C-Section Pre-Op Checklist - My Doctor Online The Permanente ...

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C-Section
Pre-Op Checklist
You are scheduled for a c-section with Dr. ___________________________________ on Date: ___________________
If you need to cancel your scheduled appointment in Walnut Creek, please call 295-5180.
If you need to cancel your scheduled appointment in Antioch Medical Center, please call 813-6970.
Location:
□ Walnut Creek L&D – You will be contacted before 8:30pm the evening prior to your surgery date. If you have not received a call,
or have other questions, please contact Labor and Delivery at 925-295-5200.
□ Antioch Med. Center L&D – You will be contacted before 8:30pm the evening prior to your surgery date. If you have not
received a call, or have other questions, please contact Labor and Delivery at 925-813-6820.
PLEASE REMEMBER, NOTHING TO EAT OR DRINK 8 HOURS PRIOR TO YOUR SCHEDULED SURGERY!
The following is a summary of the requirements for your operation. Please review this packet and fill out all of
the forms. Bring your Health Plan Card and this surgery packet to your appointments.
□ Pre-Op Physician Appointment:
Location: _______________ Dr. ____________________________________ Date: _____________ Time: ___________
□ Anesthesia Consultation: The Anesthesia Department will automatically review your history electronically. They will
contact you if necessary to review any concerns. You are welcome to contact them if you have questions or feel you need
to share any specific information. If needed, the anesthesia number is 925-295-4739.
□ Laboratory:
You will be given your lab orders at your pre-op appointment. You will need to have a blood test done between 24-72 hours but
no later than 12pm the day before your procedure.
Antioch Delta Fair - Adobe Building - Hours: 7:30am-5:30pm Monday - Friday (Closed Weekends)
Antioch Medical Center - Sand Creek Building - Hours: 7:00am-8:00pm Monday - Friday
7:00am-5:00pm Saturday
8:30am-5:00pm Sunday and Holidays
Livermore - Medical Office Building - Hours: 7:30am-1:00pm; 1:30-5:30pm Monday - Friday (Closed Weekends)
Martinez - Hacienda Building, 1 st floor - Hours: 7:30am-5:30pm Monday - Friday (Closed Weekends)
Park Shadelands - Yosemite Building - Hours: 8:00am-5:30pm Monday - Friday (Closed Weekends)
Pleasanton - North Building, 1 st floor - Hours: 6:30am-7:00pm Monday - Friday
8:00am-12:00pm Saturday (Closed Sunday)
Walnut Creek - Medical Office Building, Basement - Hours: 7:00am-7:00pm Monday – Friday
8:00am-5:00pm Saturday and Sunday
□ Emmi: We encourage you to view an online interactive demonstration of your procedure. Go to www.kp.org/mydoctor, and
enter your doctor’s name and select search. On the physician’s home page, select “Tools and Classes,” and then scroll down to
select “Prepare for Your Procedure – Emmi.”
□ Guided Imagery: Research shows that patients using imagery may be able to leave the hospital and return home more quickly
than those who do not. If you are interested in Guided Imagery, from your physicians homepage select the “Tools and Classes,”
and scroll down to “Podcasts,” or ask or ask your Doctor for more information.
□ Post Surgery Appointment:
Location: _________________Dr._________________________________ Day ___________ Date: _________Time: _________

Medical Health History
Name :______________________________________________________ Kaiser # _____________________________
Reason for Surgery:
OBGYN History:
Number of pregnancies:_______ Number of Deliveries:_______ Last Menstrual Period (1 st day)_____________
Post-menopausal: Yes/No Hysterectomy: Yes/No Birth Control Method_______________________
Gynecologic problems:
Abnormal Pap smear/Infections/Infertility Yes or No
If yes, please explain:
Other: Obstetrical (Pregnancy-related) Problems: Yes or No
Do you or have ever had any of the following conditions?
(Family, friends and relatives may help to complete this section) Circle Yes or No Comments
Heart: Heart attack or angina (chest pain), irregular heart beat) treadmill test Yes or No
Rhythm (skipped beats, missed beats, very fast heart rate) Yes or No
Heart failure (fluid on the lungs) Yes or No
Other (murmur, shortage of breath when laying flat) Yes or No
Circulation (high or low blood pressures, pain in legs with exercise) Yes or No
Lungs: Asthma, bronchitis or emphysema Yes or No
Shortage of breath or cough Yes or No
Recent cold involving the lungs (within 2 weeks) Yes or No
Nervous System (stroke, seizure, numbness, weakness, headache) Yes or No
Disease of the brain or spine. Yes or No
Liver (hepatitis, cirrhosis, jaundice, gallbladder disease or other problems) Yes or No
Kidney disease (difficult urination, infection, etc.) Yes or No
Diabetes ( high or low blood sugar) Yes or No
Thyroid disease Yes or No
Stomach (ulcers, heartburn, diarrhea, constipation, bleeding with bowel) Yes or No
Movements or abdominal pain Yes or No
Bleeding disorders (excess bleeding with cuts or dental procedures) Yes or No
Are you taking anticoagulants (blood thinners) Yes or No
Musculoskeletal System (back or neck, injuries or arthritis) Yes or No
Skin (psoriasis, abrasions, bruises or ulcerations Yes or No
Cancer (ever received chemotherapy or radiation treatments) Yes or No
Depression, Anxiety or other Mental Health problems Yes or No
Other Medical Problems? Explain
kp.org

kp.org
C-Section
Pre-Op Checklist
You are scheduled for a c-section with Dr. ___________________________________ on Date: ___________________
If you need to cancel your scheduled appointment in Walnut Creek, please call 295-5180.
If you need to cancel your scheduled appointment in Antioch Medical Center, please call 813-6970.
Location:
□ Walnut Creek L&D – You will be contacted before 8:30pm the evening prior to your surgery date. If you have not received a call,
or have other questions, please contact Labor and Delivery at 925-295-5200.
□ Antioch Med. Center L&D – You will be contacted before 8:30pm the evening prior to your surgery date. If you have not
received a call, or have other questions, please contact Labor and Delivery at 925-813-6820.
PLEASE REMEMBER, NOTHING TO EAT OR DRINK 8 HOURS PRIOR TO YOUR SCHEDULED SURGERY!
The following is a summary of the requirements for your operation. Please review this packet and fill out all of
the forms. Bring your Health Plan Card and this surgery packet to your appointments.
□ Pre-Op Physician Appointment:
Location: _______________ Dr. ____________________________________ Date: _____________ Time: ___________
□ Anesthesia Consultation: The Anesthesia Department will automatically review your history electronically. They will
contact you if necessary to review any concerns. You are welcome to contact them if you have questions or feel you need
to share any specific information. If needed, the anesthesia number is 925-295-4739.
□ Laboratory:
You will be given your lab orders at your pre-op appointment. You will need to have a blood test done between 24-72 hours but
no later than 12pm the day before your procedure.
Antioch Delta Fair - Adobe Building - Hours: 7:30am-5:30pm Monday - Friday (Closed Weekends)
Antioch Medical Center - Sand Creek Building - Hours: 7:00am-8:00pm Monday - Friday
7:00am-5:00pm Saturday
8:30am-5:00pm Sunday and Holidays
Livermore - Medical Office Building - Hours: 7:30am-1:00pm; 1:30-5:30pm Monday - Friday (Closed Weekends)
Martinez - Hacienda Building, 1 st floor - Hours: 7:30am-5:30pm Monday - Friday (Closed Weekends)
Park Shadelands - Yosemite Building - Hours: 8:00am-5:30pm Monday - Friday (Closed Weekends)
Pleasanton - North Building, 1 st floor - Hours: 6:30am-7:00pm Monday - Friday
8:00am-12:00pm Saturday (Closed Sunday)
Walnut Creek - Medical Office Building, Basement - Hours: 7:00am-7:00pm Monday – Friday
8:00am-5:00pm Saturday and Sunday
□ Emmi: We encourage you to view an online interactive demonstration of your procedure. Go to www.kp.org/mydoctor, and
enter your doctor’s name and select search. On the physician’s home page, select “Tools and Classes,” and then scroll down to
select “Prepare for Your Procedure – Emmi.”
□ Guided Imagery: Research shows that patients using imagery may be able to leave the hospital and return home more quickly
than those who do not. If you are interested in Guided Imagery, from your physicians homepage select the “Tools and Classes,”
and scroll down to “Podcasts,” or ask or ask your Doctor for more information.
□ Post Surgery Appointment:
Location: _________________Dr._________________________________ Day ___________ Date: _________Time: _________

011116-002 (4-10)
PRE-ADMIT FORM
Admit Date: Medical Record Number:
Dear Patient: To ensure accurate information, please complete this form in its entirety and return to
the Admitting Department. As a Kaiser Permanente patient, you may have a hospital fee, deductible,
copayment, or coinsurance which you are required to pay at the time of admission. If you would prefer
to make a payment in advance of your admission, please call or visit the Admitting Department.
Thank you.
Emergency Contacts Patient Information
Last Name First Name Middle Initial
Date of Birth E-mail Address
Address City State ZIP
Home Phone Work Phone Cell Phone
Ethnicity Marital Status ■ Registered Domestic Partner
■ Hispanic/Latino—Other ■ Common Law ■ Single/Never Married
■ Non-Hispanic/Non-Latino ■ Divorced ■ Separated
■ Legally Separated ■ Widowed
■ Married ■ Other
During your admission, we have ■ Name ■ Religion Clergy visit?
your permission to disclose ■ Condition ■ No Information/ ■ Yes
(check all applicable boxes): ■ Location/Phone Confidential Admit ■ No
Race ■ Native American / Eskimo /Aleutian — Other
■ Asian / Pacific Islander— Other Asian ■ White — Other White or European
■ Asian / Pacific Islander— Other Pacific Islander ■ Other
■ Black— Other Black ■ Unknown
Religion Preferred Spoken Language Preferred Written Language
Employer
Address City State ZIP
Phone Employment Status Occupation
Primary Contact Name Relationship to Patient
Home Phone Work Phone
Address City State ZIP
Secondary Contact Name Relationship to Patient
Home Phone Work Phone
Address City State ZIP

011116-002 (4-10) REVERSE
PRE-ADMIT FORM
Advance Directive Information
Do you have an Advance Health Care Directive? ■ Yes ■ No
If yes, please provide a copy to the Admitting Department.
Subscriber Information
Name Relationship to Patient
Address City State ZIP
■ Male
■ Female
Date of Birth Home Phone
Employer Employment Status
Employer Address City State ZIP
Occupation Work Phone
Other Insurance Information
Subscriber Name Relationship to Patient
Address City State ZIP
■ Male
■ Female
Date of Birth Home Phone
Subscriber Employer Employment Status
Employer Address City State ZIP
Occupation Work Phone
Medicare Claim # Part A Effective Date Part B Effective Date
Medi-Cal Benefits ID # Medi-Cal Issue Date
Workers’ Compensation Claim # Date of Injury/Illness Workers’ Compensation Policy #
Other Kaiser Permanente Region Coverage
Other Insurance Company Group Number Insurance ID
Insurance Company Address Street City State ZIP
Insurance Phone Effective Date of Insurance Coverage

Type of surgery/procedure Type of Anesthesia Problems with anesthesia or
procedures
What is your occupation? _______________________________________________
What is the name of your partner/spouse/significant other? _____________________________
Have you filled out the Advanced Health Care Directive? Yes or No
(please see Surgery Packet, and try to complete before your procedure)
Who do you designate to make decisions regarding your health if you are unable to do so?
Has any blood relative of yours had a serious reaction to anesthesia? Yes or No
If yes, explain:
Do you or have you ever smoked? Yes or No
If so ______packs/day for ____years
Do you drink alcohol? Yes or No
If so ____ oz. a day /week/ month (circle one)
Do you ever or have you ever used drugs? Yes or No
(i.e. Marijuana, cocaine, intravenous drugs)
Are you interested in a copy of our Guided Imagery CD to listen to before/during and after surgery to
help with your preparation and recovery from surgery?
Did you remember to fill out yellow Medication card with medications and allergies?
Date: Patient Signature:
kp.org
List previous surgeries, including C-Sections
Date

Women’s Health Center
Tell your surgeon of all medications, including herbals and over the counter medications that you take.
Some drugs cause bleeding when taken prior to surgery, especially blood thinners and antiinflammatories.
If you are taking Coumadin of Warfarin you will need to contact the
Anticoagulant Clinic as soon as possible at 925-372-1628. They will instruct you about changing
or discontinuing these medications prior to surgery. Stop taking the following drugs seven days
prior to surgery. If you feel you cannot stop these medications due to your medical condition, discuss
this with your surgeon as soon as possible. This list may not be totally inclusive – use it as a
supplement to your discussion with your surgeon.
Do not take medications from the list below for one week before the procedure. These drugs can cause
excessive bleeding if taken prior to surgery or biopsy. (NOTE: Tylenol is OK!)
Advil Aspergum Carpon Double –A Fiorinal Magsal Neocylate Salatin Vanquish
AlkaSeltzer Aspirin Cataflam Duoprin Flubiprofen Marnal Nuprin Saleto Vitamin E
Aleve Asproject Clinoril Duradyne Garlic Major-cin Oxalid Sine-off Voltaren
Anacin Axotal Cope Duragesic Gaysal –S Majoral PAC Solocol Warfarin
Anaprox Bayer Coricidin Durasel Gemnisyn Measurin Pabalate Supac Zorpin
Ansaid B C Tabs CP-2 Dynosal Ginko Maclomen Pabirin Synalgos
Anturane Buf Tabs Cosprin Ecotrin Ginseng Micranin Panodynes Tandearil
APSP Fort Buff A Coumadin Efficin Ibuprofen Midol Pepto-
Bismal
Tenstan
Argesic Buffaprin Dasin Emgrin Indocin Mobidin Percodan Ticlid
Athra – G Buffets II Dicifenac Empirin Isollyl Mobigesic Persantine Ticlopidine
Artholate Buffinol Dipyridamole Encaprin Kaopectate Mementum Protension Tisma
Arthropan Buflex Disalcid Equagesic Ketoralac Motrin Postel Tolectin
Ascriptin Butal Comp Doans Pills Etodolac Lanorinal Nabumetone Relafen Toradol
Asper Buf Butazolodin Dolcin Exederin Lodine Nalfon Rufen Trigesic
Aspercin Cama Dolobid Feldene Magan Naprosyn Sal-Favne UracelS
kp.org

Use this document to determine the most up-to-date hours of operation for the Laboratory, Pharmacy, and Radiology
Department for the entire Diablo Service Area. Find the location you are interested in and click on the corresponding link
underneath.
2/5/2011 1:03:00 PM
Antioch
Medical Center
Antioch
Delta Fair
Livermore Martinez Park Shadelands
Walnut Creek
Pleasanton Walnut Creek
Medical Center
Laboratory Click Here Click Here Click Here Click Here Click Here Click Here Click Here
Pharmacy Click Here Click Here Click Here Click Here Click Here Click Here Click Here
Radiology Click Here Click Here Click Here Click Here Click Here Click Here Click Here

Information about your Hospitalization and Discharge
It is very important while you are in our care that you get the information you need to care for
yourself (or to be cared for) to return home. We encourage you and yours family to ask
questions to improve the transition from hospital to home. Visiting hours are between 11am
and 8pm.
Your Nursing Care
Your nurse will be your caregiver, teacher and advocate. He or she will be able to provide
information and resources to help you prepare for your discharge from the hospital. While in
the hospital, your nursing care will be provided by 3 shifts of nurses. You will be assigned a
nurse to ensure your needs are met.
Discharge
Your physician will assess your condition daily to determine when you are well enough to leave
the hospital. A typical hospital stay for c-section is two days. Our intention is to plan on
discharging you before 11:00 am on your day of discharge. However, if for some reason other
testing needs to be done or clinical monitoring is needed; you may be discharged later than
11:00 am. Before you leave the hospital, your physician and nurses will give you information
about your continuing recovery, medications and follow up appointments. If you have
questions, there are resources available for you.
Transportation Home
Remember to check that arrangements for a ride home or to another health care setting are
confirmed. Every intent will be made to have you ready for discharge by 11:00 am. Please
arrange to have your family members available at this time to provide transportation. If you
need help arranging transportation please let a Medical Social Worker or Continuing Care
Coordinator know. Your provider will provide instructions when you will be able to drive upon
discharge.
Note: Please notify your nurse within 24 hours of admission of the name and phone number of
the person who will provide your transportation by 11:00 am on the day of discharge.
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When to Call Your OB/GYN after Discharge:
The nurses will review home care with you. Some symptoms occur with normal healing
however please call your doctor if you experience the following:
Two temperature readings of 100.4 taken 4 hours apart
A single temperature reading of 101 or greater
Unable to take fluids by mouth
Vomiting after discharge from hospital
No bowel movement within 4 days after discharge from hospital
Separation of wound edges, drainage from wound, or large red hot expanding areas
around the wound
Heavy vaginal bleeding, filling 1 pad per hour for 4 or more hours

This is to alert you to the fact that you may have a fee for your
surgical procedure, depending upon your coverage.
We in the clinic do not have access to the actual charges a
surgical procedure may incur. If you have any questions about
these fees, please contact Member Services at:
1-800-464-4000 (English) 1-800-757-7585 (Chinese Dialects)
1-800-788-0616 (Spanish) 1-800-777-1370 (TTY)
Questions regarding Kaiser Permanente’s financial assistance program, please call:
1-866-399-7696
kp.org
CO–PAY ALERT
Thank you

Women’s Health Center
Abdominal Surgery Instructions
If you’re having an incision on your abdomen (for example C/S, abdomen
hysterectomy):
Your cooperation is needed to ensure a successful outcome of your surgery. The purpose of
the Hibiclens soap is to reduce the normal bacteria on your skin that may be a potential source
of infection at the surgical site. Please follow these instructions carefully:
1. Purchase 4 oz. container of Hibiclens from pharmacy (the cost will be approximately
$5.00 to $6.00).
2. Remove any body piercing jewelry prior to showering and leave out until after the
surgery.
3. Shower the night before surgery and the morning of the surgery, using ½ of the bottle for
each shower.
4. Hair may be shampooed with regular shampoo and rinsed thoroughly prior to use of the
Hibiclens on the body.
5. Use a clean washcloth to apply the Hibiclens.
6. Wash your body from the neck down to your toes with Hibiclens.
7. Be sure to clean the area well where the surgical incision will be.
8. This is an effective cleaner, even though it doesn’t make suds well.
9. Rinse thoroughly with running water. DO NOT use any other soap or body rinse on your
skin.
10. Pat dry with a clean absorbent towel.
11. Do not use lotion, powder, deodorant or perfume/aftershave of any kind on the skin after
bathing with Hibiclens.
12.
The admitting nurse will ask you if you have taken your pre-op antimicrobial showers.
Thank you for participating in your successful surgery.
kp.org

BEFORE ANESTHESIA:
Please follow these
instructions carefully so that
your surgery/procedure is not
cancelled or delayed.
Eating and Drinking
After midnight: no food, mild,
communion, or tobacco. Up to 4
hours before surgery: clear liquids
are okay (unless Anesthesia said
no). The last 4 hours prior to
surgery; nothing at all (including
gum and mints).
MEDICATIONS:
Take only these medications (sip of
water okay):
• Stop aspirin 1 week before
surgery
• Stop Motrin (ibuprofen), Anaprox,
Feldene 2 days before.
CLOTHING /ACCESSORIES:
Wear casual clothing, easy to
kp.org
ANESTHESIA DEPARTMENT
INSTRUCTIONS FOR YOU SAFETY
remove and replace. Remove eye
makeup, artificial eyelashes, contact
lenses, all jewelry, hairpieces,
hairpins, and barrettes. Please
bring your Kaiser Permanente Card.
AFTER ANESTHESIA FOR
OUTPATIENT SURGERY
(Including local anesthesia):
You must have a responsible adult
• Drive you home (or ride in a taxi
with you)
• Help you for 8 hours after
leaving the hospital
QUESTIONS YOU MAY HAVE:
Why can’t I eat or drink?
Protective reflexes may be lost or
decreased during anesthesia, even
local or sedation. Therefore, an
empty stomach is essential because
vomit could enter your lungs when
protective reflexes are lost or
diminished. If stomach contents
enter the lungs, serious, possibly
lethal, complications will result.
What are Clear Liquids?
Clear liquids have no residue (solid
particles and fat) and digest quickly.
They include water, tea, black
coffee, Kool-Aid, clear (flavored)
Jell-O, fat free clear broth or bullion,
apple juice, cranberry juice and
grape juice. Sugar may be added to
your beverage as it dissolves with
no residue. Do not add milk, milk
products, or non-dairy creamers to
your beverages. MILK IS NOT A
CLEAR LIQUID.
Why stop Aspirin, Motrin, etc?
They decrease the blood’s ability to
clot and may increase bleeding
during surgery.
Why do I need a responsible
Adult?
All anesthetics, even locals in large
doses, produce drowsiness,
impaired judgment, and poor
coordination for several hours. It is
essential for you to arrange in
advance for assistance after leaving
the hospital.

It takes your body about 24 hours to
eliminate the drugs used.
Until then, they interfere with normal
judgment and response times. So,
plan not to operate a vehicle or
attempt to make responsible
decisions for 24 hours. It is quite
normal to feel tired and lacking in
energy for 48 hours after minor
surgery.
Why can’t I wear Contact Lenses,
Eye Makeup, and Artificial
Eyelashes?
They can cause eye injury during
anesthesia, plus contacts and
eyelashes can be lost or damaged.
Why can’t I wear my jewelry and
hairpiece?
They may become pressure point
areas while you are under
anesthesia and can cause damage
to your body. Rings should be
removed as fingers my swell during
surgery. And these items can be
lost or damaged. Leave your
valuables at home.
kp.org
ANESTHESIA DEPARTMENT
INSTRUCTIONS FOR YOU SAFETY
Can I wear my Dentures?
Usually not in the operating room.
Since dentures can be lost or
broken. It is best to take them out at
home or on the ward. You can ask
to wear them until you enter the
operating room, and then remove
them.
How soon will I leave the
Hospital?
As soon as your doctors consider it
safe. This varies with different
surgeries and anesthetics. With
outpatient surgery the average time
for leaving the hospital is between 6
and 8 hours after you arrive at
the hospital. The nurses will call the
person driving you home if they
don’t wish to wait.
Do modern Anesthetics make you
sick afterward?
Not usually. Anesthetics seldom
cause upset stomachs anymore.
Pain relieving drugs often do
though, and most operations require
their use at least once, either
before, during after surgery. Please
tell the nurses if you become
nauseated. They have medications
to treat nausea.
After Outpatient Surgery, is
there any chance I won’t be able
to go home the same day?
Yes. If any circumstances develop
which require extended care, you
will be admitted to the hospital. The
potential complications of surgery
and anesthesia will be explained in
advance by your doctors. For now,
it is important for you and your
family to understand that you might
remain in the hospital overnight or
longer.
We look forward to caring for
you. We want to give you the
care that you need and
deserve. Thank you for
choosing Kaiser Permanente.

During recovery you should avoid movements
that strain your abdominal muscles and incision.
Protect your incision as well as your low back by
using good body mechanics similar to those you
used during pregnancy. As well, you can
support your back during movement by
tightening the pelvic floor (kegel) muscles and
gently contracting the abdominal muscles.
Body Mechanic Tips
Breathe normally during movement; avoid breath
holding.
- To Get Into Bed: Sit at edge of bed, using your
arms lower yourself to your side as you bring
your legs onto the bed. Roll to your back with
knees held hip width apart rather than separating
legs.
- To Get Out of Bed: roll to your side, lower legs
over the edge of the bed and push with your
bottom elbow and top hand against the bed to sit
upright.
- To Get Out of a Chair: come to the edge of the
chair, keep your knees somewhat apart and
squeeze buttocks as you stand up.
- To Get in a Car: first sit down on the seat by
backing in, keeping both knees together, pivot to get
into car.
- Bend your knees and hips when lifting. Avoid
bending from the waist.
- Avoid using one leg forcefully as this can put stress
on abdominals and pelvic girdle i.e. do not use one
leg to shove items on the floor; or stand on one leg
kp.org
Recovery After
Cesarean Section
Page 1 of 2
and put the other over a baby gate.
- Hold a pillow against your abdomen if you
should cough or sneeze to help decrease
discomfort.
-
Regaining Abdominal Strength
In the First 6 weeks:
Many of the body/hormonal/postural
changes that occur during pregnancy linger on
several weeks after delivery. Because of this
and the added fatigue of newborn care you
need to gradually return to your regular
exercise routine. To help your body transition
use the same body mechanics you did when
you were pregnant.
Contract your pelvic floor and abdominal
muscles when lifting to help protect your low
back as well as to begin to re strengthen these
areas. (Do this by gently tightening the vaginal
and rectal muscles as if to hold in urine and
gas while also pulling in abdominal muscles as
if to zip up jeans. Breathe normally as you do
this)
Try to do 10 pelvic floor contractions
(squeeze the vaginal rectal muscles as if to
hold in urine and gas) holding 5-10 counts
while feeding your baby. Pelvic floor exercise in
the immediate postpartum period helps restrengthen
these muscles, supports the
spine/pelvic girdle and may help prevent
urinary incontinence. (JOGC 517 June 2003)
Resume walking in 15 minute
increments and gradually transition to brisk
walking as your energy level returns.
Scar Mobilization: Massage gently along and
across the length of the scar to promote
mobility and uniform healing.

6-12 Weeks Post Partum
At 6 weeks post partum you can start to
resume your regular exercise routines.
Because you are still recovering from
delivery you should exercise for less time
and at a lower intensity than pre-pregnancy
and gradually increase to your regular
routine. The following exercise will help you
re-strengthen the lower abdominals:
One Leg Heel Slide – Lay on back with
knees bent. Contract pelvic floor and
abdominal muscles as you slowly slide heel
away from body and straighten leg. Relax.
Contract muscles again as you slide heel
back to start position. Begin with 10 on each
side and work to 20-30.
Single Leg Fall Out – Lay on back with knees
bent, hip width apart and feet flat on floor.
Breathe in, as you breathe out do a pelvic
floor contraction and let one leg fall slowly
out to the side. Relax. Do a pelvic floor
contraction and bring leg back to starting
position. Begin with 10 repetitions on each
leg and work to 20 repetitions. When you
can do 20 with each leg begin to do both legs
together. Start with 10 and work to 20.
Hands and Knees – On your bed get into a
hands and knees position so that you are
square: hands under shoulders and knees
below hips. Allow back to relax into normal
curve. Breathe in and as breathe out do a
pelvic floor contraction and try to gentle pull
abdominal muscles toward spine.
kp.org
Recovery After
Cesarean Section
Page 2 of 2
Begin with 10 repetitions, hold 5. Work to 2
sets of 10 repetitions, hold 10.
ACOG Committee Opinion No. 267: Exercise During
Pregnancy and the Postpartum period.
It is important to continue with kegel exercise
(pelvic floor contractions). A strong pelvic
floor will help prevent urinary incontinence,
organ prolapse and will contribute to sexual
satisfaction.
Continue to use good posture and body
mechanics as this will prevent abdominal and
low back strain as well as protect against
organ prolapse. Be careful to support baby
well during nursing. Bring baby to your breast
as opposed to leaning forward as you nurse.
Support your low back and abdominals by
using good body mechanics when
transferring baby in and out of car.
Continue scar mobilization if your c-section
scar is painful or stiff.
Please note if you should become short of
breathe or dizzy while lying on your back
please stop the exercise immediately and let
your provider know about your symptoms.

Dear Member,
When you come in for your procedure, you will be asked if you have an Advance Directive. This is a
written form where you write down two important things:
1. Your wishes about life support and other treatments
2. Who you want to speak for you if you become too ill to speak for yourself in making medical
decisions.
Why pay attention to this now? None of us knows when a medical crisis might happen and important
decisions will need to be made. Going into the medical center is a good opportunity to think these
things over and complete the Advance Directive, so that your right to make your medical decisions can
be honored even if you can no longer speak for yourself.
We can help. A form is enclosed in this packet. Call your nearest Kaiser Permanente Health Education
Office to sign up for one of our two hour workshops to help your complete your Advance Directive.
These services are free and well worth doing for you and your loved one’s peace of mind.
Kaiser Permanente Health Education Offices:
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Advance Directives

CALIFORNIA ADVANCE HEALTH CARE DIRECTIVE
Including Power of Attorney for Health Care
Imprint / MRN
NOTE: The document meets legal requirements for most Californians, but might not be
appropriate in special circumstances. If you might have special needs, consult an attorney.
PART 1: APPOINTING AN AGENT TO MAKE HEALTH CARE DECISIONS
NOTE: You should discuss your wishes in detail with your designated agent(s)
My name is:_____________________________________ Date of Birth:________________
My address is:_______________________________________________________________
In this document I appoint an agent. That agent will make health care decisions for me
in the future, if and when I no longer have the mental capacity to make my own health
care decisions.
Optional: I want my agent to make my health care decisions now, even though I currently
have the mental capacity to make my own health care decisions. _______ (Do not initial
here if you want to continue making your own health decisions for as long as you are able.)
The following persons cannot be selected as your agent or alternate agent:
• Your primary physician
• An employee of the health care institution or residential care facility where you
receive care (unless you are related to that person or you are co-workers).
PRIMARY AGENT:
Agent’s Name: ___________________________________________________
Address:___________________________________________________________________
____________________________________________________
(Phone numbers – indicate home, work, pager, and cellular phone)
1 st ALTERNATE AGENT (If Agent is not willing, able, or reasonably available to serve.)
Name of first alternate agent: ____________________________________________________
Address:___________________________________________________________
____________________________________________________
(Phone numbers – indicate home, work, pager, and cellular phone)
2nd ALTERNATE AGENT (If Agent and 1 st Alternate are unavailable or unwilling to serve.)
Name of second alternate agent: _______________________________________
Address:___________________________________________________________
____________________________________________________________
(Phone numbers – indicate home, work, pager, and cellular phone)
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WHAT MY AGENT MAY DO
My agent will be allowed to make health care decisions for me just as I can presently make
my own. For example, I give my agent my trust to make decisions (1) to accept or refuse
treatment for me, including accepting or discontinuing food and fluid that is given through a
tube into my stomach or into a vein; (2) to choose for me a particular physician or health care
facility; and (3) to receive or review my medical information and records, or to permit release
of my records for others’ review. _______(initial here)
WHAT MY AGENT MUST DO
My agent shall make health care decisions for me by considering what I have written here, and
by considering my other wishes. My agent will try to find out as much as he/she can about my
wishes. If my agent does not know my wishes, he/she shall consider my personal values as
much as possible and make decisions that he/she thinks are in my best interest. I ask that when
my agent is trying to consider my values and prior wishes, that he/she talk to other loved ones
who know me and care about me. _______(initial here)
The following individual(s) are to be EXCLUDED from any part of health care decisionmaking
for me:
No Exclusions ____________________________________________ _______(initial here)
AFTER MY DEATH
My agent will be able to authorize an autopsy, donate all or part of my body, and/or determine
the disposition of my remains. If I have written a will or made funeral arrangements, my agent
should follow those instructions on what happens to my body after my death or other
arrangements I have made. If I want to make exceptions to this authority, I write them
here or in an attachment to this form:
No Exceptions ____________________________________________ _______(initial here)
(Sign and date the attached pages when this document is witnessed.)
PART 2: HEALTH CARE INSTRUCTIONS (Cross out the sections that do not apply)
I have made additional written instructions to my agent and attached them. _______(initial here)
(Sign and date the attached pages when this document is witnessed.)
TRUST IN AGENT: The instructions I give to my agent are guidelines to assist him/her in
making the best medical decisions for me. The subject of unacceptable treatments is a complex
one. Whether I would or would not want a particular medical intervention might depend on
context. At some point there might be a conflict between treatment instructions I have given and
what my agent thinks best in circumstances that I could not have predicted. I trust that my agent
will honor my goals and values. _______(initial here)
PERSONAL CARE DECISIONS: By my initials here I direct that my agent(s) named above
authorize personal care on my behalf including, but not limited to, choice of residence, clothing,
receipt of my mail, care for my personal belongings, care for my pet(s) if any, and all other
decisions of a personal nature not included in the description of health care. _____(initial here)
DNR ORDER: I have completed a Prehospital Do Not Resuscitate Form. _______(initial here)
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REVOCATION OF PREVIOUS DOCUMENTS: I revoke any previously-executed Power of
Attorney for Health Care, Individual Health Care Instruction, or Natural Death Act Declaration.
I have the right to revoke this directive at a future date by creating a new one.
PART 3: SIGNATURE OF PERSON WHO IS MAKING THIS DIRECTIVE
Sign the document in the presence of the witnesses or the Notary.
Date: _______________ Signature: _____________________________________________
If the person making this directive is unable to write, have the person make a mark,
have a witness write the name of the person making this directive and sign next page.
PART 4: THIS DOCUMENT MUST EITHER BE NOTARIZED OR SIGNED BY TWO
WITNESSES ON THE NEXT PAGE.
WITNESSES: Certain individuals cannot serve as witnesses. Those rules are set forth in the
following witness statements:
I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF CALIFORNIA
(1) That the individual who signed or acknowledged this Advance Health Care Directive is personally
known to me, or that the individual’s identity was proven to me by convincing evidence.
(2) That the individual signed or acknowledged this Advance Directive in my presence,
(3) That the individual appears to be of sound mind and under no duress, fraud, or undue influence,
(4) That I am not a person appointed as agent by this Advance Directive, and
(5) That I am not the individual’s health care provider, an employee of the individual’s health care
provider, the operator of a community care facility, an employee of an operator of a community
care facility, the operator of a residential care facility for the elderly, nor an employee of an
operator of a residential care facility for the elderly.
First Witness: _________________________________ _________________________________
Name (printed) Signature
Date: __________________ Address: __________________________________________
Second Witness: _______________________ __________________________
Name (printed) Signature
Date: __________________ Address: __________________________________________
ONE OF THE PRECEDING WITNESSES ALSO MUST SIGN THE FOLLOWING DECLARATION:
I further declare under penalty of perjury under the laws of California that I am not related to the
individual executing this advance health care directive by blood, marriage, or adoption, and, to the
best of my knowledge, I am not entitled to any part of the individual’s estate upon his or her death
under a will now existing or by operations of law.
Date: __________________ Signature: __________________________________________
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Only if the person making this directive is unable to write, witnesses complete this section:
_________________________________, being unable to write, made his/her mark in
our presence and requested the first of the undersigned to write his/her name, which he/she did,
and we now subscribe our names as witnesses thereto.
____________________________ _____________________________
Signature of Witness #1 Signature of Witness #2
If the principal (the person appointing the agent) currently resides in a
nursing facility, this document also must be witnessed by a representative of California’s
Long-Term Care Ombudsman Program. If the two-witness method is chosen, the
Ombudsman Program representative may serve as one of the two witnesses, or may serve as
a third witness. If the notarization method is chosen, the Ombudsman Program
representative serves as a separate witness.
DECLARATION OF OMBUDSMAN PROGRAM REPRESENTATIVE
(Required ONLY if person appointing the agent currently resides in a nursing facility.)
I declare under penalty of perjury under the laws of California that I am an ombudsman
designated by the California Department of Aging and that I am serving as a witness as required
by Section 4675 of the California Probate Code.
_________________________________ _________________________________ ____________________
Name (printed) Signature Date
CERTIFICATE OF ACKNOWLEDGEMENT OF NOTARY PUBLIC
(Not required if two-witness method is followed)
State of California, County of __________________________
On this ____ day of __________________, ______, before me, the undersigned, a Notary Public in
and for said State, personally appeared ______________________________________, personally
known to me or proved to me on the basis of satisfactory evidence to be the person whose name is
subscribed to the within instrument, and acknowledged to me that he/she executed it.
WITNESS my hand and official seal.
(seal) Signature _______________________________________
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