Cesarean Section Recovery

About one in three women who give birth end up doing so by Cesarean section, and though every mother is happy to have a healthy baby in her arms, a C-section delivery requires major surgery that takes a heavy toll on a woman’s body. 
While some doctors say they don’t want to “overload” their patients with too much information, many mothers say they often leave the hospital with too little in the way of recovery advice. 
“I was told the usual of not lifting anything heavier than my baby, but I was never told for how long or why,” says Carolyn, a mother of two in Pacifica. “I never took pain medication, so I figured that I would just do whatever didn’t cause me pain.
“I had an older child who needed to be lifted, my baby in his 10-pound car seat to transport, and strollers to retrieve and open from the back of my SUV, which has a very heavy back door,” she continues. “Basically, I went about life as normal, trying not to lift heavy items if or when it could be avoided. As it turns out, my abdominal muscles never grew back together, so I look perpetually five months pregnant, and I have chronic hip and back pain two years post-childbirth.”
Take It Slow
The ban on lifting anything heavier than 10 pounds is tough advice for mothers with a toddler awaiting their return back home. No matter how you deliver, childbirth is an overwhelming experience, and there is almost nothing as stressful as taking care of a newborn baby.
But, there’s no getting around the fact that recovery from C-section is much longer and more complicated than from a vaginal delivery. A C-section is major surgery, which requires cutting through several layers of abdominal tissue. It goes without saying: you need a lot of time to heal from something like that.
 “I tell women to get help if they can,” says Dr. Deirdre Lyell, a maternal and fetal medicine specialist at Lucile Packard Children’s Hospital at Stanford University. “This is not a time to do everything on your own. If someone offers help, your response should be, ‘Thank you.’”
First and foremost, you need to rest. Drink lots of water, eat well-balanced meals and continue taking your prenatal vitamin. This general advice – so important for breastfeeding mothers – applies particularly to women who’ve had a C-section. 
Lots of fluids help maintain a strong milk supply, as well as prevent constipation. There is some evidence that a good diet can help the wound heal.
The Importance of Moving
In the hospital, the staff will have you up and walking around the day after surgery. Though some women have a lot of pain, walking is important – however you deliver – since there is always a risk of getting blood clots in the legs that could go to the lungs. That risk is even higher for women who have had a C-section.
“I’ve taken care of several women from other countries, where they say that the recommendation is to stay in bed for three months after you give birth,” Lyell notes. “That’s just the opposite of what we recommend. The overriding principle is that a woman should be up and walking around one to two days after a Cesarean.”
Taking those first steps can be scary, and mothers who have been there advise that you hold a pillow over your incision and stand up straight. Don’t look down. Focus on an object – a chair, the bathroom door or the sink – as a goal.
Walking is the perfect activity for the next six weeks, once you start feeling well enough to get out of the house – typically a couple weeks post-surgery. If and when you graduate to another form of exercise, start slowly and stop at the first sign of pain.
And, of course, the standard guideline for sexual intercourse applies however you give birth: No sex for the first six weeks. Most women who’ve had a C-section probably won’t even want to think about it before then.
Doctors, traditionally, have advised women to avoid stairs after a C-section. But Kathryn Houston, a clinical instructor of obstetrics and gynecology at the University of California, San Francisco, shrugs off that recommendation. 
“Stairs are fine as long as you take them slowly,” she says. “I don’t tell people not to go upstairs. I don’t want them running stairs as a workout. But most people have one to two flights of stairs, and as long as you take them slow, it’s okay. That’s because you’re using your leg muscles, not abdominal muscles.”
Returning to Normal
Don’t be afraid to look at your incision. The first day, it may be covered by gauze. The area may look bruised, red and irritated. You’ll notice staples or stitches, which will usually be removed within a few days of the surgery. Looking at the incision now will allow you to be able to report changes that may indicate infection, including warmth, redness or swelling at the incision site; oozing from the incision site; worsening or sudden onset of pain; and any fever – even if your incision looks fine.
There can be significant discomfort in the first couple weeks, when the uterus is shrinking and contracting. Breastfeeding limits what medications are safe to take. Avoid aspirin. Reach instead for ibuprofen.
 “I think it’s very important that a woman take enough medication so that she’s comfortable,” Lyell continues. “Surgical pain can be significant. There are several narcotics that are considered safe for breastfeeding. A small amount crosses (into the milk supply), so it’s important to minimize the levels.”
Itching after Cesarean is not uncommon. Doctors say it’s important to identify the cause of itching, since antibiotics – routinely given before a C-section for reducing post-operative infection – can cause an allergic itching response. 
The incision itself can itch for weeks, even months. It doesn’t mean anything is amiss; indeed, itching around the incision is a sign of healing. 
Products like Aveeno, topical creams like Vitamin E, and cold packs all bring relief. So can antihistamines, but Houston doesn’t usually prescribe them since they can reduce milk supply. That’s problematic if a new mother is already having issues with breastfeeding.
All new mothers experience a major hormonal shift that can lead to depression. The question is, how do you distinguish between the normal “postpartum blues” and something more serious?
The risk is no greater after a Cesarean section, according to Houston. 
“Being a new mother is overwhelming for everyone,” she says. “The physical recovery is harder with a C-section and can add to the stress. But in terms of clinical depression, it doesn’t make a big difference.
“Most people don’t go in wanting a C-section, but the fact is that 25 percent of people get one. Some are very disappointed and feel it’s a defeat. But most women handle whatever comes and are just very happy to have a healthy baby.”
Sara Solovitch is an associate editor at Bay Area Parent.