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» Clinical pathways never replace clinical judgement. » Care outlined in this clinical pathway must be altered if it is not clinically appropriate for the individual client.

Consultant: Admission date: Time:

» DRG O01C Caesarean Delivery without Complicating Diagnosis (ALOS 3.98) » DRG O01B Caesarean Delivery with Severe Complicating Diagnosis (ALOS 5.48) » DRG O01A Caesarean Delivery with Multiple Complicating Diagnosis At least one severe (ALOS 9.33) » AN-DRG V 5 Hospital Benchmarking Funding Model 2004/05

Documentation instructions:• Initials - Indicates action / care has been ordered / administered.• N/A - Indicates preceding care / order is not applicable.• Crossing out - Indicates that there is a change in the care outlined.• V - Indicates a variation from the pathway on that day, in that section. When applicable flagitin the “Variance column”,

then document in the free text area as instructed. If this variance occurs more than once daily, document the additional times of the variance in the variance free text area and in the patient’s progress notes as applicable.

• Key Midwife / Nursing Medical / GP Physiotherapist Pharmacy Allied Health Symbols guide care to a primary professional stream, it is a visual guide only and its direction is not intended to be absolute.

• A Caesarean Birth Clinical Pathway Ongoing Care (Additional Page) (SW231a) is available for extended treatment.• A Caesarean Birth Clinical Pathway Clinical Events / Variances (Additional Page) (SW231b) is available if more space is

required for clinical events and variances.• Every person documenting in this clinical pathway must supply a sample of their initials and signature below.• Ensure ‘Expected Outcomes - Mother’s copy’ (last page) is removed from the Caesarean Birth Clinical Pathway and given

to the mother.

Signature logInitials Signature Print name Role

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(Affix identification label here)

URN:

Family name:

Given name(s):

Address:

Date of birth: Sex: M F I

Caesarean Birth Clinical Pathway

Facility: .........................................................................................................

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Every person documenting in this clinical pathway must supply a sample of their initials in the signature log

Education plan Key Midwife / Nursing Medical / GP Physiotherapist Pharmacy Allied Health

Category Interpreter required Yes No Initial DateUnderstands immediate postpartum changes

Discuss and explain:Cleaning, dressing and caring for wound

Abdominal / pelvic floor exercises

Breast changes

Bleeding up to 6 weeks after birth

Returning to normal activities

Emotional states EPDS noted: ..............................................................................................................................................

Postnatal follow up Midwife / Medical Officer follow up in ……….................……….days / weeks

Copy of ‘Pregnancy Health Record’ given to mother

Mother to make own appointment with local doctor / General Practitioner (GP) / Treating Specialist / Physician, a hospital birth discharge summary will be sent to him / herPost natal contact phone call up to 5 days post discharge

Date: ........................... and time: ........................... arranged (if applicable)

Discuss last pap smear and when to have next one

Discuss and explain Deep Venous Thrombosis (DVT) signs and symptoms

Discuss 13 Health (13 432 584) and 24 Hour help line 1800 686 268 numbers and community supports

Child Health Information - ‘Your guide to the first 12 months’ booklet identified and discussed

Reinforce: Seeking medical assistance immediately you experience fever, pain or increased bleeding

Physiotherapist Discuss the importance of abdominal / pelvic floor health and ask if mother understands and has practiced her abdominal / pelvic floor exercises

Infant feeding Mother can demonstrate:

Correct attachment breast feeding

Correct detachment for breast feeding

Correct positioning for infant feeding

Hand expressing

Discuss breast and nipple care

Discuss safe storage of breast milk

Discuss lactation and / or suppression (if applicable)

When formula feeding, is mother able to perform decontamination of bottles, formula preparation and understands transportation and storage techniques

Pain management Discuss use of simple pain relief for pain management including “after birth pains”

Contraception Discuss contraception use (method of choice)

Safe sleeping Discuss measures to reduce SIDS / SUDI

Mother can demonstrate safe sleeping techniques as wrapping, positioning and settling

Same sleeping surfaces

Discuss co-sleeping surfaces, such as not sharing beds and lounges, plus smoke free environments

Dietary advice Discuss healthy eating plan and recommend daily intake of water and fibre

Safe car travel Discuss infant restraint for vehicle

The above education plan on self care, infants and siblings has been discussed with me Yes No

I have received the Centrelink and Birth registration forms Yes No

Mother's name (please print): Signature:

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Discharge plan Initial Date

Discharge medications arranged

Mothers own medications returned

Anti D given MMR given

Discuss Pertussis immunisation for parents and grandparents

Discuss GTT at 6 weeks postnatal (if applicable)

Referrals

Medical Officer Specialist / Treating Physician

Maternity Home Care Services / post natal contact service

Child Health services

Lactation consultant

Physiotherapist

Continence Advisory Service

Allied Health Professional (see notes)

Indigenous Healthcare Worker

Wound Care Consultant

Other (please specify): ..........................................................................................................................................................................................................................Hospital discharge summary for self and baby given to mother

Faxed / sent to GP / Child Health

Antenatal screening / family care assessment form completed

Transfer to other hospitalTime: Facility name:

Further notes (including Criteria Led Discharge as per hospital protocol):

Discharge ClinicianDate: Time: Designation: Signature:

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Expected outcomes - CHART copyPhase 1 Antenatal periodPhase 2: Pre- and Post-operation• After discussion with your doctor you will be able to state an understanding of the usual pre- and post-operative care

routines, the surgery and its effects on you and the baby.After the birth• Baby will be placed skin to skin with you as soon as you are able to respond to baby.• During this time, baby will be offered its first feed.• Management of your pain ensures that your level of discomfort is in a range acceptable to you.Phase 3: Day 1 Post-operative• You will be able to explain the outcome of your baby’s birth.• Your Midwife will care for you and check on you and your baby’s progress.• Your midwife will assist you with feeding and caring for your baby.• You can expect some vaginal bleeding usually up to about 2 weeks after the birth.• In many cases you will be able to go home in 2 days after surgery if appropriate and follow-up arrangements are available.Phase 4: Discharge• Once your midwife has gone through your discharge information, and your baby has been reviewed and discharged by a

Qualified Healthcare Professional, you may go home.Phase 5: After discharge• You will be contacted via phone or a home visit up to 5 days post discharge.• A midwife may visit you in your home to provide ongoing support.• You will be offered referral to community health groups for ongoing support, i.e. Child Health, Australian Breastfeeding

Association.• You will require ongoing care from your local doctor / General Practitioner (GP) / Specialist / Treating Physician.• When you visit your doctor please take along you and your baby’s hospital discharge summary and baby’s Personal

Health Record.

Key milestonesDa

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1. Placed on pathway 2. Your care will follow the clinical pathway 3. If needed you will have blood tests taken 4. You will be seen by the Obstetric doctors 5. You will attend pre-admission clinic for an elective LSCS 6. You will be admitted to hospital 7. You will be prepared for theatre / if elective LSCS

• you will be expected to fast at least 8 hours prior to surgery

8. You will be transferred to the Operating Theatre (OT) 9. Observations taken as needed 10. Anaesthetic will be administered 11. You will be prescribed and offered regular pain relief, after

your operation

12. There will only be a little or nil wound ooze on your dressing 13. You will be eating and drinking normally 14. Your drip and catheter will be removed 15. You may by seen by your doctor daily 16. The midwife will assist you in learning how to feed and care for your baby 17. Ready for discharge. You may be given a copy of the hospital birth summary / perinatal

data report to give to your local doctor. Alternately, this will be posted to your local doctor.

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Admission dayInstructions: Initials - care attended to, Rule out - not applicable, V - variance (record and sign all variances on sheet provided or progress notes)

Key Midwife / Nursing Medical / GP Physiotherapist Pharmacy Allied HealthCategory Date: ............. / ............. / ........................ Initial V

Reviews Surgical obstetric review and admitted by medical staff

Mothers status unchanged from pre admission

Venous thrombus embolism (VTE) risk assessment reviewed and treatment commenced as ordered

Consent - completed, questions answered and consent form signed

ID bands - secured

Booked for Operating Room Suite - time: .......................................Investigations As clinically indicated

All results available and have been reviewed by medical staff

Additional tests: ................................................................................................................................................................................Pre-operative skin check Skin integrity of operative site intact

Medications / pain management

Medications reviewed and ward medication chart complete

Prophylaxis antibiotics discussed and documented

Medications given as orderedObservations / treatments

Orientated to ward and admission process explained

Midwifery admission complete

Baseline observations - documented and within normal limits

Operation site prepared

Pre-operative checklist complete

Pressure injury / Waterlow score assessed and recorded

Falls risk identified and recorded

Nutrition Fasted from - diet: ..................................... hrs fluids: .................................. hrsHygiene / elimination Showered and prepared for theatre

Activity / mobility Anti-embolic therapies available

Stockings correctly appliedMother education and discharge

Confirmation that Expected Outcomes (mother’s pathway) was given and that all procedures were explained and video (if applicable) shown in pre-admission clinic

Expected outcomes

Mother states: A - Achieved V - Variance A V2.1 Mother able to state the usual pre-and post-operative care routines, the surgery and its effects and

their concerns have been adequately addressed

Further notes:

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All perioperative documentation to be inserted here including ORMIS documentation if applicable

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Post-op day of surgeryInstructions: Initials - care attended to, Rule out - not applicable, V - variance (record and sign all variances on sheet provided or progress notes)

Key Midwife / Nursing Medical / GP Physiotherapist Pharmacy Allied Health

0–6 hrs Date: to Date: Initial Time V

Reviews Urgency of LSCS Category: 1 2 3 4 (NICE guidelines 2004)1. Immediate threat to the life of a woman or foetus2. Maternal or fetal compromise but not immediately life threatening3. Needing early delivery but no maternal or fetal compromise4. At a time to suit the woman and the caesarean section team

Gravida Parity Gestation ≥ 39 weeks

Medical decision to birth, within time appropriate to urgency category

Perinatal data report commenced

Nil postnatal risks identified

Time of birth: ............................................ Transfer to ward: ............................................Medications Medications given as ordered

Thromboembolic prophylaxis administered (if ordered)

Stockings insituPain management Pain is managed - pain score ≤ 3

Spinal Epidural PCA Infusion IMI Oral

Analgesia effective

Spinal morphine analgesia administeredObservations / Treatments

Observations of vital signs recorded as per hospital/statewide protocol Spinal Epidural GBS Diabetes LBW / SGA Other (specify: .............................................................................................................. )

Nausea and vomiting controlled

Estimated blood loss amount: ..................................... mL

Skin-to-skin when mother physically able

Nil / small amount of wound ooze, dressing intact

Lochia - bright red, ≤ 1 pad / hour

IV cannula - patent, no signs of inflammation

Fluid balance chart maintained

Nutrition Tolerating fluids / diet

Hygiene Hygiene needs attended - post-op sponge and pressure area care attended, nil reddened areas noted

Elimination IDC insitu - draining straw coloured urine, output > 30mls hour until mobileWound and dressings Dressing intact / wound ooze minimal

Mobility

Discuss and demonstrate deep breathing and leg exercises

Pressure injury / Waterlow score assessed and recorded

Falls risk identified and recordedEducation Communication assistance required and utilised? Yes No

State type: ...........................................................................................................................................................................Education plan updated

Discharge Discharge plan updatedExpected outcomes

Ask mother about the following Initial Time V2.1 Mother has all her concerns addressed such as her personal requests, breast or formula

feeding and her baby’s cares

2.2 Pain / discomfort at an acceptable level to the mother

2.3 Performing deep breathing and leg exercises to prevent complications

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Post partum LSCSInstructions: Initials - care attended to, Rule out - not applicable, V - variance (record and sign all variances on sheet provided or progress notes)



Review and physical assessment

Proceeding according to clinical pathway

Fundus (monitor / observe firm and central)

Bleeding within expected limits

Post-op observations reviewed

Positive blood group - anti D not required

Rubella immune - vaccination not required

Wound intact and clean

Nil other complaintsPhysiotherapist Bladder / bowel function, posture, ergonomics, back care and pelvic floor rehabilitation

discussedDocuments Baby’s Personal Health Record commenced

Perinatal data report commenced

Enter shift that will occur predominately within the next 8 hours Time VMedication Thromboembolic prophylaxis administered (if ordered)

Stocking insitu (if applicable)

Pain management Minimal discomfort, managed with prescribed / simple analgesiaObservations Observations of vital signs recorded as per hospital/statewide protocol

Spinal Epidural GBS Diabetes LBW / SGA Other (specify: .............................................................................................................. )

IVT IV Therapy patent, running to time, no signs of inflammation

Breasts / nipples Breasts soft, nipples intact, hand expressing demonstratedInfant feeding Mother assessed as awake and lucid, call bell within reach

Breast feeding - offered assistance

Formula feeding - offered assistance

Demonstrate feed chart recording

Wound Dressing removed (If using COMFEEL leave insitu for 7 days)

Lochia Bright red, ≤ 1 pad / hourElimination Catheter insitu, draining straw coloured urine, > 30ml / hr

IDC removed as per hospital protocol

Has voided post IDC removal

Has passed flatus

Legs Full sensation and movement, nil calf tenderness

Nutrition Tolerating fluids / diet

Hygiene Showered with assistanceMobility

Mobilising with assistance

Pressure injury / Waterlow score assessed

Mother / partner / baby falls risk identified and recorded

Emotional state Emotional needs identified including labour and birthing concernsPatient education Communication assistance required and utilised?

State type: ................................................................................................................................Education plan updated

Discharge Discharge plan updatedExpected outcomes

Ask mother about the following Initial Time V3.1 Mother has all her concerns addressed and her pain / discomfort at an acceptable level to

care for herself and her baby.

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Review and physical assessment

Proceeding according to clinical pathway

Fundus (monitor / observe)

Bleeding within expected limits

Returning to normal bowel movements

Wound intact and clean

Nil postnatal risks identified / alerts

Nil other complaintsPhysiotherapist Bladder / bowel function, posture, ergonomics, back care and pelvic floor rehabilitation

discussedEnter shift that will occur predominately within the next 8 hours Time VMedication Thromboembolic prophylaxis administered (if ordered)

Stocking insitu (if applicable)

Pain management Minimal discomfort, managed with prescribed /simple analgesia

ObservationsObservations of vital signs recorded as per hospital/statewide protocol

Spinal Epidural GBS Diabetes LBW / SGA Other (specify: .............................................................................................................. )

Breasts / nipples Breasts soft, nipples intact, hand expressing demonstratedInfant feeding Mother assessed as awake and lucid, call bell within reach

Breast feeding - offered assistance

Formula feeding - offered assistance and able to make formula

Wound Wound edges well approximated, nil / minimal wound ooze

Lochia Dark red - Pink, ≤ 1 pad / 2 hoursElimination Nil dysuria, no urinary incontinence or voiding difficulties

Bowels opened

Legs Nil calf tenderness

NutritionTolerating fluids / diet

IV removed, no signs of inflammation

Hygiene Showered independentlyMobility

Mobilising independently



Emotional state Emotional needs identified including labour and birthing concerns

Education Education plan updated

Early discharge Discharge plan updated and completedExpected outcomes

Ask mother about the following Initial Time V3.1 Mother has all her concerns addressed and her pain / discomfort at an acceptable level to

care for herself and her baby.

Further notes:

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Hospital care Home careReview Proceeding according to clinical pathway

Fundus observed to be in normal position

Nil complaints


Discharged

Physiotherapist Bladder / bowel function, posture, ergonomics, back care and pelvic floor rehabilitation discussed

Enter shift that will occur predominately within the next 8 hours Time VMedication Thromboembolic prophylaxis administered (if ordered)

Stocking insitu (if applicable)Pain management Minimal discomfort, nil pain relief required

Discomfort managed with prescribed analgesia

Observations BD observations within normal parameters

Breasts / nipples Breasts firming and filling, nipples intactInfant feeding Mother assessed as awake and lucid, call bell within reach

Breast feeding - requires minimal supervisionFormula feeding - understands increasing formula volumes required by infant

Wound Wound is clean and dry

Lochia Dark red - pink, ≤ 1 pad / 2 hoursElimination Nil dysuria, no urinary incontinence or voiding difficulties

Bowels opened


Nutrition Tolerating full diet






Education Education plan updated and completed

Discharge Discharge plan updated and completedExpected outcomes

Ask mother about the following Initial Time V3.1 Mother has all her concerns addressed to care for herself and her baby.

Further notes:

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Hospital care Home careReview Proceeding according to clinical pathway

Fundus observed to be in normal position

Nil complaints


DischargedPhysiotherapist Bladder / bowel function, posture, ergonomics, back care and pelvic floor rehabilitation

discussedEnter shift that will occur predominately within the next 8 hours Time VMedication Thromboembolic prophylaxis administered (if ordered)

Stocking insitu (if applicable)Pain management Minimal discomfort, nil pain relief required

Discomfort managed with prescribed analgesia

Observations BD observations within normal parameters

Breasts / nipples Breasts firming and filling, nipples intactInfant feeding Mother assessed as awake and lucid, call bell within reach

Breast feeding - requires minimal supervisionFormula feeding - understands increasing formula volumes required by infant

Wound Wound is clean and dry

Lochia Dark red - pink, ≤ 1 pad / 2 hoursElimination Nil dysuria, no urinary incontinence or voiding difficulties

Bowels opened


Nutrition Tolerating full diet






Education Education plan updated and completed

Discharge Discharge plan updated and completedExpected outcomes

Ask mother about the following Initial Time V3.1 Mother has all her concerns addressed to care for herself and her baby.

Further notes:

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Clinical events / variances

Date Time Variance code

Expand on variances to clinical pathway for clinical relevance, clinical history, consultations and data collection. Document as Variance / Action / Outcome. (Include name, signature, date and staff category with all entries)

Initials

B : PathwayB:09 Self care difficulties / delayB:11 Timely access to servicesB:13 Clinical judgement requiredB:00 Other

D: Post Operative ComplicationsD:06 Post op UTID:18 Not mobilised - pain / nausea / dizzinessD:23 Wound complicationsD:00 Other

M: Maternity RelatedM: 01 PV loss more than 1 pad per hourM:03 Engorged breast, nipples grazed / crackedM:11 Emergency CaesareanM:00 Other

F: Risk Factors / Social FactorsF:01 AlcoholF:02 Allergies and alertsF:03 Lives aloneF:06 SmokingF:00 Other

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Caesarean Birth Clinical PathwayCaesarean Birth Clinical Pathway

Clinical Events / Variances

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Birth SummaryLabour:

Mode of birth:

Presentation:Induction indication/ method:

Liquor:

Pain relief:

Spontaneous Induced Augmented

Clear Meconium

Nil N2O and O2 Narcotic Epidural Sterile water Spinal GA Non-pharmalogical (specify):

Membranes ruptured:

Length of labour: Date Time Duration

Onset of labour 1st stage: 2nd stage: 3rd stage: Total:

Cervix fully dilatedBaby bornPlacenta delivered

Active pushing:

Maternal position at birth:

SROM ARM

Date/Time: Total:

/ / : hrs mins

Time of onset: : Duration:

Third StageBirth mode:

Placenta:

Comments:

Membranes:

Cord:pH:BE:

Modified active management Active management Manual removal Physiological

Appears complete Incomplete

Appears complete? Yes No Ragged

Vessels: Venous: Arterial: Venous: Arterial:

Cord blood collected?

Blood loss:

Oxytocic: Time Dose Route

.................................................................................. .................... ........................... ...........................

.................................................................................. .................... ........................... ...........................

.................................................................................. .................... ........................... ...........................

.................................................................................. .................... ........................... ...........................

.................................................................................. .................... ........................... ...........................

Yes No

Measured: Estimated: Total: mL mL mL

Perineal Assessment Intact 1° tear 2° tear 3° tear 4° tear

Episiotomy Type: Indication:

Repair required? Yes No Comments: Signature:Newborn summaryBaby’s URN:

ID checked:

ID attached:Date and time of birth:Born:

Apgar score:

Morphologically normal:Comments:

Yes No

Yes No

/ / :

Alive Stillborn Macerated1 min: 5 mins:

Yes No

Sex:

Measurements:

Konakion given:

Hep B given:

Skin to skin contact for at least one hour:

Fed:

Male Female Indeterminate

HeadWeight: Length: circumference:

g cm cm

Yes No

Yes No

Yes No N/A If no, duration:

Yes, breast Yes, artificial No N/A

Birth Attendees Print names: Designation:Birth accoucher:

Midwife:

Witness:

Medical officer:

Other:

Other:

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Expected outcomes - MOTHER’S copyPhase 1 Antenatal periodPhase 2: Pre- and Post-operation• After discussion with your doctor you will be able to state an understanding of the usual pre- and post-operative care

routines, the surgery and its effects on you and the baby.After the birth• Baby will be placed skin to skin with you as soon as you are able to respond to baby.• During this time, baby will be offered its first feed.• Management of your pain ensures that your level of discomfort is in a range acceptable to you.Phase 3: Day 1 Post-operative• You will be able to explain the outcome of your baby’s birth.• Your Midwife will care for you and check on you and your baby’s progress.• Your midwife will assist you with feeding and caring for your baby.• You can expect some vaginal bleeding usually up to about 2 weeks after the birth.• In many cases you will be able to go home in 2 days after surgery if appropriate and follow-up arrangements are available.Phase 4: Discharge• Once your midwife has gone through your discharge information, and your baby has been reviewed and discharged by a

Qualified Healthcare Professional, you may go home.Phase 5: After discharge• You will be contacted via phone or a home visit up to 5 days post discharge.• A midwife may visit you in your home to provide ongoing support.• You will be offered referral to community health groups for ongoing support, i.e. Child Health, Australian Breastfeeding

Association.• You will require ongoing care from your local doctor / General Practitioner (GP) / Specialist / Treating Physician.• When you visit your doctor please take along you and your baby’s hospital discharge summary and baby’s Personal

Health Record.

Key milestones

Day

4 Po

st-O

P

Day

3 Po

st-O

P

Day

2 Po

st-O

P

Day

1 Po

st-O

P

1–6

hour

s Po

st-O

P

Day

of O

P

Pre-

adm

Clin

ic

Ante

nata

l

1. Placed on pathway 2. Your care will follow the clinical pathway 3. If needed you will have blood tests taken 4. You will be seen by the Obstetric doctors 5. You will attend pre-admission clinic for an elective LSCS 6. You will be admitted to hospital 7. You will be prepared for theatre / if elective LSCS

• you will be expected to fast at least 8 hours prior to surgery

8. You will be transferred to the Operating Theatre (OT) 9. Observations taken as needed 10. Anaesthetic will be administered 11. You will be prescribed and offered regular pain relief, after

your operation 12. There will only be a little or nil wound ooze on your dressing 13. You will be eating and drinking normally 14. Your drip and catheter will be removed 15. You may by seen by your doctor daily 16. The midwife will assist you in learning how to feed and care for your baby 17. Ready for discharge. You may be given a copy of the hospital birth summary / perinatal

data report to give to your local doctor. Alternately, this will be posted to your local doctor.

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AR

GIN

DO

NO

T W

RIT

E IN

TH

IS B

IND

ING

MA

RG

IN

of 15


URN:

Family name:

Given name(s):

Address:



For illustra

tional p

urposes only

Not for d

ownload and print

pathway caes

Documents

clinical judgement

date of birth

drg o01a caesarean delivery

drg o01c caesarean delivery

drg o01b caesarean delivery

action care

preceding care order

severe alos