Recovering From a Cesarean Birth: Tips on Healing

Cesarean birth is major abdominal surgery. New mothers need and deserve to have extra support during this special time of birth and healing. Women who have experienced either a planned or an unplanned cesarean section react to the surgery in very individual ways. Some women physically heal very quickly; others report that recovery took several weeks or even months. Avoid putting time limits on yourself. Emotionally, women’s feelings about their cesarean sections vary in range from acceptance, to disappointment, to devastation. Some women need as much emotional support as physical support for a healthy recovery. Each woman heals and grows into her new role of motherhood at her own pace. In time, you will regain your energy level and sense of well being.

To Relieve Pain and Assist Physical Healing:

At hospital:

* Ask for physical assistance, and keep nurses’ call button within easy reach.
* Take pain medication as needed for comfort. Try to avoid pain medications containing codeine as they cause constipation, making it hard to void after cesarean surgery.
* If possible, obtain a private room so that a family member may remain with you.
* Use pillows to support your abdomen when turning, standing, coughing, and when feeding the baby.
* Rest as much as possible and limit visitors. Sleep when baby sleeps.
* Rock in a rocking chair as soon as possible after surgery to speed recovery and reduce gas.
* Take short walks.
* Eat nutritious food and drink plenty of fluids. Avoid cold and carbonated beverages.
* The surgery will slow down your digestive tract, to help with constipation, try an over-the-counter stool softener, NOT a laxative.
* Each time you stand after the surgery stretch up to uncramp stomach muscles and reduce adhesions.

At home:

* Have several diapering stations so you can change baby easily.
* Let others do household chores like cooking, cleaning, and laundry.
* Check the incision daily, or have someone check it for redness, which can be a sign of infection.
* Have a list to things that need done, so when people ask, you can remember what needs done.
* Take care of yourself and your baby only.
* Remember not to lift anything heavier than your baby.
* Stay in your pajamas, so people remember you are recovering from birth and surgery.
* On the other hand, sometimes taking a shower and getting dressed really does wonders psychologically. Even in the hospital, it can help to put on your OWN clothes.
* Keep the baby near you at night so you do not have to get up.
* Have a basket that you can carry easily with nutritious snacks, fingernail clippers, lotion, a book, and other little necessary things in it.
* Eat well and drink water freely. Have a pitcher of water or juice near you.
* If you have other children, secure assistance in caring for them from family and friends.
* Consider hiring a postpartum doula.
* Increase activity gradually.

To Promote Emotional Healing:

* Keep your baby near you as much as possible and get to know your new baby.
* Breastfeed your baby to promote bonding, and release beneficial mothering hormones.
* Share your feelings with others and talk about your experience as much as you feel necessary.
* It is normal to experience a wide range of emotions including relief, happiness, sadness, anger, and feelings of loss and failure.
* Write your baby’s birth story.
* Write letters to the hospital and your doctor, explaining what you did and did not like about your birth- you can mail them, or not, but it is beneficial to write your thoughts down.
* Seek support from available resources including breastfeeding, parental, and cesarean support groups.

Read books on natural childbirth, cesarean birth, and vaginal birth after cesarean (VBAC). There are many varied reasons why a birth may have ended in a cesarean section. If you plan to have any more children, it is important for you to know that it is very likely you can have a vaginal birth next time. When you are ready to learn about VBAC, ICAN can help you find the information and support you need.

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If the mother is to be conscious, an anesthesiologist will inject spinal or epidural anesthesia (usually fentanyl, a derivative from the opium family; and bupivicane, a derivative from the cocaine family) into the mother’s back or epidural space (between the vertebra) via a thin catheter. Vomiting and/or dry heaves may occur as a reaction from the narcotics, as may uncontrollable shivering. A catheter is inserted into her urethra to allow urine to be eliminated.

In a sterile operating room, with a surgical team in “scrubs”, masks, hair net, and gloves, preparation continues with strapping the mother’s arms, crucifix-style, to an operating table. A nurse starts an IV with fluid and/or narcotics (usually demerol or stadol, a derivative of the morphine family), and an anesthesiologist applies oxygen and/or general anesthesia. A curtain is hung between the mother and her lower body to prevent her from seeing the surgery. Her belly is laid bare and she is completely naked, save for a hospital gown that is now pulled up to her neck or just below her breasts. Her belly and pubic area are rubbed with a 10% Povidone-Iodine solution (a.k.a. “Betadine”) and her pubic hair is shaved. A sticky plastic drape is laid over her belly to stabilize her skin.

A horizontal incision is made with a scalpel, just above the pubic bone where the pubic hair begins, slicing through five layers of skin, tissue, and muscle: 1) the derma, or outer layer of skin and 2) fat; 3) the fascia, the tough, thin layer that supports the muscle; 4) the rectus muscle, which is manually separated with the fingers down to the pubic bone; and 5) the peritoneum, the shiny layer that encases the entire abdominal cavity. Suction is applied to absorb excess blood. A metal “spatula” known as a bladder blade is inserted to pull back and protect the bladder. Another “spatula” known as a retractor is inserted at the top of the incision and/or on the sides, and are pulled back tightly to enlarge the incision, usually by two surgical assistants. Another incision is made into a sixth layer, the uterine lining, taking care not to cut the bladder, causing infection. Suction is again applied. Sponges and gauze are used to blot blood and fluid pooling in the abdominal cavity.

The mother may feel intense pulling and tugging to dislodge the baby’s head from the pelvis. If vertex, the baby is pulled by the neck backwards out of the pelvis and then by the head through the incision in the uterus. The baby’s nose and mouth are then suctioned to remove any amniotic fluid, mucous and/or meconium from the airway. The remainder of the baby’s body is pulled from the mother’s uterus through the abdominal incision, taking care not to tear the uterine or abdominal incision wider.

The umbilicus is clamped and cut immediately and the child may be held up over the curtain for the mother to see before being taken to a warm table to be suctioned further, toweled off, footprinted, weighed, measured, tagged and wrapped in a blanket and hat. Pitocin and/or methergine is immediately injected into the mother’s IV to begin contractions of the uterus to aid in the removal of the placenta. The remaining umbilicus is then pulled and the placenta is scraped off the uterine wall by hand to tear away the placenta from the uterine wall. The placenta is removed and examined to ensure all pieces are intact. The uterus is then removed from the mother’s body and placed on her stomach for the incision repair. One set of stitches is made in the wall of the uterus, then a second layer of stitches in the outer lining. The uterus is then pushed back through the abdominal incision and into the mother’s body. Sponges and gauze are counted to ensure none are left in the surgical cavity. The abdominal cavity is irrigated with water to flush out bacteria (to prevent infection) and check for bleeding.

Approximately 1000cc of blood is lost during the procedure. A layer of absorbable stitches are made in the rectus muscle, another layer of sutures are made in the fascia. The plastic drape is pulled away from around the abdominal incision and another set of absorbable sutures or staples may be used for the outer layer, usually removed three to five days later by a nurse. A second dose of demerol may be injected into the mother’s IV to aid in relaxation as she is wheeled into recovery to hold her child when the physician allows it. Again, the mother may experience dry heaves and/or uncontrollable shivering and chills.

Within 24 hours, the urine catheter is removed and she is allowed to stand and perhaps walk to the bathroom or shower. Within three to five days she is discharged and permitted to return home, with a check of her incision in two weeks. If infection or seeping occurs, antibiotics may be prescribed. Incision pain may occur constantly or intermittently for up to a year. Feeling may be regained on the incision site, or nerve damage may result in permanent lack of sensation. Her ability to birth normally in the future may be called into question.

For video of a cesarean section, contact The Learning Channel at (800) 544-1717 and request a copy of the video, “The Operation: Cesarean Section.”

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Rachel’s birth was the best experience I have had. My family, doula/friend, and doctor, made it all easy for me.

I was having a VBA2C…..my other doctor would not allow me to continue services with them….because I wanted to try to Labor….. I had been at the  Above Rubies Retreat April 23rd… had gotten home and started feeling twinges at about 10:30 pm but I went to bed. I woke up at 3:30 am on April 24th with severe pains and I started timing them but they were not steady. So I waited for a few hours then around 6:30 am the pains were back and steady at 5 min apart. We called Brenda to let her know and Josh called in to work, and I labored. I walked and squatted, got in the tub,got in the bed, and got on the ball. Brenda was great, she fixed me Emergen-C and a peanut butter shake—I turned my nose up at that.  She was so encouraging to me. The pains were still five minutes apart, so around 12 am on April 25th,  I decided to go into the hospital. Yes, I went - DH was not comfy with a homebirth and with the doctor change we didn’t have much time to find a midwife.

Of course the Nurses did the protocol and hooked me up, but I got out of bed every chance I had. I just should have put my foot down and said no, but anyway anything the nurse wanted to do was held off cuz I was gathering my peeps up to help inform us of what they were doing and give us time to think. Soooo, I had no pains meds! Doc Van’s associate came in and checked me, I really wanted Dr Van to be there, and finally she came.  I pushed for 40 mintues and during that time I was kinda not trying hard enough and Dr. Van said to me, hey you are almost there –  just push some more and she is out. I remember Brenda saying hey look at the mirror you can see her hair - and that was it.  I pushed and out came Rachel. It was soooo awesome.

*Brenda’s comments: Brandy is a good friend of mine, and this was my first birth as a doula! It has also been my longest birth to date, her labor was 30 hours and I was with her nearly the whole time. I loved being able to support Brandy, and was so proud of her for having the courage to stand up for what she wanted in the face of much opposition. She also did a fantastic job staying positive during her long labor. Brandy has made herself available to answer questions for other moms who are considering a VBAC – please contact me and I will be glad to put you in touch with her.

Cephalopelvic Disproportion (CPD) is a diagnosis that is often given as the reason for a cesarean section. It means that the baby’s head is too big for the mother’s pelvis, or the mother’s pelvis is too small for the baby’s head. The problem is that this diagnosis has been proven incorrect many times. Sometimes the baby comes out much smaller than the doctor estimated using ultrasound. There is at least a 20% margin of error in estimating the weights of full term babies who are suspected to be large for gestational age. (Source) Also, many mothers have gone on to give birth vaginally to larger babies than their previous babies in which they were given the CPD diagnosis. This video shows photos of women who were diagnosed with CPD and then went on to have larger babies afterwards.

If your doctor has mentioned this possibility to you and suggested a planned c-section, please consider carefully! Your body was created to give birth. Your pelvis is working for several weeks prior to labor to be ready to widen and open enough for your baby to come through. In addition, your baby’s head molds and the skull plates overlap to make it smaller to go through the birth canal. This is why many babies have misshapen heads for a few hours right after their births. Believe in your body’s ability to give birth normally, naturally, and without intervention! Your trust and confidence in your body’s process of birthing will have a huge impact on your emotions and will directly affect the length and difficulty of your labor. Focus on the positive!  

For more information, please visit the International Cesarean Awareness Network website.

Your Right to Refuse: What to Do if Your Hospital Has “Banned” VBAC Q & A

The Public Citizen Health Research Group in Washington, D.C. has estimated that half of the nearly 1 million cesareans performed every year are medically unnecessary. With more appropriate care during pregnancy, labor, and delivery, half of the cesareans could have been avoided. Clearly, there are times when cesareans are necessary. However, cesareans increase the risk to both mothers and babies. These are suggestions of things you can do to avoid an unnecessary cesarean and can help insure that your birth experience is as healthy and positive as possible.

BEFORE LABOR

• Read and educate yourself, attend classes and workshops inside and outside the hospital.
• Research and prepare a birth plan. Discuss your birth plan with your midwife or doctor and submit copies to your hospital or birth center.
• Interview more than one care provider. Ask key questions and see how your probing influences their attitude. Are they defensive or are they pleased by your interest?
• Ask your care provider if there is a set time limit for labor and second stage pushing. See what s/he feels can interfere with the normal process of labor.
• Tour more than one birth facility. Note their differences and ask about their cesarean rate, VBAC protocol, etc.
• Become aware of your rights as a pregnant woman.
• Find a labor support person. Interview more than one. A recent medical journal article showed that labor support can significantly reduce the risk of cesarean.
• Help ensure a healthy baby and mother by eating a well-balanced diet.
• If your baby is breech, ask your care provider about exercises to turn the baby, external version (turning the baby with hands), and vaginal breech delivery. You may want to seek a second opinion.
• If you had a cesarean, seriously consider VBAC. According to the American College of Obstetricians & Gynecologist, VBAC is safer in most cases than a scheduled repeat cesarean and up to 80% of woman with prior cesareans can go on to birth their subsequent babies vaginally.

DURING LABOR

• Stay at home as long as possible. Walk and change positions frequently. Labor in the position most comfortable for you.
• Continue to eat and drink lightly, especially during early labor, to provide energy.
• Avoid pitocin augmentation for a slow labor. As an alternative, you may want to try nipple stimulation.
• If your bag of water breaks, don’t let anyone do a vaginal examination unless medically indicated for a specific reason. The risk of infection increases with each examination. Discuss with your care provider how to monitor for signs of infection.
• Request intermittent electronic fetal monitoring or the use of a fetoscope. Medical research has shown that continuous electronic fetal monitoring can increase the risk of cesarean without related improvement in outcome for the baby.
• Avoid using an epidural. Medical research has shown that epidurals can slow down labor and cause complications for the mother and baby. If you do have an epidural and have trouble pushing, ask to take a break from pushing until the epidural has worn off some and then resume pushing.
• Do not arrive at the hospital too early. If you are still in the early stages of labor when you get to the hospital, instead of being admitted, walk around the hospital or go home and rest.
• Find out the risks and benefits of routine and emergency procedures before you are faced with them. When faced with any procedure, find out why it is being used in your case, what are the short and long term effects on you and your baby, and what are your other options.
• Remember, nothing is absolute. If you have doubts, trust your instincts. Do not be afraid to assert yourself. Accept responsibility for your requests and decisions.

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