April is Cesarean Awareness Month. What should you be aware of? Be aware that a cesarean, while it can be a life-saving procedure for mom and baby, is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean.
Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to add comments with your experience as well as any questions we will tag cesarean questions and answer them in a subsequent post. For more information and stories this month, check out the International Cesarean Awareness Network Blog.
Postpartum Recovery Tips for Cesarean Birth
By Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE
Giving birth, whether vaginally or by cesarean, is a major physical event. A mother's body goes through immense physical changes in the minutes, hours and first days after birth. Recovering from major abdominal surgery while making the transition to not being pregnant and caring for a newborn can be extra challenging. Here are some tips for the very first days after you have had a cesarean, and some of this information is just good info for the first days after birth, no matter how your baby arrived.
1. Discuss with the anesthesiologist about the possibility of having them administer Duramorph for immediate post-op pain. This medication is placed through the spinal needle or epidural catheter during the surgery, and usually provides effective regional pain relief for 18-24 hours. After that, you can switch over to oral medications as prescribed by your doctor or midwife.
2. Stay on top of your oral pain medication. This is not the time to be a hero! Make sure you are taking the right dosage of meds at the right time, even if the pain has not returned fully yet. It is really hard to play catch-up, so taking your medication in a timely manner allows you to feel your best, be more open to moving and functioning, and gently participating in baby care. You may even want to set your smart phone to alarm a few minutes before each dose is due, to help you track and remember what is needed and when. Give yourself some time before you try and reduce the amount of oral pain meds you need. The more you move and do some gentle, easy walking, the faster your recovery may be. Adequate pain medication will help in this process
3. Think about your recovery set up at home? Where is your bedroom? Is your bed very low to the ground? Where are your baby changing stations? If you have a lot of stairs, consider relocating your sleeping area to one that is more accessible, close to a bathroom and the kitchen/place to eat. It will only be a temporary move, but may make things easier for taking naps and resting. If your bed is very low, consider placing it temporarily on cement or wooden blocks to make it higher. It will be easier on your abdominal muscles to get up and down from a higher bed. You can set up a portable changing area for the baby close by or in the same room as where you will be spending most of your time.
4. Use a pillow to brace your abdomen when getting up from a chair, couch or bed. Sometimes, when you are laughing, sneezing or coughing, that can be helpful too. If your couch or favorite chair is too low, think about adding some extra pillows for the additional height that you need in the early days.
5. Consider using a TENS (Transcutaneous Electrical Nerve Stimulation) unit to help with post-surgery discomfort. Several studies show that women who used a TENS unit around the incision area needed less narcotic pain medication during their cesarean recovery. (TENS units can be purchased online or may be acquired from your care provider.)
6. You may want to consider using a gentle belly binder or even a rebozo to hold things together for the first days or even weeks post cesarean. Some women find that the gentle support offered by these products helps them to feel less sore and more supported. Just be sure that whatever you use does not irritate the incision. (Some care providers offer belly binders automatically during your hospital stay. If not, you can ask for one.)
7. Work at becoming an expert in the side-lying breastfeeding position, which I consider the hardest to master for the mother-baby dyad, but the most useful once you do. This way, you can rest as much as possible, and even doze for a few minutes during those extended feedings. The key to doing this successfully is lots and lots of pillows! A couple for your head, one between your legs, one behind your back at a minimum. In general, your milk may come in a little slower after surgery than after a vaginal birth, so frequent nursing sessions, and lots of skin-to-skin time with your baby will help this to happen sooner.
8. Be sure to use stool softeners, stay very hydrated and eat food with lots of fiber. Oatmeal is a galactogogue (food that helps increase milk production) and is high in fiber at the same time. Narcotic pain medication can cause constipation, and post surgery, the thought of having to strain to have a bowel movement can be emotionally challenging. Most women find the fear is worse then the reality, but it is good to do what you can to keep things moving, so to speak. Also, your bladder and urethra may be a bit irritated from the foley catheter that was placed to drain urine during surgery and the first hours of recovery. You may want to take cranberry pills or drink cranberry juice to help with bladder health and prevent a urinary tract infection. Also, you will have received IV antibiotics before or during the surgery to prevent infection, and some women are more prone to getting yeast infections after receiving antibiotics. A yeast infection on your nipples (Thrush) is no fun either, and can be shared between you and the baby. You may want to use some probiotics (found over the counter in a pharmacy) or eat yogurt with live cultures, to help restore the balance of good bacteria normally found in your digestive tract.
9. Create a nursing bag full of all the things you need during a nursing session. Cell phone, snacks, filled water bottle you can operate with one hand, something to read, burp cloth, breast care products, etc. can all be put in a bag or basket, and moved around with you, so that you have everything you need when you sit down to nurse.
10. Ask your friends and family to do some of the more physical household tasks and contribute meals during your recovery. Use a website like Takethemameal.com or Care.com for scheduling assistance and for letting people know how and when they can help.
11. Recognize that you will have lifting restrictions that limit the weight you can carry to just the baby for at least a couple of weeks or even more! It is recommended that you not lift the carseat with the baby in it until you have done some healing. You also may not be driving for several weeks, (and certainly not while on narcotic pain meds) and your partner may have returned to work already, leaving you feeling a bit isolated. It would be nice to have someone stop be every day to help, visit, or take you out for a short trip if you are up for it. You may want a baby carrier (sling, Moby Wrap etc.) to help you hold/carry your newborn while your physical recovery moves forward and your mobility returns.
12. Working with a massage therapist who specializes in postpartum recovery can also help with postpartum pain and minimize the development of internal adhesions and promote healing. Get a recommendation for someone skilled in this type of scar work and see if they make house calls! Some massage therapists will come to the house in the first days of your postpartum period.
13. Connect with your local International Cesarean Awareness Network chapter, (www.ican-online.org to find one near you) and consider joining their online group or attending a meeting when you are ready. This peer-to-peer support is invaluable as you process your birth and recover from a cesarean.
Go easy on yourself after you have had a cesarean birth. It is hard to recover from surgery and ease into parenting a newborn at the same time. Ask for help, make little changes around the house to support your recovery, and take it easy to give your body a chance to heal. Laying low and resting will give you plenty of time to connect and snuggle with your new little one while you get your strength back.
Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE, is a birth doula, doula trainer and Lamaze Certified Childbirth Educator in Seattle, WA. Sharon is also the co-leader of the Seattle chapter of the International Cesarean Awareness Network, (ICAN.) Sharon can be reached through her website, www.newmoonbirth.com, if you would like more information.