Clinical meaning
A cesarean section (C-section) is a surgical procedure in which the fetus is delivered through an incision in the abdominal wall (laparotomy) and the uterine wall (hysterotomy). The procedure involves incision through multiple tissue layers: skin, subcutaneous fat, rectus fascia, rectus abdominis muscle (separated, not cut), peritoneum, and finally the uterine myometrium. The most common uterine incision is the low transverse (Kerr) incision, made in the thinner lower uterine segment, which results in less blood loss, easier repair, and lower risk of uterine rupture in future pregnancies compared to the classical vertical incision. The uterine myometrium is composed of three smooth muscle layers: the outer longitudinal layer, the middle interlacing layer (which contains the major blood vessels and is responsible for the 'living ligature' effect that controls postpartum hemorrhage through contraction), and the inner circular layer. After delivery, the uterus must contract firmly to compress the spiral arteries at the former placental attachment site. The placental site covers approximately 200 square centimeters of endometrial surface and contains between 150 and 200 spiral arteries. Failure of the myometrium to contract (uterine atony) leaves these arteries unsupported, resulting in hemorrhage that can exceed 500 mL per minute. Postoperatively, the endometrium undergoes involution over approximately 6 weeks, during which the decidual lining is shed as lochia. Lochia progresses through three stages: lochia rubra (red, days 1-3), lochia serosa (pinkish-brown, days 4-10), and lochia alba (yellowish-white, days 11 to approximately 6 weeks). The practical nurse must understand wound healing principles as they apply to the surgical incision: the inflammatory phase (days 0-4), proliferative phase (days 4-21), and remodeling phase (day 21 to 1 year). Breastfeeding initiation after cesarean delivery may be delayed due to surgical recovery, anesthesia effects, and maternal-infant separation. The LATCH scoring system evaluates breastfeeding effectiveness across five components: Latch (attachment quality), Audible swallowing, Type of nipple, Comfort of the breast and nipple, and Hold (positioning assistance needed). Each component is scored 0-2, with a total score of 10 indicating optimal breastfeeding.