Overview
This lecture covers cesarean sections (C-sections), including their definitions, rising rates, indications, risks, types of incisions, anesthesia, nursing care, and post-operative management.
C-Section Overview and Trends
- A C-section is the delivery of a baby via the abdomen instead of the vagina.
- C-section rates in the U.S. have increased from about 23% in the 1990s to 33-35% currently.
- Some local hospitals report even higher rates (e.g., 56%).
- Key factors: decreased vaginal birth after cesarean (VBAC) rates and increased maternal requests for C-sections.
Indications for C-Section
- Approved indications: prior C-section or uterine surgery, severe maternal disease, pelvic tumors or trauma, active herpes, multiple gestation, malpresentation (e.g., breech), cephalopelvic disproportion (CPD), prolapsed cord, fetal distress, or fetal anomalies.
- Physician or maternal request alone is not an official indication.
Types and Timing of C-Sections
- Scheduled C-sections: Medically indicated before labor or as elective repeat procedures.
- Unscheduled C-sections: Emergent (acute event; delivery within 30 minutes), urgent (needs prompt but not immediate attention), or non-urgent (stable patient, can wait).
Risks of C-Section
- Maternal risks: infection, bleeding, injury to other organs (bowel, bladder), wound complications.
- Fetal risks: anesthesia effects (especially with general anesthesia), accidental injury at delivery, need for resuscitation.
- Risks increase with repeat C-sections due to uterine scarring.
Perioperative and Nursing Care
- Providers obtain informed consent and explain risks/benefits; nurses witness signature and address questions.
- Pre-op care: IV fluids, prophylactic antibiotics, blood clot prevention, shaving, Foley catheter insertion.
- Anesthesia: Epidural (boosted for C-section), spinal, or general (in emergencies or failed regional anesthesia).
- General anesthesia increases risks for both mother and baby; partners are typically not allowed in the OR.
Types of Incisions
- Skin incisions: Low transverse (bikini cut, preferred), vertical (used in emergencies).
- Uterine incisions:
- Low transverse: safest, allows for future VBAC.
- Low vertical/classical (high vertical): higher rupture risk, VBAC not recommended.
- T and J incisions: rare, associated with increased risk.
Post-Op and Postpartum Care
- Monitor for signs of infection, bleeding, respiratory status, and incision integrity.
- Include routine postpartum assessments along with typical surgical monitoring.
Key Terms & Definitions
- C-section — Surgical delivery of a baby through the abdomen.
- VBAC — Vaginal Birth After Cesarean.
- CPD — Cephalopelvic Disproportion; mismatch between fetal size and maternal pelvis.
- Emergent C-section — Urgent delivery required within 30 minutes.
- Low transverse incision — Horizontal cut in lower uterus, safest for VBAC.
Action Items / Next Steps
- Review class discussion on the ethics and implications of maternal-request C-sections.
- Study uterine incision types and their implications for future pregnancies.
- Prepare for further in-depth scenario discussions in the next class session.