Cesarean Birth

The truth is that cesarean birth rates are increasing across North America, with rates ranging from 1 in 4 to 1 in 3 births occuring by cesarean delivery. There is an increasing chance that if you are pregnant in Canada or the United States, you may end up delivering by cesarean. Therefore, all pregnant women need to inform themselves about the procedure, their rights and what their recovery might be like.

Recovering from a Cesarean – Tips on Healing
After The Cesarean – What to expect & recovery information

Recovering from a Cesarean: Tips on Healing

Congratulations on the birth of your baby! While this is an exciting time for you and your family, a cesarean is major surgery and you may be feeling sore and tired. New mothers like you need and deserve extra support during this special time of birth and healing. Women who have experienced either a planned or an unplanned cesarean respond to the surgery in very different ways. Physically, some women heal very quickly while others report that recovery took weeks or months. Women’s feelings about their cesareans range from happiness to depression. Each woman heals and grows into her new role of mother at her own pace and it is important not to put time limits on this process.

Healing in the hospital:

• Ask for assistance when you need it and keep the nurse’s call button within easy reach.
• If possible, obtain a private room so that a family member may remain with you.
• Take pain medication as needed for comfort. Many mothers have found that narcotics (like codeine) can manage pain very well but can also cause constipation. Ask your doctor about using a stool softener.
• Use pillows to support your stomach when turning, standing, coughing, and nursing.
• Rest as much as possible and limit visitors. Sleep when the baby sleeps.
• When you are ready, take short walks to prevent blood clots. If you cannot walk have someone massage your legs and ankles in bed, and keep your feet raised on a pillow. Also consider using medical support leg hose to prevent clotting if you cannot move or have to travel within six weeks of the cesarean.
• Eat healthy food and drink plenty of fluids. Avoid soda and drinking with a straw since that can make you swallow air and cause gas.
• Remember to urinate at least every 3 to 4 hours. This helps avoid or reduce the bladder pain that some mothers have after the surgery.
• If you are planning to breastfeed, talk to your nurse or a lactation consultant about positioning that will be comfortable around your incision. While some women experience a delay in their breast milk production after a cesarean, extra support will help you get a good start.

Healing at home:

• Take care of yourself and your baby only.
• Remember not to lift anything heavier than your baby for four to six weeks after surgery.
• Have a list of tasks ready for when people offer to help and don’t be shy to ask people for help.
• Let others do household chores like cooking, cleaning, and laundry. Have frozen meals prepared.
• If you have other children, ask a family member or friend to help you with their daily routine.
• Consider enlisting the help of a postpartum doula or other support person for your recovery.
• Have several diapering areas so you can change your baby easily.
• Clothe yourself based on what you need. Staying in your pajamas can remind people that you are still recovering from birth and need extra help. On the other hand, taking a shower and getting dressed can help you feel refreshed and recharged.
• Keep the baby near you at night so you do not have to get up.
• Fill a basket full of little useful things that you can carry with you. Items can include healthy snacks, your medications, a book, lotion, or a cordless phone.
• Eat well and drink plenty of fluids. Have a pitcher of water or juice near you.
• Increase activity slowly.

Call your doctor if you have any of the following symptoms:

• Any bleeding in your incision. It can mean the surgical stitches have separated.
• Unrelieved pain, or if the pain has increased.
• Pus, leaking, redness and swelling in your incision, which can indicate an infection.
• A fever can also suggest an infection, most likely in your incision.
• Pain or cramping in your arms or legs that will not go away is a serious symptom and can suggest the presence of a blood clot. Other symptoms can include sudden swelling in the arm or leg, red or discolored skin, and skin that is warm to the touch.
• Continuous headaches, dizziness or back pain could suggest after-effects of the anesthesia used during surgery.
• Symptoms of postpartum depression can include tearfulness, anxiety, appetite changes, sleep problems, extreme fatigue, and difficulty focusing your thoughts, among others.

Long-term healing:

• Keep your baby near you as much as possible.
• Vitamin E capsules can improve the skin on the cesarean scar. Wait until the scar has healed, open a capsule, pour the oil on the scar and rub slowly.
• Share your feelings with others who understand how you feel and talk about your experience as much as you feel necessary.
• Write the story of your experience, with as much detail as possible.
• Seek support from available resources including breastfeeding, parenting, and cesarean support groups like ICAN. Look for an ICAN chapter near you or join the online ICAN community.

For more support:

Call ICAN toll-free: 1(800)866-ICAN(4226)
For the ICAN website: http://www.ican-online.org
To find an ICAN chapter near you: http://ican-online.org/chapter/search
For the ICAN online community: http://ican-online.org/community/email-support-lists

This may be copied and distributed with retained copyright.
© International Cesarean Awareness Network, Inc. All Rights Reserved.

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After the caesarean

The stay in hospital

Expect to stay in the hospital for a minimum of 48 hours. In many hospitals this stay will be longer (3-4 days) particularly if you or your baby are taking a little longer to recover.

In hospital you have lots of professional support around you. This can be very useful particularly if you are a first time mother trying to get to grips with breastfeeding. The staff are there to help you and can be a wonderful resource. However be aware that some hospital staff can be very pushy about what you should and should not be doing and about what is best for your baby. You may find that being at home is calmer for you. Play it by ear once you are on the ward.

You should be checked every half hour for the first 2 hours following the surgery. This will typically check respiratory rate, heart rate, blood pressure, pain, and anaesthesia. After this 2 hours, observations should be hourly for the rest of the day provided that the observations are stable and satisfactory ^[1].

Your catheter should remain in place for no more than 12 hours. Removal is usually pain free. If you are able to walk then it can be removed earlier as this reduces the likelihood of infection.

Your pain relief may vary according to the type of pain relief you had during the surgery. Often a pain-relieving suppository will be inserted before you leave theatre and the other local anaesthesia will still be having effect for an hour or so. Following this you will usually be given pain relief in tablet form according to a strict schedule. This tablet is likely to be at least paracetamol. Some women are amazed that something like paracetamol will be sufficient given that it does not always get rid of your headaches, but it usually works fine.

You may also feel a little nauseous, though this should wear off after a couple of hours. If you have a general anaesthetic, you will probably be offered patient controlled analgesia for up to 3 days. This may be a morphine drip and is self-administering, simply pressing a button on the drip to receive a new dose of the drug.

A drain may, in rare instances, be fitted at the site of the incision. This collects any blood that might otherwise pool under the scar. This is usually removed in a day or so. This should only be used if there is a problem with the incision site ^[1].

You have an intravenous drip in your arm, to replace lost fluids. Usually this remains in place only for the first few hours after the surgery.

Getting out of bed will be encouraged within hours of having the surgery. It is a good idea to time this for when your most recent pain relief has just taken affect. If staff are insisting you get up, only do so when you feel that your pain relief is sufficient. While walking around may seem like a strange thing to do straight after such surgery, it is actually most important for circulation. It helps prevent constipation and blood clots Deep Vein Thrombosis (DVT). You will be encouraged to do ankle exercises while in bed to help circulation too. Keep you hospital stockings on. They make you look a bit like a schoolgirl but they are very important in helping to prevent Deep Vein Thrombosis (DVT) ^[2] and you will be encouraged to keep these on for the duration of your stay.

Picking up your baby is entirely possible following a caesarean. It is a myth that you will not be able to care for your baby yourself. Certainly you cannot rush to your baby’s side, it is rather difficult getting out of bed in the first day or two (although certainly not impossible). The same can be true for a woman who has had a difficult vaginal delivery. But once at the cot there is no reason why you should not pick up your baby, change and feed him/her. Having to get up frequently to your baby will be a bit tiring at first but use the staff who are there to assist you. Some women feel guilty or intimidated by members of staff who may seem too busy or harassed to assist regularly. You can choose to keep your baby with you on the bed most of the time, staff will help you create a nest so that your baby cannot slip off. It is important to follow the health professionals advice in setting this up safely.

Breastfeeding is the same as for a vaginal birth. It can be easy or challenging and the caesarean itself is not likely to affect your ability to breastfeed (your mental attitude to having had the caesarean might). It might be wise in the first few days to protect your incision site from little feet by placing a cushion over the incision site. Soon you will learn the ways of your baby and the cushion will probably not be required. There are several ways to hold your baby and you might want to try each these until you find the one or two that suit you.

Snacks are essential. Depending on when your caesarean occurs you may arrive back on the ward at a time when there is not likely to be any food available. Take in light snacks and drinks in your hospital bag so that you can supplement the hospital food whenever you feel the need. It is a good idea to drink fluids as soon as possible to help your bowels to loosen (the procedure can slow down bowel movement and cause constipation).

Showering is entirely possible once you can walk. The important thing for your first shower is not to rush it. In many instances you will be encouraged to get out bed the day after surgery to have a shower. Lifting your arms above your head i.e. to wash your hair, may feel a bit unsteadying at first. It is not impossible as long as you don’t rush. You may also be encouraged to remove the bandage over your incision site at this stage, it is far easier to do this in the shower. This seems incredibly early but you will be surprised to find that the incision site has already sealed. It is quite a daunting prospect but in most instances there is very little to see, the stitches will be internal, blood will have been wiped away prior to the bandage being put in place. You may feel that your insides are falling out. It is important to remember that your abdomen muscles have stretched during pregnancy and it is lack of muscle tone that is causing this sensation. For a few days you may feel as if you want to walk around with your hands over your incision site. If it makes you feel better, do it, but it really is not necessary. This sensation is the same as reported by many women following vaginal births.

Sensations after the birth

• The level of pain experienced post-operatively varies from one woman to the next. It may be anything from feeling unable to do any activity alone to mild discomfort when trying to get out of bed. The level of post-operative tiredness is likely to be lower following an elective caesarean than an emergency caesarean as an elective is not also recovering from labour fatigue.
• Wind trapped in your abdominal cavity can be uncomfortable, but drinking peppermint tea from the outset of your recovery usually significantly reduces this. You can also take homeopathic remedies (i.e. arnica to help reduce bruising) but should check that these are compatible with breastfeeding.
• Uterine cramping is the same as for a vaginal birth. These cramps are the contractions that help your uterus return to its original size. These cramps may coincide with starting a breastfeeding session. If you did not experience contractions (or Braxton Hicks during your pregnancy) this can be a surprise and may be rather uncomfortable. It is often described as feeling like a bad period pain. Some women do not feel these uterine contractions at all.
• Walking will cause some difficulty for the first 24 hours or so. It may make you feel like you need to hunch over. You may also feel like you need to hold your insides in, this sensation occurs with many vaginal deliveries too and is actually associated with the stretching your abdomen has experienced over the pregnancy rather than the incision. The discomfort of the first 24 hours should ease rapidly over the next few days.
• It might hurt to cough or laugh – if you hold your hand over the incision site this can be lessened. In some hospitals a physiotherapist may visit you to talk through this sort of thing and possible post-operative exercises.
• Going to the toilet is the same as for a vaginal birth. Indeed in some cases it will be far less painful or frightening an experience as compared to a vaginal birth as there will be no open incision sites in this area. You should be given medication to help with constipation. If you have not and you feel it is becoming a bit of a problem, you can ask for medication. Such medication should certainly form part of the set of drugs that you take home with you. Drinking lots of water and eating plenty of fruits will help prevent this problem.
• Post-operative loss of blood is the same as following a vaginal birth. Some women are surprised that they still have this if they have had a caesarean. You will need special sanitary towels (their extra length is important given the fact you are likely to be lying down so much of the time). Disposable pants might look quite undignified (and some women do not find they are necessary) but they can be excellent in the first few days because they are very stretchy (fitting over your still distended abdomen) and more particularly the elastic line is well above the incision site. Fitting into your pre-pregnancy underwear is not going to be possible until your uterus shrinks a little and this may take several weeks.
• General aches can be particularly noticeable if you started labour before having your caesarean, but for elective caesareans it will only really be noticeable around the incision site, if at all.
• Numbness, in and around the incision area is natural until the anaesthetic wears off. For some people this will continue even after the anaesthetic has worn off. It may also feel like mild neuralgia (tingling and sensitivity) for a time, this too usually disappears. For most women this sensation decreases over time (weeks) but for some it may be that total sensation to this small area never completely returns.
• Itching as the incision heals is common as for any cut or abrasion. For some women itching may continue for some time. If this is accompanied by fever, chills, fluid or dizziness contact your doctor, as it may be a sign of infection.
• The size of your abdomen can come as a bit of a surprise after any type of birth. Whether you had a caesarean or a vaginal delivery your abdomen does not return to it’s pre-pregnancy size immediately. Immediately following the birth you may be surprised to find that you still look 7 months pregnant. This swelling will decrease with the uterine contractions and weight loss. As the swelling decreases you may notice a slight puffiness around the incision site, this decreases with time and exercise and usually disappears altogether.
• Sharp twinges may occur at the site of the incision, you will quickly learn the things that cause this i.e. twisting or lifting. These twinges are also common at the site of an episiotomy after a vaginal birth.
• The incision site itself may feel tight or you may experience slight pulling sensations in your lower abdomen. These are common sensations and can be helped with Vitamin E creams and homeopathic remedies. As with most products you should consult a doctor before using such remedies, particularly if you are breastfeeding. The look of the incision site will vary from person to person. For some this may start as a red line, for others this may be a small pink line immediately. The vividness of the line will decrease with time (Vitamin E is thought to help with this too) and after a couple of years will be a barely discernable fine white line.
• Weepiness and mild depression is common in women following a delivery whether vaginal or caesarean. However following an unplanned caesarean this is more likely. Women have reported feeling depressed when their expectations for their birth have had to change. The more flexible your birth plan, the more likely you are to have considered a caesarean as a possible outcome of your birth. The importance of prior research and flexible birth plans should not be underestimated.

First weeks at home

As you will be told over and over "a caesarean is major stomach surgery". While you will certainly get very tired of hearing this during your pregnancy, there are a few things that are worth thinking about:

• Support once at home – after a caesarean you’re vulnerable to the same depression and fatigue that can affect women who have vaginal births. Don’t hesitate to ask friends and relatives for help, particularly if you have a toddler, they are not going to understand why you cannot pick them up for a few weeks. Friends can run errands, watch your baby while you nap, keep you company, or give you and your partner a break. If you ever feel overwhelmed, call your doctor and explain your situation. Community resources such as visiting nurses or new parents’ support groups may be available to help you.
• Your mental attitude to the birth is important. If you understand the reasons for the caesarean and were involved in the discussions prior to consenting to it you are far more likely to be able to view the birth as a positive thing. Once in recovery if you are prepared to be slow on your feet for a few days, the surprise will be lessened. Having a realistic expectation of your recovery, whether your delivery was vaginal or caesarean is important. Following both modes of delivery women report it takes up to 6 months to feel like they are relatively ‘normal’
• Drink lots of fluid – as for a vaginal delivery, you’ll need extra fluids to replace those lost in delivery and breastfeeding. For a caesarean, emptying your bladder frequently will to help reduce your risk of urinary infections
• Adhere to the advice to "take it easy" in the days immediately following the procedure, this applies whether you have had a caesarean or a vaginal delivery. Avoid housework, and don’t lift anything heavier than your baby. Think about putting everything that you and your baby might need on the same level in your house so you don’t have to go up and down stairs continuously. Make a nest on the couch and nap there during the day. Get as much help as you can with your cleaning, food preparations, and other children
• Limit the visitors during the first week – while they will be very excited for you, they will keep you from getting the rest you need to recover and care for your baby. Studies suggest that all the interruptions can be disruptive and intimidating for your baby too. Some health carers suggesting that babies should not be introduced to more than a couple of new people in the first week ^[3]
• Exercise – following any birth this should be taken slowly. Many women prefer to wait for their 6 weeks check up before starting to exercise. Finding information specific to a cesarean is quite hard to find so it is a good idea to check with your care provider.
• Use the belly support – you may have been using one of these while pregnant. It can really help when you get home, just for those first few days. It can make laying on your side and rolling over in bed much more comfortable
• Pain relief – on leaving the hospital good pain relief should be provided automatically. There should be enough to last you a couple of weeks. If you are not given medication you should not leave the hospital until you have it
• Some hospitals offer the facility to discuss your birth after you have returned home and settled in. It is a good idea to take them up on this. Any feedback that you receive will be of relevance to your overall memory of your birth and you may still have questions about it in any case. It is also good to give them feedback as this helps to refine their processes

Continuing hurdles

• Going to the toilet may still seem scary. As long as you do not strain there is nothing to worry about. If you feel constipated eat plenty of fruit and consider taking the medication that was sent home with you for this purpose
• Bending over to view your nether regions may be difficult in the first few days, but the ability quickly returns
• Don’t expect to be able to leap out of your chair to answer the door for several weeks. A woman that has had a vaginal delivery shouldn’t expect to be able to do this either
• Don’t try to drive for several weeks, until you can deal with making the sudden movements you need to make when driving in traffic. In the UK, you will usually be advised to wait about 6 weeks before you try to drive. Many women feel able to drive well before this time. However, it is important that you are able to be in full control of the vehicle, and this would include being able to do an emergency stop without hesitation due to pain or the fear of pain. Before you take the car and baby out together, make sure you can manage your baby’s car seat without hurting yourself. There is also the issue of car insurance. Although most insurance companies will be able to reassure you that your cover will not be affected, it is worth making sure that yours is not an exception. Occasionally companies will advise getting written confirmation from a doctor that you are fit to drive. Some women feel fit enough to drive after just two weeks. Be aware that the strain of driving can put undue pressure on newly forming scar tissue. But providing you are recovering well, and that you have checked your insurance cover, you may be able to make the occasional journey before the six weeks deadline
• Sex, whether you have delivered vaginally or by caesarean, might feel an impossibility both mentally and physically for weeks if not months. It is generally recommended that you avoid having sex for 4 to 6 weeks after the birth (same as for a vaginal delivery). Some women prefer to wait until they have had their 6 week check, for others it is a relief that at least one part of their life can start to return to normal before then. For both a vaginal and a caesarean birth it is completely normal to have little interest in sex while breastfeeding and recovering from the birth. Conversely some women feel highly sexual following the birth. Both responses are absolutely normal. All couples regardless of the delivery they experience face a time of adjustment. When you first make love after your caesarean you may feel some initial tenderness and tightness in your abdomen. Relaxing as much as possible and using a lubricant will help make it less stressful. You may prefer to be on top so that you can control the degree of penetration, or you may find that the "spoons" position is the most comfortable

Reprinted with permission from csections.org