Nursing Care Plan for Cesarean Delivery

Cesarean birth is an alternative to vaginal birth only when the safety of the mother and/or fetus is compromised.


NURSING PRIORITIES
1. Promote maternal/fetal well-being.
2. Provide client/couple with necessary information.
3. Support client’s/couple’s desires to participate actively in birth experience.
4. Prepare client for surgical procedure.
5. Prevent complications.

Nursing Diagnosis: Anxiety may be related to situational crisis, threat to self-concept, perceived/actual threat of maternal and fetal well-being, interpersonal transmission possibly evidenced by increased tension, distress, apprehension, feelings of inadequacy, sympathetic stimulation, restlessness

Desired Outcomes:
1. Verbalize fears for the safety of client and infant.
2. Discuss feelings about cesarean birth.
3. Appear appropriately relaxed.

Nursing interventions and rationale
1. Assess psychological response to event and availability of support system(s).
Rationale: The greater the client perceives the threat, the greater the level of her anxiety.

2. Note cultural influences/expectations.
Rationale: Some cultures (e.g., Latin, Mexican/Arab-American) may view surgical intervention as detrimental to the client’s well-being or may believe client will be stigmatized as a “weak woman” (e.g., Puerto Rican).

3. Ascertain whether procedure is planned or unplanned.
Rationale: With unplanned cesarean birth, the client/couple usually has no time for physiological or psychological preparation. Even when planned, cesarean birth can create apprehension in the client/couple owing to an actual or perceived physical threat to the mother and infant related to the condition necessitating the procedure and to the surgery itself.

4. Stay with client, and remain calm. Speak slowly. Convey empathy.
Rationale: Helps to limit interpersonal transmission of anxiety, and demonstrates caring for the client/couple.

5. Reinforce positive aspects of maternal and fetal condition.
Rationale: Focuses on likelihood of successful outcome and helps to bring perceived/actual threat into perspective.

6. Encourage client/couple to verbalize and/or express feelings (cry).
Rationale: Helps to identify negative feelings/concerns and provides opportunity to cope with ambivalent or unresolved feelings/grief. The client may also feel an emotional threat 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. Partner may question own abilities in assisting client and providing needed support.

7. Support/redirect expressed coping mechanisms.
Rationale: Enhances basic and automatic coping mechanisms, increases self-confidence and acceptance, and reduces anxiety. Note: Some client actions may be viewed as ineffective (e.g., screaming and throwing things) and need to be redirected to enhance client’s sense of control.

8. Discuss past childbirth experience/expectations, as appropriate.
Rationale: Client may have distorted memories of past delivery or unrealistic perceptions of abnormality of cesarean birth that will increase anxiety.

9. Provide period of privacy, if possible. Reduce environmental stimuli, such as the number of people present, as indicated by client’s desires.
Rationale: Allows client/couple opportunity to internalize information, marshal resources, and cope effectively.