1. Providence Nursing Institute Clinical Academy
Providence Clinical Academy
Providence Nursing Institute Clinical Academy
Perinatal Curriculum
Last Reviewed

2. What has your experience been with c/s patients?
Providence Clinical Academy
What has your experience been with c/s patients?
Pain management:
What do you know about pain management specific to cesarean section recovery?
What gaps do you still have?
Unexpected C/S:
What have your experiences been caring for families who experience an unexpected C/S?
What do you say?
How do families process?
What influences these processes?
How well do they understand what happened? Does their interpretation match the RN/LIP reports?
Maternal point of view/coping?
Father of the baby – point of view/coping?
Response from family and friends?
Have you found yourself doing different or the same postpartum care?

3. Post-traumatic stress disorder
Providence Clinical Academy
Post-traumatic stress disorder
Approximately 1-6% of women experience post-traumatic stress disorder (PTSD) following childbirth
Symptoms may include:
Intrusive re-experiencing including flashbacks or nightmares
Avoidance of stimuli
Persistent increased arousal
Anxiety and panic attacks
Feeling a sense of unreality and detachment
Feelings of fear, grief and depression
Physical response
General information on PTSD From the CDC:
Avoidance of stimuli associated with the event, including thoughts, feelings, people, places and details of the event
Persistent increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response)
Physical Response: nausea, vomiting, dizziness etc.

4. Providence Clinical Academy
Providence Clinical Academy
How they might see it…
Next few slides depict artwork created by women coping with their C/S experience
Warning to look away if they may be disturbed by images

5. Providence Clinical Academy
Providence Clinical Academy
Artwork: “First Kiss”

6. Providence Clinical Academy
Providence Clinical Academy
“Small Talk”
“a picture about the meaningless smalltalk that was held in the operation room-wether or not the yellow tape around the trees near the hospital mean that they will be cut down or not.”

7. Providence Clinical Academy
Providence Clinical Academy
“Spinal Anesthesia”

8. Providence Clinical Academy
Providence Clinical Academy
“Smile, you have a healthy baby”
Searching the internet for women’s experiences with C/S, there seems to be a lot of talk about how the medical community can sometimes make women feel like nothing else should matter except that they ended up with a healthy baby.

9. Providence Clinical Academy
Providence Clinical Academy

10. Providence Clinical Academy
Providence Clinical Academy

11. Providence Clinical Academy
Providence Clinical Academy
“The deed is done”

12. Providence Clinical Academy
Providence Clinical Academy
Artwork: entitled “Incision”
“I thought and I thought for several days about how I could put into image form how I felt about my personal birth experiences. I didn’t think I could give it justice because there is just so many aspects that deserve attention in the process of this kind of birth. Courage is definitely one. Pain. Blood. Cutting… Fear. Love. And so on… I stayed with it and eventually “Incision” seemed to almost complete itself.”

13. Providence Clinical Academy
Providence Clinical Academy
Positive

14. Providence Clinical Academy
Providence Clinical Academy
How can you help?
What do we do with the knowledge that C/S can affect women and families in such various ways?
What shouldn’t you say?
What can you say?
Resources
Group conversation
What shouldn’t you say?
I had a c/s and it was fine/great/awesome – don’t assume your experience will be someone else’s
At least you have a healthy baby OR the only thing that matters is healthy baby/healthy mom
Why aren’t you happy your baby is here?
What can you say?
How are you feeling?
What can I do to help?
Your feelings are valid

15. Providence Clinical Academy
Providence Clinical Academy
Unexpected C/S
Talk through the experience and offer clarification
Validate how they feel
Revisit their birth plan
Give choices/control when possible
Early and sustained contact with the newborn
Maternal pain management
Maintain presence of support person(s)
Continuity of caregivers
How can we facilitate coping and attachment?
Validate how they feel
Avoid “talking them out of” what they think they experienced.
Offer an empathetic ear; sometimes sitting and listening is all people need
Revisit their birth plan
Point out what went according to plan
Coordinate their PP experience to incorporate whatever remains on their birth plan
Examples: Skin to skin, breastfeeding, providing newborn care
Maternal pain management:
Mom’s recovery from major surgery need their pain controlled in such a way that they can be alert and participate in newborn care and education
Allowing support person’s to stays with the couplet and continuity of caregivers have both been well documented in the research to reduce anxiety and improve patient satisfaction scores (Perinatal Nursing, 4th ed, page 421)