1. Cesarean Sections Margaux Barlow, Jackie Engstrom, Rasika Kulkarni, Hillary O’Keefe

2. Why is this topic relevant??? Cesarean birth is the birth of the infant through an abdominal and uterine incision. As maternal and perinatal morbidity and mortality rates of cesarean births have decreased throughout the 20th century, cesarean births have increased. In 1965, they constituted 4.5% and by 2004 were 29%.

3. C. Section on the Rise

4. Significance: In the U.S. there is a fourfold risk of death compared to vaginal birth. In England, emergency cesarean birth has a ninefold risk of death when compared to vaginal and elective cesareans have a threefold risk. Women are twice as likely to be rehospitalized within 60 days of birth when compared with women who have a vaginal birth.

6. Figure 1. Cesarean Section Rate: OECD Countries Perspective 1971-1990 Source: OECD Health Systems: Facts and Trends 1960-1991 in provincial hospitals in this study.

8. Sociological Influence A study in 2004 found that Austrailian women were choose C. sections because: 71.4% - “common for people to think that cesarean section offers an easier way of giving birth” 23.1% - “the media seems to portray cesarean section as a better option than vaginal delivery”

9. Cultural Influence Another study of Brazilian women in 2008 found that: Most (64%) private sector cesareans are scheduled, although many women would have preferred a vaginal delivery! In Brazil, one-fourth of all women deliver in the private sector, where the rate of cesarean deliveries is extremely high (70%).

10. And the United States? “The singer - who is expecting her first child with her music executive husband Jordan Bratman - has allegedly decided to go for the operation like many celebrities before her because she is too posh to push.”

11. Pathophysiology History What is a cesarean? –Skin and uterine incision

12. Cultural Aspects Statistics Research studies –Brazil –South Australia

13. Impact on Women’s Health Postpartum hemorrhage Surgical & traumatic complications Fever, Infection, Pneumonia & Thromboembolic events Maternal mortality Pelvic floor disorder Loss of reproductive capabilities

14. Impact on Neonates Breastfeeding, bonding & attachment issues Respiratory effects Fetal injuries

15. Reasons for Couples choose C-Section Concern for safety of infant Fear of pain and pushing the baby Perception that a C-section is safer than vaginal delivery. Social convenience Damage to perineal floor Prior complicated/traumatic births Stress & anxiety

16. Nursing Implications In addition to vaginal delivery mothers: -Positioning -Anesthesia level checks -Urine checks Bloody urine may indicated surgical trauma to the bladder.

17. Nursing Interventions -Wound care -Coughing & Deep Breathing

18. Cesarean Impacts on Nursing Due to the increased risk of mothers return to the hospital after birth…

19. References Davidson, M., Ladewig, P. & London, M. (2008). Maternal-Newborn Nursing & Women’s Health Across the Lifespan.Upper Saddle River, NJ: Pearson Education, Inc. Gezer, A., Simsek, YO. & Altinok, TA. (2007). Elective cesarean section: evolution of obstetrician to technician. Birth: Issues in Perinatal Care (BIRTH), 34(4): 357-9. Miesnik, S., & Reale, B. (2007). A Review of Issues Surrounding Medically Elective Cesarean Delivery. AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses, 36(1): 605-15. Organization for Economic Co-oporation and Development (OECD) Health System. Facts and Trends 1960- 1991, Vol.1. Health Policy Studies No.3. Paris: OECD, 1993. Potter, J., Hopkins, K., Faúndes, A., & Perpétuo, I. (2008). Women's autonomy and scheduled cesarean sections in Brazil: a cautionary tale. Birth: Issues in Perinatal Care, 35(1), 33-40. Walker, R., Turnbull, D., & Wilkinson, C. (2004). Increasing cesarean section rates: exploring the role of culture in an Australian community. Birth: Issues in Perinatal Care, 31(2), 117-124.