What to expect after a Cesarean Section

Having a new baby has its own challenges combine this with recovering from an abdominal operation and you have life after a Cesarean section. This will include dealing with trapped wind, engorged breasts, poor pelvic floor, the need to take regular pain relief, treatment for the risk of deep vein thrombosis (blood clot in the leg) and caring for your newborn with limited mobility.

I am here to help prepare you for what to expect following the procedure and how you can help yourself.

Neither of my births with our daughters went quiet how we planned. My first was long and drawn out - far from the tranquil water birth I had envisioned. I ended up in theater with an epidural and a forceps delivery. Don't get me wrong by that point I was happy for her birth to be by any means necessary. With my second, knowing what I know about how labours work, I was expecting a quicker, easier labour and be able to get the pool birth I so wanted. NOPE! Our second daughter was breech from very early on. I tried reflexology and acupuncture methods as well as physically turning her from the outside (this is called external cephalic version - ECV - where a trained professional tries to make the baby do a somersault in the womb) but she was not having it! She kept bouncing back so after discussion about the best methods of delivering her safely we opted for a cesarean section.

From this personal experience of having a cesarean section as well as what I have learnt over the past 9 years as a qualified midwife I have compiled some tips for recovery....

PAIN RELIEF

You will be prescribed pain relief to begin once you start to feel uncomfortable after you come out of theater. You should take these on a regular basis in the first 48 hours while you begin to mobilise out of bed, deal with your new baby and establish feeding. Then take them as you need for the next 5-7 days - but no more than prescribed! If the regular pain relief is not keeping you comfortable you must tell the staff as there are changes they can make and adjustments to ensure you remain comfortable.

TRAPPED WIND

Trapped wind is a common problem following an abdominal operation due to having to disturb your intestines. It can cause deferred pain in your shoulders.

I have to admit people underestimate the pain of trapped wind. It can be worse than the pain from the operation site.

· Early mobilisation will help, ensure you mobilise little and often throughout the day.

· Chewing gum can help, by causing flatulence, therefore relieving the pain.

· There is some evidence to suggest drinking peppermint tea can help as well as eating little and often while avoiding certain food and drink ( avoid some fizzy drinks and any food with artificial sweeteners) will ease the pain until the wind passes.

BREASTFEEDING BABY

It is advised - no matter what mode of birth - that baby should be on the breast within two hours of him/her being born. While the effects of the spinal are still in effect most women find the lying down position best to feed baby for the first time. After this it depends on many factors as to which position would work best for you (the most common are the cradle position, cross cradle position, underarm position and laid-back breastfeeding, we will cover this more in next week's blog).

The process of the placenta being delivered means a drop in the hormones oestrogen and progesterone and an increase in prolactin. This triggers the milk production to start. Whether you have had a vaginal delivery or cesarean section this process WILL still happen. However if the delivery was stressful (i.e. the Cesarean was an emergency or there was a complication) this process can take a few days longer. If this is the case DON'T WORRY. Seek help from your Midwife or a breastfeeding support group or specialist and keep putting baby to the breast regularly to continue to stimulate your production. If baby is not showing signs of feeding well further actions may need to be taken until your milk comes in properly.

SWOLLEN LEGS

Swollen, feet ankles and lower legs is very normal after giving birth. This can be due to the fluids received during the operation, but also because of the hormones in your body causing water retention. It is usual for this to last for up to 2 weeks.

Ways to relieve the swelling include

· To elevate your ankles above your hips when resting

· Drink plenty of fluids

· Mobilise - go for walks around the house to start with then venture outside on short walks and work your way up

· Foot massage (although sometimes this can be too painful if very swollen)

· Healthy eating - this gives you the energy to get out and about.

·

CARING FOR YOUR WOUND

Your wound will be just below your pubic hair line (bikini line). It is essential that you keep it clean and dry to ensure you don't get an infection.

· wear loose comfortable clothes and large cotton underwear (Bridget Jones style)

· Clean and dry the wound daily (gently) once the dressing is removed

· Seek medical help if you develop a fever, increasing pain, redness or discharge

PELVIC FLOOR EXERCISES

If you think because you have not passed a baby through your birth canal because you had a caesarean section you are WRONG! You have still had a growing baby sitting on your pelvic floor for up to 9 months and this weakens your muscles. So it is very important to ensure you complete your pelvic floor exercises before the birth as well as after to prevent unwanted leakage of urine (incontinence).

For those who are not sure what a pelvic floor is let alone how to exercise it this leaflet is easy to read and understand from the chartered society of physiotherapy; http://pogp.csp.org.uk/publications/pelvic-floor-muscle-exercises-women

DRIVING, EXERCISE & CARRYING HEAVY ITEMS

Your recovery will be easier and less painful if you refrain from lifting anything heavy for a few weeks - this includes baby's in car seats, filled saucepans, big hoovers! This will give your muscles time to heal and put them under any unnecessary stress. When getting out of bed, roll onto your side and use your arms to sit up. If you need to cough or sneeze (common after surgery) place a pillow over your wound to help support your muscles while you do so.

You can resume these activities once you have fully recovered. This is different for each individual but you will need to see your GP for a check up at 6-8 weeks, by this time it would be expected you could go back to your 'normal' activities if you have not already - start gently and work your way up.

DEEP VEIN THROMBOSIS

Following a Caesarean section you will be at higher risk of developing a deep vein thrombosis (DVT). To help yourself you should

· mobilise as early as possible

· keep yourself hydrated

· wear your compression stockings as instructed

· take prescribed medication (blood thinning medication) regularly as instructed

· Report any symptoms of a DVT to your health care professional (pain, swelling and tenderness in one of your legs- usually your calf - a heavy ache in the affected area, warm skin in effected area, red skin)

Just remember a Cesarean Section is a completely different recover process to a vaginal birth and so do not be tempted to compare your recover with one.

if you would like any more help or have any questions please comment or contact me directly and I will get back to you as soon as I can.