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 1971-1990Source: 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.
