1. Analysis/nursing diagnosis:
   1. Self-esteem disturbance related to inability to give birth without surgical assistance.
   2. Anxiety/fear related to infant’s appearance (forceps marks) or awareness of potential complications.
2. Nursing care plan/implementation:
   1. Goal: minimize feelings of failure due to inability to give birth “naturally.”
      1. Explain, discuss reasons/indications for forceps-assisted birth.
      2. Emphasize no maternal control over circumstances.
   2. Goal: reduce parental anxiety, maternal guilt over infant bruising/forceps marks. Explain condition is temporary and has no lasting effects on child’s appearance.
3. Evaluation/outcome criteria:
   1. Woman verbalizes understanding of reasons for forceps-assisted birth.
   2. Woman evidences no interruption in bonding with infant.
   3. Woman experiences uncomplicated recovery.
3. Vacuum extraction (soft plastic cup with vacuum from a suction pump). Used to assist in rotation or delivery of the fetal head.
   1. Risks may include caput succedaneum and cephelhematoma.
   2. Causes neonatal jaundice, IVH-death.
4. Cesarean birth-incision through abdominal wall and uterus to give birth.
   1. Indications for elective cesarean birth:
      1. Known CPD.
      2. Previous uterine surgery (myomectomy), repeated cesarean births (depends on type of incision done).
      3. Active maternal genital herpes II infection; human papilloma virus (HPV).
      4. Breech presentation. (Note: To reduce infant morbidity/mortality, elective cesarean birth is common method of choice.)
      5. Neoplasms of cervix, uterus, or birth canal.
      6. Maternal diabetes with placental aging; fetal macrosomia (CPD); >425 g.
   2. Criteria for elective cesarean birth: L/S ratio greater than 2:1 -indicates presence of pulmonary surfactant; less risk of respiratory distress syndrome.
   3. Indications for emergency cesarean birth:
      1. Fetal:
         1. Fetal distress: prolapsed cord, repetitive late deceleration, prolonged bradycardia.
         2. Fetal jeopardy: Rh or ABO incompatibility.
         3. Fetal malposition/malpresentation.
      2. Maternal:
         1. Uterine dysfunction; rupture.
         2. Placental disorders:
            1. Placenta previa.
            2. Abruptio placentae, with Couvelaire uterus.
         3. Severe maternal PIH/eclampsia.
         4. Fetopelvic disproportion.
         5. Sudden maternal death.
         6. Carcinoma.
         7. Failed induction.
   4. Types:
      1. Low segment-method of choice:
         1. Transverse incision through abdominal wall and lower uterine segment.
         2. Transverse incision through abdominal wall, with vertical incision of lower uterine segment.
         3. Advantages-fewer   complications:
            1. Less blood loss.
            2. More comfortable convalescence.
            3. Less adhesion formation.
            4. Lower risk of uterine rupture in subsequent pregnancy/labor and birth.
            5. Cosmetically more acceptable.
      2. Classic-vertical incision through abdominal wall and uterus. Necessary for anterior placenta previa and transverse lie, <28 weeks prematurity.
      3. Porro’s-hysterotomy followed by hysterectomy. Necessary in presence of:
         1. Hemorrhage from uterine atony.
         2. Placenta accreta/percreta.
         3. Large uterine myomas.
         4. Ruptured uterus.
         5. Cancer of uterus or ovary.
   5. Assessment:
      1. Maternal physical status.
         1. Vital signs.
         2. Labor status, if any.
         3. Contractions (if any).
         4. Membranes (intact; ruptured).
         5. Bleeding.
      2. Fetal status.
         1. FHR pattern.
         2. Color and amount of amniotic fluid.
         3. Biophysical profile (BPP)
      3. Maternal emotional status.
      4. Understanding of procedure, indications for, implications.
      5. Other-as for any abdominal surgery.