Cesarean Section
Key Points
- Cesarean birth is delivery through a uterine incision when vaginal birth is unsafe or unlikely to succeed.
- Common indications include dystocia, fetal compromise, placental/cord complications, and selected maternal comorbid conditions.
- Nursing priorities include patient education, surgical readiness, fetal surveillance, and postpartum bonding support.
Pathophysiology
Cesarean birth bypasses the vaginal route when maternal, fetal, placental, or cord factors make labor continuation high risk. Surgical delivery is used electively for anticipated risk or emergently when intrapartum deterioration threatens maternal-fetal safety.
Underlying drivers include impaired labor mechanics, uteroplacental compromise, and conditions with hemorrhage or hypoxia potential. Nursing care must maintain physiologic stability, procedural safety, and informed, patient-centered communication during rapid transitions.
Classification
- Planned cesarean: Scheduled for known risk (for example, previa, persistent malpresentation, selected prior-surgery contexts).
- Unplanned/emergency cesarean: Triggered by intrapartum complications such as fetal distress or labor arrest.
- Repeat-cesarean/VBAC decision pathway: Candidate-specific risk-benefit counseling and continuous intrapartum surveillance.
Nursing Assessment
NCLEX Focus
Priority questions test when urgent conversion to cesarean is needed and what nursing preparations must occur immediately.
- Identify current indication severity (maternal instability, fetal compromise, hemorrhage risk, labor failure).
- Monitor fetal status continuously and trend maternal hemodynamics pre- and intra-procedure.
- Assess anxiety, understanding, and support-person needs during plan changes.
- Verify preoperative readiness, consent status, and team coordination for neonatal support.
Nursing Interventions
- Provide concise education on rationale, expected sequence, and recovery implications.
- Optimize positioning and perfusion, avoiding full supine compression effects.
- Prepare equipment, blood-product contingency, and neonatal-resuscitation readiness when indicated.
- Support skin-to-skin, bonding, and early feeding goals whenever clinically feasible.
Hemorrhage and Hypoxia Risk
Delays in emergency cesarean preparation during maternal-fetal deterioration can rapidly increase severe morbidity.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| anesthetic-agents | Regional or general anesthesia context | Monitor hemodynamics closely and coordinate rapid escalation if instability occurs. |
| uterotonics | Oxytocin postpartum context | Used after birth to support uterine tone and reduce hemorrhage risk. |
Clinical Judgment Application
Clinical Scenario
A laboring patient develops persistent late decelerations and failure of descent despite corrective interventions.
Recognize Cues: Ongoing fetal compromise with nonprogressive labor. Analyze Cues: Vaginal continuation is increasingly unsafe and unlikely to resolve promptly. Prioritize Hypotheses: Immediate priority is expedited, coordinated surgical birth preparation. Generate Solutions: Activate cesarean pathway, complete rapid readiness checks, and coordinate neonatal team. Take Action: Transfer safely, maintain monitoring, and support informed communication. Evaluate Outcomes: Birth occurs with stabilized maternal status and prompt neonatal assessment.
Related Concepts
- interventions-during-birth - Operative pathways often progress toward cesarean when assisted birth is not appropriate.
- labor-dystocia - Frequent indication for cesarean conversion.
- obstetrical-emergencies - Emergency scenarios may require immediate surgical delivery.
- preexisting-conditions-placing-delivery-at-risk - Comorbidity profile influences cesarean threshold.
- postpartum-hemorrhage - Post-cesarean surveillance must prioritize bleeding risk.
Self-Check
- Which intrapartum findings most strongly indicate emergency cesarean need?
- How does VBAC candidacy alter intrapartum monitoring intensity?
- Which nursing actions best preserve safety and patient-centered care during urgent cesarean transition?