Welcome to our in-depth exploration of Caesarean Section Recovery. We understand the significance of this journey for mothers and aim to shed light on the multifaceted aspects of postoperative healing. Whether you're a first-time Mum or preparing for another pregnancy and delivery, our guide will equip you with the knowledge to embrace a positive healing process.
Statistics show that up to one in three births will result in Caesarean sections. Whether that be planned (an Elective Caesarean) or unplanned (an Emergency Caesarean,) the situation that led to your Caesarean birth can significantly impact how you recover.
Caesarean Section Recovery: Understanding the Procedure
The basics of a Caesarean section
The surgical cut for a Caesarean section is not just one layer. In fact, the surgeon will go through 7 layers to get to your baby. The process starts with cutting the skin, then the fat layer, then the fascia (thick connective tissue.) They will then part the abdominal muscles, cut through the peritoneum (thinner, more delicate connective tissue layers), then the uterus, and then finally, the amniotic sac around the baby.
Here is a great video explanation of how all of these layers are cut:
After the baby is delivered, the surgeon repairs the uterus, then the other internal layers, and then the skin. These layers of sutures may not all be in line with each other, so where you see your external scar might actually be higher or lower than where the internal scars are.
The way that these internal and external layers of scar tissue heal can have a big impact on the future comfort levels and quality of life of the mother.
Different types of Caesarean procedures
As mentioned above, some Caesareans are planned, or ‘elective’, and occur without going into labour. Some Caesareans are unplanned or ‘emergency’ and occur after having gone into labour with the plan of having a vaginal birth.
Preparing for a Caesarean Section: What to Expect
Everyone’s experience will be different, so we can’t realistically prepare exactly how we will feel after major abdominal surgery like a Caesarean section… but it pays to do some preparation work in the following areas.
Open discussions with your healthcare providers - if you want to get a realistic picture of what recovery will look like, ask questions about what to expect in the first hours and days after the surgery. Things like
-
When will you be asked to stand up and walk for the first time?
-
When will your catheter will be removed and how will they determine readiness?
-
What pain medication will they give you?
-
What are some of the possible complications to be aware of?
Preparing your hospital bag
Ask them what you should pack in your hospital bag to make your recovery easier. Things like comfortable, loose-fitting clothing that is easy to get on and off and high-waisted underwear that won’t rub against the incision site. Make sure that you still pack heavy-duty maternity pads because postpartum bleeding will still occur after a Caesarean section. And understanding that constipation is common with the pain medication, you’ll be given, so packing some snacks that are good for moving your bowels (such as dried fruit, liquorice, bliss balls) is a good idea!
Consider your emotional readiness for a Caesarean birth.
Even if you’re hoping for and preparing for a vaginal birth, remember that a high proportion of women do end up needing a Caesarean section. Remember to picture what this could look like so that it’s not a completely foreign concept if it does eventuate.
Ensuring that your family and friends are prepared.
Remind them in advance that a Caesarean section is major abdominal surgery and that you will need them to help with housework, child care and baby care as much as possible in the early weeks. Remind them also that it won’t be suitable for your recovery to meet them at the shops or for a walk, and that if they come to visit, you might be best to chat to them in a reclined position, and you may ask them to leave after a short visit so that you can prioritise rest.
Preparing your older child/children for your Caesarean.
This is one that doesn’t get talked about enough! We’ve heard about buying them their own doll or pram, reading them books about becoming a big sister/brother and having a gift for them to give to the baby. But what about getting your toddler physically prepared for the birth? The first 2-3 weeks, in particular, are crucial for minimising load, allowing optimal scar healing and preparing your toddler to be more independent. At the same time, you’re still pregnant; it can be easier than introducing these concepts after the baby arrives. This could include practising tasks like getting in and out of the car, getting in and out of their high chair, getting in and out of the bath, or climbing up on a chair to give you a cuddle.
Reasons for a Caesarean birth
There are so many varied reasons why a woman might end up having a Caesarean section instead of a vaginal birth, whether elective or emergency. Those of us who work in the area of pre and postnatal care and rehabilitation know firsthand how complex this decision-making process can be.
Women may choose to have an elective Caesarean section for various personal and medical reasons. It's essential to note that the decision to have an elective C-section should be made after thorough discussions with healthcare providers to weigh the risks and benefits based on individual circumstances. Some common reasons women may choose an elective C-section include:
-
Previous C-section: Women who have previously undergone a C-section might opt for an elective C-section for subsequent pregnancies, especially if they had a positive experience with their previous C-section or have concerns about the risks of vaginal birth after Caesarean (VBAC).
-
Breech presentation: If the baby is in a breech position (feet or buttocks first) near the end of pregnancy, an elective C-section may be recommended as the safest way to deliver the baby.
-
Placenta previa: Placenta previa is a condition where the placenta partially or completely covers the cervix, blocking the baby's pathway for a vaginal birth. In such cases, an elective C-section may be the safest delivery option.
-
Medical conditions: Some maternal medical conditions, such as heart disease, certain types of uterine abnormalities, or severe hypertension, may make a vaginal birth riskier than a C-section. In these situations, an elective C-section may be recommended.
-
Multiple pregnancies: Women carrying twins, triplets, or higher-order multiples may choose an elective C-section if their healthcare provider deems it safer or if there are concerns about the babies' positions.
-
Multiple pregnancies: Women carrying twins, triplets, or higher-order multiples may choose an elective C-section if their healthcare provider deems it safer or if there are concerns about the babies' positions.
-
Fear of labour or complications: Some women may have a fear of the labour process or concerns about potential complications during vaginal birth, leading them to opt for a planned C-section.
-
Scheduled delivery: In certain situations, there may be medical indications to schedule the delivery for a specific date, such as controlling pregnancy-related conditions like gestational diabetes or preeclampsia.
-
Inability to tolerate labour pain: Women who have a low pain tolerance or medical conditions that affect their ability to tolerate labour pain might choose an elective C-section.
-
Personal preference: In some cases, women may simply prefer a planned C-section for various personal reasons, such as convenience, timing, or perceived lower stress.
An emergency caesarean section (C-section) is performed when there are urgent medical reasons that necessitate the immediate delivery of the baby via surgical intervention. Some of the common reasons a woman might need an emergency C-section include:
-
Fetal distress: If the healthcare providers observe signs that the baby is not tolerating labour well, such as abnormal heart rate patterns, an emergency C-section may be performed to deliver the baby quickly and prevent potential complications.
-
Placental abruption: Placental abruption is a serious condition where the placenta detaches from the uterine wall before delivery. It can lead to heavy bleeding and compromise the baby's oxygen supply, necessitating an emergency C-section.
-
Umbilical cord prolapse: In this situation, the umbilical cord slips through the cervix before the baby, becoming compressed and reducing blood flow to the baby. An immediate C-section is required to relieve the pressure on the cord.
-
Failure to progress in labour: If labour stalls or stops progressing, it can lead to prolonged labour, which may put the mother or baby at risk of complications. In such cases, an emergency C-section may be performed to ensure a safe delivery.
-
Placenta previa: Placenta previa is a condition where the placenta partially or completely covers the cervix. If vaginal delivery is attempted in cases of complete placenta previa, it can lead to severe bleeding, making an emergency C-section necessary.
-
Uterine rupture: In rare cases, the uterus may tear during labour, especially in women who have had previous uterine surgeries (e.g., C-sections). Uterine rupture can be life-threatening for both the mother and baby, requiring an immediate C-section.
-
Prolapsed cord or limb: Sometimes, a baby's limb or a portion of the umbilical cord may present before the baby's head. This situation can lead to complications and require an emergency C-section.
-
Maternal health complications: If the mother experiences severe medical issues during labour, such as uncontrolled bleeding, severe preeclampsia, or eclampsia (seizures), an emergency C-section may be necessary to protect her health.
-
Suspected macrosomia: Macrosomia refers to a condition where the baby is significantly larger than average. If the healthcare provider suspects that the baby's size could lead to birth complications, they might recommend an emergency C-section.
Factors Affecting Caesarean Section Recovery
Pain levels
The pain levels experienced after a Caesarean section can vary depending on various factors, including individual pain tolerance, surgical technique, the presence of complications, how much support the woman has to help with daily tasks in the early postnatal period, and whether the Caesarean was Emergency or Elective.
While the distinction between emergency and elective C-sections might not be the sole determining factor, there are some potential differences to consider:
Emergency C-section:
-
The level of pain experienced after an emergency C-section could be influenced by the reason for the emergency, which might involve more extensive surgical maneuvers and tissue trauma in certain cases.
-
Some women may not have mentally and emotionally prepared for the outcome of a caesarean section, and processing this change from expectations can drive pain perception to higher levels.
-
The urgency of some emergency caesarean sections may lead to less time for detailed preparation and explanation of the procedure to the patient, which might result in increased anxiety and stress - another potential driver for increasing pain levels.
Elective C-section:
-
Some studies suggest that elective C-sections may have slightly less postoperative pain compared to emergency C-sections, as they are typically performed under more controlled conditions.
-
Elective C-sections usually allow for better pre-operative preparation, including pain management discussions and psychological preparation.
It’s really important to note that this is a generalisation - some women may report more pain after an elective C-section, while others may find an emergency C-section to be more painful.
Also important to note is that the management of pain after a C-section has improved dramatically over the years, and medical professionals take various measures to control and alleviate pain effectively in both types of procedures.
Immediate Postoperative Care for Caesarean Section
Wound care and incision site management
Here are some key things that you can aim to do in the very early postoperative phase that could help with the healing process:
-
‘Splinting’ the wound. This refers to applying external pressure to the wound if you know that a strain is about to occur. For example, if you feel a cough or sneeze coming on, or you need to roll over to get out of bed, you could hold a pillow or a folded towel firmly against your lower abdomen.
-
Take the pain medication offered to you. It’s very important not to put up with high pain levels in the early days or weeks after a Caesarean section just because you think you should be weaning off pain medication quickly. It’s really important to use the medication offered to you to keep your pain scores low enough that you can move and breathe without excessively guarding and creating increased tension in your body.
-
Very gentle touching and then massage over the scar. It’s important from very early on that your brain recognises that the incision site is normal tissue, and doesn’t become highly sensitised to touch and pressure. Right from the beginning, gently touch, stroke and put pressure over the dressings so that the nerve endings start to experience normal sensations.
Direct touching and gentle massage can start to occur when the scar is fully healed (when you no longer have any dressings on), however you may prefer to wait until after your medical appointment at the 6 week mark. It is recommended to use a plain, unscented moisturizer that is water based, not oil based.
-
Prioritise rest. Gentle walks and stretches are great, but if you can, avoid hours of walking around the shops & housework!
Early mobility and breathing exercises
-
Optimal posture. Especially during repetitive or time-consuming tasks like feeding the baby, pushing a pram, or carrying the baby in your arms, your focus needs to be on optimising your posture. Aim to straighten up through your torso with sitting and standing postures as soon as is comfortable, rather than spending long periods of time hunched forwards - this is particularly important in the first few weeks while the scar is healing.
-
Gentle stretches. Within a comfortable pain limit, start gentle stretches and movement within the first few days. In particular, aim to get movement happening through the torso into rotation, extension and side flexion. There are video demonstrations of this in The FitRight Membership under ‘Birth & Recovery - Post Caesarean Workouts’.
-
Avoiding activities that would put pressure on the healing layers of sutures. This would include getting coughs and colds treated as quickly as possible, and getting up and down from a lying position by rolling through sidelying, and avoiding lifting anything heavier than your newborn baby in the first 2-3 weeks. It’s the unfortunate reality that for Mums of toddlers, and/or those with limited support networks, lifting prams and small children may be unavoidable, but wherever possible it is advisable to limit heavy loads in the first few weeks.
-
Gentle return to walking. As you feel able to, begin a habit of going for a walk or two each day. Most women should be able to tolerate gentle 5-10 minute walks in the first 1-2 weeks without any soreness in the Caesarean scar, and should be able to gradually work up towards 30-45 minutes of a more brisk-paced walk on most days by the 6 week mark. Listen to your body and if the scar is hurting during or after a walk, it’s a sign that you need to lessen the distance, speed or length of your walks.
Understanding Caesarean Scar Healing
Occupational Therapist Jessica Chandler explain scar tissue healing as follows: “Scar tissue forms during your body’s natural healing process. When we cause injury to our skin and the deeper tissues in the body, it responds by producing strands of collagen to mend the damage. Unlike the rest of your body, where these collagen fibres are laid down in an orderly fashion and are soft and smooth, scar tissue forms as the strands are laid down any which way, causing knots and “whirls” – and lumpy scar tissue!”
She re-iterates, however, that there are many things that you can do in both the short term and the long term, that can improve the way in which this scar tissue is arranged in order to give it more flexibility and make it behave more like the rest of your skin.
Abdominal support and wound compression is very important!
However, if you've listened to Jess and I talk on the live Q&A within The FitRight Membership, you’ll understand that not all compression is created equal. The SRC shorts are significantly more expensive than other more simple forms of compression, but if they’re an option for you then they are worth the investment due to their specific amount of compression and the way they’re designed for the compression to be in exactly the right place for a healing Caesarean wound.
Most Caesarean scars heal well by themselves and don’t require any intervention. However, there are so many things you can proactively be doing in those early days and weeks to improve your chances of having the scar heal in a way that behaves like normal skin and doesn’t cause problems.
And if you do experience ongoing pain, tightness, or symptoms that might be associated with internal scarring, remember – it’s not normal for this to be the case after the first 2-3 months, and there are people who can help!
Want to know more?
You can watch Taryn's interview with Jessica Chandler in The FitRight Membership.
FitRight runs physiotherapist-led postnatal exercise classes to provide new mums with a safe and enjoyable workout tailored to their individual recovery needs. Check out our Baby&Me classes here or get in touch by emailing hello@fitright.au if you’d like to chat about how we can help.
Want more info on Caesarean Section births? Check out Taryn's previous posts on c-sections here and here.
