Introduction:

Cesarean section (CS), once reserved for critical medical situations, has become one of the most
common surgical procedures globally, profoundly shaping maternal and neonatal healthcare
practices.
Moreover,recent data paints a compelling picture of CS prevalence. According to recent research
global CS rates continue to rise, prompting critical reflections on the appropriateness and
implications of this trend. Factors driving these escalating rates range from maternal request to
healthcare system dynamics, reflecting a complex interplay of clinical, social, and cultural
influences.(Norman et al 2019)
Technological advancements have revolutionized CS practices, offering safer and more efficient
alternatives. From minimally invasive approaches like laparoscopy and robotics to enhanced
anesthesia protocols and pain management strategies, contemporary CS techniques prioritize
maternal and neonatal well-being while optimizing surgical outcomes (Schindler et al., 2020).
However, amidst these advancements, challenges persist. Maternal and neonatal complications,
both immediate and long-term, underscore the importance of vigilant monitoring and
comprehensive care. Infections, hemorrhage, and respiratory morbidity in newborns represent just a
fraction of the multifaceted risks associated with CS
Beyond the clinical realm, CS embodies a broader sociocultural discourse. Ethical considerations
surrounding elective CS and patient autonomy intersect with healthcare provider decision-making,
highlighting the need for informed, patient-centered care models (ACOG Practice Bulletin No. 205,
2019).
However,individual patient experiences to population-level health outcomes, CS shapes the
landscape of obstetric care in profound ways by synthesizing the latest research findings and
clinical insights, we aim to navigate this complex terrain and elucidate strategies for optimizing
maternal and neonatal health in the context of Cesarean section.
OBJECTIVE
At the end of this presentation participants should be able to ;
-Define cesarean section
-State indications and contraindications of Cesarean section
-Identify types of cesarean section
-state the advantages and disadvantages of cesarean section
-Enumerate the nursing management before, during and after cesarean section
- List the implications and complications of cesarean section on maternal and child health.
DEFINITION OF TERMS
Cesarean section: C-section, is a surgical procedure used to deliver a baby through an incision
made in the mother's abdomen and uterus.
Maternal: Related to being a mother or motherhood
Fetal/Child: relating to or characteristic of a fetus, the unborn offspring of a mammal.
Health: health refers to the state of being free from illness or injury and encompasses physical,
mental, and social well-being.
Complications/Implications: refers to additional problems or difficulties that arise, often as a result
of a particular situation or condition.
CONCEPT
Caesarean section (CS) is a common procedure in obstetrics and has contributed immensely to
improving maternal and fetal outcome. Caesarean section is one of the oldest procedure in
obstetrics practice and may be a necessary end in the termination of pregnancy to abort or
minimize the complications to the mother,fetus or both. Caesarean section remains the most
common major operation performed on women worldwide with an increased rate. Mortality and
morbidity from pregnancy and labour related causes have been observed to be high in developing
nations, especially those of sub-Sahara Africa. Significant aspect of these causes can be averted
by timely Caesarean section.

A cesarean section or a C-section is a surgical procedure in which a baby is delivered through

incisions made in the abdomen and uterus, as opposed to delivering a baby in the traditional way,
via a vaginal birth. Caesarean section is planned if health care providers determine that a vaginal
delivery is not safe for example when expecting multiple,in
transverse lie, breech presentation, placenta previa,heart
disease, genital herpes, uterine fibroids, pelvic fracture or babies with congenital anomalies, weak
contractions and umbilical cord prolapse,etc occurring before or during childbirth. There are three types of
C-section incisions, all of which are healthy and safe, they include a low transverse incision across the lower
abdomen, a low vertical cut extending down the lower abdomen, and a high vertical incision across the
stomach. Complications related to infections like fever, painful urination, severe abdominal pain, discharge,
redness, odor, visible tearing of the vagina or vaginal discharge might occur. Other rare complications
include re-opening of the uterine incision, hemorrhage, blood clotting, and injury to the bowel or
bladder. C-section scars can be minimized or treated with silicone gel or sheets, pressure therapy,
dermabrasion, injections, laser treatments, and surgery. (Procter and Gamble,2022).

Caesarean section minimizes the risk and complications in pregnancy and as such reduces
maternal and fetal mortality.( Cleveland,2024).

caesarean section rates have risen from around 7% in 1990 to 21% today, and are projected to
continue increasing over this current decade. If this trend continues, by 2030 the highest rates are
likely to be in Eastern Asia (63%), Latin America and the Caribbean (54%), Western Asia (50%),
Northern Africa (48%) Southern Europe (47%) and Australia and New Zealand (45%). In the least
developed countries, about 8% of women gave birth by caesarean section with only 5% in
sub-Saharan Africa, indicating a concerning lack of access to this lifesaving surgery. In Latin
America and the Caribbean, rates are as high as 4 in 10 (43%) of all births. (WHO,2021).

Research shows that between 2000- 2022, the overall prevalence of CS in facilities across Nigeria
was 17.6%. It identified a higher prevalence of emergency CS (75.9%) compared to elective CS
(24.3%). It also identified a significantly higher CS prevalence in facilities in the south (25.5%)
compared to the north (10.6%). The commonest indications for a CS were previous scar/CS
(3.5–33.5%) and pregnancy-related hypertensive disorders (5.5–30.0%), while anaemia
(6.4–57.1%) was the most reported complication.
Risk factors for cesarean delivery complications

Many complications of cesarean delivery are unpredictable and very rare, but there are some things
that make complications more likely. These risk factors include:

* obesity
* large infant size
* emergency complications that necessitate a cesarean delivery
* long labor or surgery
* having more than one baby
* allergies to anesthetics, drugs, or latex
* maternal inactivity
* low maternal blood cell count
* use of an epidural
* premature labour
* diabetes
Types of Caesarean section
There are two types of caesarean sections:
* Planned (elective) c-sections: These are scheduled in advance when the mother or baby has a
medical condition that makes vaginal delivery risky. Some doctors suggest a planned c-section for
babies diagnosed with congenital issues to reduce delivery complications. Non-medical reasons
may lead some women to prefer c-section surgery over vaginal birth.

 Unplanned C-sections: Most C-sections are unplanned since the need for
one does not emerge until considerably closer to or during labour. Moms in
these circumstances had planned on having a vaginal birth. Yet just before
the baby is born, the mother and the doctor determine that a C-section is
the best course of action.
It might be upsetting and stressful when things change. Still, the medical
team makes every effort to ensure that the birth experience is pleasant and
safe for mother and child.

* Emergency c-sections: The urgency differenciates the planned from the unplanned from the
emergency.This type is carried
out when there is a necessity and urgency for a woman to carry out C-S due to conditions
surrounding labour and delivery .These are done when problems arise during labour, such as when
the baby is distressed, the mother is not progressing as expected or is exhausted because of long
labour. Emergency c-sections are done as quickly as possible to ensure the safety of the mother
and baby. Both c-section involve incisions in the mother's abdomen and uterus to deliver the baby.
The type and location of the incision can vary depending on the mother's medical history, the size
and position of the baby, and other factors.(MedTech, 2020)
INDICATIONS FOR CESAREAN SECTION
Maternal Indications for Cesarean (NCBI, 2023)
* Prior cesarean delivery
* Maternal request
*Pelvic deformity or cephalo~pelvic disproportion
* Previous perineal trauma
* Prior pelvic or anal/rectal reconstructive surgery
* Herpes simplex or HIV infection
* Cardiac or pulmonary disease
* Cerebral aneurysm or arteriovenous malformation
* Pathology requiring concurrent intra~abdominal surgery
Uterine/Anatomic Indications for Cesarean (NCBI, 2023)
* Abnormal placentation (such as placenta previa)
* Prior classical hysterectomy
* Prior full-thickness myomectomy
* History of uterine incision dehiscence
* Invasive cervical cancer
* Prior trachelectomy
* Genital tract obstructive mass
* Permanent cerclage
Fetal Indications for Cesarean (NCBI, 2023)
* Non reassuring fetal status (such as abnormal umbilical cord Doppler study) or abnormal fetal
heart tracing
* Umbilical cord prolapse
* Failed operative vaginal delivery
* Malpresentation
* Congenital anomaly
* Thrombocytopenia
* Prior neonatal birth trauma
CONTRAINDICATIONS OF CESAREAN SECTION
1) Dead fetus: except in
•extreme degree of pelvic contraction
•Neglected shoulder
•severe accidental hemorrhage
2) Disseminated intravascular coagulation disorder: To minimize bleed loss.
3) Extensive scar or pyrogenic infection in the abdominal wall eg in burns
4) Too premature baby
5) Fetal-pelvic disproportion
6) Pelvic tumors especially if impacted in the pelvic or cancer of the cervix.
(Teach me,2022)

Advantages of an elective C-section

* Lower risk of incontinence and sexual dysfunction after the birth of the baby.
* Lower risk of the baby being deprived of oxygen during delivery.
* Lower risk of the baby experiencing trauma while passing through the birth canal.

Disadvantages of an elective C-section

* repeated cesarean delivery with future pregnancies.
* There’s a higher risk of complications with cesarean deliveries.
*Prolong hospital stay (up to five days) and a longer recovery period.(Teach me, 2022)
Pre operative nursing management for CS
* Assessment and Screening: Conduct a comprehensive health assessment, including
medical history, allergies, current medications, and any pre-existing conditions that may impact the
surgery or anesthesia. Perform baseline vital signs, laboratory tests (e.g., complete blood count,
blood typing, coagulation studies), and fetal monitoring.
* Education and Informed Consent: Provide detailed information about the cesarean
section procedure, including indications, risks, benefits, and alternatives. Address any questions or
concerns the patient may have and obtain informed consent for the surgery.
* Preparation and Planning: Coordinate with the healthcare team to ensure all necessary
equipment, supplies, and medications are available for the procedure. Arrange for an operating
room (OR) schedule and anesthesia consultation. Prepare the patient psychologically and
emotionally for the surgery.
* NPO Status and Medication Management: Instruct the patient to maintain NPO (Nil per
oral ) status for a specified period before the surgery to prevent aspiration during anesthesia.
Manage medications according to healthcare provider orders, including withholding certain
medications that may increase the risk of bleeding or other complications.
* Preoperative Medications: Administer preoperative medications as prescribed, such as
prophylactic antibiotics to reduce the risk of surgical site infection, antacids to decrease gastric
acidity, and anticoagulants to prevent thromboembolic events.
* Preparation of the Surgical Site: Ensure the surgical site is properly prepared and draped
according to aseptic technique guidelines. Cleanse the skin with an antiseptic solution to reduce the
risk of surgical site infection.
* Patient Positioning: Assist the patient in assuming the appropriate position for the surgery,
typically lying flat on the operating table with arms extended to the sides or supported on arm
boards. Ensure proper padding and alignment to prevent pressure injuries.
* Emotional Support: Provide emotional support and reassurance to the patient and her
family members, addressing any anxiety or concerns about the upcoming surgery. Encourage open
communication and expression of feelings.
* Intravenous Access: Establish intravenous (IV) access for administration of fluids,
medications, and blood products as needed during the surgery and postoperative period.
* Documentation: Document all preoperative assessments, interventions, education
provided, and patient responses in the medical record according to institutional policies and
standards.
By implementing thorough pre-operative nursing management, healthcare providers can help
optimize outcomes and ensure a safe and successful cesarean section procedure for both the mother
and baby.
Nursing management during cesarean section (CS).
* Preparation and Monitoring: Assist with the transfer of the patient to the operating room
and ensure all necessary equipment and supplies are readily available. Continuously monitor the
patient's vital signs, oxygen saturation, and fetal heart rate if applicable.
* Assistance in Anesthesia Administration: Collaborate with the anesthesia team to provide
support during the administration of anesthesia, whether it's general anesthesia, regional anesthesia
(spinal or epidural), or local anesthesia. Monitor the patient's response to anesthesia and intervene
promptly if any adverse reactions occur.
* Surgical Assistance: Assist the surgical team by providing instruments, supplies, and
other necessary items during the procedure. Maintain a sterile field and adhere to aseptic technique
principles to prevent surgical site infection.
* Communication and Advocacy: Serve as an advocate for the patient by communicating
her preferences, concerns, and needs to the healthcare team. Provide reassurance and emotional
support throughout the surgical procedure.
* Fetal Monitoring: If the CS is performed before labor, monitor the fetal heart rate
continuously during the surgery to ensure fetal well-being. Report any abnormalities or changes in
fetal status to the obstetrician or anesthesia provider.
* Maternal Monitoring: Continuously assess the mother's vital signs, level of
consciousness, and overall condition during the surgery. Be vigilant for signs of complications such
as hemorrhage, hypotension, or respiratory distress.
* Immediate Postoperative Care: Assist with the transfer of the mother to the recovery
room or post-anesthesia care unit (PACU) after the surgery. Monitor her closely for signs of
anesthesia recovery, pain, bleeding, or other complications.
POST OPERATIVE NURSING MANAGEMENT
* Monitoring Vital Signs: Regular assessment of vital signs including blood pressure, pulse,
temperature, and respiratory rate to detect any signs of complications such as hemorrhage or
infection.
* Pain Management: Administering pain relief medications as prescribed to manage
post-operative pain, which may include opioids, nonsteroidal anti-inflammatory drugs (NSAIDs),
or other analgesics. Additionally, non-pharmacological pain management techniques such as
positioning, relaxation exercises, and heat therapy can be used.
* Wound Care: Monitoring the surgical incision site for signs of infection, hematoma, or
dehiscence. Providing education on proper wound care, including instructions for dressing changes,
signs of infection, and when to seek medical attention.
* Mobility and Activity: Encouraging early ambulation to prevent complications such as
deep vein thrombosis and promote circulation. Providing assistance as needed and educating the
patient on safe movement techniques.
* Urinary Care: Monitoring urinary output and assessing for urinary retention.
Encouraging adequate hydration and assisting with bladder emptying if necessary. Educating the
patient on signs of urinary tract infection and when to seek medical attention.
* Bowel Management: Assessing bowel function and providing interventions to prevent
constipation, such as dietary modifications, hydration, and stool softeners if needed. Encouraging
early mobilization and ambulation to stimulate bowel function.
* Breastfeeding Support: Assisting with breastfeeding positioning and latch, providing
education on breastfeeding techniques, and addressing any concerns or difficulties the mother may
have. Supporting the mother in establishing breastfeeding and providing resources for lactation
support if needed.
* Emotional Support: Providing emotional support and reassurance to the mother as she
adjusts to the post-operative recovery period and cares for her newborn. Addressing any concerns
or anxieties she may have and providing information on postpartum mood disorders and available
support services.
* Family Education: Educating family members on how they can support the mother
during the post-operative recovery period, including assistance with newborn care, household tasks,
and emotional support.
* Follow-up Care: Scheduling follow-up appointments with healthcare providers to
monitor recovery progress, assess for complications, and address any ongoing concerns or issues.

Maternal Implications:
* Increased Risk of Infection: Cesarean sections are associated with a higher risk of
surgical site infections, endometritis, and urinary tract infections due to the surgical incision and
prolonged hospital stays (ACOG, 2022).
* Postpartum Hemorrhage: C-sections are linked to an elevated risk of postpartum
hemorrhage, primarily due to uterine atony and surgical trauma, necessitating vigilant monitoring
and management (ACOG, 2022).
* Thromboembolic Events: Women who undergo Cesarean sections have a heightened risk
of venous thromboembolism, emphasizing the importance of thromboprophylaxis and early
mobilization (ACOG, 2022).
* Delayed Recovery: Compared to vaginal delivery, recovery after Cesarean section is
typically more prolonged, requiring adequate pain management, support, and rehabilitation to
facilitate healing (Gong et al., 2023).
* Placental Abnormalities: Cesarean sections are associated with an increased risk of
placenta previa, placenta accreta, and other placental abnormalities in subsequent pregnancies,
necessitating careful monitoring and management (ACOG, 2022).
* Psychological Impact: Women who undergo Cesarean sections may experience
psychological distress, including feelings of disappointment, guilt, or trauma, highlighting the
importance of psychosocial support (ACOG, 2022).
* Breastfeeding Challenges: C-sections can pose challenges to breastfeeding initiation and
establishment due to delayed skin-to-skin contact, maternal-infant separation, and potential
maternal discomfort or medication use (ACOG, 2022).
* Chronic Pelvic Pain: Some women may experience chronic pelvic pain following
Cesarean section, attributed to scar tissue formation, nerve injury, or pelvic floor dysfunction,
requiring comprehensive assessment and management (ACOG, 2022).
* Subsequent Pregnancy Risks: Cesarean sections increase the risk of complications in
subsequent pregnancies, including uterine rupture, placental abnormalities, and cesarean scar
pregnancies, necessitating close monitoring and obstetric care (ACOG, 2022).
* Impact on Fertility: There is evidence to suggest that Cesarean sections may have
long-term effects on fertility, including alterations in uterine anatomy and impaired implantation,
although further research is needed to elucidate these associations (ACOG, 2022).
*
* Immune Function: Cesarean section delivery may affect the development of the infant's
immune system, potentially impacting susceptibility to infections and autoimmune diseases later in
life. Disruption of the natural passage through the birth canal can alter exposure to maternal
microbiota and immune factors, influencing immune system maturation (ACOG, 2022).
* Antibiotic Exposure: Infants born via Cesarean section may be exposed to antibiotics
during the procedure, impacting the colonization of their gut microbiota and potentially
contributing to antibiotic resistance and dysbiosis (ACOG, 2022).
* Risk of Cesarean Scar Pregnancy: Women who have undergone Cesarean section are at
increased risk of cesarean scar pregnancies in subsequent pregnancies, which can result in
life-threatening complications such as uterine rupture and hemorrhage (ACOG, 2022).
* Impact on Maternal-Infant Interaction: Cesarean section delivery can impact the
immediate maternal-infant interaction due to factors such as maternal recovery from anesthesia,
separation during surgical procedures, and delayed skin-to-skin contact, which may affect bonding
and attachment (Smith et al., 2023).
* Risk of Uterine Rupture in Future Pregnancies: Cesarean section increases the risk of
uterine rupture in subsequent pregnancies, particularly if a classical incision was used or if there is
a short inter pregnancy interval, necessitating careful monitoring and management during
subsequent pregnancies (ACOG, 2022).
* Adverse Effects of Anesthesia: Anesthesia administered during Cesarean section may
have adverse effects on both the mother and the fetus, including
* respiratory depression,
* hypotension
* neonatal sedation,
* requiring vigilant monitoring and management •
* blurry vision
* vomiting or nausea
* diarrhea
* stomach, back, or leg pain
* fever
* swelling of the throat
* prolonged weakness
* pale or yellowed skin
* hives, swelling, or blotchy skin
* dizziness or fainting
* difficulty breathing
* weak or fast pulse
* Severe reaction (Health-lin, 2023) (ACOG, 2022).
* Implications for Future Fertility Treatments: Cesarean section may impact future fertility
treatments, such as in vitro fertilization (IVF), due to potential alterations in uterine anatomy,
scarring, and impaired endometrial receptivity, which may affect treatment outcomes (ACOG,
2022).
* Risk of Maternal Mortality: Although rare, Cesarean section is associated with an
increased risk of maternal mortality compared to vaginal delivery, particularly in settings with
limited access to emergency obstetric care and resources (ACOG, 2022).
* Long-term Pelvic Floor Dysfunction: Some women may experience long-term pelvic
floor dysfunction following Cesarean section, including urinary incontinence, pelvic organ
prolapse, and sexual dysfunction, which may impact quality of life and require specialized
management (ACOG, 2022).
* Potential for Surgical Complications: Cesarean section carries inherent risks of surgical
complications such as wound dehiscence, infection, adhesions, and bowel or bladder injury, which
may necessitate additional surgical interventions or prolonged hospitalization (ACOG, 2022).
*
Child Health Implications:
* Respiratory Complications: Infants born via Cesarean section are at increased risk of
respiratory complications such as transient tachypnea of the newborn (TTN) and respiratory
distress syndrome (RDS), demanding close monitoring and supportive care (Smith et al., 2023).
* Low Apgar scores
*Neonatal Jaundice: Cesarean sections are associated with a higher incidence of neonatal jaundice,
potentially due to factors such as delayed breastfeeding initiation and altered gut microbiota,
requiring monitoring and phototherapy as needed (ACOG, 2022).
*NICU Admission: Babies delivered by Cesarean section are more likely to require admission to
the neonatal intensive care unit (NICU) for respiratory support, monitoring, or management of
complications, highlighting the need for comprehensive neonatal care (Smith et al., 2023).
* Delayed Breastfeeding Initiation: Maternal recovery from Cesarean section may delay
breastfeeding initiation, impacting early breastfeeding success and maternal-infant bonding,
necessitating proactive lactation support and counseling (ACOG, 2022).
* Birth Injuries: Cesarean sections may be associated with an increased risk of birth
injuries, such as lacerations or brachial plexus injuries, although the overall incidence is lower
compared to vaginal delivery (ACOG, 2022).
* Allergic Diseases: There is evidence to suggest that Cesarean section delivery may be associated
with an increased risk of allergic diseases such as asthma and eczema in childhood, although the
underlying mechanisms are not fully understood (ACOG, 2022).
* Gut Microbiome Alterations: Cesarean section delivery can disrupt the establishment of the infant
gut microbiome, potentially affecting immune development and long-term health outcomes,
emphasizing the importance of strategies to promote microbial colonization (ACOG, 2022).
* Childhood Obesity: Infants born via Cesarean section may have a higher risk of childhood
obesity and metabolic disorders, although further research is needed to elucidate the underlying
mechanisms and potential preventive strategies (ACOG, 2022).
* Impact on Bonding and Attachment: Maternal-infant bonding and attachment may be
impacted by Cesarean section delivery, particularly if early skin-to-skin contact and breastfeeding
initiation are delayed, underscoring the importance of promoting maternal-infant interaction (Smith
et al., 2023).
* Long-term Neuro developmental Outcomes: Although research findings are mixed, some
studies suggest that Cesarean section delivery may be associated with subtle differences in
neurodevelopmental outcomes in childhood, highlighting the need for further investigation and
monitoring (ACOG, 2022).
* Psychological and Emotional Implications
*Maternal Psychological Well-being: The experience of undergoing a C-section can have
significant psychological implications for mothers, including feelings of disappointment, loss, and
trauma (ACOG, 2022). Providing comprehensive psychosocial support is essential for promoting
maternal mental health.
*Bonding and Attachment: C-sections can impact maternal-infant bonding and attachment,
particularly if early skin-to-skin contact and breastfeeding initiation are delayed (Smith et al., 2023).
Implementing practices that prioritize bonding can help mitigate these effects. *Strategies
for Optimizing Cesarean Section Outcomes. Shared
Decision-Making: Shared decision-making between healthcare providers and pregnant
individuals is essential for determining the most appropriate mode of delivery, taking into account
both medical indications and patient preferences (ACOG, 2022). .
Enhanced Recovery Protocols: Implementing enhanced recovery after surgery (ERAS) protocols
for C-sections has been shown to improve maternal outcomes, reduce postoperative pain, and
shorten hospital stays (Gong et al., 2023)
OTHER COMPLICATIONS MAYBE DIVIDED INTO:
Stage Complications
Immediate Postpartum haemorrhage (>1000ml)
Wound haematoma (increased in patient with large BMI/diabetes/immunosuppressed)
Intra-abdominal haemorrhage
Bladder/bowel trauma (more common in patients who have had previous abdominal
surgery)
Neonatal:
transient tachypnoea of the newborn
fetal lacerations (1-2% risk, higher with previous membrane rupture)
Intermediate Infection:
urinary tract infection
endometritis
respiratory (higher risk if general anaesthetic used)
Venous thromboembolism
Late Urinary tract trauma (fistula)
Subfertility (there is a delay in conceiving compared to women who have had vaginal
deliveries)
Regret and other negative psychological sequelae
Rupture/dehiscence of scar at next labour (VBAC)
Placenta praevia/accreta
Caesarean scar ectopic pregnancy
SUMMARY
Caesarean section is a procedure performed to save the life of the fetus and sometime to save the
life of the woman. Although risks are low, affected women suffer from severe complications. The
first caesarean section performed has a bearing on management of subsequent pregnancies. It is
crucial that the procedure is performed when necessary. The evolution of caesarean section has
shown marked improvement in maternal outcome especially after the introduction of antibiotics.
Complications of caesarean sections are common in patients who have had a previous Caesarean
section
CONCLUSION

A cesarean section or a C-section is a surgical procedure in which a baby is delivered through

incisions made in the abdomen and uterus, as opposed to delivering a baby in the traditional way,
via a vaginal birth. Caesarean section is planned if health care providers determine that a vaginal
delivery is not safe for example when expecting multiple,in
transverse lie, breech presentation, placenta previa,heart
disease, genital herpes, uterine fibroids, pelvic fracture or babies with congenital anomalies, weak
contractions and umbilical cord prolapse,etc occurring before or during childbirth. There are three types of
C-section incisions, all of which are healthy and safe, they include a low transverse incision across the lower
abdomen, a low vertical cut extending down the lower abdomen, and a high vertical incision across the
stomach. Complications related to infections like fever, painful urination, severe abdominal pain, discharge,
redness, odor, visible tearing of the vagina or vaginal discharge might occur. Other rare complications
include re-opening of the uterine incision, hemorrhage, blood clotting, and injury to the bowel or
bladder. C-section scars can be minimized or treated with silicone gel or sheets, pressure therapy,
dermabrasion, injections, laser treatments, and surgery. (Procter and Gamble,2022)
RECOMMENDATIONS

women

Antenatal education on natural childbirth preparation with training in breathing and

relaxation techniques should be provided to expectant mothers

Health care professionals should provide Childbirth training workshop for pregnant
women

Psychosocial couple-based prevention programme should be provided at all levels

of care

Pelvic floor muscle training (PFMT) exercises with telephone follow-up in case
of complications

* Psychoeducation for women with fear of childbirth

Prenatal education for partners of pregnant women

Nurse-led applied relaxation training programme

.
*women should be enlightened on the importance and disadvantage of caeserean section
*Teach pregnant women early signs in pregnancy that may warrant c section
*Nurses and other health care providers should teach postpartum women on how to care for
incision site to prevent complications and wound infection.

References:

* American college of Obstetricians and Gynecologists (ACOG): (2022).Practice Bulletin

No - 226 : Singleton Gestation: cesarean Delivery. Obstetrics and Gynecology
139(3), e1O1 - e119.
* ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. Obstet Gynecol.
2019;133(2):e110-e127.
*Cleveland clinic
https://my. cleaveland clinic. org /treatments/7246- Cesarean birth-C- Section.
*Gong, Y., Zhou., Y., Zhang, H., & Cai, W. (2023). Enhanced recovery After surgeryProtocols for
cesarean section:A systematic reviewAnd meta-analysis of randomized controlled trails. BJOG: An
international journal of obstetrics and gynecology, 130(3),297-306
*Med Tech (2020)
https//:www.meridian/life.com
*National library of medicine. National Center for biotechnology information.
.NLT.nih.gov (NCBI) (2023)
* Norman SM, Tuuli MG, Odibo AO, Caughey AB. Efficacy of antibiotics prophylaxis for
intra-amniotic infection in laboring women: a systematic review. Am J Obstet Gynecol.
2019;221(6):540-554.

*Procter and Gamble, (2022) ;

https://www.pampers.com/en-us/baby/parenting-life/article/c-section-scar

*Smith, G.C., Pell, J.P., & Donnie,R (2023). Cesarean Section and Risk of respiratory distress
syndrome in term infants: A Population-based study-Obstetrics and gynecology, 141(1), 108-115.

*Teach me (2022)
https//:www.teachmeobygn.com
* Yehudit Schindler, Daniel Lublin, Leanna Olteanu, Ran Neigrr, Joseph Blessing (2022) (Science
Direct)