procedure takes between 35 to 40 doctors usually administer oxytocin to stimulate
minutes.  contractions. However, if this has no effect, the
 What are the complications linked to a c-section? doctors may have no choice but to perform a
cesarean. 
Cesarean sections are more painful, more disabling,  Fetal distress
requires a longer hospital stay, and is four times more
risky than a normal vaginal delivery. Uterine Fetal distress is also often a reason why doctors
infection is one of the common complications decide to do a cesarean section. In cases of prolonged
associated with cesarean sections and it occurs ten labour and fetal distress, some doctors would prefer
times more frequently than in vaginal deliveries. to do a cesarean section as the safer option to
Other complications arising from are performing a mid-forceps or low-forceps delivery.
thrombophlebitis, urinary tract infection, respiratory They are of the opinion that a cesarean is less risky
problems in the newborn  for the baby in these situations. 
and complications of anaesthesia. However, doctors
are constantly making improvements in surgical What is the Definition of Cesarean Section?
technique. This, accompanied by the swift pace of
medical advancement, serves to reduce the risk of
this procedure.  Cesarean childbirth consists of an operation to deliver
  a baby through an incision in the abdomen.

Description of Cesarean Section

"Once a section, always a section." - Is this true?
Until recently the operation was usually used as a last
It was a widely accepted belief that most women, resort because of a high rate of maternal
whose earlier childbirth was done through a cesarean complications and death. With the availability of
section, had to have a repeat cesarean section for antibiotics to fight infection and the development of
subsequent childbirth. Initially, the 'classical' method modern surgical techniques, the once high maternal
of doing a cesarean was to make a vertical incision in mortality rate has dropped dramatically. As a result,
the upper part of the uterus. Incisions like this are the cesarean childbirth rate has increased
more likely to rupture when labour begins leading to dramatically.
bleeding that could put the lives of both the mother
and baby at risk. However, a woman who has had a
low transverse incision (as opposed to the classical There are three main types of cesarean operations,
vertical incision) in the uterus is a better candidate for each named according the location and direction of
a vaginal birth after cesarean (VBAC). This is the uterine incision:
because this incision cuts through the lower part of
the uterus that has fewer muscles and is less full of Low Transverse, a transverse (horizontal) incision in
blood vessels lowering the chances of bleeding due to the lower uterus
uterine rupture. The present practice for women who
have had previous cesarean sections with a low Low Vertical, a vertical incision in the lower uterus
transverse incision in the uterus is to give them a trial
of labour and vaginal birth. However, the doctors Classical, a vertical incision in the main body of the
should be prepared to perform an emergency uterus
cesarean should the need arise. 
Today, the low transverse incision is used almost
Breech babies exclusively. It has the lowest incidence of
hemorrhage during surgery as well as the least
Doctors often perform a cesarean as a matter of chance of rupturing in later pregnancies.
course when the baby is in a breech position. A
breech is when the baby's feet or bottom enter the Sometimes, because of fetal size (very large or very
birth canal first instead of the head. This makes a small) or position problems (breech or transverse), a
vaginal delivery particularly risky because there are low vertical cesarean may be performed.
more chances of a prolapsed cord or fetal injury. If
the doctor and his team have some experience in
doing vaginal breech deliveries, they can attempt to
In the classical operation, a larger vertical incision Other situations. If you have vaginal herpes and
allows a greater opening; it is used in some active sores in the vaginal area, your doctor might do
emergency situations as well as for fetal size or a cesarean to try to prevent your passing on the
position problems. This approach involves more disease to your baby. A cesarean section is usually
bleeding in surgery and a higher risk of abdominal performed in mothers with HIV before labor to
infection. All subsequent deliveries must be by prevent transmission HIV from mother to baby.
cesarean section after a classical delivery due to the Women diagnosed with invasive cervical cancer who
higher risk of uterine rupture. have bulky cancer lesions on the cervix are offered
classical cesarean section to deliver the baby. Lastly,
Although any uterine incision may rupture during a women pregnant with a baby with bleeding problems
subsequent labor, the classical is more likely to do so, may be offered a cesarean section to prevent birth
and more likely to result in death for the mother and trauma to the infant.
fetus than a low transverse or low vertical incision.
Malpractice concerns, a woman?s
There are many reasons why a woman might need to preference, obesityand insurance coverage are also
deliver by Cesarean section, although not all doctors factors which may play a role in whether to perform a
agree on when one is really necessary. The most cesarean delivery.
common reason is failure to progress (FTP) in labor,
where labor has stalled because the cervix has Until recently, it was medically accepted that once a
stopped dilating or uterine contractions are weak. The woman had a cesarean, she should have all of her
second most common reason for cesarean section is children by cesarean because of the concern about
fetal distress. Sometimes the baby can not tolerate the tearing the incision. Yet studies have shown "once a
strong contractions associated with labor. When the cesarean, always a cesarean," no longer holds true for
fetal heart tracing becomes non-reassuring, a most women. Today, the option of attempting to give
cesarean section is usually performed. Another birth through the vagina is open to women who have
common reason for cesarean section is previous had previous low transverse incision cesarean births,
cesarean section or surgery on the uterus. Women and over half of these have successful vaginal
who delivered by a classical cesarean section in a deliveries.
previous pregnancy must deliver by cesarean section
for all following pregnancies. However, women with If vaginal delivery is a possibility for you, here are
a history delivering by low transverse cesarean some reasons why you may wish to attempt it:
section are given the choice of scheduling a repeat
cesarean section or trying to deliver vaginally. Also Less risk. A vaginal delivery usually has fewer
some women with a history of surgery to remove complications for the mother than a cesarean birth.
fibroids may need to deliver by cesarean section. As there is no abdominal incision, the risks of
infection, bleeding, or other problems resulting from
Other less common reasons for a cesarean section are surgery or anesthesia are much lower.
listed below:
Shorter recovery. Your stay in the hospital is likely to
Cephalopelvic Distortion (CPD. Another indication be briefer after vaginal delivery. The average time
of cesarean delivery is cephalopelvic disproportion spent in the hospital is 1 to 3 days, whereas the
(CPD), a rare condition in which the baby's head is average stay after a cesarean birth is 3 to 5 days.
too large to fit through the mother's pelvis. Recovery at home is faster as well, since women who
deliver by cesarean must limit their activity for 4 to 6
Malposition of the fetus. In breech position, the weeks to allow the abdominal incision to heal.
baby's buttocks or feet are positioned to come out
first instead of the head. Twins might need to be More involvement. Some women wish to be awake
delivered by cesarean if the first baby or both are and fully involved in the birth process. There may
breech. Malposition of the fetus does not necessarily also be more limitations on the presence of others in
mean a cesarean delivery. the room during the cesarean birth process.

Vaginal bleeding/placenta previa/placental DEFINITION

abruption. Vaginal bleeding late in pregnancy often
indicates placenta previa, a low-lying placenta that A cesarean section is a surgical procedure in which
covers part or all of the inner opening of the cervix. If incisions are made through a woman's abdomen and
the bleeding does not stop with bedrest, the doctor uterus to deliver her baby.
probably will perform a cesarean, to prevent
hemorrhage. Vaginal bleeding late in pregnancy also
may indicate placental abruption, where the placenta PURPOSE
separates from the uterine wall before delivery. In
Cesarean sections, also called c-sections or cesarean
some cases of mild abruption, it may be possible to
deliveries, are performed whenever abnormal
deliver vaginally. If there is heavy bleeding or fetal
conditions complicate labor and vaginal delivery,
distress caused by abruption (abruption can lead to
threatening the life or health of the mother or the
maternal shock, which, together with a reduced
baby. Dystocia, or difficult labor, is the other
amount of functioning placenta, can deprive the fetus
common cause of c-sections. The procedure is
of adequate oxygen), a cesarean generally is
performed in the United States on nearly one of every
necessary.
four babies delivered—more than 900,000 babies of the genital tract, and preeclampsia (high blood
each year. The procedure is often used in cases where pressure related to pregnancy).
the mother has had a previous c-section.
Choosing cesarean section
The most common reason that a cesarean section is
performed (in 35% of all cases, according to the A 1997 survey of female obstetricians found that
United States Public Health Service) is the woman 31% would choose to have a c-section without trial of
has had a previous c-section. The "once a cesarean, labor if they had an uncomplicated pregnancy. This
always a cesarean" rule originated when the uterine finding mirrors a growing movement to allow women
incision was made vertically (termed a "classical the right to choose c-section over vaginal delivery,
incision"); the resulting scar was weak and had a risk even when no indications for c-section exist.
of rupturing in subsequent deliveries. Today, the
incision is almost always made horizontally across There are a number of reasons why a woman might
the lower end of the uterus (called a low transverse choose a c-section in the absence of the usual
incision), resulting in reduced blood loss and a indications. These include:
decreased chance of rupture. This kind of incision
allows many women to have a vaginal birth after a
cesarean (VBAC).  Convenience. A scheduled c-section would
allow a woman to choose the time and date
of delivery to avoid conflicting with work or
The second most common reason that a c-section is
family obligations.
performed (in 30% of all cases) is difficult childbirth
 Fear of childbirth. A woman might fear the
due to non-progressive labor (dystocia). Difficult
pain of labor and delivery and feel that a
labor is commonly caused by one of the three
scheduled c-section would allow her to
following conditions: abnormalities in the mother's
circumvent it.
birth canal; abnormalities in the position of the fetus;
or abnormalities in the labor, including weak or  Avoiding risks of vaginal delivery. Certain
infrequent contractions. The mother's pelvic structure risks inherent to vaginal delivery (urinary or
may not allow adequate passage for birth. When the rectal incontinence, sexual dysfunction,
baby's head is too large to fit through the pelvis, the dystocia) are avoided in a c-section.
condition is called cephalopelvic disproportion
(CPD). Demographics

Another 12% of c-sections are performed to deliver a Women of higher socioeconomic status are more
baby in a breech presentation (buttocks or feet first). likely to have a c-section, 22.9%, compared to 13.2%
Breech presentation is found in about 3% of all of women who live in low-income families. C-
births. section rates are highest among non-Hispanic white
women (20.6%). Asian-American women have a c-
In 9% of all cases, c-sections are performed in section rate of 19.2%; African-American women, a
response to fetal distress, which refers to any rate of 18.9%, and Hispanic women, a rate of 13.9%.
situation that threatens the baby such as the umbilical
cord wrapped around the baby's neck. This may Description
appear on the fetal heart monitor as an abnormal
heart rate or rhythm. Fetal brain damage can result Regional anesthesia, either a spinal or epidural, is the
from oxygen deprivation. Fetal distress is often preferred method of pain relief during a c-section.
related to abnormalities in the position of the fetus or The benefits of regional anesthesia include allowing
abnormalities in the birth canal, causing reduced the mother to be awake during the surgery, avoiding
blood flow through the placenta. the risks of general anesthesia, and allowing early
contact between mother and child. Spinal anesthesia
The remaining 14% of c-sections are indicated by involves inserting a needle into a region between the
other serious factors. One is prolapse of the umbilical vertebrae of the lower back and injecting numbing
cord: the cord is pushed into the vagina ahead of the medications. An epidural is similar to a spinal except
baby and becomes compressed, cutting off blood that a catheter is inserted so that numbing
flow to the baby. Another is "placental abruption," medications may be administered continuously.
whereby the placenta separates from the uterine wall Some women experience a drop in blood pressure
before the baby is born, cutting off blood flow to the when a regional anesthetic is administered; this can
baby. The risk of this is especially high in multiple be countered with fluids and/or medications.
births (twins, triplets, or more). A third factor is
"placenta previa," in which the placenta covers the In some instances, use of general anesthesia may be
cervix partially or completely, making vaginal indicated. General anesthesia can be more rapidly
delivery impossible. In some cases requiring c- administered in the case of an emergency (e.g.,
section, the baby is in a transverse position, lying severe fetal distress). If the mother has a coagulation
horizontally across the pelvis, perhaps with a disorder that would be complicated by a drop in
shoulder in the birth canal. blood pressure (a risk with regional anesthesia),
general anesthesia is an alternative. A major
The mother's health may make delivery by c-section drawback of general anesthesia is that the procedure
the safer choice, especially in cases of maternal carries with it certain risks such as pulmonary
diabetes, hypertension, genital herpes, malignancies aspiration and failed intubation. The baby may also
be affected by the anesthetics since they cross the her arm. Leads for monitoring the mother's heart rate,
placenta; this effect is generally mild if delivery rhythm, and blood pressure are attached. In
occurs within 10 minutes after anesthesia is the operating room , the mother is given anesthesia,
administered. usually a regional anesthetic (epidural or spinal),
making her numb from below her breasts to her toes.
Once the patient has received anesthesia, the In some cases, a general anesthetic will be
abdomen is washed with an antibacterial solution and administered. Surgical drapes are placed over the
a portion of the pubic hair may be shaved. The first body, except the head; these drapes block the direct
incision opens the abdomen. Infrequently, it will be view of the procedure.
vertical from just below the navel to the top of the
pubic bone or, more commonly, it will be a Aftercare
horizontal incision across and above the pubic bone
(informally called a "bikini cut"). A woman who undergoes a c-section requires both
the care given to any new mother and the care given
The second incision opens the uterus. In most cases, a to any patient recovering from major surgery. She
transverse incision is made. This is the favored type should be offered pain medication that does not
because it heals well and makes it possible for a interfere with breastfeeding. She should be
woman to attempt a vaginal delivery in the future. encouraged to get out of bed and walk around eight
The classical incision is vertical. Because it provides to 24 hours after surgery to stimulate circulation (thus
a larger opening avoiding the formation of blood clots) and bowel
movement. She should limit climbing stairs to once a
To remove a baby by cesarean section, an incision day, and avoid lifting anything heavier than the baby.
is made into the abdomen, usually just above the She should nap as often as the baby sleeps, and
pubic hairline (A). The uterus is located and arrange for help with the housework, meals, and care
divided (B), allowing for delivery of the baby (C). of other children. She may resume driving after two
After all the contents of the uterus are removed, weeks, although some doctors recommend waiting
the uterus is repaired, and the rest of the layers of for six weeks, the typical recovery period from major
the abdominal wall are closed (D). (Illustration by surgery.
GGS Inc.)
Risks
than a low transverse incision, it is used in the most
critical situations such as placenta previa. However, Because a c-section is a surgical procedure, it carries
the classic incision causes more bleeding, a greater more risk to both the mother and the baby. The
risk of abdominal infection, and a weaker scar. maternal death rate is less than 0.02%, but that is four
times the maternal death rate associated with vaginal
Once the uterus is opened, the amniotic sac is delivery. Complications occur in less than 10% of
ruptured and the baby is delivered. The time from the cases.
initial incision to birth is typically five minutes. The
umbilical cord is clamped and cut, and the newborn The mother is at risk for increased bleeding (a c-
is evaluated. The placenta is removed from the section may result in twice the blood loss of a vaginal
mother, and her uterus and abdomen are stitched delivery) from the two incisions, the placental
closed (surgical staples may be used instead in attachment site, and possible damage to a uterine
closing the outermost layer of the abdominal artery. The mother may develop infection of the
incision). From birth through suturing may take 30– incision, the urinary tract, or the tissue lining the
40 minutes; the entire surgical procedure may be uterus (endometritis); infections occur in
performed in less than one hour. approximately 7% of women after having a c-section.
Less commonly, she may receive injury to the
Diagnosis/Preparation surrounding organs such as the bladder and bowel.
When a general anesthesia is used, she may
There are several ways that obstetricians and other experience complications from the anesthesia. Very
doctors diagnose conditions that may make a c- rarely, she may develop a wound hematoma at the
section necessary. Ultrasound testing reveals the site of either incision or other blood clots leading to
positions of the baby and the placenta and may be pelvic thrombophlebitis (inflammation of the major
used to estimate the baby's size and gestational age. vein running from the pelvis into the leg) or a
Fetal heart monitors, in use since the 1970s, transmit pulmonary embolus (a blood clot lodging in the
any signals of fetal distress. Oxygen deprivation may lung).
be determined by checking the amniotic fluid for
meconium (feces); a lack of oxygen may cause an Undergoing a c-section may also inflict
unborn baby to defecate. Oxygen deprivation may psychological distress on the mother, beyond
also be determined by testing the pH of a blood hormonal mood swings and postpartum depression
sample taken from the baby's scalp; a pH of 7.25 or ("baby blues"). The woman may feel disappointment
higher is normal, between 7.2 and 7.25 is suspicious, and a sense of failure for not experiencing a vaginal
and below 7.2 is a sign of trouble. delivery. She may feel isolated if the father or
birthing coach is not with her in the operating room,
When a c-section becomes necessary, the mother is or if an unfamiliar doctor treats her rather than her
prepped for surgery. A catheter is inserted into her own doctor or midwife. She may feel helpless from a
bladder and an intravenous (IV) line is inserted into loss of control over labor and delivery with no
opportunity to actively participate. To overcome conservative in diagnosing dystocia and fetal distress,
these feelings, the woman must understand why the taking a position of "watchful waiting" before
c-section was necessary. She must accept that she deciding to operate.
could not control the unforeseen events that made the
c-section the optimum means of delivery, and Approximately 3–4% of babies present at term in the
recognize that preserving the health and safety of breech position. Before opting to perform an elective
both her and her child was more important than her c-section, the doctor may first attempt to reposition
delivering vaginally. Women who undergo a c- the baby; this is called external cephalic version. The
section should be encouraged to share their feelings doctor may also try a vaginal breech delivery,
with others. Hospitals can often recommend support depending on the size of the mother's pelvis, the size
groups for such mothers. Women should also be of the baby, and the type of breech position the baby
encouraged to seek professional help if negative is in. However, a c-section is safer than a vaginal
emotions persist. delivery when the baby is 8 lb (3.6 kg) or larger, in a
breech position with the feet crossed, or in a breech
Normal results position with the head hyperextended.

The after-effects of a c-section vary, depending on A vaginal birth after cesarean (VBAC) is an option
the woman's age, physical fitness, and overall health. for women who have had previous c-sections and are
Following this procedure, a woman commonly interested in a trial of labor (TOL). TOL is a
experiences gas pains, incision pain, and uterine purposeful attempt to deliver vaginally. The success
contractions (also common in vaginal delivery). Her rate for VBAC in patients who have had a prior low
hospital stay may be two to four days. Breastfeeding transverse uterine incision is approximately 70%. The
the baby is encouraged, taking care that it is in a most severe risk associated with TOL is uterine
position that keeps the baby from resting on the rupture: 0.2–1.5% of attempted VBACs among
mother's incision. As the woman heals, she may women with a low transverse uterine scar will end in
gradually increase appropriate exercises to regain uterine rupture, compared to 12% of women with a
abdominal tone. Full recovery may be achieved in classic uterine incision. To minimize this risk, the
four to six weeks. American College of Obstetricians and Gynecologists
(ACOG) recommends that VBAC be limited to
The prognosis for a successful vaginal birth after a women with full-term pregnancies (37–40 weeks)
cesarean (VBAC) may be at least 75%, especially who have only had one previous low transverse c-
when the c-section involved a low transverse incision section.
in the uterus and there were no complications during
or after delivery. Cesarean Section 

Morbidity and mortality rates Definition

A cesarean section is a surgical procedure in which
Surgical injuries to the ureter or bowel occur in incisions are made through a woman's abdomen and
approximately 0.1% of c-sections. The risk of uterus to deliver her baby.
infection to the incision ranges from 2.5% to 15%.
Purpose
Urinary tract infections occur in 2–16% of patients
post-c-section. The risk for developing a deep-vein Cesarean sections, also called c-sections, are
thrombosis is three to five times higher in patients performed whenever abnormal conditions complicate
undergoing c-section than vaginal delivery. labor and vaginal delivery, threatening the life or
health of the mother or the baby. In 2003, about 27%
Of the hundreds of thousands of women in the United of U.S. deliveries were cesarean, up 6% from 2002.
States who undergo a c-section each year, about 500 The procedure is often used in cases where the
die from serious infections, hemorrhaging, or other mother has had a previous c-section. Dystocia, or
complications. The overall maternal mortality rate is difficult labor, is the other common cause of c-
estimated to be between six and 22 deaths per sections.
100,000 births; approximately one-third of maternal
Difficult labor is commonly caused by one of the
deaths that occur after c-section can be attributed to
three following conditions: abnormalities in the
the procedure. These deaths may be related to the
mother's birth canal; abnormalities in the position of
health conditions that made the operation necessary,
the fetus; or abnormalities in the labor, including
and not simply to the operation itself.
weak or infrequent contractions.

Alternatives Another major factor is fetal distress, a condition

where the fetus is not getting enough oxygen. Fetal
When a c-section is being considered because labor is brain damage can result from oxygen deprivation.
not progressing, the mother should first be Fetal distress is often related to abnormalities in the
encouraged to walk around to stimulate labor. Labor position of the fetus or abnormalities in the birth
may also be stimulated with the drug oxytocin. A canal, causing reduced blood flow through the
woman should receive regular prenatal care and be placenta. Other conditions also can make c-section
able to alert her doctor to the first signs of trouble. advisable, such as vaginal herpes, hypertension, and
Once labor begins, she should be encouraged to move diabetes in the mother.
around and to urinate. The doctor should be
Precautions Another 12% of c-sections are performed to deliver a
There are several ways that obstetricians and other baby in a breech presentation: buttocks or feet first.
doctors diagnose conditions that may make a c- Breech presentation is found in about 3% of all
section necessary. Ultrasound testing reveals the births.
positions of the baby and the placenta and may be
used to estimate the baby's size and gestational age. In 9% of all cases, c-sections are performed in
Fetal heart monitors, in use since the 1970s, transmit response to fetal distress. Fetal distress refers to any
any signals of fetal distress. Oxygen deprivation may situation that threatens the baby, such as the
be determined by checking the amniotic fluid for umbilical cord getting wrapped around the baby's
meconium (feces)—a lack of oxygen causes an neck. This may appear on the fetal heart monitor as
unborn baby to defecate. Oxygen deprivation may an abnormal heart rate or rhythm.
also be determined by testing the pH of a blood
The remaining 14% of c-sections are indicated by
sample taken from the baby's scalp; a pH of 7.25 or
other serious factors. One is prolapse of the umbilical
higher is normal, between 7.2 and 7.25 is suspicious,
cord: the cord is pushed into the vagina ahead of the
and below 7.2 is a sign of trouble.
baby and becomes compressed, cutting off blood
When a c-section is being considered because labor is flow to the baby. Another is placental abruption: the
not progressing, the mother should first be placenta separates from the uterine wall before the
encouraged to walk around to stimulate labor. Labor baby is born, cutting off blood flow to the baby. The
may also be stimulated with the drug oxytocin. risk of this is especially high in multiple births
(twins, triplets, or more). A third factor is placenta
When a c-section is being considered because the previa: the placenta covers the cervix partially or
baby is in a breech position, the doctor may first completely, making vaginal delivery impossible. In
attempt to reposition the baby; this is called external some cases requiring c-section, the baby is in a
cephalic version. The doctor may also try a vaginal transverse position, lying horizontally across the
breech delivery, depending on the size of the mother's pelvis, perhaps with a shoulder in the birth canal.
pelvis, the size of the baby, and the type of breech
position the baby is in. However, a c-section is safer The mother's health may make delivery by c-section
than a vaginal delivery when the baby is 8 lbs (3.6 the safer choice, especially in cases of maternal
kg) or larger, in a breech position with the feet diabetes, hypertension, genital herpes, Rh blood
crossed, or in a breech position with the head incompatibility, and preeclampsia (high blood
hyperextended. pressure related topregnancy).

A woman should receive regular prenatal care and be Preparation

able to alert her doctor to the first signs of trouble. When a c-section becomes necessary, the mother is
Once labor begins, she should be encouraged to move prepped for surgery. A catheter is inserted into her
around and to urinate. The doctor should be bladder and an intravenous (IV) line is inserted into
conservative in diagnosing dystocia (nonprogressive her arm. Leads for monitoring the mother's heart rate,
labor) and fetal distress, taking a position of rhythm, and blood pressure are attached. In the
"watchful waiting" before deciding to operate. operating room, the mother is given anesthesia—
usually a regional anesthetic (epidural or spinal),
Description making her numb from below her breasts to her toes.
The most common reason that a cesarean section is In some cases, a general anesthetic will be
performed (in 35% of all cases, according to the administered. Surgical drapes are placed over the
United States Public Health Service) is that the body, except the head; these drapes block the direct
woman has had a previous c-section. The "once a view of the procedure.
cesarean, always a cesarean" rule originated when the
classical uterine incision was made vertically; the The abdomen is washed with an anti-bacterial
resulting scar was weak and had a risk of rupturing in solution and a portion of the pubic hair may be
subsequent deliveries. Today, the incision is almost shaved. The first incision opens the abdomen.
always made horizontally across the lower end of the Infrequently, it will be vertical from just below the
uterus (this is called a "low transverse incision"), navel to the top of the pubic bone, or more
resulting in reduced blood loss and a decreased commonly, it will be a horizontal incision across and
chance of rupture. This kind of incision allows many above the pubic bone (informally called a "bikini
women to have a vaginal birth after a cesarean cut").
(VBAC).
The second incision opens the uterus. In most cases a
The second most common reason that a c-section is transverse incision is made. This is the favored type
performed (in 30% of all cases) is because it heals well and makes it possible for a
difficult childbirth due to nonprogressive labor woman to attempt a vaginal delivery in the future.
(dystocia). Uterine contractions may be weak or The classical incision is vertical. Because it provides
irregular, the cervix may not be dilating, or the a larger opening than a low transverse incision, it is
mother's pelvic structure may not allow adequate used in the most critical situations, such as placenta
passage for birth. When the baby's head is too large previa. However, the classical incision causes more
to fit through the pelvis, the condition is called bleeding, a greater risk of abdominal infection, and a
cephalopelvic disproportion (CPD). weaker scar, so the low transverse incision is
preferred.
Once the uterus is opened, the amniotic sac is that it is in a position that keeps the baby from resting
ruptured and the baby is delivered. The time from the on the mother's incision. As the woman heals, she
initial incision to birth is typically five minutes. may gradually increase appropriate exercises to
regain abdominal tone. Full recovery may be seen in
Once the umbilical cord is clamped and cut, the four to six weeks.
newborn is evaluated. The placenta is removed from
the mother, and her uterus and abdomen are stitched Key terms
closed (surgical staples may be used instead in Breech presentation — The condition in which the
closing the outermost layer of the abdominal baby enters the birth canal with its buttocks or feet
incision). From birth through suturing may take 30- first.
40 minutes. Thus the entire surgical procedure may
be performed in less than one hour. Cephalopelvic disproportion (CPD) — The
condition in which the baby's head is too large to fit
Aftercare through the mother's pelvis.
A woman who undergoes a c-section requires both
the care given to any new mother and the care given Classical incision — In a cesarean section, an
to any patient recovering from major surgery. She incision made vertically along the uterus; this kind of
should be offered pain medication that does not incision makes a larger opening but also creates more
interfere with breastfeeding. She should be bleeding, a greater chance of infection, and a weaker
encouraged to get out of bed and walk around eight scar.
to 24 hours after surgery to stimulate circulation (thus
avoiding the formation of blood clots) and bowel Dystocia — Failure to progress in labor, either
movement. She should limit climbing stairs to once a because the cervix will not dilate (expand) further or
day, and avoid lifting anything heavier than the baby. (after full dilation) the head does not descend through
She should nap as often as the baby sleeps, and the mother's pelvis.
arrange for help with the housework, meals, and care
of other children. She may resume driving after two Low transverse incision — Incision made
weeks, although some doctors recommend waiting horizontally across the lower end of the uterus; this
for six weeks, the typical recovery period from major kind of incision is preferred for less bleeding and
surgery. stronger healing.

Risks Placenta previa — The placenta totally or partially

covers the cervix, preventing vaginal delivery.
Because a c-section is a surgical procedure, it carries
more risk to both the mother and the baby. The Placental abruption — Separation of the placenta
maternal death rate is less than 0.02%, but that is four from the uterine wall before the baby is born, cutting
times the maternal death rate associated with vaginal off blood flow to the baby.
delivery. However, many women have a c-section for
serious medical problems. The mother is at risk for Prolapsed cord — The umbilical cord is pushed into
increased bleeding (because a c-section may result in the vagina ahead of the baby and becomes
twice the blood loss of a vaginal delivery) from the compressed, cutting off blood flow to the baby.
two incisions, the placental attachment site, and
possible damage to a uterine artery. Complications Respiratory distress syndrome (RDS) — Difficulty
occur in less than 10% of cases. The mother may breathing, found in infants with immature lungs.
develop infection of either incision, the urinary tract,
or the tissue lining the uterus (endometritis). Less Transverse presentation — The baby is laying side-
commonly, she may receive injury to the surrounding ways across the cervix instead of head first.
organs, like the bladder and bowel. When a general
anesthesia is used, she may experience complications VBAC — Vaginal birth after cesarean.
from the anesthesia. A 2004 report said that spinal
The prognosis for a successful vaginal birth after a
anesthesia and obesity impair a mother's respiratory
cesarean (VBAC) may be at least 75%, especially
function during cesarean section procedures. Obese
when the c-section involved a low transverse incision
women were particularly susceptible to breathing
in the uterus and there were no complications during
problems. Very rarely, a woman may develop a
or after delivery.
wound hematoma at the site of either incision or
other blood clots leading to Abnormal results
pelvicthrombophlebitis (inflammation of the major
vein running from the pelvis into the leg) or a Of the hundreds of thousands of women in the United
pulmonary embolus (a blood clot lodging in the States who undergo a c-section each year, about 500
lung). die from serious infections, hemorrhaging, or other
complications. These deaths may be related to the
Normal results health conditions that made the operation necessary,
and not simply to the operation itself. New research
The after-effects of a c-section vary, depending on
in 2004 reported that c-section delivery affects the
the woman's age, physical fitness, and overall health.
amount of breast milk an infant may receive from its
Following this procedure, a woman commonly
mother for the first five days following birth. This
experiences gas pains, incision pain, and uterine
can result in lower post-birth weighs as well. But the
contractions—which are also common in vaginal
study found that by the sixth day, mother who had
delivery. Her hospital stay may be two to four days.
Breastfeeding the baby is encouraged, taking care
delivered by c-section began to produce milk at the Post-surgery you may feel nauseated or cold from
same rate as those who delivered vaginally. anesthesia along with pain around your incision. Do
not be afraid to request more pain medication; it will
Undergoing a c-section may also inflict not interfere with breastfeeding. With the advice and
psychological distress on the mother, beyond permission of your doctor, try to get out of bed eight
hormonal mood swings and postpartum to 24 hours after surgery in order to prevent blood
depression ("baby blues"). The woman may feel clots and help stimulate your bowels. Also be sure to
disappointment and a sense of failure for not alert your doctors if you suffer from a fever or
experiencing a vaginal delivery. She may feel oozing, swelling, and redness around the incision site
isolated if the father or birthing coach is not with her which may indicate an infection.
in the operating room, or if she is treated by an
unfamiliar doctor rather than by her own doctor or Cesarean Childbirth Overview
midwife. She may feel helpless from a loss of control Cesarean delivery, also known as cesarean section, is
over labor and delivery with no opportunity to a major abdominal surgery involving 2 incisions
actively participate. To overcome these feelings, the (cuts): One is an incision through the abdominal wall
woman must understand why the c-section was and the second is an incision involving the uterus to
necessary. She must accept that she couldn't control deliver the baby. While at times absolutely necessary,
the unforeseen events that made the c-section the especially in emergencies or for the safety of the
optimum means of delivery, and recognize that mother or the baby, cesarean childbirth is not a
preserving the health and safety of both her and her procedure to be undertaken lightly by the doctor or
child was more important than her delivering the expectant mother. During the surgical delivery, if
vaginally. Women who undergo a c-section should be not an emergency, the woman may be awake
encouraged to share their feelings with others. but numb from the chest to the legs.
Hospitals can often recommend support groups for
such mothers. Women should also be encouraged to
seek professional help if negative emotions persist.  History: Legend has it that the Roman
leader Julius Caesar was delivered by
Cesarean Section Delivery this operation, and the procedure was named after
him. However, Caesar's mother lived many years
after his birth, and at that time, the operation most
Low Transverse C-Section
likely caused death in the mother. In addition, no
mention is made of this procedure prior to the
Low transverse (horizontal) incisions are usually Middle Ages; therefore, Caesar’s contribution to
made at the top of the bikini line and doctors prefer the naming of this operation is practically
this method because of minimal blood loss or impossible. The most likely origin for the term is
chances for infection. After your doctor separates in reference to a Roman law created in the 8th
tissues and your abdominal muscles, he or she will century BC that ordered the procedure in the last
make another incision in your lower uterus and the few weeks of a pregnancy in dying women to save
amniotic fluid is suctioned out. With more room for the child's life.
delivery, the doctor can now either pull your baby out
with his or her hands or use forceps or a vacuum for
extra help.  How often used: The rate for cesarean
delivery increased steadily from 4.5% in 1965 to
21% in 1998. Since then, the rate has either
Classic C-Section remained unchanged or declined slightly. Overall,
with improvements in anesthesia, pain control,
The classic c-section leaves the mother with a large, andantibacterial techniques, serious complications
vertical scar across her belly. In the past, doctors from birth through cesarean section have fallen
implemented this technique because it provided more dramatically in the last 30 years
room to deliver the baby; however, doctors soon
realized that this method also raised the chances of Cesarean Childbirth Causes
complications and infections. The classic c-section is Some of the reasons for the increased use of cesarean
now primarily reserved for delivering premature childbirth include the following: 
babies. If you've had a classic c-section in the past,
you may not be able to have future vaginal deliveries
due to the high risk of uterine rupture.  Use of heart rate monitors to evaluate the
fetal heart rate pattern
 Baby positioned in a manner other than
Regardless of the type of c-section, your doctor will
head first
first administer an epidural to relieve any pain. After
 Woman’s preference or repeat cesarean
swabbing your belly with antiseptic, he or she will
make the incision in your abdomen wall, navigate his sections
or her way through the abdominal muscles, and make  Labor does not progress to delivery
another incision in the lower uterus. Your doctor will  Mother has an active genital
drain your amniotic fluids and welcome your baby herpesinfection (baby needs to avoid potential
into this world! Following your baby will be the exposure through the birth canal)
delivery of your placenta, and the surgical team will  Mother has HIV infection
then stitch together the incision.  Malpractice concerns
 Birth in a private, for-profit hospital
Recovery From a C-Section
 Woman’s higher level of education and diameter of the human skull is presented to
social status the pelvis in the best way. This, of course,
 Obesity increases the success of a vaginal delivery. 

The most frequent reasons for performing a cesarean o There are, however, various other
delivery are discussed below. presentations of the fetus, which make vaginal
delivery difficult, including the commonly
known breech position (when the baby’s
 Repeat cesarean delivery: There are 2 types
buttocks are in the lower portion of the uterus).
of uterine incisions—a lowtransverse incision and
Certain forms of breech delivery have a very
a vertical uterine incision. The direction of the
low increased risk to the fetus. But, as a rule,
incision on the skin (up and down or side to side)
breech deliveries may cause more
does not necessarily match the direction of
complications, including death and neurologic
the incision made in the uterus. 
disability.
o Careful counseling, analysis of
o As the name implies, the low
the exact type of breech position, and an
transverse incision is a horizontal cut across
estimate of the baby’s weight are required
the lower part of the uterus. In the United
before making any decision about an
States, whenever possible, a low skin incision
attempted vaginal delivery or delivery by
below or at the bikini line with a low
cesarean section
transverse uterine incision is the approach of
 Fetal status: Although an attractive and
choice.
much-used tool, the fetal heart rate monitor has
o A vertical incision on the uterus
not improved birth outcomes as once expected.
may be used for delivering preterm babies,
Some believe the lack of improved outcomes is
abnormally positioned placentas, pregnancies
because many current practicing doctors are
with more than onefetus, and in extreme
poorly trained in interpreting the subtleties of fetal
emergencies.
heart rate patterns. Since the use of continuous
o In the last 20 years, studies have
fetal heart rate monitoring in labor was begun,
shown that women who have had a prior however, birth experts say death of a fetus during
cesarean section with a low transverse incision labor is much more rare than in the past.
may safely and successfully go through labor
 Emergency situations: If the woman is
and have a vaginal delivery in later
severely ill or has a life-threateninginjury or
pregnancies. The same, however, cannot be
illness with interruption of the normal heart or
said of women who have had vertical incisions
lung function, she may be a candidate for an
on the uterus. 
emergency cesarean section. When performed
within 6-10 minutes of the onset of cardiac arrest,
 In about 10% of women the procedure may save the newborn and improve
with vertical uterine incisions, their uterus the resuscitation rate for the mother. This
will rupture (break open). procedure, obviously, is performed only in the
 The uterus may rupture direst circumstances.
even before labor begins in up to 50% of
 Elective sterilization: A desire for elective
these women.
sterilization is not an indication for cesarean
 Uterine rupture can be
delivery. Sterilization after a vaginal delivery can
dangerous to the fetus even if delivery is
be performed via a tiny 3-cm incision along the
accomplished immediately after a uterine
lower edge of the umbilicus or as a delayed
rupture. Diagnosing a uterine rupture can
procedure 6 weeks after delivery
be difficult, and signs of a rupture can
with laparoscopic surgery or vaginal surgery.
include increased bleeding, increased pain,
or an abnormal fetal heart rate tracing.
 Previous cesarean deliveries: Women with When to Seek Medical Care
a prior history of more than 1 low transverse Watch for complications and contact a health care
cesarean section are at slightly increased risk for provider or go to the hospital if severe problems
uterine rupture. This risk increases significantly develop. 
when the woman has had 3 cesarean deliveries. If
an abdominal delivery is planned and a trial of  If damage to the bladder occurred during
labor is not an option, the best time for delivery is surgery, an abnormal discharge from
determined when the lungs of the fetus are acatheter placed in the bladder may be noticed
mature. and come through the genital area or the
 Lack of labor progression: If the woman is abdominal wall. This catheter will be removed at
having adequate contractions but no change in a later visit when the bladder has healed and
the cervix (opening to the uterus) beyond 3 urination is occurring. Pain or difficulty with
centimeters dilation or the woman is unable to urination may suggest an infection of the bladder.
deliver the fetus despite complete dilation of the  If infection of the fetal tissues or the uterine
cervix and "adequate" pushing for 2-3 hours, lining is present, care must be taken in noting the
cesarean delivery may be performed. type of discharge from the vagina(abnormal or
 Abnormal position of the fetus: In a normal bad smelling) and whether afever is present.
delivery, the baby presents head first. In this  Worsening abdominal pain, especially
position—as it is in most births—the smallest when infection of the uterus or tissues
 of conception is present, may mean a worsening clot in the deep veins of the pelvis or the lungs, or a
or new infection. Vomiting and an inability to deep separation of the wound such that the lining of
keep down fluids associated with abdominal pain the abdomen is open, admission to the hospital for
may suggest an unrecognized intestinal injury observation and appropriate intensive therapy is
from surgery. likely.
 Vaginal bleeding after cesarean delivery, as
with a vaginal delivery, should gradually decrease Self-Care at Home
in the days following delivery. A sudden increase Barring complications, the woman may leave the
in vaginal bleeding should be checked by a hospital usually 48-96 hours after a cesarean
doctor. childbirth. If complications occur during surgery, the
 Call a doctor if urinating is difficult or hospital stay may be longer. Once home, watch for
painful.   further complications in the healing process.
 Use home care with a surgical incision, and
call a doctor if redness spreads around the wound Wound care can be handled at home.
or an abnormal discharge is coming from it; this
may signal an infection.  Care of the surgical incision is relatively
simple. Water can wash over the wound as long as
Seek medical care at a hospital’s emergency the impact of water is not directly onto the wound.
department for the following concerns:  Keeping the wound clean and dry is important for
adequate healing. This includes avoiding coverage
by skin folds, which can lead to excessive
 Fever with abdominal pain
moisture and infection.
 Sometimes, the wound can separate at its
 Separation of the wound edges, blood and edges, and blood or fluid or both may come out. If
fluid loss, or both this happens, seek immediate medical attention.
 If the wound edges are not closing
 Severe increase in vaginal bleeding properly, the wound may be left open at the time
of discharge from the hospital. In this situation,
 Inability to keep down fluids the wound should be packed as instructed by the
hospital staff 2-3 times a day. Open wounds will
 Abnormal, foul-smelling vaginal discharge gradually heal from the base of the wound to the
surface requiring less and less packing as the days
go by.
 Inability to urinate
Medical Treatment
Exams and Tests If separation of the wound is superficial (near the
A health care provider may assess the following surface), the wound will be packed appropriately, and
conditions after a cesarean section: proper wound care instructions will be given. Wound
care supplies will also be given, and an appointment
 Examine the surgical incision for infection. for appropriate follow-up care will be scheduled.

 Check to see if the wound has separated Medications

(possibly just on the surface).
 If the problem is simply
 Assess for infection of the uterus and inadequatepostoperative pain control, proper pain
abnormal amounts of vaginal bleeding. medication will be prescribed.

 Make sure the bladder or the kidneys are  If a simple bladder infection, an
not infected. uncomplicated kidney infection, or a simple
wound infection is present,
appropriateantibiotics will likely be given and an
 Make sure severe anemia is not present
appointment for a follow-up evaluation will be
from delivery-related blood loss.
made.

 Make sure there is no evidence suggesting

 If a clot is in the leg and it has not moved
a clot in the deep veins that is either localized or
anywhere, then the woman may be either admitted
has moved to the lungs.
to the hospital or sent home with appropriate anti-
clotting injections (varies from hospital to
 Conduct a pelvic examination. hospital).

 Order further evaluation with blood tests, Outlook

uterine cultures, urine tests, and imaging. A normal vaginal delivery in later pregnancies is
often possible, depending on the type of incision that
Cesarean Childbirth Treatment was performed and the reason the birth was
If there is concern about infection of the uterus, performed by cesarean section.
unrecognized damage to the bladder or intestines, a
 Cesarean childbirth may have these types of you must get up and walk within 24 hours after
complications: the operation.
 Urinary function and bladder injury:
 Excessive bleeding: This is the most common Typically, a catheter is inserted into the bladder
complication of a cesarean delivery and may be before the surgery to remove urine. Usually, the
caused by many different factors.  catheter is removed within 24 hours after the
surgery as soon as the woman is ready to begin
o In short, at the time of active walking. Often, some initial pain occurs when
labor, the uterus receives 20% (up to 30%, in urinating—as with vaginal deliveries. However,
some cases) of the blood pumped to the body with a cesarean delivery, significant damage can
by the heart. When a surgeoncuts the uterus, a occur to the bladder in the course of the surgery. 
certain amount of blood loss will occur.
o On average, cesarean deliveries o The frequency of this type of
result in more than twice the blood loss of injury is more common in women who have
vaginal deliveries. Various factors contribute had abdominal surgery or infection that results
to this difference. Because most childbearing in scarring in the abdomen. Sometimes, a
women are young and healthy, they tolerate catheter may need to be in place for weeks
the blood loss well and recover a normal blood after discharge from the hospital.
volume within a relatively short time after o In the course of a cesarean
delivery. hysterectomy, the tubes emptying urine from
o Women who have had multiple the kidneys to the bladder (the ureters—
deliveries in quick succession, especially one ureter on each side) can be damaged.
cesarean sections, are susceptible to significant Repair of this injury usually depends on the
anemia (loss of volume of red blood cells). surgeon recognizing the injury during the
Excessive bleeding along the incision line or operation and fixing it then.
from the uterus after the delivery of
the infant may require the doctor to give Bowel function and bowel injury: Typically,
medications to promote contraction of the bowel function after a cesarean section returns
uterus and therefore control the bleeding. quickly. Return of normal bowel function is usually
o Sometimes, an artery supplying aided if the woman is aggressive about getting up
blood to the uterus is cut. This requires stitches and walking. Sometimes, bowel function does not
to control bleeding from the artery. return normally after cesarean delivery, even
o Bleeding may at times be so without specific damage to the bowel. This is termed
difficult to control that the uterus has to be postoperative ileus. The causes are many and are not
removed as a means to control the bleeding. completely understood. In the case of actual bowel
This is called a cesareanhysterectomy. injury, the nature and degree of complication depend
 Infection: The risk of infection of the uterus is on the size, severity, and location of the injury.
much higher after cesarean delivery than after Unrecognized bowel injury can lead to life-
vaginal delivery. A number of factors contribute threatening illness with severe abdominal pain and
to infection, above and beyond the simple fact that fever (usually but not always present in such cases).
an operation with an incision of the uterus has The incidence of bowel injury, as with bladder
been performed. Generally, many conditions, such injury, is increased if the woman has had other
as a prolonged labor course, that often put a abdominal surgery or infection.
woman in a position of requiring a cesarean
section may also make her more prone to  Prolonged hospital stay: After vaginal
developing infections. delivery, the woman is typically free to go home
within 48 hours. However, observation after a
o Infection of the skin incision is cesarean section typically runs a minimum of 2
much more common than infection in the days. If infection, significant bleeding, slow return
incision made in the uterus, although they of bowel and bladder function, or injury to
often occur together. The risk for infection in internal organs occurs, the hospital stay can be
the skin incision can be decreased by giving extended.
antibiotics during the surgery.  Anesthesia and pain medications: Anesthesia
o Doctors can use certain types of for a cesarean section can be delivered by an
skin preparations to clean the abdomen for injection into the spinal fluid (spinal anesthesia),
surgery. placed via a catheter into the space outside of the
o Proper wound care after the spinal fluid but surrounding the spinal column
surgery is essential. (epidural anesthesia). General anesthesia may also
 Clots: Blood clots can form in the pelvis or the be given; this makes the person completely
leg. If a clot breaks off and travels (embolize) to "asleep."  
the lungs, it can cause of death and disability after
delivery, whether it is vaginal or cesarean. o General anesthesia is typically
However, women who undergo cesarean reserved for emergency deliveries when there
childbirths are much more prone to clots than is not enough time to provide spinal or
women who deliver vaginally. Therefore, it is epidural anesthesia.
imperative that if you deliver by cesarean section, o All of the methods can be
supplemented with an injection of local
 anesthesia into the incision site during the Problems with labor or delivery:
surgery. After surgery, oral and injection drugs
can be used to help control the pain.  Baby's head is too large to pass through
o The advantage of epidural mother's pelvis (cephalopelvic disproportion)
anesthesia is that repeat doses of pain  Prolonged or arrested labor
medication can be given after the surgery for  Very large baby (macrosomia)
pain control.
o Properly dosed, these
Problems with the placenta or umbilical cord:
medications do not necessarily interfere with
the woman’s ability to get up and about after
surgery.  Placenta attaches in abnormal location
(placenta previa)
C-section  Placenta prematurely separated from uterine
wall (placenta abruptio)
A C-section, also called a cesarean section, is the  Umbilical cord comes through the cervix
delivery of a baby through a surgical opening in the before the baby (umbilical cord prolapse)
lower belly area.
Risks
Description
A C-section is a safe procedure. The rate of serious
A C-section delivery is performed when a vaginal complications is extremely low. However, certain
birth is not possible or is not safe for the mother or risks are higher after C-section than after vaginal
child. delivery. These include:
Surgery is usually done while the woman is awake
but numbed from the chest to the feet. This is done  Infection of the bladder or uterus
by giving her epidural or spinal anesthesia.  Injury to the urinary tract
The surgeon make a cut across the belly just above  Injury to the baby
the pubic area. The uterus and amniotic sac are
opened, and the baby is delivered. A C-section may also cause problems in future
The health care team clears the baby's mouth and pregnancies. This includes a higher risk for:
nose of fluids, and the umbilical cord is clamped and
cut. The pediatrician or nurse makes sure that the  Placenta previa
infant's breathing is normal and that the baby is  Placenta growing into the muscle of the
stable. uterus and has trouble separating after the baby
The mother is awake, and she can hear and see her is born (placenta accreta)
baby. The father or another support person is often  Uterine rupture
able to be with the mother during the delivery.
Why the Procedure is Performed All surgeries carry risks. Risks due to anesthesia may
include:
The decision to have a C-section delivery can depend
on the obstetrician, the delivery location, and the
woman's past deliveries or medical history. Some  Reactions to medications
reasons for having C-section instead of vaginal  Problems breathing
delivery are:
Reasons related to the baby: Risks related to surgery in general may include:

 Abnormal heart rate in the baby  Bleeding

 Abnormal position of the baby in the uterus  Blood clots in the leg or pelvic veins
such as crosswise (transverse) or feet-first  Infection
(breech)
 Developmental problems such as Outlook (Prognosis)
hydrocephalus or spina bifida Most mothers and infants recover well, with few
 Multiple babies in the uterus (triplet and problems.
some twin pregnancies)
Women who have C-section deliveries can have a
normal vaginal delivery with later pregnancies,
Reasons related to the mother:
depending on the type of C-section performed and
the reason the C-section was performed.
 Active genital herpes infection
 Large uterine fibroids low in the uterus near Many women who attempt a vaginal birth after
the cervix cesarean (VBAC) delivery are successful. However,
 HIV infection in the mother there is a small risk of uterine rupture associated with
 Previous uterine surgery, including VBAC attempts, which can endanger the mother and
the baby. It is important to discuss the benefits and
myomectomy and previous C-sections
risks of VBAC with your obstetric health care
 Severe illness in the mother, including heart
provider.
disease, toxemia, preeclampsia or eclampsia
Recovery Therefore, as long as the mother has had one or two
previous cesarean deliveries with a low-transverse
The average hospital stay after C-section is 2 to 4
uterine incision, and there are no other indications for
days. Recovery takes longer than it would from a
a cesarean, she is a candidate for vaginal birth after
natural birth. Walking is encouraged the day of
cesarean, also called VBAC (say as "vee-back").
surgery to speed recovery. Pain can be managed with
medications taken by mouth.
Cesarean sections are safe, and can even save the
lives of both mother and baby during emergency
Although cesarean (C-sections) are relatively safe
deliveries. Expectant mothers should be prepared for
surgical procedures, they should only be performed
the possibility of having one. Keep in mind, in
in appropriate medical circumstances. Some of the
childbirth, it’s not only the delivery method that
most common reasons for a cesarean are:
matters, but the end result: a healthy mother and
baby.
 If the baby is in a feet first (breech) position
 If the baby is in a shoulder first (transverse) PRE-PROCEDURE
position
 If the baby’s head is too large to fit through INDICATIONS
the birth canal
 If labor is prolonged and the mother’s cervix Maternal Indications
will not dilate to 10 centimeters Trial of labor that fails, is not tolerated, or
 If the mother has placenta previa, where the is not indicated
placenta is blocking the birth canal Antepartum hemorrhage or bleeding
 If there are signs of fetal distress which is disorder
when the fetus is in danger because of Pelvic or uterine abnormality
decreased oxygen flow to the fetus Placental abnormality
Severe hypertension or severe preeclampsia
Some common causes of fetal distress are: Active maternal herpes simplex genital
infection
 Compression of the umbilical cord Fetal Indications
 Compression of major blood vessels in the Malpresentation
mother’s abdomen because of her birthing Arrest of descent
position Failed trial of forceps or vacuum
 Maternal illness due to hypertension, Fetal distress
anemia, or heart disease Fetal anomalies or very low or very high
birthweight
Like many surgical procedures, cesarean sections Cord prolapse
require anesthesia. Usually, the mother is given an Multiple gestation or twins with first being
epidural or a spinal block. Both of these will numb nonvertex
the lower body, but the mother will remain awake. If Perimortem
the baby has to be delivered quickly, as in an Maternal HIV infection
emergency, the mother may be given a general CONTRAINDICATIONS
anesthetic, which will make her fall asleep.
Patient refusal of operation with clear
During the surgery, an incision is made in the lower consequences explained and accepted
abdomen followed by an incision made in the uterus. ANATOMY
There is no pain associated with either of these
Bladder
incisions because of the anesthesia. The doctor will
open the uterus and the amniotic sac. Then the baby  The ureters enter the pelvis deep to the
is carefully eased through the incision and out into peritoneum and then turn medially with the nerves
the world. The procedure usually lasts about 20 and vessels of the uterus at the base of the broad
minutes. ligament.
Uterus
 The uterine blood vessels run at the base of
Afterward, the physician delivers the placenta and the broad ligaments.
stitches up the incisions in the uterus and abdominal Abdominal Wall (Inferior to the Arcuate Line)
wall. Usually, the mother is allowed to leave the
 Immediately beneath the skin is a fatty
hospital within a few days, barring complications like
layer that overlies the anterior layers of the rectus
wound infections.
sheath and the aponeurosis of the abdominal
oblique muscles.
One concern that many women have is whether  The transversalis fascia lies beneath the
they’ll be able to have a normal delivery after having rectus abdominis. At the midline, the umbilical
a cesarean. The answer depends on what the reasons prevesical fascia is present, along with the urachus.
were for having the c-section in the first place. If it A fatty layer separates the transversalis fascia (or
was because of a one-time problem, like umbilical the umbilical prevesical fascia) from the
cord compression or breech position, then the mother peritoneum.
may be able to have a normal birth. CARE
 Table 3 shows typical postoperative orders for
cesarean section.

Post-procedure Patient Education

First 24 Hours
 Advise the patient of what to expect and
about pain management.
 Keep the Foley catheter in place.
 Advise early breastfeeding and bonding.
First Postoperative Day
 The patient should ambulate to prevent
atelectasis and pneumonia.
 If bowel sounds are present, advance the
diet.
 If the patient is ambulating well, remove
the Foley catheter.
 Change the IV to a heparin lock.
 Oral narcotic analgesia can replace PCA
pump, IV, or IM narcotics.
Second Postoperative Day
 Many patients can be discharged 36 hours
after a cesarean section.
 If the skin incision has closed, the staples
can be removed and replaced with Steri-Strips.
Discharge Instructions for the Patient
 No driving for 10 days.
 Refrain from intercourse for 4 to 6 weeks.
 Water can wash over the wound as long as
water has no direct impact on the wound. Keep the
wound clean and dry.
 Notify the physician's office of the
following problems: Pus seeping out of the wound,
fever, painful urination, difficulty breathing,
shortness of breath, or increasing pain.
 Follow up in the office for a wound check
in 1 week.
 Limit activity to walking for the first week,
back to full activity by 6 weeks.
COMPLICATIONS

 Complications associated with anesthesia

 Injury to the bladder or ureters
 Injury to the bowel
 Uterine hemorrhage
 Infection: Endometritis, urinary tract
infection, respiratory infection, atelectasis, wound
infection, septic pelvic thrombophlebitis
 Pulmonary embolism
 Risk of rupture in future deliveries
 Injury to the child