Recovering from c-section in Thailand

As printed on BAMBI Magazine, October 2019

_Cesarean sections are growing in popularity not only in Thailand but in most countries across the world. Whether you are having elective surgery or want to be prepared in case of an emergency C-section, understanding the recovery after a Cesarean should not be underestimated.

By Sheena Flannery, DONA Certified Postpartum Doula_

C-section is not the easy option, yet the “too posh to push” label persists. It is important to recognize that Cesarean section is major abdominal surgery, with significant risks, and it requires a lengthy recovery, difficult, especially when caring for a newborn.

Knowing what to expect can help with recovery and ease the transition into motherhood. Below are some important aspects of C-section recovery.

Surgery

Depending on baby’s condition at birth, you may have the opportunity to spend a short time together in the operating room, and the hospital staff will take your first family picture. Baby is then transferred to the nursery, and your partner will accompany them. This can be a vulnerable time for you, as you are alone in the O.R. while your OB/GYN completes the Caesarean. Sometimes the anesthesiologist will offer or administer a sedative for the suturing procedure. If you do not want to receive sedation, please let your medical team know.

Day Zero – Immediately Post- Op

On completion of surgery, you will be monitored in recovery for a couple of hours. If all is well with you and baby, this is when they will bring your baby, and you’ll get to breastfeed and properly hold your little one. You will be required to lie quite flat so make sure to let the nurses help you with skin to skin and to latch baby this first time. Partners or doulas are not typically allowed to be in recovery with you. Depending on the hospital and whether you were sedated, you may be permitted to recover in a private room on the birth unit with your partner and baby present. Explore this option with your doctor.

Back to the Postnatal Room

You will return to your postnatal room once the doctor is happy with your vital signs, but you won’t feel much from the waist down for another 12-24 hours as the spinal block slowly wears off. Throughout this time, you will be bed bound. As you regain feeling in your legs, wiggle your toes and circle your ankles to promote circulation and avoid post-op blood clots.

Your inputs and outputs will be monitored until you are mobile. You will have a Foley catheter that empties your bladder. This will be removed 24 hours after surgery. You may continue to receive IV fluids and pain medication. Do not eat until told to do so by your medical team. Upon removal of your catheter, drink plenty of fluids and mobilize. Nurses will continue to monitor your urine output for a further 12 -24 hours.

You might feel itchy – this is from the pain medication you received via IV – usually morphine. Tell your nurse if you experience itching as they can treat this with medication. Sometimes just a sponge bath helps, these are available from your nurse, so do not be afraid to ask as it can make you feel a million times better.

Lochia is the blood loss experienced in the days and weeks after birth. Due to close observation in the first 24 hours after cesarean, you must wear standard hospital pads to measure blood loss. This is a rather uncomfortable loop pad (think 1958!) that the nurses will change while you are unable to move. Make sure you bring your own pads for when you can get up (Mothercare sells both postpartum pads and disposable underwear which is easier to manage when you are still in pain and can’t bend over easily). Lochia still happens in c-section patients, and you will experience bleeding for the first six weeks postpartum, just like mothers that had vaginal deliveries.

Day 1 – Moving (or Shuffling!)

Once cleared by your doctor, you will be encouraged and supported to gently mobilize.

Getting up for the first time: This is going to be the most painful part of the entire recovery. Take adequate pain relief at least 30 minutes before attempting to get out of bed. Try to mentally prepare yourself for this and breathe through it. Also, be ready for a lot of blood when you get up. This is totally normal. You will be allowed your first shower and will feel so much better afterward.

Your abdomen has been opened, and you have been immobile for over 24 hours. That leads to GAS! You may experience shoulder pain from trapped gas – this can be surprisingly painful and feel very strange because it’s in your shoulder. You will be prescribed medication which should help with releasing gas. Some research suggests that chewing gum after a C-section can also help prevent gas and pain from trapped gas

Mobilizing can put pressure on your stitches. Belly Binders or postpartum belts help to draw the skin around your stitches together and reduces pain at the wound site. Remember you also have internal sutures so slow, steady movements are best. The first day after surgery you should be able to move to and from the toilet, and around your bed, any further should be by wheelchair.

The first 6 weeks

Continue your convalescence by extending your movement and mobilization a little more each day. Do not lift anything heavier than your baby at this time and listen to your body. Moving promotes circulation, which in turn promotes healing.

You also need to rest to aid recovery, your body has been through a major operation. Allow your partner and family to help you in the early days and weeks. They can do everything apart from breastfeeding. While in hospital don’t feel guilty for availing of the nursery now and again to allow you to rest.

Keep taking regular pain relief for at least 2-3 weeks. This will help you to mobilize, help with milk production, and make you feel stronger to take care of your baby. Remind the medical team of any drug allergies you have and do not be afraid to ask for stronger pain relief if regular paracetamol is not adequate for you. All medications should be explained by the nursing team and be properly labeled by the pharmacy when leaving the hospital.

When it’s time to leave the hospital, you should receive instructions on how to care for your wound. Most doctors will provide a plaster for your wound that will allow you to shower. After four weeks, when your wound has closed, silicone patches have proven to be effective for scar management and to avoid keloids. Breastfeeding might be challenging initially because of incision pain and the effect of IV fluids during and after your C-section. Remember that it’s a skill that you and baby learn together. A doula or lactation consultant can help you ensure the best position to lessen pain. Do not suffer, seek help early to avoid ongoing issues. The rugby hold is a popular choice as it ensures baby is not lying on your incision.

Postpartum swelling in the absence of a severe headache and high blood pressure is normal. This physiological swelling starts on day three and concentrates mainly on the feet. It will pass by day 10. If the swelling doesn’t go away or you get severe headaches and blurry vision, please see your doctor immediately – postpartum preeclampsia can still occur up to six weeks postpartum.

As you physically recover from a C-section, you and your partner might be emotionally affected by the birth, especially if your C-section was unplanned. Processing your delivery can take time. If you feel unhappy or uneasy with the outcome of your birth, seek support. Discuss it with your doula or a midwife, The Bumps team are always here to help and signpost you to support.

Getting back to your usual self

This might take some time. Driving, sexual intercourse, and exercise are usually allowed after your six weeks postpartum check with your OB/GYN, but please follow your doctor’s advice. Also discuss birth control options, as you should avoid getting pregnant again for at least one year after a C-section to allow your body to heal fully. After six weeks, you can consider seeing a women’s health physiotherapist to help you rehabilitate your core and pelvic floor.

Procedures vary from hospital to hospital, this article will not reflect all practices; it is for information only and should not be taken as medical advice. Speak to your doctor and ask all the questions you need to understand what to expect!