Cesarean Sections

Margaux Barlow, Jackie Engstrom, Rasika Kulkarni, Hillary O’Keefe

Why is this topic relevant???

• Cesarean birth is the birth of the infant through an abdominal and uterine incision.

• As maternal and perinatal morbidity and mortality rates of cesarean births have decreased throughout the 20th century, cesarean births have increased.

• In 1965, they constituted 4.5% and by 2004 were 29%.

C. Section on the Rise

Significance:

• In the U.S. there is a fourfold risk of death compared to vaginal birth.

• In England, emergency cesarean birth has a ninefold risk of death when compared to vaginal and elective cesareans have a threefold risk.

• Women are twice as likely to be rehospitalized within 60 days of birth when compared with women who have a vaginal birth.

Figure 1. Cesarean Section Rate: OECD Countries Perspective 1971-1990

Source: OECD Health Systems: Facts and Trends 1960-1991in provincial hospitals in this study.

Sociological Influence

• A study in 2004 found that Austrailian women were choose C. sections because:

• 71.4% - “common for people to think that cesarean section offers an easier way of giving birth”

• 23.1% - “the media seems to portray cesarean section as a better option than vaginal delivery”

Cultural Influence

• Another study of Brazilian women in 2008 found that:

• Most (64%) private sector cesareans are scheduled, although many women would have preferred a vaginal delivery!

• In Brazil, one-fourth of all women deliver in the private sector, where the rate of cesarean deliveries is extremely high (70%).

And the United States?

• “The singer - who is expecting her first child with her music executive husband Jordan Bratman - has allegedly decided to go for the operation like many celebrities before her because she is too posh to push.”

Pathophysiology

• History• What is a cesarean?

– Skin and uterine incision

Cultural Aspects

• Statistics • Research studies

– Brazil

– South Australia

Impact on Women’s Health

• Postpartum hemorrhage• Surgical & traumatic complications• Fever, Infection, Pneumonia & Thromboembolic

events• Maternal mortality• Pelvic floor disorder• Loss of reproductive capabilities

Impact on Neonates

• Breastfeeding, bonding & attachment issues

• Respiratory effects

• Fetal injuries

Reasons for Couples choose C-Section

• Concern for safety of infant• Fear of pain and pushing the baby• Perception that a C-section is safer than vaginal

delivery.• Social convenience• Damage to perineal floor• Prior complicated/traumatic births• Stress & anxiety

Nursing Implications

• In addition to vaginal

delivery mothers:

- Positioning- Anesthesia level checks- Urine checks Bloody urine may indicated surgical

trauma to the bladder.

Nursing Interventions

- Wound care- Coughing & Deep Breathing

Cesarean Impacts on Nursing

• Due to the increased risk of mothers return to the hospital after birth…

References

Davidson, M., Ladewig, P. & London, M. (2008). Maternal-Newborn Nursing & Women’s Health

Across the Lifespan.Upper Saddle River, NJ: Pearson Education, Inc.

Gezer, A., Simsek, YO. & Altinok, TA. (2007). Elective cesarean section: evolution of obstetrician to technician. Birth: Issues in Perinatal Care (BIRTH), 34(4): 357-9.

Miesnik, S., & Reale, B. (2007). A Review of Issues Surrounding Medically Elective Cesarean Delivery. AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses, 36(1): 605-15.

Organization for Economic Co-oporation and Development (OECD) Health System. Facts and Trends 1960-1991, Vol.1. Health Policy Studies No.3. Paris: OECD, 1993.

Potter, J., Hopkins, K., Faúndes, A., & Perpétuo, I. (2008). Women's autonomy and scheduled cesarean sections in Brazil: a cautionary tale. Birth: Issues in Perinatal Care, 35(1), 33-40.

Walker, R., Turnbull, D., & Wilkinson, C. (2004). Increasing cesarean section rates: exploring the role of culture in an Australian community. Birth: Issues in Perinatal Care, 31(2), 117-124.