hourly and rated in a way that is easy to understand, such as a 0-to-10 numeric scale with an ongoing goal of a level less than 3. Pain relief may be delivered in various ways following surgery.

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Pain medication can be provided intrathecally before the surgery, as a patient-controlled analgesia in oral form or the use of multiple delivery methods depending how far out from surgery the patient may be. The most common form of initial pain relief is a one-time injection given intrathecally. Both morphine and hydromorphone provide excellent coverage for patients and can last up to 24 hours following placement, which decreases the need for additional IV opioids. Common adverse effects for both include nausea or vomit- ing and pruritus immediately after administration.21

An advantage

of intrathecal morphine is that it does not pass into the breast milk, allowing for safe administration in the breastfeeding patient. For patients receiving additional narcotics, education should

be provided that supports bonding and interaction with the newborn while decreasing the risk for falls. Once a patient is able to ambulate, urinary catheters should be discontinued, and patients should be encouraged to walk throughout the day. Patients should be instructed to shower 24 hours following surgery, to wash the incision with soap and water, and to dry gently. If patients are at higher risk for infection due to obesity, extra attention should be given to wound care, such as allowing the incision to air dry and placing an absorbent dressing over the incision. Before discharge, patients should be taught signs and symptoms

of infection so they can continue monitoring the incision following discharge. Early recognition of possible infection can decrease the risk of sepsis and help prevent severe complications. Patients should be given expected times to return to their provider’s office for follow-up appointments as well as contact information.

The family-centered gentle cesarean A new method of supporting family-centered care has been dubbed “the gentle cesarean.” The gentle cesarean applies the same sup- portive concepts that happen in the labor and birth room to the OR. This form of care allows the patient and her family to see the birth of their baby through a clear plastic curtain versus the more common blue shield that many ORs use. When the baby is close to being born, the anesthesia provider will slightly lift the head of the bed. The blue drape will be dropped to ensure that the patient will be able to see the birth. At minimum, one hand will be left free so the patient may hold her newborn. The newborn will be placed on the mother’s chest immediately following birth. At that time, the blue drape is repositioned until the surgery is complete. The newborn is dried quickly, assessed by an appropriate staff member, and placed skin-to-skin on the mother’s chest with a warm blanket covering both of them. Breastfeeding can be initiated at this time.22 For many women, not being able to see their baby being born

is one of the hardest things about not having a vaginal birth. Incorporating the gentle cesarean philosophy supports the family without compromising the sterile field or putting the patient and her family at risk. While the concept is easy to explain, changing the culture in the OR to support this will need many champions.

Caring for the family Caring for the family after a cesarean section goes far beyond the surgical interventions to prevent infection. Many strides have

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