Chapter 11: Intrapartum and Postpartum Care of Cesarean Birth Families

Cesarean births are classified as either scheduled, occurring before labor onset due to conditions such as previous cesarean delivery, maternal or fetal health complications, or fetal malpresentation, or unscheduled, which may be emergent, urgent, or nonurgent depending on clinical circumstances. The chapter emphasizes strategies to prevent unnecessary primary cesarean deliveries by adhering to precise definitions of labor arrest, promoting trial of labor after cesarean for eligible candidates to reduce population-level cesarean rates and maternal morbidity, and implementing nonmedical interventions including continuous labor support and maternal repositioning. Perioperative nursing care encompasses three distinct phases: preoperative assessment including informed consent documentation and intravenous fluid administration to prevent anesthesia-related hypotension, intraoperative care involving patient safety protocols such as time-out verification and left lateral positioning to avoid supine hypotension syndrome with neuraxial anesthesia as the preferred approach, and postoperative management in the post-anesthesia care unit focusing on vital sign stabilization, respiratory monitoring when intrathecal morphine is used, and venous thromboembolism prevention through early ambulation and sequential compression devices. The chapter addresses significant maternal complications including postpartum hemorrhage, infection at markedly elevated rates compared to vaginal birth, thromboembolic disease, and placenta accreta in repeat cesarean deliveries, with particular attention to risks in women with elevated body mass index. Family-centered care principles are integrated throughout, highlighting the importance of early skin-to-skin contact in the operating room to promote bonding and reduce neonatal intensive care transfers, while providing emotional support for women processing feelings related to unplanned surgical delivery. Discharge criteria and postpartum education address warning signs including heavy bleeding, malodorous lochia, and infectious symptoms requiring immediate clinical attention.