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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© International Cesarean Awareness Network, Inc. All Rights Reserved

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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© International Cesarean Awareness Network, Inc. All Rights Reserved.

“Two of the most over-utilized and most commonly performed surgeries in America are cesarean sections and hysterectomies. When a doctor and a hospital get involved in the natural process of childbirth, time is money. “Spontaneous deliveries,” as they are often referred to (where there is no surgical intervention), are time-consuming for doctors.”

To read the rest of this article, click here.

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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© International Cesarean Awareness Network, Inc. All Rights Reserved.

*Note from Brenda: The cesarean rate in Texas for 2006 was 33.2% and is much higher in certain hospitals in our area. This is an issue that every pregnant woman needs to be informed about.

Cesarean Fact Sheet

Catecholamines
The Process of labor does stress an infant, resulting in a release of stress hormones (catecholamines, pronounced “cat-a-cola-means”) that are crucial for the protection and good health of the baby.
Catecholamines cause vital processes in the baby which help it survive and adapt at birth, according to researchers Hugo Lagercrantz and Theodore Slotkin. The effects of the catecholamines on a baby, which include a slowing of the heart rate, protect it from less oxygen during contractions. The baby is also put into a highly alert state that researchers believe may help in infant attachment at birth.

From: A Good Birth & A Safe Birth

What do Catecholamines do?
*Improves Breathing
*Increases lung surfactant
*Increases lung-liquid absorption
*Improves lung compliance
*Dilates bronchioles
*Protects Heart and Brain
*Increases blood flow to vital organs
*Mobilizes Fuel
*Breaks down normal fat into fatty acids
*Breaks down glycogen (in liver) to glucose
*Stimulates new production of glucose by liver
*Facilitates Bonding?
*Dilates pupils
*Appears to increase alertness

From: “The Stress of Being Born”, Lagercrantz and Slotkin

Endorphins-The Body’s Natural Narcotic
Circulating throughout your body are natural hormones that relax you when stressed and relieve pain when you hurt. Most mothers don’t even know these biologic labor assistants exist and, more important, that they can influence when and how these hormones are released. In the 1970’s researchers studying drug addiction stumbled upon the presence of specialized areas in the brain, called receptor sites, for morphine-like substances. They discovered endorphins (from, endogenous, meaning “produced in the body,” and morphine-like substances), chemical pain relievers produced in the nerve cell that attach to receptor sites on the cell blunting the sensation of pain in these cells. Here’s what we know about these natural remedies and how they can work for you.
*Endorphin levels go up during contractions in active labor (especially during the second stage of labor), are highest just after birth and return to prelabor levels two weeks postpartum.
*Endorphin levels were found to be highest during vaginal deliveries, less high in cesarean births in which the mother had also labored, and lowest in cesarean births performed before mother’s labor had begun.
*Endorphin levels are elevated in newborns who had signs of fetal distress during delivery. The baby also receives these natural pain relievers during birth.
*Endorphin levels are increased during strenuous exercise, and there is no activity in the world that is more strenuous than labor.
*As an added benefit, endorphins stimulate the secretion of prolactin, the relaxing “mothering” hormone that regulates milk production and gives a woman a boost in interacting with her baby. Researchers believe that it is a combination of these hormones that contribute to the “birth high”.
*Endorphins may account for the “high” mothers experience after a birth when sleep eludes them. Also, it seems possible that a mother having a surgical birth without going through labor may experience lower hormone levels after birth, which could account for the sometimes observed delay in milk supply after a cesarean birth.
*Like commercially produced narcotics, endorphins behave differently from woman to woman. This may be why some women are more sensitive to pain than others.
*Instead of the periodic “blast” you get with injectable narcotics (often making you groggy), your endorphins give you steady assistance throughout labor.
*Laboring mothers who are aware of these hormonal effects describe their feelings as “naturally drugged.” Set the birthing conditions that let these labor helpers work for you.

From: The Birth Book by William Sears MD & Martha Sears RN

Labor For a While Before Your Cesarean
You may think, “Why should I go through all that work and pain if I’m going to have a cesarean anyway?” While it may be inconvenient for the hospital or doctor, it is often medically beneficial for your baby if you labor as long as possible before an elective cesarean. Besides indication that baby is ready to be born, some precesarean contractions let the baby benefit from the natural hormones of labor. Studies show that babies delivered by cesarean after mothers labor a while have fewer breathing problems in the first few days after birth than babies whose mothers were not in labor. Labor prepares baby for changes that are coming rather than being snatched from his nest without warning.

From: The Birth Book by Dr. William Sears

http://www.mothersnature.com/pregnancy/info/catech.html

I was busy doing my ironing one evening and happened to catch the last 20 minutes of a “documentary” where a film crew were following a famous woman, pregnant with her third child. It showed her meeting with her private obstetrician and anaesthetist to discuss her fear of needles. The celebrity, lets call her “K”, was not worried about “being cut open”, but feared the thought of a needle being put into her back, the epidural. During the discussion, the anaesthetist reminded “K” about last time when the obstetrician had put some pain killers into her rectum and when “K” looked shocked that this had happened to her, the anaesthetist added “There is nothing dignifying about childbirth!”.

I felt a great sense of sadness hearing these words, but also for poor “K” who had not been aware of what had happened to her during her last caesarean section. Working as a doula and doula trainer, I hear birth stories on a regular basis from clients and I also read a lot of trainee doulas own memories of their births. To have something “done” to you, without your knowledge, is usually the main reason why women feel their births have been horrible and traumatising. I kept thinking, why is this woman choosing to have an epidural and a caesarean section? Has she been given all the facts to make an informed choice or is she handing herself over on a plate, trusting that the experts will do what is best for her and her baby?
It is difficult to answer the question why celebrities elect to have a caesarean section since every woman is unique and I don’t want to generalise, but I would say that there are a couple of areas that can be identified.

I believe pregnant women are in a light state of hypnosis. They are very susceptible to anything they hear or see related to pregnancy and child birth. In society today, the press and media paint a very negative picture of childbirth and women are led to believe that having a baby is impossible without medical interventions. Childbirth in films or TV dramas is always portrayed in dramatic scenes of crisis, fear and tension. The media seem to consistently caricature childbirth as a horrendous and frightening process that anyone in their right mind would want to avoid. It is pretty difficult to get away from all the negativity. Just being pregnant and sitting on a bus will attract someone who is eager to tell a story about how somebody they knew nearly died giving birth, not to mention all the friends, family and neighbours who all have a story to tell. All this is bound to contribute toward the decision of an elective caesarean section.

 Another big reason must be the fact that women want to be in control. Especially when you are a celebrity! There is so much information about pregnancy and childbirth. Women believe that having prepared and planned the birth in detail will somehow give them control. However, natural childbirth involves the primitive part of the brain where all the hormones and endorphins are produced. Women need to keep out of their “intelligent brain” and let the body take control. This is a natural process which, if the circumstances are right will happen, but a woman needs to feel safe in her environment. She also needs to be able to switch off her thinking brain and this might mean she will be acting out of character. The woman might make strange noises, start swearing or screaming and shouting. I can guess that having made a habit of being in total control, this is an area which any celebrity would find extremely difficult to deal with, especially if this was leaked to the media. A caesarean section would be seen as the only available means of staying in control.

I also believe that celebrities might be fooled into thinking that if they pay for the best maternity care in the country, they will be given the right advice and have a perfect birth. Yes, you will get what you ask for, but does that mean you will be left with a beautiful birth memory? A postnatal client of mine had her baby at a private hospital in London with a private obstetrician. At 9 centimetres dilated, she asked for an epidural, and immediately one was administered. Anyone trained in birth physiology, will know that this request for an epidural in the late stages of labour is due to an increase of stress hormones in the body. It activates the “fight or flight” reflex and women very often ask for pain relief, say things like “I can’t do it anymore!” and even try to get off the bed to go home! This is usually a good sign that things are progressing well and that the baby will soon be born. In this case, the epidural left her unable to feel when to push and the birth ended with an episiotomy and ventouse delivery. Speaking to her about her birth experience, she feels angry that they gave her the epidural at such a late stage. What she had preferred would have been someone there to tell her how well she was doing and that soon she would be holding her baby in her arms. However, she was not paying for emotional support, she was paying for medical care and that means getting what you ask for, even if it is not what you really want.

I would encourage women to find all the information they can and ask for second opinions with regards to their options. Electing to have a caesarean section is not the “easy way out”. A caesarean involves major stomach surgery and the risks compared to a vaginal birth are much higher. Of course, caesareans do save babies and mothers lives, but I feel it should only be an option when there is a real need for it. I’m not interested in beating up the women who are making the choice to have an elective caesarean. I just want women to have all of the information they need to make this choice and I am not convinced that this is happening. I feel sad for women that are celebrities and trust that the care they will receive will be what is best for them because they are paying for it. Birth in not about passing or failing and every woman has got the right to choose what she wants but I would like to think that she knows exactly what it is that she says “yes” to.

By: Ido Pollock

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