Caesarean section as a means of delivering babies has been around for centuries with numerous references to the procedure appearing in ancient writings (Simm & Matthew, 2008). It is now the most common major surgical intervention carried out on women in the world, with between 23% and 30% of deliveries in the United Kingdom by Caesarean Section (Beech, 2004). This rate is all the more surprising when one considers that Caesarean section accounted for just 5.3% of United Kingdom births in 1973 (Kitzinger, 1998). This rising rate has huge cost implications for an already financially stretched National Health Service. As far back as 1997 the Audit Commissions Report suggested that each 1% rise in the Caesarean Section rate would cost the National Health Service five million pounds per year. However, the cost of this rising rate has also implications in clinical terms, with some studies suggesting that maternal mortality is three to seven times greater following abdominal rather than vaginal birth and maternal morbidity even greater, even with elective procedures (McCourt, Bick & Weaver, 2004).
The following care study aims to critically analyse the care and management of a maternity patient undergoing an elective Caesarean section. The patients history, journey and outcome will be discussed with reference to maternal request for non – medically indicated surgery, risks, management and the impact anxiety has on maternal decision making and perioperative midwifery care. The role of the midwife in surgical pre- assessment as well as psychological support of patients will also be discussed. Midwives do not work solely within the theatre environment, but have a role in all aspects of the patient’s obstetric journey and this is reflected in the discussion. No identifying details of the patient concerned have been used in order to maintain confidentiality and the individual concerned has given permission for their story to be used.
Mrs. A is a 38 year old Para 1(i.e. one previous birth). Her first pregnancy was uneventful and she had hoped to have a normal delivery, however, following a long and difficult labour she had a forceps delivery in theatre due to a non – reassuring fetal heart rate and suspected fetal compromise. A healthy baby girl was born weighing 7lbs 5oz. Her postnatal course was uneventful but Mrs. A found the whole labour and delivery experience deeply traumatic and resulted in her waiting ten years before trying for a second child.
Mrs. A booked with the maternity unit in her second pregnancy at 12 weeks gestation and had routine antenatal care and a healthy and uneventful antenatal course. At 34 weeks gestation Mrs. A saw her obstetric consultant and requested an elective Caesarean section stating she had been left with a fear of childbirth due to her previous traumatic birth experience. After some discussion, her consultant agreed and Mrs. A was booked to have an elective Caesarean section at 39 weeks gestation.
Numerous techniques for Caesarean section are described but all follow the same basic procedure. The uterus is exposed by entering the abdominal cavity through the abdominal wall. The peritoneum covering the uterus is opened and the uterus incised. The baby is delivered followed by the placenta. Haemostasis is achieved by closure of the uterine muscle and abdominal wall (Simm & Matthew, 2008). Mrs. A had no medical indications for an elective Caesarean section. The National Institute for Clinical Excellence (2004) recommends that elective Caesarean section only be performed in certain circumstances. These include, breech presentation at term if external cephalic contraindicated or failed, twin pregnancy if first twin breech, HIV positive mothers, HIV and hepatitis C, primary genital herpes in the third trimester and grade 3 and 4 placenta praevia. The guidelines further recommend that maternal request on its own is not an...