Postpartum recovery and care after a caesarean section – Your step-by-step midwife guide
Updated: Mar 28, 2022
Congratulations! Now, the real fun begins. 😊
So, your baby came out the sunroof. Caesareans have come a long way, and in most cases the recovery is much quicker than it used to be. You won’t need to worry about your perineum healing as much, but since there has been a lot of pressure on your pelvic floor throughout your pregnancy anyway, it will still need time to recover and restrengthen.
Caesareans are generally done in a surgical theatre as they are, after all, major abdominal surgery. In theatre you will have a team of people there to help make everything run smoothly. Once the spinal block that will numb you is administered by the anaesthetist, surgery can begin. I have often found that women are quite surprised by the fact that they can still feel some of the procedure. Not pain, but like there’s movement in your belly. This is normal. Midwives often describe it as “feeling like someone is doing the dishes in your belly”.
Caesareans can vary from one obstetrician to the next. They each have their own style and preferred methods of suturing or staples. Some can also use a tiny hot tip to cauterise the skin, to stop bleeding. This has a slight burning smell. It’s fine. I only mention it because one of my girlfriends was quite surprised by it. Once the procedure is over, you’ll have a recovery period in theatre before going back to the postnatal ward. This is to make sure that you are comfortable and safe, with one-on-one care while the spinal block is wearing off and your body is catching up to everything.
Once your caesarean is completed, a lot of hospitals now will allow your baby to stay with you. This is great. So check with your hospital to see if this is something you can do.
However, if your baby needs a little more help initially, it will go to special care nursery or NICU (Neonatal Intensive Care Unit). Some babies need a little time or help to transition from being in your belly to the outside world. Their lungs may need a little more time to strengthen or to clear any fluid from them, in which time they often need the administration of oxygen and extra care.
Once you return to the postnatal ward, you’ll have a midwife looking after you. They will be in and out of your room, keeping an eye on you and your baby. It’s very likely that you will not be getting out of bed till the next day or maybe that night, if your caesarean was early in the morning.
You’ll need regular analgesia. Your anaesthetist will have charted a schedule of pain relief that you may need, but it doesn’t mean that you’ll have every drug prescribed. Everyone’s pain control or tolerance is different. It’s a good idea to know what you could be taking and when. Some midwives will write it down for you, so that you can keep track of it according to your needs. Your midwife most likely has four other patients to look after, so keep this in mind and work with her. Nothing will take away the pain completely. Once your spinal block has worn off, you’ll be able to feel your wound, but the pain should be bearable and you should be reasonably comfortable. This is when you need to start taking pain relief – before the pain increases – and then continue a regular schedule.
Check with your midwife about when you can start eating and drinking, as this can also vary depending on your obstetrician. There’s often a period of clear liquids followed by very light meals. One of my patients took her doctor’s instructions of clear fluids only as an invitation to have a glass of champagne. Now, I don’t blame her – that would be my clear fluid choice too. What a great way to celebrate, but hold off the champs till at least the next day, and check with your doctor first.☺
I also found another patient eating sushi and blue cheese as soon as she got back to the ward. Again, I understand this. But your stomach has been moved around and you’ve just had surgery. Let your body rest or you could trigger a bowel obstruction or just throw it all up. ☹
A good indication that you’re ready for a little light food is passing wind. Yes, we actually encourage this after a caesarean. We hope to hear bowel sounds, like your stomach gurgling, followed by the passing of wind. This indicates the body is working well again.
The other thing you may experience in the next 24 hours is pain on the tip of your shoulder (shoulder tip pain). This is often referred pain from wind, and it can be quite uncomfortable. You literally need to let that wind out. Peppermint tea or peppermint water can help this. Check if your midwife can get these for you. Try to relax and maybe have a few minutes on your own to pass the wind without stage fright.
You may want to freshen up, especially if you were in labour that led to a caesarean. This is something your midwife can help you with, while you still remain in bed. She can give you wet face towels to wipe down and help you with a bird or bed bath. Changing into your own top will also be nice. If you are breastfeeding, keep this in mind when choosing your post-operation clothing.
Getting out of bed for the first time
The first time you get up and out of bed will be the hardest. Staying in bed too long only makes it harder, as your body becomes stiffer.
Make sure you’ve had plenty of pain relief, and give it time to kick in. Most pain relief needs 30 to 40 minutes to work effectively. Double-check this with your midwife, as she'll be able to guide you according to what you’re taking.
You need to take your time. Move, but don’t run out of bed.
You need to do everything yourself, with a midwife present to verbally guide you the first time. It’s important that no one pulls you up or tries to physically move you, or they may hurt your wound, as they can’t know what your body is feeling and can or can’t tolerate. You need to be in tune, and in control of your movements.
For six weeks, your abdominal muscles are not to be used, so you cannot just simply sit up. You need to get up, like you did while you were pregnant, by rolling onto your side and using your arms to push off the bed to sit up. While you still have it, you may prefer to use your hospital bed by raising the back to sit you up. Then use your arms to push the rest of your back off the bed, while rotating your legs around, pacing your feet off the edge of the bed.
Sit up and place your feet on the ground. You may feel a little dizzy or lightheaded, so just pause for a moment and let your body get used to the shift. This is a good time to have a drink of cold water or apple juice. Rub your toes or feet on the floor to help ground you.
When you’re ready, stand. Pause and tuck your bottom in to stand up straight. Most women tend to walk like a duck, with their bottom out. Although this is cute, you need to stand straight to stabilise yourself. Have another drink if you need it. There will be a burning sensation on your wound. Support it with one hand. It will get better.
Walk to your best shower ever! The water will soothe your muscles and wash away most of the evidence.
If you still feel a little dazed, first put some cold water on your feet and calves. It will ground you and elevate low blood pressure. A cold face washer on your face or neck will help too.
Try to stand, but if you need to sit, there should be a seat in the shower for you. In my experience, I have found that washing your hair the first time you get up is a little ambitious.
You may need help drying your legs and putting your undies and pants on. Some women literally bounce out of bed and feel great. Others need a little help. Tomorrow you should be fine on your own. Reassess this then.
After you’re dressed, you may feel great, but try not to push yourself too much.
The first day out of bed, activities should be light. Have a shower, go to the toilet, walk around your room and take care of your baby. Small steps at a time, judging by how you are progressing. Rest and have a day sleep, but don’t stay in bed all day or your body will tighten up again.
Over the next few days you’ll begin to feel stronger. You should be able to shower and dress on your own and do more each day. On day three of your recovery journey you can try doing a lap of the ward. Start with one hallway at a time, remembering that you need to walk back. And take a friend with you.
By the time you head home you should be feeling more independent.
Know exactly when your doctor says it is safe for you to drive. Most recommend four to six weeks without driving. It is important to know when it’s safe, not only for your welfare but also for your car insurance. God forbid you’re in a car crash, and then find out that your insurance refuses to cover it. Also be mindful of your steering wheel and your caesarean scar – driving too soon could be fatal. Once your doctor says that you’re safe to drive, get behind the wheel and, before you drive, see if you can firmly brake without discomfort. Even if you are feeling great, keep your first few outings short. You may experience some delayed discomfort later that day. And go slowly over speed bumps – they can cause pain.
Your abdominal muscles need a period of recovery and support while they are healing. This can take up to six weeks. It is important that you don’t do any heavy lifting. Nothing heavier than your baby, or five kilograms as a rough guide, depending on your personal frame. It could be less.
You will need to either wear Tubigrip or support undies. A physio will probably visit you while you’re in hospital, or you can discuss this with your midwife. The support will help your muscles heal and return to their place. They may feel like they are leaning forward, or when changing from side to side in bed, you may experience a sagging sensation. Soft compression will help, till the muscles recover. The support undies should feel firm but comfortable; they shouldn’t be sucking your stomach in a lot. Listen to your body and if you’re not sure, have them checked.
It’s important that you do not wear clothing such as undies, pants or leggings that are tight just under or just above your wound. These types of clothing can cause fluid retention in your muscles, above and below your wound, adding unnecessary pressure. Your undies need to be without a tight elastic; seamless or light lace are a better option, and they need to be the right size. Your pants need to be loose or should go above your belly, like they did while you were pregnant. This is when support undies are the best. They need to go right up to just under your bra, or above your bellybutton. If you can, get underwear that opens at the bottom, so that you can go to the toilet. Women often complain about taking them on and off too often.
Finally, trust in your body’s ability to heal. Give things time. Please, don’t try to be brilliant by doing too much. That will only slow-down your recovery and weaken your body. This is the time to heal, nurture, nourish and rest, while looking after your baby. They’ll be plenty of time for long walks and latte outings later and you’ll enjoy it then.
Looking after yourself = the best mummy for your baby.
Always check with your own Doctor, midwife or healthcare professional prior to following any information here - to ensure it's safe and adequate for you and your situation. This is not a midwife - patient - client relationship.