Caesarean recovery

Every woman is different when it comes to caesarean recovery, depending on the circumstances of the caesarean. If you’ve had your heart set on a vaginal birth, possibly a natural one at home or a birthing centre, then a caesarean may leave you feeling very upset, cheated and disappointed.

Although this won’t necessarily affect your physical recovery, it could take some time to recover emotionally from the possible trauma of an emergency c-section. Even a woman who’s had an elective caesarean may feel down about it afterwards. On the other hand, some women take it all in their stride, be it an emergency or otherwise.

Fortunately, the euphoria and excitement of having a beautiful newborn baby and attending to its care usually helps to take a new mother’s mind off any disappointment or trauma. However, many women do ask for counselling to help with the emotional side of caesarean recovery, so don’t be shy about asking for it if you need it.

There are, of course, also significant physical aspects to caesarean recovery. It is, after all, a major operation! Every pregnant woman should know what happens, because even with a healthy, low-risk pregnancy there is a chance of complications that could require an emergency dash to the operating theatre.

After the birth, you’ll usually stay in hospital for several days – usually just 3 or 4 – before going home. But caesarean recovery takes weeks, not days. So when you get home, you’ll need help to take care of yourself, your new baby and any other children.

Getting plenty of rest and eating well are essential for getting over any surgery, but especially with a caesarean, as there are massive demands on your body and emotions. Caesarean recovery, breastfeeding, sleep deprivation and the rollercoaster ride of postnatal hormones can be a big workload for even the healthiest and toughest of women.

The first 24 hours after the Caesarean

Once you’ve been stitched up, you’ll be wheeled out of the operating theatre and into a recovery room where you’ll be monitored for a few hours to ensure all is well. Except under extreme circumstances, your baby will be with you, and your partner can be there too.

Once you’ve been given the all clear by medical staff, you’ll be taken to a room on a ward, which you may be sharing with one or more other new mothers and babies, or possibly have to yourself.

If you plan to breastfeed, you can start right away. Ask the nurse to help you get into a side-laying position or to show you the football hold, so there won’t be any pressure on the caesarean incision. If you find it difficult to breastfeeding during caesarean recovery because of the pain from the incision, ask to see a lactation consultant as soon as possible. The consultant will give you expert advice and guidance, including directions for correctly positioning your baby so as not to hurt your abdomen or get sore nipples.

If you had a general anaesthetic, you’ll probably be groggy for a while after you wake up, in which case you may not feel safe holding your baby on your own while in recovery. This means you may not get the opportunity to breastfeed for up to several hours after the birth.

You may feel quite nauseated during the first 48 hours of caesarean recovery, but you can ask for medication to control it. You may also feel itchy all over, especially if you’ve had narcotics in your epidural. Again, let medical staff know so they can give you something to relieve the itchiness.

Like any new mother, after a caesarean birth you also have engorged breasts, mood swings and vaginal discharge. And as the anaesthetic wears off, there will be pain – maybe a lot.

If you have an epidural (as opposed to a general anaesthetic), it is usually left in after the birth to help with pain relief during the first 12-24 hours of a caesarean recovery. A type of morphine may be added, which can provide excellent post-partum pain relief without grogginess.

If you don’t get morphine, you’ll be given systemic narcotics for immediate pain relief. This will either be given as an injection every 3 to 4 hours, or you’ll give it to yourself with a system called ‘patient controlled analgesia’. With this system, you push a button when you’re feeling the pain and it delivers medication through the IV inserted in your arm. Don’t worry – there’s no risk of overdosing as the machine controls the dosage, so you never receive more than what is safe.

If you are still in pain, tell the nurse and ask for more medication. Don’t hold back as this is not the right time for showing what a strong young mother you are - the longer you wait to ask for pain relief, the harder it can be to control the pain. If the nurse can’t help you, ask for an obstetrician. Pain can interfere with your breastfeeding and your emotional well-being. The more comfortable you are, the happier you should feel.

Not having enough pain relief can also stop you from moving around, which in turn can affect caesarean recovery.

Within the first 24 hours after the birth of your baby, you’ll be encouraged to get up and walk about. Gentle movement can aid caesarean recovery and help prevent constipation and potentially dangerous blood clots. Do not attempt to get out of bed by yourself, though. Your legs will probably be numb and may feel jelly-like after the epidural or general anaesthetic. Also, your balance could be affected and you could still be groggy. While you’re waiting to get mobile again, wriggle and point your toes, move your feet from side to side and lightly shake your legs to help get the blood moving.

Getting moving can help speed up caesarean recovery, but keep these guidelines in mind:

• Always have help from your partner or nurse
• Support your incision by holding a pillow over it
• Avoid the tendency to lean forward or hunch over – instead, stand up straight and don’t look down
• Focus on an object such as a chair or a window ledge

During the first few days of caesarean recovery, you will be closely monitored for signs of infection along the incision. The nurses will also keep an eye on your appetite, how much fluid you’re drinking, and your bladder and bowel functions.

Every few hours a nurse will check on you, to take your vital signs, feel your belly to ensure your womb is firm, and to assess vaginal bleeding. For several days after the birth, you’ll have a bright red discharge that is called lochia, which is blood and tissue from the lining of your womb.

The area of the incision site may feel numb and sore, and the caesarean scar will be slightly raised, puffy, and darker than surrounding skin. The incision will be checked and carefully monitored to ensure it is healing properly. You’ll be given instructions on how to care for it – such as how to use your hands or a pillow to support the cut when you cough, sneeze or laugh.

You’ll also be told how to cough or do breathing exercises to expand your lungs and clear any fluid that has accumulated, especially if you’ve had a general anaesthetic. If fluid remains in your lungs, it can lead to pneumonia.

Around 12 hours after the birth, providing all is well, the IV and catheter are usually removed and you can start eating again. However, you may experience gas and bloating during the first few days. This is because surgery makes your digestive system a bit sluggish. Getting up and walking around will help sort out the problem, but if it persists, tell a nurse and ask for something to help. You may be given an over-the-counter medication.

24 to 72 hours after the Caesarean

By the second day after the surgery, you should be taking at least a couple of short walks, at first with the help of your partner or a nurse. It’s a good idea to go for a walk soon after you’ve had pain relief as you will feel more comfortable and more likely to enjoy a stroll.

Your walks could include a trip to the bathroom. It’s important to go to the toilet regularly, as a full bladder puts pressure on the incision, and also makes it harder for your womb to stay contracted.

After 3 or 4 days, the doctor will remove your stitches or staples. If everything looks good, you and your baby will be able to go home. But before you leave the hospital, talk to your doctor about preventative care and pain relief during the at-home stage of caesarean recovery.

Just before you are discharged from hospital, you should be given a list of instructions for your care at home, including how to protect your scar, how to relieve or avoid constipation, and more.

It is also a good idea to finalise arrangements for the help you’ll need at home, although your partner can probably make sure this is taken care of.

Caesarean recovery at home

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You’ll probably be glad to get home where you can enjoy your newborn in familiar and comfortable surroundings.

Keep in mind that you have had major surgery and so cannot expect to entertain visitors, cook and do housework in the first few weeks of caesarean recovery. It’s likely you’ll feel fatigue, discomfort, and varying degrees of pain for the 4-6 weeks it takes for a caesarean incision to heal.

The instructions from the hospital may go something like this:

Take it easy. Get plenty of rest and don’t feel in the least bit guilty about sleeping, napping, and lounging on the sofa for as long as you need to. Keep everything you need for you and your baby within easy reach. Over-doing it in the first few weeks can set back your recovery.

Watch for infection and other complications. Report to your doctor immediately if you have any signs of infection or fever, including:

• A temperature over 38ºC
• Severe pain in your abdomen
• Sudden worsening or onset of pain
• Redness, warmth, swelling or discharge from the incision
• Flu-like symptoms accompanied by pain in one or both breasts
• Hives
• Vaginal discharge that continues to be bright red for 4 days (it should turn pink and then yellow-white)
• Foul-smelling vaginal discharge
• Burning when you pee
• Blood in your urine
• Extremely heavy bleeding that soaks a maxi pad within 1 hour
• Passing large blood clots
• Red or painful areas on your legs

Move around when not resting. Try to get up and get walking as it helps prevent complications such as blood clots and also promotes healing. Start slowly and don’t overdo it. Gradually increase your activity. Within 6-8 weeks you should be able to start gentle exercising, but you must first get the okay from your doctor.

Don’t lift anything heavier than your baby for 8 weeks.

Avoid heavy housework and other activities for 8 weeks.

Don’t drive a car for 6 weeks. This advice does vary from doctor to doctor so ask yours.

Support your abdomen. Don’t hunch over when you stand up and walk. Stand tall with your shoulders back and head held high. Hold your abdomen near the incision when you cough, sneeze, laugh, or do any other sudden movement. Use pillows or rolled up towels for support when you breastfeed your baby.

No sex, but cuddling can be good. It’s usually recommended that you wait 6 weeks before having sex again. However, keep in mind that your body may feel like a war zone for much longer than that, so sex may be the last thing on your mind for a while. That doesn’t mean you can’t do other intimate things. Spending time with your partner, even if it’s just a quick kiss and some careful cuddling for a few minutes in the morning or while baby is asleep during the day, can help you feel like a couple again. Many new parents feel especially close after a baby is born and these feelings of love can boost your well-being during a caesarean recovery. However, do remind your partner to be very careful of your abdomen, and to hold back on the bear hugs.

Take medication as needed. Your doctor will recommend what is best for you. You may need prescription painkillers for up to a week after the birth, gradually changing to over-the-counter painkillers. If you’re breastfeeding, you may be advised to avoid taking aspirin or any other medication containing acetylsalicylic acid.

Drink lots of water. It helps to relieve constipation.

Eat lots of healthy food rich in nutrients and fibre. This includes fresh fruit and vegetables. As well as helping to prevent or avoid painful constipation, you need the vitamins and minerals to help your body heal. A nourishing diet is also very important if you’re breastfeeding during caesarean recovery.

Use over-the-counter medications for mild conditions. Your doctor may suggest a mild laxative or stool softener if high-fibre natural foods and drinking lots of water haven’t relieved your constipation.

Usually within 8 weeks of a caesarean, most women are feeling back to normal. If you take a bit longer, don’t worry. Caesarean recovery varies from woman to woman. But if you feel your caesarean recovery is taking too long or there’s something wrong, see your doctor.