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9 Cesarean Birth Nursing Care Plans

UPDATED ON OCTOBER 13, 2023

BY GIL WAYNE BSN, R.N.

Cesarean birth, also termed cesarean section, is the delivery of a
neonate by surgical incision through the abdomen and uterus.
The term cesarean birth is used in nursing literature rather
than cesarean delivery to accentuate that it is a process of
birth rather than a surgical procedure. This method may occur
under planned, unplanned, or emergency conditions. Indications
for cesarean birth may include abnormal labor, cephalopelvic
disproportion, gestational hypertension or diabetes mellitus,
active maternal herpes virus infection, fetal
compromise, placenta previa, or abruptio placentae.

Table of Contents

 Nursing Care Plans and Management

 Nursing Problem Priorities
 Nursing Assessment
 Nursing Diagnosis
 Nursing Goals
 Nursing Interventions and Actions
 1. Initiating Patient Education and Health Teachings
 2. Managing Acute Pain
 3. Preventing Infections
 4. Preventing Hypovolemia and Hemorrhage
 5. Promoting Safety and Preventing Injuries
 6. Reducing Anxiety and Fear
 7. Promoting Adherence to Therapeutic Regimen
 8. Administering Medications and Pharmacologic Support
 Recommended Resources
 See also
 Recommended Resources
 References and Sources
Nursing Care Plans and Management

The nursing care plan for patients undergoing a Cesarean birth

involves monitoring vital signs, incision site, and post-operative
pain, providing education on incision care
and postpartum recovery, and assisting with early ambulation
and mobilization. Nursing management includes providing pain
relief measures, promoting deep
breathing and coughing exercises to prevent complications,
administering prescribed medications, assessing and managing
incision site complications, and providing emotional support and
guidance throughout the recovery process.

Nursing Problem Priorities

The following are the nursing priorities for patients undergoing a

Cesarean birth:

 Pain management and comfort

 Incision site assessment and care
 Monitor vital signs and post-operative complications
 Promotion of breastfeeding and bonding
 Education on postpartum recovery and self-care
 Assistance with early ambulation and mobilization
 Emotional support and guidance
Nursing Assessment

Assess for the following subjective and objective data:

 Incision site pain or discomfort

 Swelling, redness, or discharge at the incision site
 Post-operative bleeding or unusual vaginal discharge
 Difficulty or pain while moving or walking
 Fatigue or exhaustion
 Breast engorgement or difficulty with breastfeeding
 Emotional changes such as mood swings or baby blues
 Incision site infection or wound complications (less
common but possible)
Nursing Diagnosis

Following a thorough assessment, a nursing diagnosis is

formulated to specifically address the challenges associated
with cesarean birth based on the nurse’s clinical judgment and
understanding of the patient’s unique health condition. While
nursing diagnoses serve as a framework for organizing care, their
usefulness may vary in different clinical situations. In real-life
clinical settings, it is important to note that the use of specific
nursing diagnostic labels may not be as prominent or commonly
utilized as other components of the care plan. It is ultimately the
nurse’s clinical expertise and judgment that shape the care plan
to meet the unique needs of each patient, prioritizing their health
concerns and priorities.

Nursing Goals

Goals and expected outcomes may include:

 The client will verbalize understanding of indications for

cesarean birth and postoperative expectations.
 The client will state that they feel well prepared for
cesarean birth.
 The client will recognize this as an alternative childbirth
procedure to achieve the best result possible in the end.
 The client will perform or participate in necessary
procedures appropriately to understand the rationale behind
the actions.
 The client verbalizes reduced discomfort or pain.
 The client appears relaxed, can rest or sleep, and
participates appropriately.
 The client verbalizes methods that provide relief.
 The client demonstrates relaxation skills and diversional
activities as indicated for the situation.
 The client is afebrile (temperature below 38℃/100.4℉) and
free of purulent drainage or erythema of the surgical site.
 The client achieves timely wound healing without
complications.
 The client’s amniotic fluid remains clear with a mild odor.
 The client remains normotensive, with fewer than 800
ml blood loss.
 The client has scant to no bleeding on the surgical dressing.
 The client’s urine-specific gravity remains between 1.003
and 1.030.
 The client’s weight loss is not more than 5 to 10 lbs (11 to
22 kgs).
  The client displays optimal FHR.
 The client manifests normal variability on the monitor strip.
 The client reduces the frequency of late or
prolonged variable decelerations.
 The mother is free of injury.
 The client and her partner discuss feelings about cesarean
birth.
 The client appears relaxed and comfortable.
 The client and her partner will verbalize fears for the safety
of herself and the infant.
 The client and her partner will express
decreased anxiety after explaining cesarean birth.
 The client will identify and discusses negative feelings.
 The client will verbalize confidence in herself and her
abilities.
 The client will identify coping strategies for the present
situation.
 The client will verbalize fears and feelings of vulnerability.
 The client will express individual needs and desires.
 The client will participate in the decision-making process
whenever possible.
 The client will participate in the development of goals and
care plans.
 The client will demonstrate behaviors necessary to
incorporate a therapeutic regimen in daily life.
 The client will participate in the decision-making process
about the infant.
 The client will demonstrate techniques to enhance the care
of the infant.
 The client will display a desire to strengthen her parenting
skills.
Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients

undergoing a cesarean birth may include:
1. Initiating Patient Education and Health Teachings

Cesarean section (CS) is one of the most common major surgical

procedures worldwide. Despite being a vital obstetric procedure
that saves the lives of women and infants, it is not free of short
and long-term adverse events for both. Childbearing women
themselves, their relatives, and society might prefer delivery by a
CS due to a lack of general knowledge about the advantages of
vaginal delivery, fear from pain, widespread misconceptions
about urinary and sexual functions after vaginal delivery, and the
misbelief that a CS is safer for the baby (Wali et al., 2020).

Assess the client’s or couple’s level of understanding.

Determining the level of understanding facilitates the planning of
preoperative teaching and identifies content needs.

Appraise knowledge toward the procedure.

Most clients fail to retain the information instilled during
childbirth classes. Therefore, clients have difficulty remembering
or understanding the details during the entire process.

Assess the level of stress and whether the procedure was

planned or not.
Defines the client’s or couple’s readiness to incorporate
information. Clients who are extremely worried
about surgery may need a detailed explanation of the procedure
to reduce their anxiety to a tolerable level.

Provide accurate information in easy-to-understand terms and

clarify misconceptions.
The stress of the situation can affect the client’s ability to
understand the information required to make informed decisions.
They may not process the new information if they do not
understand the terminology.

Encourage the couple to ask questions and verbalize their

understanding of the matter.
Provides an opportunity to assess and evaluate the client’s or
couple’s understanding of the situation. Answer all specific
questions that the couple has and fill in gaps in knowledge as
necessary. Be certain that all information that you offer is
correct.

Review indications necessitating alternative birth methods.

Cesarean birth should be viewed as an alternative and not an
abnormal situation to enhance maternal and fetal safety and
well-being.

Explain preoperative procedures in advance and present

rationale as appropriate.
Explanation of the logical reasons why a particular choice was
made is vital in preparation for the procedure. Immediate
preoperative procedures such as surgical skin preparation,
eating nothing before the time of surgery, premedications, and
method of transport to surgery should be clearly explained by the
nurse.

Review the necessity for postoperative measures.

Educate the client about the rationale behind necessary
postoperative measures such as indwelling bladder catheter, IV
fluid administration, and placement of an epidural catheter for
post-procedure pain relief (if preferred by the client). Knowing
the rationale behind the procedures may allow the client to feel a
sense of control over her situation.

Educate the client preoperatively and

reinforce learning postoperatively, including demonstration of
leg exercises, proper coughing, deep breathing
techniques, incentive spirometry, splinting, and abdominal
tightening exercises.
Provides routine to prevent complications associated with
venous stasis and hypostatic pneumonia and lessen stress on
the operative site. Abdominal tightening reduces distress
associated with gas formation and abdominal distension.
Periodic deep breathing exercises fully aerate the lungs and
help prevent stasis of lung secretions. Preoperative education
can help reduce anxiety about the procedure and clients are
more likely to comprehend what is being taught.

Stress anticipated sensations further during the delivery and

recovery period.
Knowing the possible outcomes helps prevent unnecessary
anxiety. Preoperative teaching aims to acquaint the client with
the cesarean procedure and any special equipment used.

Use visual aids during teaching if necessary.

Draw pictures or show illustrations of anatomy, as needed. These
materials could enhance the client’s learning experience and
make it easier to understand and recall the teachings fully. See
the resources section below for a list of teaching aids you can
use.

Discuss and develop a postoperative pain management plan and

review the use of the pain scale.
Developing a pain management plan with the client increases the
likelihood of successful pain management. Some clients may
expect that cesarean birth produces less pain than a vaginal
birth or fear becoming addicted to opioid agents (Wali et al.,
2020).

Note the presence of maternal factors that negatively affect

placental circulation and fetal oxygenation.
Decreased circulating volume or vasospasms within
the placenta decrease oxygen available for fetal uptake.
Vasospasm in gestational hypertension impedes blood flow to the
mother’s organs and placenta, reducing maternal blood flow
and nutrition flow and decreasing available oxygen to the fetus.

Document fetal heart rate (FHR), note any changes or

decelerations during and following contractions.
Owing to hypoxia, fetal distress may transpire; may be displayed
by reduced variability, late decelerations, and tachycardia
followed by bradycardia. Late decelerations suggest that the
placenta is not delivering enough oxygen to the fetus. Infection
from prolonged rupture of membranes also increases FHR (Ghi et
al., 2020).

Examine color and amount of amniotic fluid when membranes

rupture.
Fetal distress in vertex presentation is manifested
by meconium staining, resulting from a vagal response to
hypoxia. Meconium staining is a common complication
during labor and is a common cause for cesarean birth as shown
by 5% to 25% of meconium-stained amniotic fluid cesarean
deliveries (Hasan et al., 2021; Fernandez et al., 2018).

Document the presence of variable decelerations; change client’s

position from side to side.
Variable decelerations suggest that there is inadequate amniotic
fluid to cushion the cord or it is being compressed. Compression
of the cord between the birth canal and presenting part may be
relieved by position changes. The woman should be turned to her
left side to relieve pressure on the umbilical cord and improve
blood flow through it.

Auscultate FHR when membranes rupture.

In the absence of full cervical dilation, occult or visible prolapse
of the umbilical cord may necessitate cesarean birth. Rates
outside the normal range of 110 to 160 beats/minute for a term
fetus suggest a prolapsed umbilical cord after an amniotomy was
performed.

Monitor fetal heart response to preoperative medications or

regional anesthesia.
Following delivery, narcotics normally reduce FHR variability and
necessitate naloxone (Narcan) administration to reverse
narcotic-induced respiratory depression.
Maternal hypotension results from local anesthetic blockade of
the sympathetic nervous system leading to vasodilation.
Because uterine blood flow is not autoregulated, a decrease in
maternal blood pressure decreases uteroplacental perfusion.
Fetal bradycardia occurs within 15 to 45 minutes after initiation
of both epidural and combined spinal-epidural (CSE) anesthesia
(Galante, 2010).

Apply internal lead, and monitor fetus electronically as indicated.

Gives more precise measurements of fetal response and
condition. Continuous electronic fetal monitoring (EFM) allows
the nurse to collect more data about the fetus, which is why it is
used commonly in most hospitals. FHR and uterine contraction
patterns are continuously recorded.

Administer supplemental oxygen to mother via mask.

Maximizes oxygen available for placental uptake. Administer
10L/min for 30 minutes to increase fetal oxygenation. Oxygen
administration has also been used prophylactically in the second
stage of labor on the assumption that this is a time of high risk
for fetal distress (Fawole & Hofmeyr, 2012).

Administer IV fluid bolus before initiation of epidural or spinal

anesthesia.
Optimizes uteroplacental perfusion helps prevent a hypotensive
response. Administer saline solution to improve cardiac output,
circulatory volume, and uteroplacental perfusion. However, the
nurse should observe for fluid volume overload and pulmonary
edema.

Implement amniotransfusion, as indicated.

Amniotransfusion involves instilling a saline infusion by catheter
into the uterine cavity to restore amniotic fluid volume to relieve
umbilical cord compression that can interrupt fetal oxygenation.

Assist the healthcare provider with the elevation of the vertex, if

required.
Position changes may reduce pressure on the cord. Manual
elevation of the fetal presenting part using two fingers or the
whole hand through the vagina can be done, as well as
positioning the client into a steep Trendelenburg position,
exaggerated Sim’s position or knee-chest position to relieve cord
compression until cesarean birth is performed (Ahmed & Hamdy,
2018).

Implement measures to reduce uterine activity, as prescribed.

Excess uterine activity (tachysystole) is more than five
contractions in 10 minutes, averaged over 30 minutes (the
normal is five contractions or fewer in 10 minutes).
Discontinuing oxytocin or administering tocolytics that decrease
the healthcare provider may prescribe uterine activity.

Administer tocolytic drugs as prescribed by the healthcare

provider.
See Pharmacologic Management

Plan the presence of a pediatrician and neonatal intensive care

nurse in the delivery room for both scheduled and emergency
cesarean births.
Due to underlying maternal conditions and alternative birth, the
neonate may be preterm or experience altered responses,
necessitating immediate care or resuscitation.

2. Managing Acute Pain

The experience of pain during childbirth is complex and

subjective. Several factors can affect the client’s perception of
labor pain, making each experience unique. Consistently, pain
during childbirth is ranked high on the pain rating scale
compared to other painful life experiences (Labor & Maguire,
2008). Cesarean birth is among surgery procedures that induce
pain, and surgery threatens the body’s integrity. Increased serum
catecholamines and cortisol may lead to decreased pelvic blood
flow and increased pain during labor while disrupting normal
labor and delivery, prolonged deliveries, emergency cesarean
birth, medical and surgical interventions, and increased
dissatisfaction with childbirth experiences (Ahmadi, 2020).

Assess location, characteristics, frequency, severity, and

onset/duration of pain, especially related to the indication for
cesarean birth.
Data can help indicate the suitable choice of treatment and guide
interventions. The client awaiting imminent cesarean birth may
encounter varying degrees of discomfort, depending on the
indication for the procedure, e.g., failed induction, dystocia. A
study determined that the reasons for performing cesarean birth
were the above-normal baby’s weight, fetal distress, dystocia,
placenta previa, placenta abruption, decreased fetal percentage,
and malposition (Solehati & Rustina, 2015).

Assess the client’s perceptions, along with behavioral and

physiological responses.
Research shows that experiencing pain during labor and early
puerperium is higher in women after a cesarean birth. However,
many clients opt to deliver via cesarean for fear of pain (Ilska et
al., 2020). According to research conducted in Iran, over 70% of
pregnant women demand cesarean without medical necessity,
92% of which are due to fear of labor pain and normal delivery
complications. Correcting false client perceptions may help them
prepare adequately in dealing with childbirth pain.

Note the client’s attitude toward pain and use of specific pain
medications.
Fear of labor pain is the most common fear of childbirth (Ahmadi,
2020). According to previous studies, fear of pain increases the
amount of pain and stress during labor. Additionally, the pain
intensity is influenced by cultural factors. Culture has a role in
pain tolerance and psychological perception of pain (Solehati &
Rustina, 2015). Some clients may avoid pharmacological pain
relief because of cultural and religious beliefs.
Educate the patients about the effects of regional and general
anesthesia.
See Pharmacologic Management

During labor and delivery

Perform pain assessment every time the client reports pain.

Note, compare, and investigate changes from previous reports to
identify labor progress or rule out worsening of the client’s
condition or development of complications. Always rate the
client’s pain using a rating scale and identify its characteristics
(frequency, duration, severity, intervals).

Monitor the client’s vital signs.

Note for signs of tachycardia, hypertension, and increased
respirations. Changes in these vital signs often indicate acute
pain and discomfort.

Observe nonverbal cues of pain, especially in clients who cannot

communicate.
The nurse’s observations may not always be congruent with
verbal reports indicating the need for further evaluation,
especially in clients who cannot communicate verbally or clients
who strictly adhere to their birth plan, which strictly prohibits the
use of pharmacologic agents for pain relief. Nevertheless, these
women should be assured that pain relief is available at any time
during labor.

Avoid anxiety-producing circumstances (e.g., loss of control) and

encourage the presence of a partner.
Levels of pain tolerance are individual and are affected by
various factors. Extreme anxiety following an emergency may
develop discomfort due to fear, tension, and pain affecting the
client’s ability to cope. Providing social and professional support
to the client creates comfort and reassurance and reduces pain
(Ahmadi, 2020).
Encourage the client to verbalize feelings about pain.
Allow the client to verbalize her perceptions about pain and
acknowledge the pain experience. Pain is a subjective
experience and cannot be felt by others. Convey acceptance of
the client’s response to pain.

Teach and demonstrate proper relaxation techniques—position

for comfort as possible. Use therapeutic touch, as appropriate.
Relaxation techniques such as deep breathing exercises, music
therapy, massages, etc., can help decrease anxiety and tension,
promote comfort, and enhance a sense of well-being. Excessive
fear and worry increase the release of catecholamines such as
adrenaline and potentiate painkiller stimuli, increase the
perception of pain in the cerebral cortex and decrease pain
tolerance (Ahmadi, 2020).

Review client’s knowledge of and expectations about pain

management and previous experiences with pain and methods
used.
Antenatal childbirth preparation has a role in increasing maternal
satisfaction and may reduce pain scores. Antenatal education is
also essential when obtaining consent from the client; the aim is
to provide good information to facilitate mothers to form realistic
expectations about pain management during childbirth (Labor &
Maguire, 2008).

Postpartum care and interventions

Encourage adequate rest periods after cesarean birth.

The period after cesarean birth includes recovery from surgery
and adapting to motherhood. The client needs to rest adequately
to prevent fatigue and recover appropriately before assuming the
new role of being a mother. Parents may appreciate early
discharge, as it provides the family, including older siblings, an
opportunity to be together in the home environment (Kruse et al.,
2020). Additionally, it provides adequate social and moral support
for the woman.
Discuss with family ways to assist the client and reduce the
pain.
Emotional and psychological support provided by the family can
help in recovery and reduce postpartum pain.

If indicated, administer sedatives, narcotics, or preoperative

drugs.
See Pharmacologic Management

Assess location, characteristics, frequency, severity, and

onset/duration of pain, especially related to the indication for
cesarean birth.
Data can help indicate the suitable choice of treatment and guide
interventions. The client awaiting imminent cesarean birth may
encounter varying degrees of discomfort, depending on the
indication for the procedure, e.g., failed induction, dystocia. A
study determined that the reasons for performing cesarean birth
were the above-normal baby’s weight, fetal distress, dystocia,
placenta previa, placenta abruption, decreased fetal percentage,
and malposition (Solehati & Rustina, 2015).

Assess the client’s perceptions, along with behavioral and

physiological responses.
Research shows that experiencing pain during labor and early
puerperium is higher in women after a cesarean birth. However,
many clients opt to deliver via cesarean for fear of pain (Ilska et
al., 2020). According to research conducted in Iran, over 70% of
pregnant women demand cesarean without medical necessity,
92% of which are due to fear of labor pain and normal delivery
complications. Correcting false client perceptions may help them
prepare adequately in dealing with childbirth pain.

Note the client’s attitude toward pain and use of specific pain
medications.
Fear of labor pain is the most common fear of childbirth (Ahmadi,
2020). According to previous studies, fear of pain increases the
amount of pain and stress during labor. Additionally, the pain
intensity is influenced by cultural factors. Culture has a role in
pain tolerance and psychological perception of pain (Solehati &
Rustina, 2015). Some clients may avoid pharmacological pain
relief because of cultural and religious beliefs.

Educate the patients about the effects of regional and general

anesthesia.
See Pharmacologic Management

During labor and delivery

Perform pain assessment every time the client reports pain.

Note, compare, and investigate changes from previous reports to
identify labor progress or rule out worsening of the client’s
condition or development of complications. Always rate the
client’s pain using a rating scale and identify its characteristics
(frequency, duration, severity, intervals).

Monitor the client’s vital signs.

Note for signs of tachycardia, hypertension, and increased
respirations. Changes in these vital signs often indicate acute
pain and discomfort.

Observe nonverbal cues of pain, especially in clients who cannot

communicate.
The nurse’s observations may not always be congruent with
verbal reports indicating the need for further evaluation,
especially in clients who cannot communicate verbally or clients
who strictly adhere to their birth plan, which strictly prohibits the
use of pharmacologic agents for pain relief. Nevertheless, these
women should be assured that pain relief is available at any time
during labor.

Avoid anxiety-producing circumstances (e.g., loss of control) and

encourage the presence of a partner.
Levels of pain tolerance are individual and are affected by
various factors. Extreme anxiety following an emergency may
develop discomfort due to fear, tension, and pain affecting the
client’s ability to cope. Providing social and professional support
to the client creates comfort and reassurance and reduces pain
(Ahmadi, 2020).

Encourage the client to verbalize feelings about pain.

Allow the client to verbalize her perceptions about pain and
acknowledge the pain experience. Pain is a subjective
experience and cannot be felt by others. Convey acceptance of
the client’s response to pain.

Teach and demonstrate proper relaxation techniques—position

for comfort as possible. Use therapeutic touch, as appropriate.
Relaxation techniques such as deep breathing exercises, music
therapy, massages, etc., can help decrease anxiety and tension,
promote comfort, and enhance a sense of well-being. Excessive
fear and worry increase the release of catecholamines such as
adrenaline and potentiate painkiller stimuli, increase the
perception of pain in the cerebral cortex and decrease pain
tolerance (Ahmadi, 2020).

Review client’s knowledge of and expectations about pain

management and previous experiences with pain and methods
used.
Antenatal childbirth preparation has a role in increasing maternal
satisfaction and may reduce pain scores. Antenatal education is
also essential when obtaining consent from the client; the aim is
to provide good information to facilitate mothers to form realistic
expectations about pain management during childbirth (Labor &
Maguire, 2008).

Postpartum care and interventions

Encourage adequate rest periods after cesarean birth.

The period after cesarean birth includes recovery from surgery
and adapting to motherhood. The client needs to rest adequately
to prevent fatigue and recover appropriately before assuming the
new role of being a mother. Parents may appreciate early
discharge, as it provides the family, including older siblings, an
opportunity to be together in the home environment (Kruse et al.,
2020). Additionally, it provides adequate social and moral support
for the woman.

Discuss with family ways to assist the client and reduce the
pain.
Emotional and psychological support provided by the family can
help in recovery and reduce postpartum pain.

If indicated, administer sedatives, narcotics, or preoperative

drugs.
See Pharmacologic Management

3. Preventing Infections

If the cesarean birth is performed hours after the membranes

rupture, a woman’s risk for infection will be higher than if the
membranes were still intact. Amniotic fluid helps protect the
fetus from infectious agents due to its inherent antibacterial
properties. After the rupture of membranes, the cervical canal
becomes the usual pathway for cervical and vaginal flora,
causing infections. Additionally, the skin also serves as the
primary line of defense against bacterial invasion, so when the
skin is incised for a surgical procedure, this important line of
defense is lost.

Assess history for preexisting conditions or risk factors. Note

time of rupture of membranes.
Persons with a history of diabetes or hemorrhage have increased
chances of infection and poor healing. The risk of
chorioamnionitis increases while the pregnancy progresses,
which may increase fetal risk contamination.

Assess the client’s vital signs for signs and symptoms of

infection.
Rupture of membranes occurring 24 hours before the surgery
may result in chorioamnionitis before surgical intervention and
impair wound healing. An elevated temperature of at least 39℃
(102.2℉) or between 38℃ (100.4℉) and 39℃ (102.2℉) within 30
minutes and one of the clinical symptoms are signs of clinical
chorioamnionitis. Chorioamnionitis presents as a febrile illness
associated with an elevated WBC count, uterine tenderness,
abdominal pain, foul-smelling vaginal discharge, and fetal and
maternal tachycardia (Fowler & Simon, 2021).

Assess fetal heart rates regularly.

Fetal tachycardia (rate >160 beats per minute) may be the first
sign of infection. Poor fetal oxygenation may also occur,
especially with abnormal labor (Leifer, 2018). In the presence of
fetoplacental infection or inflammation, the production
of cytokines and other inflammatory mediators leads to an
increase of the FHR baseline secondary to a dysregulation of the
thermoregulatory center and the increased metabolic rate (Ghi et
al., 2020).

Assess amniotic fluid drainage for color, clarity, and odor.

Cloudy, yellow, or foul-smelling amniotic fluid suggests infection,
and meconium (green) staining suggests fetal compromise but is
also seen with prolonged pregnancy.

Observe for localized signs of infection at the surgical incision

site.
Surgical site infection (SSI) occurs in up to 11% of women after
cesarean birth and is manifested as wound infection,
endometritis, or urinary tract infection. The Centers for Disease
Control and Prevention (CDC) defined SSI as an infection
occurring 30 days after the operative procedure. However, they
may appear after discharge and are managed, outpatient. The
skin and subcutaneous tissue may have purulent drainage, a
positive culture, complaints of pain or tenderness, or evidence of
swelling, redness, or heat (Burke & Allen, 2020).
Provide perineal care per protocol, particularly once membranes
have ruptured.
Decreases risk of ascending infection. Assist the client in
maintaining good perineal hygiene by wiping from front to back.
Good hygiene reduces the possibility of introducing bacteria into
the birth canal. Vaginal cleansing with a 10% solution of
povidone-iodine swab stick for 30 seconds should be considered
for women in labor, especially those with ruptured membranes
(Burke & Allen, 2020).

Strictly adhere to preoperative skin preparation; scrub according

to protocol.
Decreases risk of skin contaminants entering the operative site,
reducing the risk of preoperative infection. High-quality studies
found that betadine and chlorhexidine as skin antisepsis
preparation are sufficient and optimal when the solution is
allowed to dry, per the manufacturer’s instructions (Burke &
Allen, 2020).

Record hemoglobin and hematocrit and estimated blood loss

during the surgical procedure.
The risk of post-delivery infection and poor healing increases if
hemoglobin levels are low and blood loss is excessive. Compared
with vaginal birth, women having a cesarean birth, especially a
repeat cesarean, incur the highest risk for postpartum
hemorrhage (PPH) (Burke & Allen, 2020). Excessive blood loss
reduces immunity and leads to a lowering of hemoglobin
concentration, which increases the risk of infection by negatively
affecting macrophage activity and impeding wound healing
(Abdelraheim et al., 2019). Greater blood loss is associated with
classic incision than lower uterine segment incision.

Stress proper handwashing techniques by

all caregivers between therapies/clients.
Hand hygiene is the single most effective way to prevent
infections. The World Health Organization (WHO) and the CDC
recommend hand hygiene as the first, simplest, and most cost-
effective technique for infection control. Healthcare providers,
clients, and their family members in the healthcare setting need
to closely adhere to hand hygiene guidelines to prevent and
minimize nosocomial infections (Damanabad et al., 2021).

Maintain sterile techniques for invasive procedures.

Using a sterile technique on invasive procedures (e.g., IV start,
urinary catheterization, etc.) reduces the microbial count and
creates a sterile field that helps prevent infections. Breaks in the
technique can lead to infections in the client, leading to higher
healthcare costs and severe complications (Tennant & Rivers,
2021).

Encourage early ambulation after cesarean birth.

Early mobilization is often part of a surgical bundle “fast track” or
“enhanced recovery after surgery” (ERAS). It is recommended to
improve many short-term outcomes after surgery, including a
rapid return of bowel function and decreased length of hospital
stay, thereby reducing the risk for infection (Macones et al.,
2019).

Instruct client and family about techniques to protect the skin’s

integrity and prevent the spread of infection.
Surgical site infections occur in approximately 10% of clients,
>80% of which develop after discharge, which indicates a need
for the client and their family to be provided with comprehensive
information on the normal discharge course, signs and symptoms
of infection, activity restrictions, and instructions on when to
seek medical attention (Macones et al., 2019). Symptoms to
watch out for that may indicate SSI are fever, pain, tenderness,
purulent drainage of abscess on the incision site, and evidence
of swelling, redness, or heat (Burke & Allen, 2020).

Emphasize the necessity of taking antibiotics as directed and

using “leftover” drugs.
Premature discontinuation of treatment when the client feels
well may yield reinfection and antibiotic resistance. The major
contributors to resistance development include clinical misuse,
self-medication, ease of availability of antibiotics, and poor
hospital-based antibiotic use regulation in both developing and
developed countries (Chokshi et al., 2019).

Administer parenteral, intravenous antibiotics within 60 minutes

before cesarean birth skin incision, as indicated.
See Pharmacologic Management

Obtain blood, vaginal, and placental cultures, as indicated.

Evaluate the results of blood and wound cultures before the
initiation of antibiotics to help determine the infecting organisms
and degree of involvement. Laboratory findings typical of
infection include leukocytosis with neutrophilia, a left shift, and
lactic acidosis. However, no postpartum infection can be
excluded based on lab work alone (Boushra & Rahman, 2021).

4. Preventing Hypovolemia and Hemorrhage

During a Cesarean birth, blood loss is a normal occurrence as the

uterus is highly vascularized. However, excessive blood loss or
postpartum hemorrhage can occur, which is characterized by
heavy or continuous bleeding. It is a serious complication that
can lead to hypovolemic shock and requires prompt medical
intervention, including uterine massage, administration of
uterotonics, fluid replacement, and possible blood transfusion to
stabilize the patient’s condition and prevent further
complications.

Assess the client’s intake and output and document for at least
24 hours.
Keep an accurate intake and output record of the client to
ensure an adequate fluid balance has been achieved. A full
uterus can obstruct a full bladder and fetal head; therefore,
encourage voiding every two (2) hours if possible or catheterize if
the bladder is distended and the client cannot void.
Assess the client’s respirations, BP, and pulse before, during, and
after surgery.
To detect the earliest signs of bleeding, monitor blood pressure,
pulse, and respiratory rate approximately every 15 minutes for
the first hour after surgery, every 30 minutes for the next 2 hours,
every hour for the next 4 hours, or as specifically prescribed. A
minimal but continued change in vital signs is as ominous a sign
of hemorrhage as is a sudden alteration in these measurements.

Assess for signs indicative of possible hemorrhage.

Observe for signs of hemorrhage, which include falling blood
pressure (more than 20 mmHg systolic), systolic blood pressure
less than 80 mmHg, or a drop of 5 to 10 mmHg over several
readings; a change in pulse rate greater than 110 beats/minute or
less than 60 beats/minute; respirations more rapid and stressed
from previous readings; and restlessness and a sense of thirst.
Notify the healthcare provider of any changes in vital signs that
may indicate hemorrhage.

Assess the client’s dressing on the incision site and check for
excessive vaginal discharges.
Inspect the dressing over the client’s surgical incision for blood
staining each time vital signs are assessed to document no
incisional bleeding. Observe the perineal pad for lochia flow and
palpate fundal height each time to document uterine contraction.
Blood oozing vaginally or from a surgical wound can pool
considerably under the client before being otherwise visible.

Assess the client’s fundal height and abdomen regularly.

A client who has had spinal or epidural anesthesia will not
experience pain on uterine palpation until the anesthesia has
worn off. Therefore, uterine palpation should not increase her
pain. Palpate gently enough once the anesthesia has worn off to
not cause increased pain but thoroughly enough to determine
uterine consistency. Assess the remainder of the abdomen for
softness. A hard, “guarded” abdomen is one of the first signs
of peritonitis.
Note the shift in behavior or mental status and cyanosis of
mucous membranes.
Oxygen deficits are manifested first by changes in mental status,
later by cyanosis. The presentation may include altered cognitive
and neuromuscular function in clients with severe fluid volume
depletion. Altered mentation can be both a cause and a
consequence of volume depletion (Asim et al., 2019).

Remove nail polish on fingernails and toes.

Removal of nail polish allows the nurse to visualize the nail beds
for assessing circulatory status. During the capillary refill test,
pressure is applied on the nail bed until it turns white. Then, the
pressure is released, and the amount of time it takes for the
blood to return is measured.

Place a towel or wedge under the client’s hip.

Placing a towel wedge shifts the uterus off of the inferior vena
cava and increases venous return. Compression caused by
obstruction of the inferior vena cava and aorta by the gravid
uterus in a supine position may cause as much as a 50%
decrease in cardiac output (Kim & Wang, 2015).

Encourage the client to increase fluid intake, as indicated.

Introduce oral fluid slowly (e.g., ice chips for the first hour, then
sips of clear liquid such as ginger ale, Jell-O, tea, or flavored ice).
Teach the client to continue to drink large quantities of fluid
after they return home (at least 6 glasses daily) so they have
adequate body fluid to make breastfeeding successful.

Administer supplemental oxygen via a mask, as indicated.

Oxygen administration increases the oxygen available for
maternal and fetal uptake. Maintaining adequate uterine
perfusion can optimize fetal oxygenation, prevent acidosis,
deliver nutrients, and eliminate waste products from the uterine
myometrium (Caughey et al., 2018).
Administer IV fluids with or without oxytocin, as indicated.
It is important to infuse IV fluids during cesarean birth at a
monitored rate. Rapid infusion can lead to cardiac overload,
while slow infusion can lead to inadequate circulatory
compensation. Oxytocin may be added, as prescribed, to the first
one or two liters of IV fluid after surgery to ensure firm uterine
contraction. Oxytocin aids myometrium contraction and reduces
blood loss from exposed endometrial blood vessels. Be aware
that the client is prone to hemorrhage when the oxytocin is
discontinued. This is the first time her uterus is asked to
maintain contraction on its own, so monitor the client’s vital
signs carefully.

Administer blood and blood products as indicated.

A strong recommendation on blood transfusion in postpartum
hemorrhage is that the client receives RBCs as soon as possible
in case of massive hemorrhage. Additionally, the early treatment
of coagulopathy with fresh frozen plasma (FFP) and platelets
determines maternal morbidity and mortality. Fibrinogen plasma
level has been a good predictor of hemorrhage severity because
it plays a critical role in maintaining and achieving hemostasis.
Fibrinogen concentrates offer rapid restoration of the fibrinogen
concentration with a small-volume infusion with minimal
preparation time (Bonnet & Benhamou, 2016).

Administer tranexamic acid as prophylaxis, as prescribed.

See Pharmacologic Management

5. Promoting Safety and Preventing Injuries

After a Cesarean birth, patients may be at an increased risk of

falls and injury due to the physical changes and recovery
process. They may experience post-operative pain, limited
mobility, and difficulty with activities of daily living, which can
contribute to a higher risk of accidents. It is important to provide
a safe environment, educate patients on proper body mechanics
and movement techniques, encourage early mobilization, and
implement fall prevention strategies to minimize the risk of injury
and promote a safe recovery.

Assess and record the time of first bowel sounds auscultated

after the surgery.
During surgery, the intestine can feel pressure, resulting in a
paralytic ileus or halting of intestinal function with obstruction.
Late-onset of bowel movements after cesarean birth with spinal
anesthesia can cause discomfort to the mother and prolonged
hospital stay (Akalpler & Okumus, 2018).

Assess the client’s voiding pattern, including frequency, output,

appearance, and time of the first postoperative output.
An indwelling catheter will be inserted during cesarean delivery
to reduce bladder injury and increase time to first voiding,
leading to early catheter removal and reducing incidences
of urinary tract infection (Macones et al., 2019). Additionally,
after removing the catheter, the woman should void in 4 to 8
more hours. Assess for bladder refilling by palpation to
determine urinary retention, which can be potentially dangerous
because a full bladder may inhibit the uterus from contracting,
increasing the risk for postpartum hemorrhage.

Assess the surgical incision every 8 hours for every nursing shift.
Surgical incisions heal by primary intention. The nurse should
routinely assess the surgical incision to ensure that the wound
edges are approximated, and there are no signs of infection such
as erythema or purulent discharges.

Assess the client’s vital signs, especially the respiratory rate,

every 15 minutes for the first 1 to 2 hours and then every 30
minutes for 1 hour according to hospital policy.
The nurse should closely monitor the client for depressed
respiratory function, especially if general anesthesia has been
administered. There is a greater potential for postoperative
sedation with general anesthesia than regional anesthesia
(Caughey et al., 2018).
Assess the client’s lower extremity reflexes to return sensation
to the lower limbs.
The administration of spinal or epidural anesthesia during
cesarean birth produces numbness to the lower extremities that
should disappear after a few hours. To assess for return of
sensation, the nurse may elicit the knee-jerk reflex or the
Achilles reflex by striking the plantar surface of the foot with a
reflex hammer while creating a 90-degree angle.

Remove prosthetic devices before surgery.

Before surgery, follow hospital protocols regarding removing
jewelry, contact lenses, piercings, hair ornaments, acrylic nails,
or nail polish. These accessories can become accidentally
dislodged or damaged during surgery. Nail polish should be
removed to allow healthcare providers to assess for a capillary
refill during the procedure.

Monitor urine output following insertion of an indwelling

catheter.
An indwelling catheter reduces bladder size and keeps the
bladder away from the surgical field. Catheterization may prevent
bladder injury and postoperative urinary retention. A distended
bladder is also expected to interfere with exposure and
complicate surgery (Li et al., 2010). Additionally, the physiologic
stress of surgery or lack of blood flow to the kidneys due to
decreased blood pressure can cause kidney failure. All
reproductive tract surgery also puts the ureter flow at risk
because the edema that collects in the surgical area can press
on the ureters.

Obtain the urine specimen for routine analysis, protein, and

specific gravity. Ensure that laboratory results are available
before surgery is started.
Preoperative assessment procedures for the client may include
circulatory and renal function tests, complete blood count,
coagulation profile, serum electrolytes, and blood typing and
crossmatching. Keep in mind that blood values need to be
evaluated in light of the changes in pregnancy.

Ensure early, if not immediate, removal of indwelling catheter

after cesarean birth.
Clients without indwelling catheters had a shorter mean
ambulation time and length of hospital stay. Even though the
urinary catheter was removed 12 hours after surgery, the
incidence of urinary tract infection was still significantly higher.
Additionally, there is a higher incidence of discomfort and
increased time to first voiding in clients with indwelling
catheters, according to a Cochrane review (Macones et al.,
2019).

Encourage enhanced recovery after surgery (ERAS)

sham feeding (chewing gum) as appropriate after cesarean birth.
Problems such as constipation, postoperative ileus, and
abdominal distention may be seen as an effect of anesthesia
after abdominal surgery. Sham postoperative feeding with
chewing gum after abdominal surgery appeared to reduce the
time to recover gastrointestinal function (Macones et al., 2019).
Chewing gum activates the cephalic vagal reflex and stimulates
the digestive cephalic phase by imitating eating (Akalpler &
Okumus, 2018).

Encourage early mobilization after cesarean birth, as indicated.

Early mobilization can improve many short-term outcomes after
surgery, including the rapid return of bowel function, reduced risk
of thrombosis, and decreased length of stay (Macones et al.,
2019).

Restrict oral intake up to 6 hours before surgery, as indicated.

The client may be encouraged to drink clear fluids until 2 hours
before surgery. A light meal may be eaten up to 6 hours before
surgery. The European Society of Anesthesiology Guideline
recommended that adults are allowed clear fluid intake 2 hours
before elective surgeries (including cesarean births), and solid
food is prohibited for 6 hours (Wilson et al., 2018).

Encourage the use of compression stockings as ordered by the

healthcare provider.
Pregnant and postpartum women are at an increased risk of
venous thromboembolism due to decreased physical
mobility after major abdominal surgery. Pneumatic compression
stockings may be used to prevent thromboembolic disease in
clients who underwent cesarean birth (Macones et al., 2019).

Administer ephedrine or phenylephrine and antiemetics to

prevent nausea and vomiting, as prescribed.
See Pharmacologic Management

Administer IV fluids such as lactated Ringer’s solution before

surgery.
IV fluids ensure that the client is fully hydrated and will not
experience hypotension from epidural anesthesia administration.
If possible, start a line at the client’s non-dominant hand using a
large-size catheter or needle (18 or 20 gauge), so blood
replacement therapy can be administered by the same line if
needed. Learn more about IV fluids here.

Maintain specific instrument and sponge counts at critical times

during closure, according to hospital protocol.
Guarantees that all equipment and sponges are accounted for
and not accidentally left in the client’s body. Preventing retained
surgical items requires using combined evidence-based
strategies supported by nursing leaders who value safe, patient-
centered care by increasing the staff members’ knowledge with
an effective safety-sponge technology system (Grant et al.,
2020).

Assist with positioning for anesthesia; support legs in

postoperative transfer to stretcher. Document the client’s
response during and after anesthesia.
The sitting and lateral decubitus positions are usually used for
epidural anesthesia. The client with epidural or spinal anesthesia
may acquire weakness or decreased sensation of lower
extremities. Postdural puncture headache may occur after, which
is a common complication associated with epidural and spinal
anesthesia (Folino & Mahboobi, 2021).

6. Reducing Anxiety and Fear

After a Cesarean birth, some patients may experience feelings of

no control, low self-esteem, and anxiety. This may stem from the
perception of not having control over the birth process, the
surgical intervention, and the recovery period. Moreover,
changes in body image and self-perception may contribute to
feelings of low self-esteem. Addressing these emotions through
open communication, providing information and support, and
involving the patient in decision-making can help alleviate these
concerns and promote emotional well-being.

Assess psychological response to events and availability of

support systems.
The greater the client perceives the threat, the greater her
anxiety level. Women who are extremely worried about the
cesarean birth may need a detailed explanation of the procedure
to reduce their anxiety to a tolerable level.

Determine stress level and learning needs.

Provides a database to build on to provide information that will
decrease anxiety. Overwhelming or persistent fears result in
excessive stress reactions.

Consider cultural influences or expectations.

Some cultures (e.g., Latin, Mexican/Arab-American) may view
surgical intervention as detrimental to the client’s well-being or
may believe the client will be stigmatized as a “weak woman”
(e.g., Puerto Rican). Women who have a cesarean birth might be
stigmatized because they are seen as having avoided something
difficult, the rite of passage into motherhood of going through
hours of agonizing labor (Cripe, 2017).

Know whether the procedure is planned or not.

If the procedure is unplanned, the client or couple usually has
limited physiological or psychological preparation time. Cesarean
birth can still create apprehension even if planned due to the
perceived physical threat to the mother and infant.

Note and validate expressions of fear, distress, or feelings of

helplessness.
Validation helps the nurse and the client deal realistically with
fear. Numerous fears surrounding childbirth have been reported,
and these include fear of losing control, emergency cesarean
birth, death or injury to themselves or the baby, inadequate
support/care from care providers, not having a voice in decision
making, pain, epidural anesthesia, episiotomies or perineal tears,
and the unknown (Bryanton et al., 2021).

Remain with the client, and stay calm. Speak slowly and convey
empathy.
Therapeutic communication helps to reduce interpersonal
transmission anxiety and shows care for the client or couple.
Studies, such as the Akbarzadeh et al., have proved that nurse
companionship with the client positively reduces maternal
anxiety during and after cesarean birth (Mostafayi et al., 2021).

Reinforce positive aspects of maternal and fetal condition.

It focuses on the likelihood of a desirable outcome and helps
bring perceived or actual threats into perspective.

Let the client or couple verbalize their inner thoughts and

feelings.
Helps to distinguish negative feelings and concerns and provides
a chance to cope with uncertain or unresolved feelings of grief.
The client may also feel emotional intimidation to her self-
esteem, owing to her feelings that she has failed, that she is
weak as a woman, and that her expectations have not been met.
The partner may question their abilities in assisting the client
and providing needed support.

Support or redirect expressed coping mechanisms.

Improves fundamental and automatic coping mechanisms,
increases self-confidence and acceptance and reduces anxiety.
Note: Some actions by the client may be viewed as ineffective
(e.g., screaming and throwing things) and need to be redirected
to enhance the client’s sense of control. Participants of a
research study voiced that gaining control and developing a plan
for their birth helped them cope with their fears (Bryanton et al.,
2021).

Allow the client to discuss and elaborate past childbirth

experiences or expectations, as appropriate.
The client may have twisted thoughts of past delivery or
unrealistic perceptions of abnormality of cesarean birth that will
increase anxiety.

Allot time for privacy.

Allows the client or couple to process information, organize
resources, and cope effectively.

Guide the client through preoperative nursing care.

Familiarization with preoperative nursing care can significantly
reduce the client’s anxiety, heart rate, respiratory rate, and blood
pressure (Mostafayi et al., 2021).

Appraise circumstances contributing to a sense

of powerlessness.
Powerlessness becomes a major stress factor for clients
experiencing their first hospitalization, including fear of the
unknown. Unplanned (and sometimes planned) cesarean birth
may be characterized by the client’s or couple’s sense of loss of
control over the birth experience (Burcher et al., 2016).
Identify the client’s strengths and past successful coping
strategies.
Helps the client to recognize their ability to deal with a difficult
situation. One of the most important strategies for coping with
the fear of childbirth is the feeling of confidence. Maternal
confidence can be derived from four important factors, according
to a qualitative study by Ahmadi (2020): faith in God, receiving
support, raising awareness, and positive thinking.

Encourage the client to consider options in care when possible

(e.g., IV placement, choice of anesthesia, and use of the mirror).
Provide client opportunities to control as many events (e.g.,
choice of food, placement of IV cannula, choice of anesthesia
type, etc.) as care restrictions may permit the client to have
some sense of control over the situation.

Recognize client or couple’s expectations and desires

concerning the delivery experience.
Provides an opportunity to accommodate needs and encourage a
positive experience. Increasing awareness and preparation for
childbirth is an important strategy for coping with the fear of
childbirth. Well-prepared women have higher confidence which
translates to reduced fear of losing control of the situation
(Ahmadi, 2020).

Allot personal time and space for the couple before the surgery,
if possible. Stay with the client if the partner is absent.
Provide an opportunity to let the couple talk about the situation
through their means. Leaving the client alone may result in
feelings of abandonment and adds anxiety. Providing ongoing
emotional and psychological support to the mother creates
comfort and reassurance and reduces fear and pain (Ahmadi,
2020).

Provide information, and talk about the client or couple’s

perceptions.
Providing information diminishes stress brought by
misconceptions and unfounded fear. By receiving correct
information, well-prepared women for pregnancy and childbirth
have greater expectations of actual pain levels and are less
likely to experience inability and loss of control (Ahmadi, 2020).

Develop a care plan with the client specifying goals agreed on.
Enhances commitment to the plan and optimizing outcomes.
Shared decision-making before and during labor and delivery is
critical for developing and preserving a client-provider
relationship characterized by trust, mutual respect,
multidirectional communication, and shared power/control
(Ahmadi, 2020).

Facilitate return to a productive role in whatever capacity

possible for the client.
The extent of recovery following a cesarean birth varies among
clients. For some women, emotional recovery is much more
difficult than physical recovery. Difficulties with infant care,
particularly breastfeeding, also influence the client’s productive
role. The presence of support and social interaction can
positively impact the client’s emotional and physical recovery.
Education about infant care and breastfeeding also increases the
client’s control of the situation and her new role as a mother
(Puia, 2018).

Encourage the client to think productively and positively and

take responsibility for their thoughts.
Having positive attitudes such as paying attention to positive
aspects like becoming a mother and others’ positive experiences
and using positive visualization such as imagining the pleasing
results of childbirth and having beautiful perceptions about the
moment of mother and child visit creates positive thinking. It
ultimately reduces the fear of childbirth (Ahmadi, 2020).
7. Promoting Adherence to Therapeutic Regimen

The postpartum period is a difficult time, where new roles and

responsibilities are assumed. During this period, the parents
have to learn infant care, establish a safe environment for the
infant, learn the new roles, and deal with the problems related to
the infant. However, the postpartum period is also when the
mother needs the most information, support, and qualitative
care. Being discharged from the facility 24 hours after birth may
be sufficient to prevent complications; however, it is not
sufficient enough to support the mother to adapt to her new
situation. Therefore, at such a critical period, the mother’s
physical and mental health should be closely monitored after the
discharge (Capik et al., 2015).

Assess the environment for factors causing sensory overload.

Cesarean birth can be tedious for the client, and she may not
concentrate on the procedures being performed. Determine the
factors that can be controlled and cannot be controlled.

Assess the extent of the client’s ability to move in bed and

breastfeed.
Explain the importance of getting out of bed and caring for the
neonate. Early ambulation helps prevent thrombophlebitis, and
early breastfeeding helps establish an adequate milk supply.

Assess the client’s and partner’s ability to comprehend

information, including literacy, level of education, and primary
language.
This provides opportunities to clarify viewpoints or
misconceptions. It also verifies that the client and her partner
have accurate and factual information to make informed choices.
The prenatal and postpartum periods are needed to prepare the
woman and family adequately for recovery and parenting
(Miovech et al., 2013).
Determine cultural, spiritual, and health beliefs and ethical
concerns.
Identifying these factors provides insight into thoughts and
factors related to individual situations. Beliefs will affect the
client’s perception of the situation and participation in the
therapeutic regimen. Interventions may be incongruent with the
client’s social and cultural lifestyle and perceived
role/responsibilities.

Provide the client information about the cesarean birth

postpartum care.
Information about postpartum care and how to manage possible
complications can help decrease anxiety and put perceived
“chaos” in perspective. An unplanned, emergency cesarean
delivery can be especially stressful, with its unfamiliar and
intrusive procedures occurring in rapid succession, straining the
ability of the mother to assimilate the experience (Miovech et al.,
2013). Providing information helps prepare the women for a new
life, decreases maternal morbidity during this period, and
promotes recovery (Salam Ramadan & Farrag, 2018).

Explain the physiological process of the woman during the

postpartum period.
Explanations about the process of returning to the nonpregnant
state should be provided at this time by the nurse. Women need
to learn that the discomfort associated with the healing incision
may take months to resolve. The ability to move quickly and
easily will return gradually. Methods to accomplish teaching can
include pamphlets, videos in the postpartum unit, and
postpartum follow-up calls (Miovech et al., 2013).

Listen to the client’s and partner’s reports and comments.

Listening actively conveys a message of concern and belief in
the individual’s capabilities to resolve the situation positively.
Each interaction with the postpartum woman should have
specific teaching and learning goals because often the woman
will be discharged according to externally applied criteria rather
than personal readiness (Miovech et al., 2013).

Provide positive reinforcements for efforts.

Positive feedback encourages the continuation of the desired
behaviors. Emphasize positive aspects of the situation,
maintaining a positive attitude toward the client’s capabilities
and potential for improvement. Helping the client to feel
accepting about herself and her individual capabilities will
promote growth and strengthening of her self-care skills.

Promote client and partner’s participation in the planning and

evaluating process.
Discharge planning should include helping parents make
arrangements for obtaining help from relatives and friends and
spacing activities throughout the day to reduce fatigue. The
management of one is not effective for the other, therefore, a
correct evaluation is necessary so that the woman receives
appropriate interventions (Miovech et al., 2013).

Develop a plan for self-monitoring with the client.

Share data pertinent to the client’s condition such as laboratory
results or blood pressure readings. This provides a sense of
control and enables the client to follow their own progress and
make informed choices.

Assess the client’s or couple’s perception of the situation and

note individual concerns.
Identifying individual factors will aid in focusing interventions
and establishing a realistic care plan. When a cesarean birth is
unscheduled, the client does not have much preoperative time to
think about how she will feel after surgery. Most clients are
surprised to realize how quickly they become fatigued and how
painful a simple surgical incision can be. Identifying essential
factors that can affect their parenting role should be done early
to put forth interventions before discharge.
Determine cultural and religious influences on parenting
expectations of self and infant.
This information is crucial to helping the family identify and
develop a treatment plan that meets its specific needs. For
example, Chinese parents rarely praise their children verbally,
because their culture encourages modesty and humility. Chinese
typically express their emotions in more subtle forms than
Western people (Chung et al., 2018).

Assess the client’s or couple’s level of stress and discomfort.

A study demonstrated that an atmosphere full of stress and
discomfort in high-risk pregnancies might reduce maternal
attachment behaviors. Adaptations to changes in pregnancy in
normal conditions were already considered a crisis, as well. In
case of a health risk for the mother or the infant, conditions
would be more difficult, requiring more flexibility and patience
(Rookesh et al., 2021).

Assess parenting skill level, considering intellectual, emotional,

and physical strengths and limitations.
This identifies areas of need for further education, skill training,
and factors that might interfere with assimilating new
information. If the parent’s behavior shows strong intent for
interaction, it attracts the attention of infants and initiates
mutual exchange, response, and participation (Chung et al.,
2018).

Note the presence and effectiveness of extended family support

systems.
Having a support system provides role models for parents to help
them develop their parenting style. However, some role models
may be negative and/or controlling. The history of parental
evolution and the way parents have interacted with their own
parents can also influence how they behave with their children in
the future (Vafaeenejad et al., 2019).
Encourage the mother to breastfeed the infant.
Unless the infant was transferred to another unit, the nurse
should provide the mother ample time to hold and breastfeed her
infant. The average woman can breastfeed satisfactorily after a
cesarean birth. However, caution the client that this may cause
temporary uterine pain as the uterus contracts with
breastfeeding, which could be beneficial in preventing
postpartum hemorrhage. Intensive breastfeeding may facilitate
increased maternal emotional care resulting in greater security
attachment (Gibbs et al., 2018).

Involve the client in activities with the infant that they can
accomplish successfully.
Participating in infant care enhances the client’s self-concept.
Studies showed that mothers in a vaginal birth group are more
motivated to take care of newborns and felt less tired than
mothers in a cesarean birth group, who were more likely to fail in
their efforts to care for their infants (Chen & Tan, 2019).

Encourage early skin-to-skin contact between mother and infant.

Research showed that mother-infant attachment status directly
affected infants’ emotional, sentimental, and neonatal
dimensions and behavioral problems. Results of a study indicated
that the ratio of infants transferred to the Neonatal Intensive
Care Unit (NICU) for examination after skin-to-skin contact
immediately after cesarean birth was significantly different from
the group with no mother-infant contact. These results support
immediate, uninterrupted skin-to-skin contact for all mothers
regardless of birth mode (Rookesh et al., 2021).

Recognize and provide positive feedback for nurturant and

protective parenting behaviors.
Emphasize positive aspects of the situation, maintaining a
positive attitude toward the parent’s capabilities and potential
for improvement. This reinforces the continuation of desired
behaviors. Helping the parents to feel accepting about
themselves and individual capabilities will promote growth and
strengthening of their skills.

Refer the client/couple to resources such as books, classes, and

support groups.
The client should be able to develop support systems appropriate
to their situation. Providing information and role models can help
people learn to negotiate and develop skills for parenting and
living together.

8. Administering Medications and Pharmacologic Support

Medications administered during a Cesarean birth primarily

include anesthesia agents, such as general anesthesia or
regional anesthesia (spinal or epidural). These medications are
used to provide pain relief and numbness during the surgery.
Tocolytics are medications used in some cases of Cesarean birth
to inhibit uterine contractions and delay labor. Supportive
medications, such as analgesics and antibiotics, may also be
given to manage post-operative pain, prevent nausea
and vomiting and prevent infections, respectively.

Tocolytic drugs
Tocolytics had been used to decrease the uterine contractions,
relieve the pressure in the case of a prolapsed umbilical cord,
and improve the placental perfusion and hence the blood supply
to the fetus. However, the nurse should monitor uterine atony
postpartum because tocolytics can cause uterine atony (Ahmed
& Hamdy, 2018).

General anesthesia
General anesthesia induces a state of unconsciousness, allowing
the mother to be completely unaware and asleep during the
procedure. It is typically used when regional anesthesia is
contraindicated or not preferred by the patient. General
Regional anesthesia
Regional anesthesia, specifically spinal or epidural anesthesia, is
a common choice for Cesarean births. It allows the mother to
remain awake and alert, providing the opportunity for the mother
to participate in the birth experience and bond with her baby
immediately after delivery.

Sedatives, narcotics, or preoperative drugs.

Promotes comfort by blocking pain impulses. Potentiates the
action of anesthetic agents. Most women report pain and require
opioid analgesia following cesarean birth—approximately 20% of
women who undergo a cesarean birth experience severe acute
postoperative pain. Individualized or stratified post-discharge
opioid prescribing practices have been shown to reduce
unnecessary opioid analgesic prescription and consumption, so
they should be implemented routinely (Carvalho & Habib, 2019).

Antibiotics within 60 minutes before cesarean birth skin incision

A prophylactic antibiotic may be requested to prevent the
development of an infectious process or as a treatment for an
identified infection, especially if the client has had prolonged
rupture of membranes. In all women, a first-generation
cephalosporin is recommended; in women in labor or with
ruptured membranes, the addition of azithromycin confers an
additional reduction in postoperative infections (Caughey et al.,
2018).

Ephedrine or phenylephrine and antiemetics

Nausea and vomiting are common symptoms experienced during
a cesarean birth, and that happens during the surgery if the
client is awake. Nausea and vomiting can increase the potential
risk of aspiration, which is a recognized cause of maternal death.
Maternal hypotension from regional anesthesia is a common
cause of nausea and vomiting. A Cochrane review study revealed
that the use of colloid or crystalloid preloading, intravenous
administration of ephedrine or phenylephrine, and lower limb
compression reduced the incidence of spinal anesthesia-related
hypotension. Antiemetic agents also effectively prevent
postoperative nausea and vomiting during cesarean birth
(Macones et al., 2019).

Tranexamic acid as prophylaxis

Studies show that prophylactic use of tranexamic acid at
cesarean birth had a biologic effect, in that calculated estimated
blood loss was significantly lower among clients who received
the drug than those who received placebo. Tranexamic acid has
fibrinolytic effects that are achieved at least in part by promoting
hemostasis, and it also reduces bleeding-related mortality among
clients with postpartum hemorrhage. The survival benefit
associated with the earlier administration of the drug suggests
that it may prevent coagulopathy after delivery rather than treat
it (Sentilhes et al., 2021).

Recommended Resources

Recommended nursing diagnosis and nursing care plan books

and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from
you. We may earn a small commission from your purchase. For more information,
check out our privacy policy.

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based

Guide to Planning Care
We love this book because of its evidence-based approach to nursing
interventions. This care plan handbook uses an easy, three-step system
to guide you through client assessment, nursing diagnosis, and care
planning. Includes step-by-step instructions showing how to implement
care and evaluate outcomes, and help you build skills in diagnostic
reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent
evidence-based guidelines. New to this edition are ICNP diagnoses, care
plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and

Rationales
Quick-reference tool includes all you need to identify the correct
diagnoses for efficient patient care planning. The sixteenth edition
includes the most recent nursing diagnoses and interventions and an
alphabetized listing of nursing diagnoses covering more than 400
disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting

Client Care
Identify interventions to plan, individualize, and document care for more
than 800 diseases and disorders. Only in the Nursing Diagnosis Manual
will you find for each diagnosis subjectively and objectively – sample
clinical applications, prioritized action/interventions with rationales – a
documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical,

Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB,
pediatrics, and psychiatric and mental health. Interprofessional “patient
problems” focus familiarizes you with how to speak to patients.

See also

Other recommended site resources for this nursing care plan:

MUST READ!
 Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and
conditions. Includes our easy-to-follow guide on how to
create nursing care plans from scratch.
 Nursing Diagnosis Guide and List: All You Need to Know to Master
Diagnosing
Our comprehensive guide on how to create and write
diagnostic labels. Includes detailed nursing care plan guides
for common nursing diagnostic labels.
Other care plans related to the care of the pregnant mother and
her baby:

 Abortion (Termination of Pregnancy) | 8 Care Plans

 Cervical Insufficiency (Premature Dilation of the Cervix) | 4
Care Plans
 Cesarean Birth | 11 Care Plans
 Cleft Palate and Cleft Lip | 7 Care Plans
 Gestational Diabetes Mellitus | 8 Care Plans
 Hyperbilirubinemia (Jaundice) | 4 Care Plans
 Labor Stages, Induced, Augmented, Dysfunctional,
Precipitous Labor | 45 Care Plans
 Neonatal Sepsis | 8 Care Plans
 Perinatal Loss (Miscarriage, Stillbirth) | 6 Care Plans
 Placental Abruption | 4 Care Plans
 Placenta Previa | 4 Care Plans
 Postpartum Hemorrhage | 8 Care Plans
 Postpartum Thrombophlebitis | 5 Care Plans
 Prenatal Hemorrhage (Bleeding in Pregnancy) | 9 Care Plans
 Preeclampsia and Gestational Hypertension | 6 Care Plans
 Prenatal Infection | 5 Care Plans
 Preterm Labor | 7 Care Plans
 Puerperal & Postpartum Infections | 5 Care Plans
 Substance Abuse in Pregnancy | 9 Care Plans
Recommended Resources

 Cultural Birthing Practices and Experiences. An eBook that

details the different cultural and ethnic practices during
childbirth in Australia. A great resource if you want to
expand your knowledge about these practices.
 Intrapartum Care for a Positive Childbirth Experience. A
resource by the WHO that details what they recommend and
what they don’t during intrapartum care. Check out the
executive summary!
References and Sources

Recommended journals, books, and other interesting materials to

help you learn more about cesarean birth nursing care plans and
nursing diagnosis:

 Abdelraheim, A. R., Gomaa, K., Ibrahim, E. M., Mohammed, M. M., Khalifa, E.

M., Youssef, A. M., Abdelhakeem, A. K., Hassan, H., Alghany, A. A., & Gelany,
S. E. (2019, July 8). Intra-abdominal infection (IAI) following cesarean section:
a retrospective study in a tertiary referral hospital in Egypt. BMC Pregnancy
and Childbirth, 19(234).
 Ahmadi, Z. (2020, 03 20). Identifying and explaining experiences of fear of
childbirth and coping strategies: A qualitative study. Journal of Qualitative
Research in Health Sciences, 9(1), 47-58.
 Ahmed, W. A. S., & Hamdy, M. A. (2018, August 21). Optimal management of
umbilical cord prolapse. International Journal of Women’s Health, 10, 459-
465.
 Akalpler, O., & Okumus, H. (2018, Sept-Oct). Gum chewing and bowel function
after Caesarean section under spinal anesthesia. Pakistan Journal of Medical
Sciences, 34(5), 1242-1247.
 Asim, M., Alkadi, M. M., Asim, H., & Ghaffar, A. (2019, January
21). Dehydration and volume depletion: How to handle the
misconceptions. World Journal of Nephrology, 8(1), 23-32.
 Bonnet, M. P., & Benhamou, D. (2016, June 27). Management of postpartum
haemorrhage. NCBI. Retrieved January 12, 2022.
 Boushra, M., & Rahman, O. (2021, July 15). Postpartum Infection –
StatPearls. NCBI. Retrieved January 9, 2022.
 Bryanton, J., Beck, C. T., & Morrison, S. (2021, April 22). When Fear
Surrounding Childbirth Leads Women to Request a Planned Cesarean
Birth. Western Journal of Nursing Research.
 Burke, C., & Allen, R. (2020, March/April). Complications of Cesarean Birth
Clinical Recommendations for Prevention and Management. The American
Journal of Maternal/Child Nursing, 45(2), 92-99.
 Carvalho, B., & Habib, A.S. (2019). Personalized analgesic management for
cesarean delivery. International Journal of Obstetric Anesthesia, 40, 91-100.
 Caughey, A. B., Wood, S. L., Macones, G. A., Wrench, I. J., Huang, J., Norman,
M., Pettersson, K., Fawcett, W. J., Shalabi, M. M., Metcalfe, A., Gramlich, L.,
Nelson, G., & Wilson, D. (2018, December). Guidelines for intraoperative care
in cesarean delivery: Enhanced Recovery After Surgery Society
Recommendations (Part 2). American Journal of Obstetrics and Gynecology,
219(6), 533-544.
 Chen, H., & Tan, D. (2019, February 21). Cesarean Section or Natural
Childbirth? Cesarean Birth May Damage Your Health. Frontiers in
Psychology, 10(351).
 Chokshi, A., Sifri, Z., Cennimo, D., & Horng, H. (2019, Jan-Mar). Global
Contributors to Antibiotic Resistance. Journal of Global Infectious
Diseases, 11(1), 36-42.
 Chung, F.-F., Wan, G.-H., Kuo, S.-C., Lin, K.-C., & Liu, H.-E. (2018, September
6). Mother-infant interaction quality and sense of parenting competence at six
months postpartum for first-time mothers in Taiwan: a multiple time-series
design. BMC Pregnancy and Childbirth, 18(365).
 Cripe, E. T. (2017, March 29). “The Scarlet C”: Exploring Caesarean Section
Stigma. Health Communication, 33(6), 782-785.
 Damanabad, Z. H., Valizadeh, L., Hosseini, M., Abdolalipour, M., & Jafarabadi,
M. A. (2021, July 23). Comparing the Effects of Face-to-Face and Video-Based
Educations on Hand Hygiene Knowledge and Performance among Mothers in
Neonatal Intensive Care Unit: A Randomized Controlled Trial. Nursing and
Midwifery Studies, 10(3), 158-164.
 Fawole, B., & Hofmeyr, G. (2012, December 12). Maternal oxygen
administration for fetal distress. Cochrane Database of Systematic
Reviews, (12).
 Fernández, V. R., y Cajal, C. N. L. R., Ortiz, E. M., & Naveira, E. C. (2018).
Intrapartum and perinatal results associated with different degrees of staining
of meconium-stained amniotic fluid. European Journal of Obstetrics &
Gynecology and Reproductive Biology, 228, 65-70.
 Fowler, J. R., & Simon, L. V. (2021, September 8). Chorioamnionitis –
StatPearls. NCBI. Retrieved January 9, 2022.
 Galante, D. (2010, March 10). Considerations on labor analgesia and drug
complications. British Journal of Anaesthesia, 105(eLetters Supplement).
 Ghi, T., Pasquo, E. D., Dall’Asta, A., Commare, A., Melandri, E., Casciaro, A.,
Fieni, S., & Frusca, T. (2020, October 13). Intrapartum fetal heart rate
between 150 and 160 bpm at or after 40 weeks and labor outcome. Acta
Obstetricia et Gynecologica Scandinavica, 100(3), 548=554.
 Gibbs, B. G., Forste, R., & Lybbert, E. (2018, January 31). Breastfeeding,
Parenting, and Infant Attachment Behaviors. Maternal and Child Health
Journal, 22, 579-588.
 Grant, E. K., Gattamorta, K. A., & Foronda, C. L. (2020, March 21). Reducing
the risk of unintended retained surgical sponges: A quality improvement
project. Perioperative Care and Operating Room Management, 21.
 Hasan, F., Ahmed, N., Jamil, R., Ali, L., & Khan, F. A. (2021, 06 30). Frequency
and Indications of Primary Cesarean Section. Journal of Surgery
Pakistan, 26(1).
 Ilska, M., Banas, E., Gregor, K., Salmeri, A. B., Ilski, A., & Cnota, W. (2020,
August). Vaginal delivery or cesarean section – Severity of early symptoms of
postpartum depression and assessment of pain in Polish women in the early
puerperium. Midwifery, 87.
 Kim, D. R., & Wang, E. (2015, August 15). Prevention of supine hypotensive
syndrome in pregnant women treated with transcranial magnetic
stimulation. Psychiatry Research, 218, 1-2.
 Kjerulff, K. H., & Brubaker, L. H. (2017, October 20). New mothers’ feelings of
disappointment and failure after cesarean delivery. Birth, 45(1), 19-27.
 Kruse, A. R., Lauszus, F. F., Forman, A., Kesmodel, U. S., Rugaard, M. B.,
Knudsen, R. K., Persson, E.-K., Uldbjerg, N., & Sundtoft, I. B. (2020, November
11). Effect of early discharge after planned cesarean section on recovery and
 parental sense of security. A randomized clinical trial. Acta Obstetricia et
Gynecologica Scandinavica, 100(5), 955-963.
 Labor, S., & Maguire, S. (2008, December). The Pain of Labour. Reviews in
Pain, 2(2), 15-19.
 Leifer, G. (2018). Introduction to Maternity and Pediatric Nursing (8th ed.).
Elsevier.
 Li, L., Wen, J., Li, Y., & Li, Y. (2010, December 23). Is routine indwelling
catheterization of the bladder for cesarean section necessary? A systematic
review. BJOG: An /International Journal of Obstetrics and Gynecology, 118(4),
400-409.
 Macones, G. A., Caughey, A. B., Wood, S. L., Wrench, I. J., Huang, J., Norman,
M., Pettersson, K., Fawcett, W. J., Shalabi, M. M., Metcalfe, A., Gramlich, L.,
Nelson, G., & Wilson, D. (2019, September). Guidelines for postoperative care
in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society
recommendations (part 3). American Journal of Obstetrics and
Gynecology, 221(3), 247.
 Miovech, S. M., Knapp, H., Borucki, L., Roncoli, M., Arnold, L., & Dorothy
Brooten. (n.d.). Major Concerns of Women After Cesarean Delivery. NCBI.
Retrieved January 14, 2022.
 Mostafayi, M., Imani, B., Zandi, S., & Jongi, F. (2021, June). The effect of
familiarization with preoperative care on anxiety and vital signs in the
patient’s cesarean section: A randomized controlled trial. European Journal
of Midwifery, 5, 1-7.
 Nanthiphatthanachai, A., & Insin, P. (2020). Effect of chewing gum on
gastrointestinal function recovery after surgery of
gynecological cancer patients at Rajavithi Hospital: a randomized controlled
trial. Asian Pacific journal of cancer prevention: APJCP, 21(3), 761.
 Pillitteri, A., & Silbert-Flagg, J. (2018). Maternal & Child Health Nursing: Care
of the Childbearing & Childrearing Family (8th ed.). Wolters Kluwer.
 Puia, D. (2018, Winter). First-Time Mothers’ Experiences of a Planned
Cesarean Birth. The Journal of Perinatal Education, 27(1), 50-60.
 Rookesh, Z., Kaviani, M., Zarshenas, M., & Akbarzadeh, M. (2021, October
22). Comparison of Maternal-Infant Attachment in Cesarean Delivery Based on
Robson Classification: A Cross-Sectional Study. Iranian Journal of Nursing
and Midwifery Research, 26(6), 500-507.
 Salam Ramadan, S. A. E., & Farrag, R. E. (2018, October). Utilization of Self-
Care Guideline to Promote Quality of Life Among Women Undergoing Cesarean
Section. The Malaysian Journal of Nursing, 10(2).
 Sentilhes, L., Senat, M. V., Le Lous, M., Winer, N., Rozenberg, P., Kayem, G.,
Verspyck, E., Fuchs, F., Azria, E., Gallot, D., Korb, D., & Desbriere, R. (2021,
April 29). Tranexamic Acid for the Prevention of Blood Loss after Cesarean
Delivery. The New England Journal of Medicine, 384(17).
 Shen, D., Moriyama, M. H., Ishida, K., Fuseya, S., Tanaka, S., & Kawamata, M.
(2020, May 12). Acute postoperative pain is correlated with the early onset of
postpartum depression after cesarean section: a retrospective cohort
study. Journal of Anesthesia, 34, 607-612.
  Solehati, T., & Rustina, Y. (2015, June 22). Benson Relaxation Technique in
Reducing Pain Intensity in Women After Cesarean Section. Anesthesiology
and Pain Medicine, 5(3).
 Tennant, K., & Rivers, C. L. (2021, September 21). Sterile Technique –
StatPearls. NCBI. Retrieved January 9, 2022.
 Vafaeenejad, Z., Elyasi, F., Moosazadeh, M., & Shahhosseini, Z. (2019, April
9). Psychological factors contributing to parenting styles: A systematic
review. F1000Research, 7(906).
 Wilson, R. D., Caughey, A. B., Wood, S. L., Macones, G. A., Wrench, I. J., Huang,
J., Norman, M., Pettersson, K., Fawcett, W. J., Shalabi, M. M., Metcalfe, A.,
Gramlich, L., & Nelson, G. (2018, December). Guidelines for Antenatal and
Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery
(ERAS) Society Recommendations (Part 1). American Journal of Obstetrics
and Gynecology, 219(6), 523.e1-523.e15.
Reviewed and updated by M. Belleza, R.N.

CategoriesMaternal and Newborn Care Plans, Nursing Care

PlansTagsAcute Pain, Anxiety and Anxiety Disorders, Caesarean Section
(C-Section), Decreased Cardiac Output and Risk for Decreased Cardiac
Output, Deficient Knowledge (Knowledge Deficit), Impaired Gas
Exchange, Powerlessness, Risk for Infection, Risk for Injury, Risk for
Maternal Injury, Sensory-Perceptual Alterations, Situational Low Self-
Esteem

11 Gestational Diabetes Mellitus Nursing Care Plans

7 Preeclampsia & Gestational Hypertensive Disorders Nursing Care Plans

and Management

Gil Wayne BSN, R.N.

Gil Wayne ignites the minds of future nurses through his work as a part-time nurse
instructor, writer, and contributor for Nurseslabs, striving to inspire the next
generation to reach their full potential and elevate the nursing profession.

1 thought on “9 Cesarean Birth Nursing Care Plans”

1. KRL Subasinghe
March 7, 2022 at 10:16 AM
This one is valuable for nurse-midwifery trainees. It’s good for to
us make an advanced care plan and easy to work in the OB ward.
Reply
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