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Updating Care of Cesarean Section Patients
Updating Care of Cesarean Section Patients C I I E R Y I , H. R E Y N O L D S , R N , B S N
At a time when prepared childbirth and the participation of both parents in labor and delivery is being stressed, nurses need to reexamine the impact of a cesarean section on the family. Nurses need to he active in modifying those experiences of a cesarean section family that niuy he in direct conflict with their expectations: loss of participation in delivery, separation of the couple during delivery, diminution of the father’s role, and prolonged isolation of the infant front the parents after delivery. Nursing cure of these putients should be maternity-oriented rather than surgery-oriented.
48
The care of maternity patients in this country is moving ‘toward family-centered care. Prenatal classes are more widely publicized and attended, more patients are asking to be involved in labor and delivery instead of being “put out”, and more and more fathers are asserting their rights to participate in the births of their children. Most professionals involved with maternity and pediatric care are attempting to provide care that is family oriented, both in response to their patients’ expectations and as an incentive to families. In light of this movement toward family-oriented care, nurses need to take another look at how they are treating their cesarean section families. In their article, “The Cesarean Section Patient Is a New Mother Too”, Bampton and Mancini discuss nursing care tailored to the physical needs of a cesarean section mother. They also discuss the dependency needs of these patients and the increased difficulty with bonding to their babies.’ There is more, however, that nurses need to consider in order to provide meaningful nursing interventions for the cesarean section family. The cesarean section patient has her baby taken from her, delivered without her participation or her husband’s. If she has general anesthesia, it may be hours before she knows the particulars about the baby. Medication and anesthesia blur memory and perception, leaving incomplete or perhaps false impressions that will linger in her memory all her life. If the patient and her husband did not plan to be together for the delivery, if the mother had anticipated little more than letting the doctor deliver her baby, then the trauma of a cesarean section will not frustrate many of her expectations. Further, if she did not picture the immediate postpartum period as one of closeness with her husband and baby, then the separation of the baby from the family that is still adhered to in many hospitals will not be upsetting.
One Family’s Experience But what of the couple who has gone to prenatal classes and been promised a uniquely fulfilling experience of bringing their child into the world together? What happens to the expectations of a couple who wanted to spend some time together alone with the baby in the recovery room? What happens to the mother who does not recover from delivery as fast as she expected? In the days and weeks to come, the patient and her husband may feel cheated of an experience that they had eagerly anticipated. If the mother has the operation with her first child, they may never participate in delivering a child. True, the ultimate measure of success is having a healthy baby, safely, one way or the other, and women who have had cesarean sections are grateful for their safety and their baby’s. But the whole premise of progressive maternity care is to make the birth of a child a family affair. Consider the following case: Mr. and Mrs. W. had attended early prenatal classes and, later, Lamaze classes. After two days of off-and-on contractions she went into hard, active labor. Pelvimetry prior to this had shown “ a very small pelvis”. After eight hours of nonprogression, she was taken to surgery. Her husband was with her until she was given general anesthesia. There had been no indication of fetal distress, but Mr. W. described the staff as “hurried”. Mr. W. had asked a nurse if the operation would effect her ability to breastfeed. The nurse had replied, as she left the room, “She’ll probably have a lot of trouble anyway because of her inverted nipple.” After leaving his wife, Mr. W.’s immediate response was to call a friend, who happened to be a physician, to sit with him. He was very “shaky”. As they sat talking, Mr. W. asked many questions: how long would she be in surgery, how long would she be in the hospital, what type of scar would she have. The baby boy had been born and he had seen him, but at this point his major concern was, quite naturally, his wife. July/August 1977 JOCN Nursing
Mr. W. watched his baby through the nursery glass for 45 minutes until his wife was in the recovery room. During this time the nurse bathed the baby, took his vital signs, and lavaged his stomach. No one came to talk to Mr. W. I t was more than 5 hours later when Mrs. W. saw her son. During this time, Mrs. W. had been awake and resting comfortably. Her son had had a gestational estimate performed, a glucose feeding, and a nap. Four friends of this couple had seen the baby and talked to Mrs. W. about him before he was finally brought to her. By this time he was in a deep sleep and unable to attempt a first breastfeeding. Mrs. W. was in the hospital 6 days. She found she was sleepy much of the time and put a great amount of energy into using the blow bottles, turning, coughing, ambulating, answering the phone, entertaining friends, and trying to nurse her baby. She knew she needed a good night’s sleep and so decided she couldn’t have the baby room-in. She thought rooming-in was a 24-hour all-or-nothing proposition (nursery policy at that hospi-
warn me after they knew the size of my pelvis.” N o one discussed trial labor with her. The longer hospitalization made her lonely for her husband. When breastfeeding was “going downhill” it “added
explain the procedure, and anticipate Some of the experiences ahead, A can also be invaluable in helping the mother begin looking at
“Verbal communication is extremely important at this time even though the nurses may be very busy with procedures. Silence is many times frightening to the patient and her husband.” another failure”. “Nothing went as we planned.” Several weeks after delivery she wondered if she would ever feel “normal”. Until Mrs. W. talked with other cesarean section mothers, she thought her feelings and physical reactions were “abnormal”.
her feelings of loss: loss of the promise of a normal delivery. For patients needing repeat cesarean sections, the mother’s and father’s wishes can be made known to the hospital staff in advance and every effort made to accommodate them. Active participation in planning for the experience What Nurses Can Do may help minimize the sense of pasThere are some procedural and sivity associated with the operation. behavioral changes that nurses can F o r the patient who enters the make which would help a cesarean hospital in labor and subsequently section mother reconcile her feelings requires surgery, there is very little and expectations and incorporate a time to assimilate the experience and its ramifications, sometimes a matter of minutes between the time the de“There are some procedural and behavioral changes that nurses cision to operate is made and the first can make which would help a cesarean section mother reconcile incision. Her need and her husband’s her feelings and expectations and incorporate a positive experi- need for support in the postpartum as well as the immediate intrapartum ence into her memory.” period can be anticipated. Immediately, as the mother is being shaved, having a catheter intal was not all-or-nothing). No one ex- positive experience into her memory. serted, etc., the nurse should not plained the system to her or asked if she The family can be helped to make a only explain what she is doing but wanted some rooming-in. positive start toward bonding with attempt to provide reassurance that a The final blow was when she thought the baby. Procedural changes may cesarean section is being performed breastfeeding was not going well. O n the involve on-the-spot nursing judg- t o assure a healthy baby and mother. fifth night she broke down crying. A nurments as well as constant review and Separation of the parents from each sery nurse spent several hours talking cooperation by medical and nursing other can be made easier by giving with her about her depression. She felt personnel in setting written policy. an approximate timetable: “You will comforted and somewhat consoled just by talking with the nurse. When the Nursing care supportive of the fam- be in the operating room in about nurse pointed out that most mothers go ily requires a listening ear and adap- ten minutes. The baby is born in through a postpartum depression, tation of care based on the knowl- only a few minutes. Your husband “something clicked”. She had been edge of the needs of cesarean section will be with the baby shortly after he warned about this but failed to recognize families. or she is born. We expect you will be it in herself. In a few cases, primary cesarean awake within an hour and then your Months later, she reflected on her ex- section can be anticipated before the husband will be with you and probperience. She described it as a “nightonset of labor, e.g., the case of an ably the baby too.” The above statemare” and revealed that she felt a “wall” between herself and her child for a long elderly primigravida with a breech ments can be adapted to fit the situatime. She was angry about the lengthy presentation. In these instances, the tion. Verbal communication is separation from the baby, angry that pre- mother has more time to think about extremely important at this time the experience ahead of her. Nurses even though the nurses may be very natal classes had failed to talk about cesarean sections, angry that “they did not are in a position to answer questions, busy with procedures. Silence is July/August 1977 JOCN Nursing
49
many times frightening to the patient and her husband. Later, on the postpartum ward, reliving the whole experience with a sympathetic listener can go a long way toward helping the couple integrate the experience. A visit from
ting procedures have been done in the nursery, the father can take his baby with a nurse to the recovery room. Here, if the mother has had spinal anesthesia or is reacted from general anesthesia, mother and father and child can spend time to-
“. . . although the mother has delivered safely and has a healthy infant, the couple did lose something: the ‘we did it together’ that was promised them,. . .”
’
or whether stepping back to the periphery would be more helpful. On the ward, repeated and continued contact with the baby is as important for a cesarean family as for a normal postpartum family. This may mean extra nursing time to help the mother handle the baby, feed him, change his diapers, and put him in and take him out of the bassinet. But these early memories of her child are important and helpful in establishing a relationship. Wondering what was going on with the baby those first hours and days and feeling that the staff was “loaning” her the baby at infrequent intervals can be a source of frustration and resentment for the mother. Rooming-in for parts of the day, if the mother wishes, should not be denied. For the family who has an emergency c-section because of fetal distress, the burden placed on their resources is heavy. Because of
the labor room nurse can help clear gether sharing the joy of the event. up any misconceptions about what The father has a role immediately happened. As a further step, once and the mother has the pleasure of the couple has verbally relived the knowing that her husband is with the experience, it is important for them baby. The father is no longer “that to begin looking at their reaction to man on the other side of the glass.” the operation and to know that if Indeed, some hospitals now permit they feel a sense of loss, perhaps fathers in the operating room where some anger, sadness, bitterness, or they can sit facing their wives, lendeven guilt, that these are normal re- ling support and experiencing the actions. For in a very real sense, al- delivery together. though the mother has delivered safely and has a healthy infant, the “On the ward, repeated and continued contact with the baby are couple did lose something: the “we as important for a cesarean family as for a normal postpartum did it together” that was promised family. This may mean extra nursing time. . ” them, the “most wonderful experience” that everyone seems to talk about. The couple needs to work For the mother, it is impossible to anesthesia and the stress of the surgithrough this and a nurse can help the predict how medication will affect cal procedure, the mother may not process considerably, initiating the her memory, either short term or be immediately anxious about the long term. She may remember only baby. She may draw inward, leaving talk if necessary. Promoting bonding between the things said to her or remember the father to cope alone with his new baby and the parents is made mostly visual impressions. All staff fears for his child and concern for his more difficult by a cesarean section, coming in contact with her should wife. During this time the mother but much can be done for the family make an effort to talk about the to support and encourage their ef- baby. If she has had spinal anes- should be told that the baby is in the forts. Basic in providing support at thesia, the staff present in the oper- nursery, receiving the best of care, this time is to assure many early op- ating room should make every effort and that he will need to stay there for portunities for the parents to get to to tell her about the baby until he is the present. She should be reassured know the baby by seeing, touching, stable, at which time she can be that she will be with the baby as soon holding, comforting, and talking, not shown the baby and touch him be- as possible. With early ambulation as only to the baby but to each other. fore he is taken to the waiting father. a part of postoperative care routine, When a mother has had general there should be no objection to takThe reality of the physical presence of the baby goes far in aligning the anesthesia, as she is reacting and for ing the mother in a wheelchair to the a while afterwards, the nurse should nursery on the first postpartum day if parents’ thoughts. Nurses are in a unique position to talk with her about the baby. It may the infant is too ill to be brought to assure these early opportunities so be necessary to repeat things many her. In the meantime, the pediatrithat later the parents have positive times. She may not be able to state cian will have visited her; she should impressions. For the father, once the questions she has in her mind so the have met a nursery nurse and been baby has been given immediate care nurse should describe to her the sex given the nursery phone number and in the operating room and the pe- of the child, some physical character- encouraged to call at any time. The diatrician feels the baby is stable, in- istics (hair color, amount, etc.), the nurse caring for the infant should stead of having the nurse carry the baby’s condition if known, etc. take it on herself to get in touch with baby to the nursery the father can be When the father and baby arrive, the the mother if she has not called or gowned and waiting outside the op- nurse can use her skills to determine visited by 24 hours postpartum. erating room to carry his baby to the whether she can be more effective in For the father of a stressed infant, nursery with the nurse. Once admit- helping the parents look at the baby every effort to keep him informed
50
July/August 1977 JOCN Nursing
must be made. He was “shut out” of the delivery, his supportive role diminished, so nursing staff should attempt to keep him involved. He should be taken to the nursery to talk with the pediatrician and staff and to see his baby as soon as the infant is settled. Then, he should be taken to t h e recovery room to be with his wife. Keeping him from his infant
the changes and methods should be set up.2 Fortunate staff nurses may work in a vital situation where their suggestions for policy changes are considered seriously and given a trial if the goal is commonly shared with their administrators. In such situations, the nurse may be encouraged to draw up specific plans for presenta-
“For the father of a stressed infant, every effort to keep him informed must be made. He was ‘shut out’ of the delivery, his supportive role diminished, so nursing staff should attempt to keep him involved.” and wife is cruel and in most circumstances unnecessary. Bringing About Change Changing procedure and written policy to meet the needs of c-section families is an integral part of obstetric and pediatric nursing. But changing policy can be difficult at times, as all nurses know. In planning for the care of these families, nurses from labor and delivery, the nursery, and postpartum all have a role to play. In addition, the pediatric and obstetrical physicians will have to approve changes. At present, many obstetrical facilities are revamping their procedures and policies; if those involved will remember to include cesarean section families when policies are changed, it may be easier to institute desired changes. For nurses in a leadership position, time is well spent in planning a course of action for changes before anything is haphazardly undertaken. Staffing availability and attitudes, equipment, and facilities must be considered.’ Those staff involved in the care of cesarean section patients should be included in planning for changes. A small pilot run should be attempted to work out procedural difficulties; control systems and allowance for periodic evaluation of
July/August 1977 JOCN Nursing
tion to the rest of the nurses. Other nurses find themselves in a situation where any change or suggestion is met with resistance or passive interest. In dealing with c-section patients, nurses from labor and delivery, operating room, recovery room, postpartum, and the nursery all may be involved, and a nurse meeting resistance on her own ward can seek support from staff on the other units or from a clinical coordinator to overcome inertia. A physician supportive of her goals may be an ally to a staff nurse meeting resistance. If change is difficult while working toward policy revision, any nurse can practice subtle revisions in care that do not necessarily need written policy. For example, the labor nurses could wheel a cesarean section mother past the nursery glass to look at her infant on her way to her postpartum room if she hasn’t been able to see him yet. A nursery nurse ally could wheel the baby over to show him to the mother. Conclusion Hospital policies may vary, but nurses can provide care to their cesarean section families that is responsive to their needs. Helping the mother and father work through the
reality of the operation and the possible loss of a normal labor and delivery in the future is a necessary service that a nurse can provide. It is a nurse’s responsibility to assure many early opportunities for the parents and the baby to begin knowing each other. Nurses can help a child receive a positive start in life by providing responsive and responsible care to the family of a cesarean section patient.
Acknowledgment The author thanks C. Philip Reynolds, MD, for his support and Sharon Joseph, RN, for her encouragemen t. References 1. Bampton, B. A , , and J. M. Mancini: “The Cesarean Section Patient Is a New Mother Too”. JOCN Nurs 2(4):58-61, Jul/Aug 1973 2 . Stevens. B.: The Nurse As Executive. Wakefield, Massachusetts, Contemporary Publishers, pp 57-61, 1975
Address reprint requests to Ms. Cheryl B. Reynolds, RN, 7068 Lipmann, San Diego, CA 92122.
Cheryl Reynolds graduated from Duke University and for three months following was the live-in nurse for the Kienast quintuplets in New Jersey. She has had experience in neonatal intensive care and outpatient pediatrics, serving as a team leader in the latter area while at the same time carrying a case load of 200 families as u nurse practitioner. She has also been active in dejining nursing roles, speaking und teaching, and working to modify hospital and nursing care of cesarean section families.
51
At a time when prepared childbirth and the participation of both parents in labor and delivery is being stressed, nurses need to reexamine the impact of a cesarean section on the family. Nurses need to he active in modifying those experiences of a cesarean section family that niuy he in direct conflict with their expectations: loss of participation in delivery, separation of the couple during delivery, diminution of the father’s role, and prolonged isolation of the infant front the parents after delivery. Nursing cure of these putients should be maternity-oriented rather than surgery-oriented.
48
The care of maternity patients in this country is moving ‘toward family-centered care. Prenatal classes are more widely publicized and attended, more patients are asking to be involved in labor and delivery instead of being “put out”, and more and more fathers are asserting their rights to participate in the births of their children. Most professionals involved with maternity and pediatric care are attempting to provide care that is family oriented, both in response to their patients’ expectations and as an incentive to families. In light of this movement toward family-oriented care, nurses need to take another look at how they are treating their cesarean section families. In their article, “The Cesarean Section Patient Is a New Mother Too”, Bampton and Mancini discuss nursing care tailored to the physical needs of a cesarean section mother. They also discuss the dependency needs of these patients and the increased difficulty with bonding to their babies.’ There is more, however, that nurses need to consider in order to provide meaningful nursing interventions for the cesarean section family. The cesarean section patient has her baby taken from her, delivered without her participation or her husband’s. If she has general anesthesia, it may be hours before she knows the particulars about the baby. Medication and anesthesia blur memory and perception, leaving incomplete or perhaps false impressions that will linger in her memory all her life. If the patient and her husband did not plan to be together for the delivery, if the mother had anticipated little more than letting the doctor deliver her baby, then the trauma of a cesarean section will not frustrate many of her expectations. Further, if she did not picture the immediate postpartum period as one of closeness with her husband and baby, then the separation of the baby from the family that is still adhered to in many hospitals will not be upsetting.
One Family’s Experience But what of the couple who has gone to prenatal classes and been promised a uniquely fulfilling experience of bringing their child into the world together? What happens to the expectations of a couple who wanted to spend some time together alone with the baby in the recovery room? What happens to the mother who does not recover from delivery as fast as she expected? In the days and weeks to come, the patient and her husband may feel cheated of an experience that they had eagerly anticipated. If the mother has the operation with her first child, they may never participate in delivering a child. True, the ultimate measure of success is having a healthy baby, safely, one way or the other, and women who have had cesarean sections are grateful for their safety and their baby’s. But the whole premise of progressive maternity care is to make the birth of a child a family affair. Consider the following case: Mr. and Mrs. W. had attended early prenatal classes and, later, Lamaze classes. After two days of off-and-on contractions she went into hard, active labor. Pelvimetry prior to this had shown “ a very small pelvis”. After eight hours of nonprogression, she was taken to surgery. Her husband was with her until she was given general anesthesia. There had been no indication of fetal distress, but Mr. W. described the staff as “hurried”. Mr. W. had asked a nurse if the operation would effect her ability to breastfeed. The nurse had replied, as she left the room, “She’ll probably have a lot of trouble anyway because of her inverted nipple.” After leaving his wife, Mr. W.’s immediate response was to call a friend, who happened to be a physician, to sit with him. He was very “shaky”. As they sat talking, Mr. W. asked many questions: how long would she be in surgery, how long would she be in the hospital, what type of scar would she have. The baby boy had been born and he had seen him, but at this point his major concern was, quite naturally, his wife. July/August 1977 JOCN Nursing
Mr. W. watched his baby through the nursery glass for 45 minutes until his wife was in the recovery room. During this time the nurse bathed the baby, took his vital signs, and lavaged his stomach. No one came to talk to Mr. W. I t was more than 5 hours later when Mrs. W. saw her son. During this time, Mrs. W. had been awake and resting comfortably. Her son had had a gestational estimate performed, a glucose feeding, and a nap. Four friends of this couple had seen the baby and talked to Mrs. W. about him before he was finally brought to her. By this time he was in a deep sleep and unable to attempt a first breastfeeding. Mrs. W. was in the hospital 6 days. She found she was sleepy much of the time and put a great amount of energy into using the blow bottles, turning, coughing, ambulating, answering the phone, entertaining friends, and trying to nurse her baby. She knew she needed a good night’s sleep and so decided she couldn’t have the baby room-in. She thought rooming-in was a 24-hour all-or-nothing proposition (nursery policy at that hospi-
warn me after they knew the size of my pelvis.” N o one discussed trial labor with her. The longer hospitalization made her lonely for her husband. When breastfeeding was “going downhill” it “added
explain the procedure, and anticipate Some of the experiences ahead, A can also be invaluable in helping the mother begin looking at
“Verbal communication is extremely important at this time even though the nurses may be very busy with procedures. Silence is many times frightening to the patient and her husband.” another failure”. “Nothing went as we planned.” Several weeks after delivery she wondered if she would ever feel “normal”. Until Mrs. W. talked with other cesarean section mothers, she thought her feelings and physical reactions were “abnormal”.
her feelings of loss: loss of the promise of a normal delivery. For patients needing repeat cesarean sections, the mother’s and father’s wishes can be made known to the hospital staff in advance and every effort made to accommodate them. Active participation in planning for the experience What Nurses Can Do may help minimize the sense of pasThere are some procedural and sivity associated with the operation. behavioral changes that nurses can F o r the patient who enters the make which would help a cesarean hospital in labor and subsequently section mother reconcile her feelings requires surgery, there is very little and expectations and incorporate a time to assimilate the experience and its ramifications, sometimes a matter of minutes between the time the de“There are some procedural and behavioral changes that nurses cision to operate is made and the first can make which would help a cesarean section mother reconcile incision. Her need and her husband’s her feelings and expectations and incorporate a positive experi- need for support in the postpartum as well as the immediate intrapartum ence into her memory.” period can be anticipated. Immediately, as the mother is being shaved, having a catheter intal was not all-or-nothing). No one ex- positive experience into her memory. serted, etc., the nurse should not plained the system to her or asked if she The family can be helped to make a only explain what she is doing but wanted some rooming-in. positive start toward bonding with attempt to provide reassurance that a The final blow was when she thought the baby. Procedural changes may cesarean section is being performed breastfeeding was not going well. O n the involve on-the-spot nursing judg- t o assure a healthy baby and mother. fifth night she broke down crying. A nurments as well as constant review and Separation of the parents from each sery nurse spent several hours talking cooperation by medical and nursing other can be made easier by giving with her about her depression. She felt personnel in setting written policy. an approximate timetable: “You will comforted and somewhat consoled just by talking with the nurse. When the Nursing care supportive of the fam- be in the operating room in about nurse pointed out that most mothers go ily requires a listening ear and adap- ten minutes. The baby is born in through a postpartum depression, tation of care based on the knowl- only a few minutes. Your husband “something clicked”. She had been edge of the needs of cesarean section will be with the baby shortly after he warned about this but failed to recognize families. or she is born. We expect you will be it in herself. In a few cases, primary cesarean awake within an hour and then your Months later, she reflected on her ex- section can be anticipated before the husband will be with you and probperience. She described it as a “nightonset of labor, e.g., the case of an ably the baby too.” The above statemare” and revealed that she felt a “wall” between herself and her child for a long elderly primigravida with a breech ments can be adapted to fit the situatime. She was angry about the lengthy presentation. In these instances, the tion. Verbal communication is separation from the baby, angry that pre- mother has more time to think about extremely important at this time the experience ahead of her. Nurses even though the nurses may be very natal classes had failed to talk about cesarean sections, angry that “they did not are in a position to answer questions, busy with procedures. Silence is July/August 1977 JOCN Nursing
49
many times frightening to the patient and her husband. Later, on the postpartum ward, reliving the whole experience with a sympathetic listener can go a long way toward helping the couple integrate the experience. A visit from
ting procedures have been done in the nursery, the father can take his baby with a nurse to the recovery room. Here, if the mother has had spinal anesthesia or is reacted from general anesthesia, mother and father and child can spend time to-
“. . . although the mother has delivered safely and has a healthy infant, the couple did lose something: the ‘we did it together’ that was promised them,. . .”
’
or whether stepping back to the periphery would be more helpful. On the ward, repeated and continued contact with the baby is as important for a cesarean family as for a normal postpartum family. This may mean extra nursing time to help the mother handle the baby, feed him, change his diapers, and put him in and take him out of the bassinet. But these early memories of her child are important and helpful in establishing a relationship. Wondering what was going on with the baby those first hours and days and feeling that the staff was “loaning” her the baby at infrequent intervals can be a source of frustration and resentment for the mother. Rooming-in for parts of the day, if the mother wishes, should not be denied. For the family who has an emergency c-section because of fetal distress, the burden placed on their resources is heavy. Because of
the labor room nurse can help clear gether sharing the joy of the event. up any misconceptions about what The father has a role immediately happened. As a further step, once and the mother has the pleasure of the couple has verbally relived the knowing that her husband is with the experience, it is important for them baby. The father is no longer “that to begin looking at their reaction to man on the other side of the glass.” the operation and to know that if Indeed, some hospitals now permit they feel a sense of loss, perhaps fathers in the operating room where some anger, sadness, bitterness, or they can sit facing their wives, lendeven guilt, that these are normal re- ling support and experiencing the actions. For in a very real sense, al- delivery together. though the mother has delivered safely and has a healthy infant, the “On the ward, repeated and continued contact with the baby are couple did lose something: the “we as important for a cesarean family as for a normal postpartum did it together” that was promised family. This may mean extra nursing time. . ” them, the “most wonderful experience” that everyone seems to talk about. The couple needs to work For the mother, it is impossible to anesthesia and the stress of the surgithrough this and a nurse can help the predict how medication will affect cal procedure, the mother may not process considerably, initiating the her memory, either short term or be immediately anxious about the long term. She may remember only baby. She may draw inward, leaving talk if necessary. Promoting bonding between the things said to her or remember the father to cope alone with his new baby and the parents is made mostly visual impressions. All staff fears for his child and concern for his more difficult by a cesarean section, coming in contact with her should wife. During this time the mother but much can be done for the family make an effort to talk about the to support and encourage their ef- baby. If she has had spinal anes- should be told that the baby is in the forts. Basic in providing support at thesia, the staff present in the oper- nursery, receiving the best of care, this time is to assure many early op- ating room should make every effort and that he will need to stay there for portunities for the parents to get to to tell her about the baby until he is the present. She should be reassured know the baby by seeing, touching, stable, at which time she can be that she will be with the baby as soon holding, comforting, and talking, not shown the baby and touch him be- as possible. With early ambulation as only to the baby but to each other. fore he is taken to the waiting father. a part of postoperative care routine, When a mother has had general there should be no objection to takThe reality of the physical presence of the baby goes far in aligning the anesthesia, as she is reacting and for ing the mother in a wheelchair to the a while afterwards, the nurse should nursery on the first postpartum day if parents’ thoughts. Nurses are in a unique position to talk with her about the baby. It may the infant is too ill to be brought to assure these early opportunities so be necessary to repeat things many her. In the meantime, the pediatrithat later the parents have positive times. She may not be able to state cian will have visited her; she should impressions. For the father, once the questions she has in her mind so the have met a nursery nurse and been baby has been given immediate care nurse should describe to her the sex given the nursery phone number and in the operating room and the pe- of the child, some physical character- encouraged to call at any time. The diatrician feels the baby is stable, in- istics (hair color, amount, etc.), the nurse caring for the infant should stead of having the nurse carry the baby’s condition if known, etc. take it on herself to get in touch with baby to the nursery the father can be When the father and baby arrive, the the mother if she has not called or gowned and waiting outside the op- nurse can use her skills to determine visited by 24 hours postpartum. erating room to carry his baby to the whether she can be more effective in For the father of a stressed infant, nursery with the nurse. Once admit- helping the parents look at the baby every effort to keep him informed
50
July/August 1977 JOCN Nursing
must be made. He was “shut out” of the delivery, his supportive role diminished, so nursing staff should attempt to keep him involved. He should be taken to the nursery to talk with the pediatrician and staff and to see his baby as soon as the infant is settled. Then, he should be taken to t h e recovery room to be with his wife. Keeping him from his infant
the changes and methods should be set up.2 Fortunate staff nurses may work in a vital situation where their suggestions for policy changes are considered seriously and given a trial if the goal is commonly shared with their administrators. In such situations, the nurse may be encouraged to draw up specific plans for presenta-
“For the father of a stressed infant, every effort to keep him informed must be made. He was ‘shut out’ of the delivery, his supportive role diminished, so nursing staff should attempt to keep him involved.” and wife is cruel and in most circumstances unnecessary. Bringing About Change Changing procedure and written policy to meet the needs of c-section families is an integral part of obstetric and pediatric nursing. But changing policy can be difficult at times, as all nurses know. In planning for the care of these families, nurses from labor and delivery, the nursery, and postpartum all have a role to play. In addition, the pediatric and obstetrical physicians will have to approve changes. At present, many obstetrical facilities are revamping their procedures and policies; if those involved will remember to include cesarean section families when policies are changed, it may be easier to institute desired changes. For nurses in a leadership position, time is well spent in planning a course of action for changes before anything is haphazardly undertaken. Staffing availability and attitudes, equipment, and facilities must be considered.’ Those staff involved in the care of cesarean section patients should be included in planning for changes. A small pilot run should be attempted to work out procedural difficulties; control systems and allowance for periodic evaluation of
July/August 1977 JOCN Nursing
tion to the rest of the nurses. Other nurses find themselves in a situation where any change or suggestion is met with resistance or passive interest. In dealing with c-section patients, nurses from labor and delivery, operating room, recovery room, postpartum, and the nursery all may be involved, and a nurse meeting resistance on her own ward can seek support from staff on the other units or from a clinical coordinator to overcome inertia. A physician supportive of her goals may be an ally to a staff nurse meeting resistance. If change is difficult while working toward policy revision, any nurse can practice subtle revisions in care that do not necessarily need written policy. For example, the labor nurses could wheel a cesarean section mother past the nursery glass to look at her infant on her way to her postpartum room if she hasn’t been able to see him yet. A nursery nurse ally could wheel the baby over to show him to the mother. Conclusion Hospital policies may vary, but nurses can provide care to their cesarean section families that is responsive to their needs. Helping the mother and father work through the
reality of the operation and the possible loss of a normal labor and delivery in the future is a necessary service that a nurse can provide. It is a nurse’s responsibility to assure many early opportunities for the parents and the baby to begin knowing each other. Nurses can help a child receive a positive start in life by providing responsive and responsible care to the family of a cesarean section patient.
Acknowledgment The author thanks C. Philip Reynolds, MD, for his support and Sharon Joseph, RN, for her encouragemen t. References 1. Bampton, B. A , , and J. M. Mancini: “The Cesarean Section Patient Is a New Mother Too”. JOCN Nurs 2(4):58-61, Jul/Aug 1973 2 . Stevens. B.: The Nurse As Executive. Wakefield, Massachusetts, Contemporary Publishers, pp 57-61, 1975
Address reprint requests to Ms. Cheryl B. Reynolds, RN, 7068 Lipmann, San Diego, CA 92122.
Cheryl Reynolds graduated from Duke University and for three months following was the live-in nurse for the Kienast quintuplets in New Jersey. She has had experience in neonatal intensive care and outpatient pediatrics, serving as a team leader in the latter area while at the same time carrying a case load of 200 families as u nurse practitioner. She has also been active in dejining nursing roles, speaking und teaching, and working to modify hospital and nursing care of cesarean section families.
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