C-section recovery: what to expect (2023)

A caesarean section is major abdominal surgery that allows surgeons to deliver a baby by making cuts in the abdomen and uterus. Cesarean sections can be planned (elective) or unplanned (emergency). Emergency c-sections are performed for a variety of reasons, including when vaginal delivery is unsafe for mother and baby, which can be the case with prolonged labor, when the baby does not fit in the pelvis (pelvic head disproportion or CPD), abnormal placenta (when the placenta is on the cervix or deep in the uterus or surrounding organs), and fetal distress (when the baby has abnormal heart rate changes in utero).

A planned caesarean section occurs when the caesarean section is planned in advance (before birth) because of a history of previous caesarean sections or at the mother's request, rather than a vaginal delivery without medical or birth-related problems. Planned cesarean sections are usually scheduled at 39 or 40 weeks of pregnancy.

During surgery, an obstetrician makes a 6- to 7-centimeter horizontal (near the pubic line) or vertical (below or above the navel) abdominal incision that cuts layers of skin and muscle down to the uterus. The obstetrician then delivers the baby through the incisions and removes the placenta before closing the incisions with stitches.

Preparing for a Cesarean

Before a cesarean section, the patient may have blood tests to check for anemia because the risk of blood loss during a cesarean section is increased. Cesarean section patients also usually have a preoperative consultation with an anesthetist to discuss pain management options.

Other common preoperative instructions often include:

• Avoiding solid food for a period of time before surgery (as recommended by a healthcare professional)
• Filling prescriptions for certain medications, such as antacids, strong pain relievers, and drugs to prevent blood clots
• Take a bath or shower before the operation, paying special attention to cleaning the abdominal area
• Stock up on nursing pads, bras, and loose-fitting clothing for post-op comfort
• Stopping certain medications before the c-section
• Arrive in the preoperative area prior to surgical time (as instructed by your provider)

instant recovery

A typical C-section takes about an hour: the baby is usually delivered in 10 to 15 minutes, and suturing the incision takes the rest of the time. In emergencies, the time between the obstetrician's decision to perform an emergency caesarean section and the delivery of the baby is called the delivery decision interval. The recommended delivery interval when the lives of mother and child are in imminent danger is 30 minutes. If the situation is not fatal, the delivery interval can be up to 75 minutes, according to the National Institute for Health and Care Excellence^[2]cesarean delivery. National Institute of Health and Excellence. Accessed on 11/16/2022..

After delivery, you will be transferred to a recovery room where a nurse will check you regularly and check your vital signs (blood oxygen, heart rate and blood pressure levels), pain levels, firmness of the uterus, area of the incision and the amount of vaginal bleeding.

"Breastfeeding [due to problems with breast milk production] can be somewhat delayed [after cesarean delivery]," notes Kate Woeber, Ph.D, certified midwife and associate professor in residence at the University of Nevada, Las Vegas. Breast milk production can be affected by the mother's stress caused by a c-section or by a reduced release of oxytocin – an important breastfeeding hormone. According to a study published in 2016, factors that may delay the initiation of breastfeeding after a cesarean section include separation of mother and baby (reduced skin contact), low birth weight, insufficient milk production, low capacity of baby sucking or refusal to breastfeed IBMC Pregnancy and Birth Diary^[3]Hobbs AJ, Mannion, CA, McDonald SW, et al.The influence of cesarean section on the onset, duration and difficulties of breastfeeding in the first four months after delivery. BMC Pregnancy Birth 2016(90)..

“This will help ensure that the mother's pain is well controlled so that she can breastfeed whenever the baby shows interest and that skin-to-skin contact is facilitated. A breast pump and professional support (from a lactation consultant) should also be available. For some people, pumping breast milk before birth can help," says Dr Woeber.

The first day after a c-section is often the hardest and it can be painful to move. Take all prescription pain relievers on time, and time your bathroom or bedroom visits to coincide with starting pain medication, suggests Dr. Wober before. Going to the bathroom and emptying your bladder every few hours helps control bleeding and cramping and reduces your risk of blood clots, she adds.

week one

At this stage of recovery, you will likely experience severe pain: expect numbness, itching and increased tenderness at the incision site. You may also experience pain in other parts of your body, such as B. your back and ribs, which can leave you feeling tired, sore, and unable to carry out most daily tasks. Therefore, it is important to follow all of your surgeon's post-operative instructions. "I strongly recommend that you stay on top of your pain medication," says Teen. "C-section pain can be quite intense, especially in the first week or two after surgery."

Also, expect vaginal bleeding known as lochia. “This [bleeding] is your body’s way of removing leftover blood, bacteria, mucus and tissue [from pregnancy]. It can take up to six weeks after a C-section,” explains Teen. "Use pads to control bleeding instead of tampons because [tampons] can lead to infection. Initially, your lochia may be heavy and dark red, but the amount and color should decrease over six weeks," he adds. If the bleeding persists for a long time, contact your doctor.

A c-section is a major operation, so it's difficult to recover while caring for a newborn. Dr Woeber recommends enlisting help if you're available for anything other than feeding your newborn and caring for yourself, such as:

Second week

"In general, though, most things should start to improve over time. In addition to reaching out for support, if available, the trick to a healthy recovery is listening to the signals your body is sending you," says Dr. Woeber. For example, if you're cramping or bleeding more than the day before, extra rest is appropriate, she adds.

Another symptom to look out for during this time isbaby blues, according to Dr. Woeber. While most people experience postpartum blues, fatigue, and tears after giving birth, these symptoms are usually relieved with more rest. However, the mother may have postpartum depression if symptoms are severe and last for more than two weeks (whereas resolution of symptoms within two weeks is called "baby blues"). In that case, professional help is key, says Dr. Woeber.

"You may also be asked to return to your doctor during this time so that he or she can review the surgical incision. At that point, you are usually healed, with reduced bleeding and minimal post-pain, and breastfeeding may be easier," says the doctor Woeber. "One thing that may not improve for some time, however, is fatigue - which is not surprising given that parents are caring for babies who have no idea what time it is and who don't have regular schedules for many months," she explains.

third week

According to Teen, by the third week, lochia should be significantly reduced. Bleeding can occur in women for up to six weeks after giving birth, but you should notice a reduction in the amount, she adds.

"If you feel ready, you can start doing light exercise at this stage, depending on how you feel and what your doctor recommends. Start with a short, slow walk around the block, and gradually increase the distance when you feel physically ready" , says Teen. However, avoid strenuous exercise or heavy lifting until evaluated at your six-week postpartum appointment, she adds.

weeks four and five

Vaginal bleeding may be minimal or absent, and your pain should be (mostly) manageable, according to Teen. With proper care, your incision should heal well. Some women continue to experience pain or a pulling sensation at the incision site at this point in the recovery period, she adds.

sixth week

You'll likely have a postpartum visit this week, during which your gynecologist will examine you, review your incision, discuss how your recovery is going, and let you know if you've gotten rid of your physical limitations, says Teen. "Once you're free at your postpartum appointment, I highly recommend c-section scar mobilization—a technique that promotes elasticity at the incision site and reduces pain," she adds.

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Here are some guidelines to help with your recovery process, according to available experts and research.

wound care

According to Teen, follow these steps when caring for your incision:

• Wash the area with mild soap and water (usually while showering), gently applying soap and rinsing under running water. Avoid rubbing the site. Dry the area. A wet incision can increase the risk of infection at the incision site because . Bacteria thrive in moist areas.
• If your doctor instructs you to keep the area covered, let it dry completely before changing the dressing.
• Avoid applying creams, perfumes, or oils to the area, as these products can cause irritation or infection.
• Avoid soaking or swimming in a bathtub or hot tub until you get approval from your provider.
• Apply light pressure to the incision (with a pillow or towel) whenever you cough, sneeze, or laugh.
• If you have Steri-Strips (a type of bandage) over your incision, you can wet them when you shower. They will fall off on their own, so avoid rubbing or picking at them.

the motionless position

“A lot of pillows or a good breastfeeding pillow are helpful for anyone breastfeeding a newborn, but especially for people with a c-section scar,” says Dr. Woeber. Underarm breastfeeding, also known as the "football position", uses pillows for support while sitting upright, as well as under the arm, while cradling the baby between the arm and side to avoid pressure on the incision while breastfeeding. Another supported position is to lie on your side, supporting your back, shoulders and neck with a pillow and allowing your baby to nurse while lying down and facing you.

Trying out breastfeeding positions can help to avoid excess pressure on the belly and reduce the pain of breastfeeding.

physical activity

Below are recommendations for activities to try or avoid during recovery:

• Avoid lifting anything heavier than your baby for the first six to eight weeks after a c-section.
• During the first few weeks of recovery, according to Teen, avoid exercises that stress your core (abdominal muscles), such as B. twisting moves, sit-ups, planks, squats, jumps, jogging, biking, or driving.
• Exercise should be avoided for many weeks after major surgery, but light activities like walking are recommended to help prevent depression, blood clots, constipation and other illnesses, says Dr. Woeber.
• Do without any strenuous house cleaning.
• Avoid repetitive use of stairs, Teen says. If you can't completely avoid stairs for the first few weeks, try to limit the number of times you go up and down in a day, she adds.
• Avoid sex until your provider gives you the green light, usually at your six-week follow-up visit.

Red flags for cesarean section recovery

Some emergency symptoms to look out for after a c-section are:

• Redness, discharge, swelling or opening of the incision
• Persistent fever above 100 degrees Fahrenheit
• severe abdominal pain
• heavy vaginal bleeding
• Swollen legs, face or hands
• Feelings of sadness or depression

Do not hesitate to contact your doctor if you notice these changes or other worrying symptoms.