been made in allowing partners and family members into the labor rooms, but hospitals may still prohibit them from being present during certain stages of surgery. The family-centered care model describes methods needed to provide the most optimal care available to the patient and those who care for her. The family-centered care focuses on sharing information among patient, family and healthcare team in an open manner while still respecting the opinions of others on the team. It involves the patient and her family in the decisions that need to be made throughout their care.22 Family-centered care in the OR involves the partner at many

different stages. Education regarding what to expect during surgery and how to care for the patient can be provided to anyone who will be involved directly before the surgery. Some hospitals are changing their rules regarding epidural placements and allowing the birth partner to be present, which relaxes the patient. Partners may also be able to provide the skin-to- skin contact with the newborn if the mother is not able to for


1. What is the No.1 risk factor for infection after a cesarean section?

a. Multiple births b. Obesity c. Diabetes d. Hair removal before surgery

2. Post-cesarean complications can be decreased in the obese patient by:

a. Administering the same amount of antibiotics as a patient with a normal BMI

b. Encouraging bed rest until the pa- tient is discharged from the hospital

c. Advising the patient to keep the incision moist and covered

d. Increasing the dose of antibiotics based on BMI, as well as encouraging early ambulation

3. The current cesarean section rate in the United States is about:

a. 20% b. 16% c. 32% d. 50%

4. How can surgical site infection bundles help prevent infection?

a. Develop a systematic way for all team members to care for the patient

b. Provide a checklist for the nurse to follow

c. Keep all the surgical supplies in one space

d. Bundles do not help prevent infection

5. Chlorhexidine provides antimicrobial properties for up to _____ hours on the skin:

a. Two b. 18 c. 24 d. 48

6. Clipping is preferred to using a ra- zor to remove hair on the surgical site because:

a. Razors remove more hair, which decreases the risk of infection.

b. Clipping removes hair without creat- ing breaks in the skin.

c. Razors cannot be used more than once, so are too expensive.

d. Clipping decreases the chance of the nurse being cut by a razor.

7. The most optimal time for antibiotic prophylaxis is:

a. After cord clamping b. During cord clamping

c. Two to six hours before a scheduled C-section

d. 30 to 60 minutes before a C-section

8. Good hand hygiene involves washing hands:

a. Before entering the surgery suite but not after surgery since gloves were worn

b. Only after patient contact

c. Before and after invasive procedures, such as inserting a urinary catheter

d. Only if exposed to bodily fluids

9. A significant drawback of prophy- lactic administration of mupirocin (Bactroban) is:

a. Mupirocin-resistant MRSA is begin- ning to develop.

b. Not everyone may colonize MRSA.

c. MRSA does not always lead to infec- tion in patients who are positive.

d. There are no drawbacks to using medications on patients who do not test positive for the microbes.

10. Skin-to-skin contact between the mother and newborn in the OR has been shown to:

a. Make the newborn hypothermic

b. Increase maternal bonding and breastfeeding

c. Make it difficult for a nurse to assess a newborn appropriately

d. Increase the risk of vomiting due to the patient’s movement when hold- ing her infant

11. Controlling pain following a cesarean section helps the mother:

a. Sleep throughout the night while her baby is in the nursery

b. Ambulate early so that her risk of deep vein thrombosis is reduced

c. Sit up and eat d. Breastfeed on a strict schedule

12. Although embracing the concept of the gentle cesarean requires a culture change in current surgical practice, it supports family-centered care because:

a. Patients will sue if they see the physi- cian do something wrong.

b. Patients will not want to actually see the birth.

c. Many women would like the opportu- nity to witness the birth of their baby.

d.Women will interfere with the surgical procedure, so they must have both arms strapped down.

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various reasons. One study showed that newborns became relaxed faster being skin-to-skin with their fathers than with their mothers.23 One in every three women undergoes a cesarean section

in the United States. The numbers have continued to climb during the last 10 years. Postpartum complications, including infection, deep vein thrombosis and delayed maternal-newborn bonding, can impact the family unit significantly. Developing a surgical site infection bundle that includes pre-, peri- and postoperative care of the patient can decrease risks and increase patient satisfaction. Evidence-based protocols and guidelines may be used to support the family unit and create a culture of change for families undergoing one of the most exciting times of their lives. •

Elaine Brown, MS, RNC-OB, EFM-C, is clinical nurse educator at a large academic university.

EDITOR’S NOTE: References available at

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