C is for Cesarean Recovery

These days it is not uncommon to labor for hours and possibly even push for hours, and end up needing a cesarean to deliver your baby.  If this happens, it means that your recovery is going to be hard.  Your body is tired and sore from the strains of labor, and then add on major abdominal surgery to that, and you are likely to be in a lot of pain.  If this happens, remember that it was the best choice for you and your baby – if you labored/pushed for hours with no change it likely means your baby was in a less than ideal position and may not have changed to allow for a vaginal birth.  Or you may have chosen to schedule a cesarean for personal reasons or due to having a previous cesarean.  In extreme cases, you may even have needed an emergency cesarean. 

No matter the reason for having a cesarean birth, your recovery will still be difficult.  Emotionally you may be happy with your cesarean, be dissatisfied, or even experience depression.  Your emotional response plays a large part in how quickly you may recover.  If you are struggling to accept your cesarean, try talking to your partner, doula, or a therapist, they may have another perspective on your cesarean that can help you to accept and/or even embrace your cesarean.

After the surgery, be prepared to have full body shakes – this is a reaction to the anesthesia.  It can be annoying and strange as your body shakes involuntarily; warm blankets may help but won’t stop the shaking.  This shaking will usually stop within a few hours.  Depending on the medications used by your anesthesiologist you may also be groggy, itchy, and nauseous.  After the surgery you will also get these cool leg cuffs to massage your legs and prevent blood clots, these cuffs are called sequential compression devices, SCDs.  They will inflate and deflate frequently, just like a blood pressure cuff.  Your cesarean recovery will also include fundal massages, afterpains, and vaginal discharge just like a vaginal birth, so be prepared for those as well.

Depending on your hospital you may go to a post-op area right after the surgery for one to two hours before going to your recovery room, or you may go straight to your recovery room.  Your doctor may limit you to a liquid diet for the first few hours, to ensure you are able to keep liquids down before eating something with more substance.  You may also get shoulder pains after the surgery; this is referred pain caused by the buildup of gas, so try to limit food and drinks that make you gassy.  Be prepared for pain the first time you urinate, this stinging is from the catheter (usually removed twelve hours after your surgery) that was used during the surgery, but will go away quickly.  Your incision will usually be closed with dissolvable sutures or staples.  If closed with staples, they will be removed before leaving the hospital.  Once you are able to walk steadily, you are also able to shower, which will feel amazing!  Usually you will stay in the hospital 48-72 hours following your cesarean.

Some things that can help with the recovery process are:

Having a Gentle Cesarean:

If you choose to have a cesarean, your emotional recovery will likely be easier than if you had to have an emergency cesarean.  These days many hospitals are open to a cesarean birth plan to include dim lighting, soothing music, immediate skin-to-skin, and even a clear surgical drape if that interests you.  Ask the anesthesiologist and staff to put all IVs, straps, and medical equipment on your non-dominant arm so your dominant arm is able to hold, or at least touch your baby freely.  If you plan on breastfeeding, ask that all medications are safe for immediate nursing.  Some moms even consider vaginal seeding as explained in the movie Microbirth.

Staying Hydrated:

This is important with vaginal births as well.  Dehydration after your birth can lead to constipation, which can be very painful, and the resulting pushing will put a lot of strain on the cesarean incision. 

Get Some Sleep:

…Or as much sleep as you can with a newborn.  After any major body strain, especially surgery, your body needs rest to recover.  Your body heals faster while you sleep as you aren’t exerting energy doing anything else.  Consider utilizing the nursery overnight while still at the hospital.  If you plan on breastfeeding, just make sure you give them strict instructions not to feed your baby formula or give him/her a pacifier, and to bring your baby to you every 3 hours to nurse.  When you are discharged, consider hiring a postpartum doula to help with nights or even a few hours during the day so you can get some restful, uninterrupted, sleep. 

Belly Binding:

Using a belly binder or wrap during recovery can help put less strain on the incision.  The belly binder puts light pressure and compression over your midsection including the cesarean incision.  Some belly binders are like extremely high-waisted underwear to prevent the binder from sliding up, while others wrap only around the abdomen.  You can use the binder immediately following the procedure once you have enough feeling back to allow movement.  The binder can help you heal faster and also holds your stomach and organs in place making walking and moving more comfortable.  Using a binder also eliminates the need to hold a pillow over the incision when you need to sneeze, cough, laugh, stand, or turn.  If you don’t plan on wearing a binder, definitely make sure to get some high wasted underwear, high enough that the elastic band won’t rest on your incision. 

Medications:

Make sure you stay on top of taking your medications.  If you wait until you feel pain to take your medications, it will take time to feel relief.  If you take the Ibuprofen every few hours as prescribed you should be able to stay comfortable.  Staying pain free is the best way to be able to bond with your baby; it is hard to bond when in pain.  You will likely need pain relief for at least the first one to two weeks.  You will also be prescribed a stool softener; you will want to take this as prescribed to make sure you don’t have to strain to use the bathroom which will cause incision and other discomfort.  If you are taking medications stronger than Ibuprofen, make sure to ask your doctor if they are safe to take when nursing. 

Scar Massage:

When you have a cesarean, your abdominal wall is cut as well as your uterus.  This means you have two incisions healing.  When you have a major surgery involving incisions, there is a chance your scar tissue will adhere where it shouldn’t-- to the other organs or tissues surrounding it.  If there is an adhesion, this can lead to lasting pain in the incision area.  When your incision is fully healed, no more bleeding or scab, it is safe to begin massaging the scar.  Your scar will seem big and very prominent at first, but over time it will heal and shrink and the color will lighten.  Once fully healed, a scar cream may help decrease its prominence even more.  To learn the best way to massage your cesarean scar, watch the video below.  This may also help soften the scar tissue, prevent bladder incontinence, prevent pain with sex, and help with lower back pain. Remember to readdress your scar tissue every so often in the coming years with a quick massage.

Other Suggestions:

As soon as the cesarean medication wears off, get out of bed and get moving – with assistance.  Try to make sure you are moving within 24-hours of the surgery.  Move at least once a day or have someone massage your legs to help prevent blood clots.  While sitting or laying you can also wiggle your feet, rotate your ankles, and move and stretch your legs to help keep your blood flowing.  Eating healthy will give your body the nutrients it needs to heal.  Avoid drinks with bubbles (sparkling water, sodas, etc.) and using a straw as this can cause gas and great discomfort.  Take a break from household chores when you get home, focus on you and your new baby – leave the chores to others.  For six weeks following your surgery you should lift nothing heavier than your baby.  Limit the number of times you take stairs to once or twice daily the first few weeks.  Rocking in a rocking chair can be a good way to speed recovery as well.  Avoid taking a bath until your incision is fully healed.

You should call your doctor if your incision is bleeding or has pus, redness, swelling, or leaking.  Dizziness, headaches, back pain, and cramping or pain in your legs that doesn’t go away can all be signs of a problem.  Also, if you have a fever, be sure to call your doctor.  It is normal for your incision to itch and have some numbness, but if the itching is severe you may want to talk to your doctor.

Cuddle your baby as much as possible, do skin-to-skin, and nurse frequently the first few weeks to encourage bonding and the release of positive hormones.  Some ideal positions for breastfeeding after a cesarean include the football hold and the side-lying hold, these allow you to nurse your baby without putting any pressure on your incision.  Your milk may also take a few days more to come in.  Until then, nurse your baby as much as possible to encourage it.

When getting in and out of bed, try rolling to your side, dropping your legs off the bed, and then pushing yourself up to sitting.  This will put the least amount of strain on your incision and abdominal muscles.  Then stand up very straight to help stretch your back and abdomen muscles each time you get out of bed.

When choosing what to wear, you want to find clothes that will not rub your incision.  Maxi dresses or leggings with a long shirt are great options that won’t rub directly on your incision.  Latched Mama makes some wonderful breastfeeding clothes that are comfortable during cesarean recovery, including hoodies for the colder months.

Having a cesarean birth does not preclude you from having a vaginal birth later.  If you want more kids and would like to have a vaginal birth, it is still possible.  Find your local ICAN chapter, International Cesarean Awareness Network for vaginal birth after cesarean, VBAC, support. 

What helped you most during your cesarean recovery?

Next week I will be blogging about the letter D… D is for Discharge – when and how you will be discharged from the hospital.