What You Should Know About Recovery From A Cesarean Section.

Whether preparing yourself for the unexpected or researching what to expect after a planned cesarean, it can be hard to find reliable information on what to expect from the recovery. The reality is that nearly 30% of babies born in the US are born by cesarean; while this rate is astronomically and unnecessarily high (the World Health Organization has stated that our cesarean rate should be roughly 10-15%, less than that suggests possible barrier to care and more than that means it is overused), it is also a procedure that is sometimes medically necessary to ensure the health of the birthing parent and child.

You are in for a longer hospital stay

While the time on the L&D unit is typically about two hours, similar to after a vaginal birth, those hours may be spent in a PACU or postoperative room rather than back in your L&D room, depending on your hospital. While in this initial recovery room, EKG leads will remain in place to monitor your heart rhythms, your blood pressure and pulse will be closely monitored, and inflatable boots/leg wraps will be placed around your calves to prevent blood clots/keep your blood flowing away until you are up and moving. A urinary catheter is placed before surgery and remains in place for up to 24 hours (or longer in rare occurrences that the bladder is injured during surgery).

Unlike a straightforward vaginal birth, after which many people stay for two nights in the hospital or even leave a day early, initial recovery from a cesarean birth is more complicated and requires extra time and attention in the hospital. The typical length of stay after a cesarean is four days. During that time, your providers are monitoring closely for signs of infection, monitoring your blood loss from and after your cesarean, and helping you prevent blood clots by getting you moving. Your providers should also be talking to you about incision care and comfort.

It may help to bring some extra goodies with you to the hospital if you are going in for a planned cesarean or at higher than average risk (carrying multiples, maternal heart disease, active internal herpes lesions, among others). Here’s my recommended take-alongs (or things you may think about a family member grabbing for you and bringing if you end up needing a cesarean):

• cranberry juice (for reducing the likelihood of a urinary tract infection after catheterization)
• high fiber snacks (they won’t want you to leave the hospital until you poop)
• prune juice or molasses (again, the poop thing. Yes, they will give you colace but many people don’t want to take it unless needed)
• nursing pillow, specifically the MyBrestFriend pillow, as it doesn’t rub against the incision site like other nursing pillow do… (also, it’s just the best one there is, in my honest opinion).

General Tips for Hospital Stay and Beyond

Myself and two of my friends and colleagues, Diana Snyder of Matrescence Doula Services and Julie Brill of WellPregnancy, have chimed in with some fantastic daily pointers:

• Hold pressure on your incision site with a pillow if you have to cough/sneeze
• Don’t get behind on pain medications and come up with a plan with your provider so you get the relief you need while decreasing some of the unwanted side effects of pain medications, like constipation and drowsiness.
• Roll to the side and push yourself up with your elbow/ arms. Don’t use your abs to sit up.
• Drink lots of fluid and eat high-fiber foods and juices that promote easier bowel movements. Milk of magnesia often is recommended on top of the colace given by the hospital, which is commonly not enough. Constipation and impaction are serious problems for cesarean parents and straining can be very painful and risky with the incision.
• Be gentle on yourself and surround yourself with support if possible, you should not be doing housework once you are home. Try to have someone who can do everything for the baby besides feeding them.
• Have stations set up where you sit so everything you need (food, water, burpcloths, etc) are in close reach
• be assertive with your provider if something is not right. Cesarean patients are at higher risk of complications.
• Be proactive if you think you may need help processing your experience or suffering from a perinatal mood and anxiety disorder. Cesareans are associated with higher risk of postpartum depression.
• Loose comfortable clothes with soft wide waists will be necessary for quite a while.
• Increase activity slowly. If you don’t feel well or have increased lochia, stop.
• Have a list of things visitors can do when they come. Put people to work for you!
• Be choosy who you speak to about your experience so you don’t get people saying dismissive things eg., ‘at least you have a healthy baby’
• Don’t lift anything heavier than the baby.
• Rest as much as possible with feet above heart until swelling is gone from ankles.
• As much skin-to-skin with newborn as possible because it raises oxytocin which excellent for breastfeeding and bonding, but also decreases pain and depression risk.
• If you live in a two-story home, try to only go up/down the stairs once a day. If living area is upstairs, for instance, that often looks like showering before coming downstairs for the day, rest on the couch, then going upstairs after dinner.

Your pelvic floor will need some TLC, including your vagina

• Pelvic floor muscle functions include:
  support for the pelvic floor organs including the bladder, bowel, and uterus
• assisting in urinary and fecal continence
• aiding in sexual performance (orgasm);
• stabilizing connecting joints.

Depending on when in labor a cesarean was performed but even in planned cesareans, it can come as a real surprise when your postpartum nurse first starts peeking around under your bedsheets and inspecting your pad. You will still experience lochia, the vaginal discharge made up of the uterine lining that sheds after your baby is born as well as bleeding from site your placenta was attached. Your nurse will be checking to ensure your flow is normal and there are no signs of complication. Additionally, the catheter that was placed during your surgery can lead to discomfort, and small lacerations. Your nurse may use a peri-bottle to wet and cleanse the area for you.

Tip: Once you are going to the bathroom on your own, if you have discomfort when you pee, use the peri-bottle to rinse the area with warm water while you go. Your flow may be bright red and heavy for the first few days, containing small clots. Over the next few weeks the flow will slow, changing from pink/brown to yellow/white. It may become watery, too. Any foul-smelling or green/yellow discharge should be noted and reported to providers.

For longer-term pelvic floor and cesarean recovery, I highly recommend those who gave birth by cesarean to have at least a few appointments with a pelvic floor PT. See my resources page for a few local favorites or contact me. I also recommend chatting with your PT about scar massage for preventing/treating scar adhesions between fascial layers, as this can improve your long-term comfort.

Where to find support:

ICAN, the International Cesarean Awareness Network, which also has local meet-ups and support.

A good therapist that specializes in perinatal support- again, see my resources page. 

Postpartum Doula support. Please contact me for individualized referrals!