What are the postoperative care priorities for a patient after a cesarean (C) section?

Immediate Post-Cesarean Section Care Priorities

The urinary catheter should be removed immediately after cesarean delivery if the patient does not need ongoing strict assessment of urine output, as this reduces the risk of urinary tract infection, discomfort, and promotes earlier mobilization. 1

Initial Assessment and Monitoring

• Monitor vital signs including temperature, blood pressure, heart rate, respiratory rate, and oxygen saturation to detect early signs of complications 1
• Assess the surgical incision site for signs of bleeding, infection, or seroma formation 2
• Evaluate uterine tone and fundal height to ensure appropriate uterine contraction and detect early signs of postpartum hemorrhage 3
• Check lochia (vaginal bleeding) amount, color, and odor to monitor for excessive bleeding or infection 1

Pain Management

• Implement multimodal analgesia with scheduled acetaminophen and NSAIDs as first-line treatment, which is opioid-sparing and compatible with ERAS protocols 1
• Assess pain regularly using a standardized pain scale to ensure adequate pain control 1
• Reserve opioids for breakthrough pain not controlled by acetaminophen and NSAIDs 1

Early Mobilization

• Encourage early mobilization as soon as regional anesthesia has worn off to reduce the risk of thromboembolism 1
• Assist the patient with first ambulation to prevent falls due to potential orthostatic hypotension 1
• Document successful ambulation in the patient's chart 1

Nutrition and Hydration

• Offer a regular diet within 2 hours after cesarean delivery, as early feeding has been shown to improve maternal satisfaction, reduce hunger and thirst, and promote earlier return of bowel function 1
• Ensure the diet provides adequate fiber to prevent constipation 1
• Monitor for nausea and vomiting, which may occur with early feeding but is typically self-limited 1

Urinary Catheter Management

• Remove the urinary catheter immediately after cesarean delivery if ongoing strict urine output assessment is not needed 1
• Immediate catheter removal (versus 12-hour removal) significantly reduces the incidence of postoperative bacteriuria, dysuria, burning on micturition, urinary frequency, and urgency 1
• Monitor for successful voiding after catheter removal 1

Glucose Control

• For patients with diabetes, check capillary blood glucose (CBG) after delivery as insulin requirements fall rapidly 1
• Monitor for hypoglycemia, especially during breastfeeding 1
• Discontinue therapy for patients with gestational diabetes; those with type II diabetes can continue metformin and glibenclamide even while breastfeeding 1

Thromboembolism Prophylaxis

• Assess venous thromboembolism risk and implement appropriate prophylaxis 1
• Consider mechanical methods (graduated compression stockings, intermittent pneumatic compression) as they have been shown to reduce death from pulmonary embolism 1
• Early mobilization is a key component of thromboembolism prevention 1

Breastfeeding Support

• Facilitate early skin-to-skin contact and breastfeeding initiation if desired by the mother 1
• Provide lactation support and education 1
• Monitor for hypoglycemia during breastfeeding, especially in diabetic patients 1

Wound Care

• Assess the incision site regularly for signs of infection, dehiscence, or seroma formation 2
• Keep the incision clean and dry 2
• Provide education on proper wound care and signs of infection to report 2

Discharge Planning

• Use standardized written discharge instructions to facilitate discharge counseling 1
• Provide comprehensive information on the normal recovery course, signs and symptoms of infection, activity restrictions, and when to seek medical attention 1
• Educate about the high incidence of surgical site infections that develop after discharge (approximately 10% of patients, with >80% developing after discharge) 1

Common Pitfalls and How to Avoid Them

• Delayed catheter removal: Remove immediately after surgery to reduce urinary tract infection risk 1
• Inadequate pain control: Use scheduled multimodal analgesia rather than as-needed medications 1
• Delayed mobilization: Encourage early ambulation to prevent thromboembolism 1
• Prolonged fasting: Initiate early feeding to improve satisfaction and recovery 1
• Inadequate discharge education: Use standardized written instructions to ensure comprehensive information about wound care and warning signs 1