Caesarean Section
INTRODUCTION
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.
CASE HISTORY
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.
CASE HISTORY