Maternidad.Recovering from your Caesarean birth

 

For various reasons, the numbers of women giving birth by Caesarean section (also called ‘operative birth’) has increased markedly over the past twenty years. The UK caesarean section rate has increased from 12% in 1990 to 25% in 2010-2011. While Caesarean birth is now a very common occurrence in UK maternity services, it is important to remember that having a Caesarean section is a major operation. To put it in context, if you were in hospital having had your appendix removed, you would not be expected to care for a newborn baby! Recovering from a Caesarean birth is also a very individual experience; some women will find that their recovery runs smoothly, whilst others will find that it takes them a bit longer to recover.

This article has been written to provide you with practical guidance to help you recover from your Caesarean section, including the ‘do’s’ and ‘don’ts’ in getting back to normal daily activities. We advise that you read this section in conjunction with our information on ‘Postnatal Exercises’.

Because a Caesarean section involves a cut into the abdominal wall (tummy), you are more likely to experience discomfort or pain, which can make carrying out every day activities like sitting, lying down, bending and walking uncomfortable and quite difficult. However, it is important that, unless you aren’t well enough to do so, you get out of bed and start moving about as soon as possible. This is because staying in bed and not mobilising can lead to an increased risk of developing a blood clot in your leg (called a deep vein thrombosis – DVT) as well as, possible problems with breathing, walking and your physical strength and general recovery. The hospital staff will be able to help you and there are also things that you can do to help yourself.

 

Breathing exercises

Most Caesarean births are performed under an epidural or spinal anaesthetic (called regional anaesthesia); however, in emergency situations where the baby needs to be born urgently, a Caesarean may need to be performed under general anaesthetic (GA) – this is where you are asleep for the operation. It is important to keep your chest and lungs as clear as possible after the birth; this is particularly the case where you had a GA. The following breathing exercise is very simple and should be done regularly until you’re up out of bed:

  • Take a slow deep breath in through your nose and hold for a count of two
  • Sigh the air out through your mouth
  • Repeat this exercise three times.

 

Are you sitting comfortably?

It is important to watch your posture and ensure maximum comfort for your abdomen. Sitting awkwardly can pull on your abdominal wound and cause unnecessary discomfort.  Placing a pillow or rolled bathroom towel in the small of your back can help to reduce any discomfort. Where your back is well supported, your abdomen will feel much more comfortable. If you are breastfeeding your baby, you could also try using a pillow to raise your baby, so that they are level with your breasts. This helps to avoid you having to hunch forwards while feeding.

When you are standing, try to do so with a straight back and remain as upright as possible. Supporting your abdomen and wound site with your hands can be very helpful in the early days when you are likely to be feeling quite sore.

 

Lying down and getting in and out of bed

Getting plenty of rest is important in recovering from your Caesarean birth; however, finding a comfortable position can be a little challenging, especially during the first few days following your Caesarean section. If you like to sleep lying on your back (supine), you may find it helpful to rest with a pillow under your thighs; this prevents unnecessary pulling on your abdominal muscles/wound site. If you prefer to rest lying on your side, try placing a pillow under your abdomen, or under your leg to give additional support.

Advice on getting in and out of bed is available in the section on ‘Postnatal Exercises’, but the basic steps are as follows:

  • Roll over onto your side and bend your knees so they are brought up towards your chest
  • Gently swing your feet off the bed, using your hands to push yourself upright. Your legs will act as a counterbalance
  • Sit upright on the edge of the bed and press down on the mattress with both hands to stand yourself upright
  • This process should be reversed when you wish to get back into bed.

 

Coping with coughing, laughing and sneezing after a Caesarean

Because you have an abdominal wound, you are likely to feel very sore and uncomfortable in the early days; particularly when your muscles strain during coughing, sneezing or laughing. There are things you can do to help ease this discomfort though – try supporting your wound with both hands or using a pillow to give support. If on a bed, try sitting with your knees bent upwards and lean forwards into a pillow when coughing or sneezing.

If you have any mucous (phlegm) on your chest after your Caesarean, the physiotherapist (physio) can show you how to help cough it up. They will probably advise you to use short forced breaths out through your mouth – this is also called a ‘huff’. It is just the same action, as when you are steaming up a mirror to clean it. A huff is the most effective and least painful way to cough up any mucus.

 

Maintaining a healthy circulation

As previously mentioned, it is important that you keep the circulation in your legs healthy while you are less mobile. Doing ankle exercises using circular motions, or bending and stretching your ankles/feet in a rapid up and downwards motion is important. You can start doing these exercises from immediately after your baby’s birth and you should continue doing them regularly (for half a minute at a time) until you are up out of bed and mobilising. These exercises are also very good in helping to reduce any swelling of the feet and ankles caused by the extra fluid that is present during pregnancy.

 

Pelvic floor exercises

These exercises are extremely important even where your baby was born by Caesarean. This is because the increased weight of the baby in your uterus (womb) during pregnancy places extra strain on the pelvic floor muscles weakening them; this can lead to stress incontinence (ie where coughing, sneezing, laughing causes urine to leak). Keeping these muscles strong is important because they help to support your abdominal contents and back, as well as your bladder and bowel function. It is recommended that you start doing these exercises, as soon as possible.

NB. You should not do pelvic floor exercises if you have a urinary catheter in your bladder – catheters tend to be removed around 12 hours after a Caesarean birth, unless there are specific reasons for it to remain in for longer.

 

How to do pelvic floor exercises

  • Sit comfortably
  • Squeeze the muscles that you use to stop yourself passing urine; this action pulls the vagina and rectum upwards and backwards
  • Hold for up to 10 seconds and then release
  • You may feel that you want to instinctively hold your breath while tightening your muscles; however, it is important that you breathe regularly throughout
  • Aim to do around 50 pelvic floor exercises a day; perhaps five sets of 10 pelvic floor exercises ensuring that you rest in between each set. You can do these whilst feeding your baby or watching the TV. The great thing about pelvic floor exercises is that nobody will know that you’re doing them unless you pull a funny face!
  • You should not contract any other muscles at the same time eg your stomach, thighs, or the muscles of your buttocks.

 

Getting your abdominal muscles back in tone

It is possible to do gentle abdominal exercises after a Caesarean, but these should be taken slowly, because it is likely to feel uncomfortable at first.

Pelvic tilts

  • Lie on your back with your knees bent and your feet flat on the bed
  • While gently squeezing your pelvic floor and buttocks, tilt your pelvis up and flatten your back onto the bed or floor
  • Maintain this position for a maximum of 10 seconds, breathing throughout and then release gently
  • Repeat several times
  • This exercise will not harm your abdominal wound.

Knee rolling

  • Draw in your abdomen and pelvic floor
  • Move your legs gently first to the right and then to the left, but only go as far as feels comfortable
  • Your buttocks should not lift off the bed
  • Repeat this action several times and try to do a few sets of this exercise each day.

Is it safe to lift objects?

It can be very difficult to limit lifting activities; particularly, if you have older children to care for. However, your uterus and abdominal muscles will need time to heal, so you should avoid any heavy lifting (including lifting toddlers and baby equipment, such as pushchairs) for the first two to three months after your Caesarean section. If you do need to lift moderately heavy objects, bend your knees, keep your back straight, draw in your abdominal and pelvic floor muscles and keep the load that you are lifting as close to your body as is possible. Your body will tell you if you are doing too much, too soon because it will hurt! Sometimes a sign that you may be overdoing it is your vaginal loss (lochia) becomes heavier.

Sport activities

Once your abdominal wound has healed and you have had your six week postnatal check to ensure that everything is as it should be, you can start doing sports activities again. However, abdominal exercises and competitive sports should be avoided for the first three months following your Caesarean section. Should you have any queries about the suitability of different sports activities, you can speak with an obstetric physiotherapist and/or your GP.

Returning home from hospital

Returning home from hospital can be a bit of a shock to the system, particularly, if you have older children to care for. Prepare to feel very tired at first and try to make sure that you get plenty of rest at every available opportunity. Accept any offers of practical help from neighbours, family and friends, whether it is help with the laundry and ironing, accepting a plate of hot food, or taking any older children out for an hour or two. As you recover from your Caesarean and start to feel stronger, you will feel ready to begin doing normal activities again. It is however, important that you pace yourself and build up gradually.

Driving a car

The general advice tends to be to avoid driving for the first six weeks after your Caesarean. The car safety belt tends to lie across the Caesarean scar, which can be uncomfortable; you may find that a small pillow placed between yourself and the seat belt reduces any discomfort when you are being driven in the car. When it comes to getting behind the wheel again, you need to make sure that you aren’t feeling too fatigued and are able to concentrate when driving. You also need to be able to perform an emergency stop.

Check with your car insurance company to ensure that you are covered to drive; the majority of insurance brokers will provide valid insurance cover between four to six weeks following the birth.

Sexual intercourse

It is perfectly normal to feel a loss of libido (lack of sexual desire/interest) after your baby’s birth. Resuming sexual intercourse is an individual matter and only you and your partner will know when it feels right. For more detailed information and guidance, see the relevant sections on ‘Sex after childbirth’ and ‘Sexual health and contraception’.

 

Summary

If you have any queries or concerns regarding how you are feeling and/or the activities that you should or should not be undertaking following your Caesarean, it is important that you speak with your midwife, health visitor, obstetric physiotherapist or GP for their advice. For many women, having a Caesarean section is the first time that they’ve had an operation, so there will be a lot to get used to. Remember to pace yourself and listen to what your body is telling you

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