A C-section is a common procedure, in fact up to 30% of births in New Zealand occur this way, whether they are an emergency birth or planned. Being prepared with what to expect, however it happens for you, will help you feel more in control and prepared for the recovery after C section process.
This blog is intended for information and preparation purposes for pregnant Mumma's preparing for birth. Having some understanding about what to prepare for if your birth results in a C section will go a long way towards supporting and promoting your mind-body recovery.
I work as a maternity nurse providing postnatal care for Mum's and their new-borns from within two-three hours after birth until discharge or transfer to a primary unit from the ward; this blog is written from my perspective and experience with the process you will likely follow after birth with some insight from Mum's during this time also.
On a daily basis I care for women during one of the most treasured periods of their lives, supporting and educating them as they discover the magic but also struggle with the challenges of recovery after C section while bonding and caring for their new-born. Your journey is your own to cherish and I strive to make it as personal and easy as possible, but yes, there is so much to learn and I recognise not all information can be taken in these early days, which is why having this information ahead of time can help reduce the overwhelm.
Often a C section will need to occur as a result of an emergency during labour which may leave you feeling unprepared for the recovery journey you are on, hopefully this resource will set you up with some insight and set you up for a positive experience. I am acutely aware of the lack of guidance and support Mums who have birthed their baby via c section and am here to change that!
Here's how the first 24-48 hours might look after your C section.
Your surgery and initial 2-4 hours after:
A C section is major surgery and not to be underestimated. You will usually have a spinal anaesthetic and be awake for the procedure.
If you have been in labour and you need an emergency C section, it may happen very quickly, within only a few minutes or maybe there is more time, however a planned C section will likely be more calm and less rushed, you will need to be fasted (have no food or fluids for a few hours prior to your surgery) and run through a pre-screen assessment process with an admitting Midwife or Nurse and Anaesthetic Doctor.
The Anaesthetic Doctor will put a spinal anaesthetic into you lower back with some local anaesthetic via a needle, you will need to try and round your back as much as possible to make this easier for them (awkward I know with a pregnancy belly, I recommend practising cat/cow movements on your hands and knees or sitting on a swiss ball leading up to birth to help with this).
A Nurse or Midwife will insert a catheter into your bladder to drain your urine while you have your surgery which will stay in until you are able to get out of bed to the toilet after surgery.
You will be allowed your support person with you, they need to change into scrubs/theatre clothes to go into the operating theatre with you, unless you need to have a general anaesthetic and be put to sleep which is rare.
A screen will be put up between your face and your belly for you and your partner's comfort which can be pulled down as your baby is born.
A C section involves the surgeon cutting through six-seven layers of skin and tissue then putting them all back together again (some layers are stitched and some placed together) after the baby is born, more about recovery from this below.
As your baby is born; skin to skin with Mum and baby (naked baby placed directly on Mum’s chest) is enabled with delayed umbilical cord clamping to allow optimal blood supply to get into baby from the placenta (unless there is an emergency with you or baby, cord clamping will need to occur more quickly).
Once your surgery is finished you will be wheeled into the recovery room, where you will be cared for and supported to have ongoing skin to skin with your baby and establish feeding within one-two hours. Staff will support you to achieve a good side lying position to facilitate latching your baby for a feed. If your baby doesn't latch effectively, staff may assist you to do some hand expressing of your colostrum and give this to baby, usually via a small syringe.
Staff will check your tummy often, pressing firmly to feel your uterus has contracted down, monitor your bleeding and change your pad for you in the first few hours of recovery while you are still on the bed.
Please note: you will still have vaginal bleeding after a c section as you would a vaginal delivery.
You will have an intravenous needle line in your hand or your arm with fluids running and maybe an infusion for the initial couple of hours post surgery.
You will be allowed to eat and drink if you feel able.
If you are feeling sick, itchy or sore please inform the staff and they can give you medication for this.
Once staff are satisfied you and your baby are stable and ready for transfer to the ward, a midwife or nurse from the ward will come and get you and an orderly will assist wheeling you to the ward.
If your baby needs extra support after birth, either initially or a few hours down the track, NICU (Neonatal Intensive Care Unit)Dr’s will assess and care for your baby along with midwives and/or nurses. Your baby might need to be taken to the NICU ward, you will be kept informed, your partner will likely be able to be with your baby and staff will support you to see your baby as soon as able also. I understand that this is a very tough time for new parents when their baby is unwell and staff will do their best to get you reunited with your baby as soon as able.
Once on the ward:
You will be admitted to the maternity ward when you and your baby are well and stable, this will likely occur at around three-four hours after surgery, you will be settled in and orientated to the ward. If there are concerns about you or your baby, relevant Doctor’s will review, support and care for you along with your midwife or nurse at any stage along your recovery journey.
You will be able to eat and drink as able.
Please ask for pain relief when you feel your sensation starting to return and pain creeping in sooner rather than if or when it gets worse, some ladies need a lot of pain relief, others only simple paracetamol and diclofenac.
Getting up: Ensuring you have had some pain relief prior to getting up and your sensation has returned to normal, your midwife or nurse will encourage and support you to mobilise within about 8-12 hours of surgery. This will help get your blood flowing properly, your bowels working again and enable you to use the toilet.
Always roll onto your side when getting out of bed, gently swing your legs over the edge of the bed and push yourself up with your arms. This will reduce the pressure your place on your abdomen and scar which has a lot of healing to do.
You will have had a catheter inserted into your bladder for the surgery to drain your bladder, this can usually be removed when you get up as long as you are able to walk to the toilet. Removal is a simple process, removing a small amount of water from a balloon which is blown up inside your bladder from a port on the side of the catheter. You will likely be asked to wee into a jug to measure your next two wee’s to ensure you are able to empty your bladder properly, if you have trouble going to the toilet which sometimes happens, please let staff know.
You will be able to shower, most ladies can shower themselves, there is usually a seat to sit on where you can enjoy your ‘first shower’. Caution with washing hair with your hands up for long periods, this can cause dizziness/fainting, ask for help if needed.
After you have mobilised that first time and manage ok, you will be able to mobilise gently when you need to. I encourage a good balance between rest and gentle walking within your room or the ward in the first couple of days.
Continue to keep on top of your pain relief so you can manage simple cares for you and your baby, you need to be comfortable enough to function as a new Mum.
Ask for assistance from the staff for breastfeeding, especially if this is your first time breastfeeding and you are learning. It is easier to get support with a good and comfortable latch to start with rather than get sore nipples and struggle with latching the baby due to pain later.
Your baby might have a ‘recovery sleep' for about 4-6 hours after their initial feed, unless they need to be interrupted for special monitoring such as blood sugar testing. After the initial recovery sleep, it is recommended to feed your baby at least every 3-4 hours, no longer than four hours between feedings (from the start of a feed) for the first few days. Your first night is often reasonably settled, however the second night is typically very busy with baby cluster-feeding trying to bring your milk in, so be prepared for not a lot of sleep.
You will be seen by the Doctors the next day after your baby’s birth, you may be medically cleared and could potentially transfer to a primary unit for a further 1-2 nights for recovery and support if there are beds available or stay a further night at the tertiary hospital then discharge home.
Typical length of stay for a routine c section recovery is two nights with a possible third or fourth at a primary unit. If there is a concern with yourself (such as high blood pressure or other C section recovery concerns), Doctors will recommend you stay for longer at your tertiary hospital, often up to four days. If there is a concern with baby, you will also likely stay longer, depending on if baby remains on the ward with you or needs admission to NICU.
If your baby gets admitted to NICU for a longer period of time and you are well and cleared for discharge, expect a discharge and support plan from NICU after approximately two nights. In most cases you will go home and need to travel in daily to be with your baby. If you don't have a breast pump, the hospital or your midwife should be able to support you to organise to borrow one.
Essentials to bring to hospital:
For Mum:
Lip balm
A drink bottle with straw/sippy spout
Toiletries, bodywash, shampoo/conditioner, toothbrush, hairbrush, spare hairbands etc (caution with fancy smelling toiletries as can interfere with your scent that baby is bonding with)
Maternity pads and comfortable high waisted underwear up to 6-8 changes in case of heavy bleeding (or maybe even disposable maternity underwear with medium to high absorbency)
Nipple balm
PJ’s and comfortable clothes (easy front access for establishing breastfeeding is best)
Snacks for all times of the day
Long phone charger
For baby:
Wet wipes (nappies are supplied where I work, however check with your midwife what is supplied)
Baby swaddles/muslin or stretchy wraps
Woollen blanket
Baby singlets, preferably merino x 4-5
Baby outfits/growsuits x 4-5
Woollen jersey(s) and hat(s)
Note: Dads are not guaranteed to be able to stay with you, be prepared for them to be asked to leave around 9pm if relevant.
Dad’s food or drink won’t be supplied, get them to pack some extra snacks for themselves, there is likely to be a kitchen they can use to keep food in fridge/freezer and heat food in microwave and make tea/coffee.
There may be a washing machine on the ward, ask the staff if you need to do any washing.
Longer term recovery after c section
As you have read above, a C section is major surgery, six layers of tissue that often heal fused together.
Deep core breathing is a great gentle way to start your recovery after C section, re-training your lungs to breathe and inflate down again after being squashed upwards by your growing baby. Sometimes pain from the scar will also cause you to feel tense and not want to breathe well also, so be sure to manage your pain well, so you can breathe well.
Lots of tension can cause nasty upper body aches and pain, along with feeding and baby snuggling positions, so gentle mobility movements can also be a nice way to reduce some tension.
Scar tissue massage from at least six weeks will be beneficial to loosen up your scar so the layers of tissue can glide over each other well and your core muscles can learn to function well and restore their strength.
For more guidance and support to kickstart your recovery join my Re-energised C section Recovery Program. It will educate and guide you through how to promote your healing and recovery right from as early as the first week of recovery after C section right through to returning to full function.
I would love to hear your birth story and your experiences of recovery after C section, leave me a comment below or send me an email.