caesarean section caesarean section overview

8/16/2019 Caesarean Section Caesarean Section Overview

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Caesarean section overview

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NICE PathwaysPathways

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Caesarean section overview NICE Pathways

Caesarean section pathwayCopyright © NICE 2015.

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Consent

Request consent after providing evidence-based information and in a manner that respects thewoman's dignity, privacy, views and culture, while taking into consideration the clinical situation.

A pregnant woman is entitled to decline the offer of treatment such as caesarean section, evenwhen the treatment would clearly benefit her or her baby's health. Refusal of treatment needs tobe one of the woman's options.

When a decision is made to perform a caesarean section, make a record of all the factors thatinfluence the decision, and which of these is the most influential.

3 Planning the mode of birth

See Caesarean section / Planning the mode of birth

4 Performing caesarean section

See Caesarean section / Performing caesarean section

5 Care after caesarean section

Care of the baby

An appropriately trained practitioner skilled in the resuscitation of the newborn should bepresent at caesarean section performed under general anaesthesia or where there is evidenceof fetal compromise.

Babies born by caesarean section are more likely to have a lower temperature. Offer thermalcare in accordance with good practice for thermal care of the newborn baby.

Encourage and facilitate early skin-to-skin contact between the woman and her baby because itimproves maternal perceptions of the infant, mothering skills, maternal behaviour, andbreastfeeding outcomes, and reduces infant crying.

NICE has produced a pathway on postnatal care .



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Care of the woman

Offer women additional support to help them to start breastfeeding as soon as possible after thebirth of their baby. This is because women who have had a caesarean section are less likely tostart breastfeeding in the first few hours after the birth, but, when breastfeeding is established,they are as likely to continue as women who have a vaginal birth.

Allow women who are recovering well after caesarean section and who do not havecomplications to eat and drink when they feel hungry or thirsty.

Remove the urinary bladder catheter once a woman is mobile after a regional anaesthetic andnot sooner than 12 hours after the last epidural 'top up' dose.

Do not offer routine respiratory physiotherapy to women after a caesarean section under general anaesthesia, because it does not improve respiratory outcomes such as coughing,phlegm, body temperature, chest palpation and auscultatory changes.

In addition to general postnatal care, provide women with:

specific care related to recovery after caesarean section

care related to management of other complications during pregnancy or childbirth.

Include the following wound care 1:

removing the dressing 24 hours after the caesarean section

specific monitoring for fever

assessing the wound for signs of infection (such as increasing pain, redness or discharge),separation or dehiscence

encouraging the woman to wear loose, comfortable clothes and cotton underwear

gently cleaning and drying the wound daily

if needed, planning the removal of sutures or clips.

For women who have urinary symptoms, consider the possible diagnosis of:

urinary tract infection

stress incontinence (occurs in about 4% of women after caesarean section)

urinary tract injury (occurs in about 1 per 1000 caesarean sections).

For women who have heavy and/or irregular vaginal bleeding, consider that this is more likely tobe due to endometritis than retained products of conception.



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1 For more recent recommendations on wound care see the prevention and control of healthcare-associated

infections pathway .


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Pay particular attention to women who have chest symptoms (such as cough or shortness of breath) or leg symptoms (such as painful swollen calf) because women who have had acaesarean section are at increased risk of thromboembolic disease (both deep vein thrombosisand pulmonary embolism).

Inform women that after a caesarean section they are not at increased risk of difficulties withbreastfeeding, depression, post-traumatic stress symptoms, dyspareunia and faecalincontinence.

While women are in hospital after having a caesarean section, give them the opportunity todiscuss with healthcare professionals the reasons for the caesarean section and provide bothverbal and printed information about birth options for any future pregnancies. If the womanprefers, provide this at a later date.

NICE has written information for the public explaining the guidance on caesarean section .

Length of hospital stay is likely to be longer after a caesarean section (an average of 3–4 days)than after a vaginal birth (average 1–2 days). Offer women who are recovering well, areapyrexial and do not have complications, early discharge (after 24 hours) from hospital andfollow-up at home, because this is not associated with more infant or maternal readmissions.

Women who have had a caesarean section should resume activities such as driving a vehicle,carrying heavy items, formal exercise and sexual intercourse once they have fully recoveredfrom the caesarean section (including any physical restrictions or distracting effect due to pain).

NICE has produced a pathway on postnatal care .

Quality standards

The following quality statements are relevant to this part of the pathway.

Caesarean section quality standard

8. Post caesarean section discussion

9. Monitoring for postoperative complications following caesarean section

Resources

The following implementation tools are relevant to this part of the pathway.



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http://www.nice.org.uk/guidance/cg132/informationforpublichttp://pathways.nice.org.uk/pathways/postnatal-carehttp://pathways.nice.org.uk/pathways/postnatal-carehttp://www.nice.org.uk/guidance/cg132/informationforpublic


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Caesarean section: electronic audit tool

Caesarean section: baseline assessment

Caesarean section: clinical case scenarios

Caesarean section: costing template

Caesarean section: costing report

Caesarean section: podcast

Caesarean section: slide set

6 NICE pathway on safe midwifery staffing for maternity settings

See Safe midwifery staffing for maternity settings

7 NICE pathway on patient experience in adult NHS services

See Patient experience in adult NHS services



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http://guidance.nice.org.uk/CG132/ElectronicAudit/xls/Englishhttp://guidance.nice.org.uk/CG132/BaselineAssessment/xls/Englishhttp://guidance.nice.org.uk/CG132/ClinicalScenarioshttp://guidance.nice.org.uk/CG132/CostingTemplate/xls/Englishhttp://guidance.nice.org.uk/CG132/CostingReport/pdf/Englishhttp://www.nice.org.uk/guidance/cg132/resourceshttp://guidance.nice.org.uk/CG132/SlideSet/ppt/Englishhttp://pathways.nice.org.uk/pathways/safe-midwifery-staffing-for-maternity-settingshttp://pathways.nice.org.uk/pathways/patient-experience-in-adult-nhs-serviceshttp://pathways.nice.org.uk/pathways/patient-experience-in-adult-nhs-serviceshttp://pathways.nice.org.uk/pathways/safe-midwifery-staffing-for-maternity-settingshttp://guidance.nice.org.uk/CG132/SlideSet/ppt/Englishhttp://www.nice.org.uk/guidance/cg132/resourceshttp://guidance.nice.org.uk/CG132/CostingReport/pdf/Englishhttp://guidance.nice.org.uk/CG132/CostingTemplate/xls/Englishhttp://guidance.nice.org.uk/CG132/ClinicalScenarioshttp://guidance.nice.org.uk/CG132/BaselineAssessment/xls/Englishhttp://guidance.nice.org.uk/CG132/ElectronicAudit/xls/English


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Category 1 caesarean section

Immediate threat to the life of the woman or fetus

Category 2 caesarean section

Maternal or fetal compromise which is not immediately life-threatening

Sources

Caesarean section (2011) NICE guideline CG132

Your responsibility

The guidance in this pathway represents the view of NICE, which was arrived at after carefulconsideration of the evidence available. Those working in the NHS, local authorities, the wider public, voluntary and community sectors and the private sector should take it into account whencarrying out their professional, managerial or voluntary duties. Implementation of this guidanceis the responsibility of local commissioners and/or providers. Commissioners and providers arereminded that it is their responsibility to implement the guidance, in their local context, in light of

their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistentwith compliance with those duties.

Copyright

Copyright © National Institute for Health and Care Excellence 2015. All rights reserved. NICEcopyright material can be downloaded for private research and study, and may be reproducedfor educational and not-for-profit purposes. No reproduction by or for commercial organisations,or for commercial purposes, is allowed without the written permission of NICE.

Contact NICE

National Institute for Health and Care ExcellenceLevel 1A, City Tower Piccadilly PlazaManchester

M1 4BT



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www.nice.org.uk

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caesarean section caesarean section overview

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