The time after a caesarean section can be an overwhelming time for a woman. The body has undergone a great deal of physical strain and it is normal for mental health to go up and down during the first few weeks. In this guide, we will go through common discomforts that can occur after a caesarean section, whether it was planned or not. Remember that the journey to recovery is individual and any discomfort will be experienced differently from person to person.
You may want to start by reading the article: how a caesarean section works.
In this guide after a caesarean section:
- Breastfeeding and milk production
- Baby blues and postpartum depression
- Peeing and pooping after childbirth
After the operation
If you are anesthetized during your caesarean section, it is common to feel tired and sometimes nauseous afterwards. The midwife will feel your abdomen and make sure that the uterus has contracted properly. She will also check that you are not bleeding too much from the vagina or from the wound on your abdomen. Some women may keep the catheter inserted during the operation overnight and in other cases the midwife will remove it the same day. The wound on your belly may be sore for a couple of weeks, sometimes longer. However, it is important that it feels better and better every day and the bandage will be checked regularly by the nursing staff. You will be offered painkillers for the first few days. It is common to stay in the maternity ward for 1-2 days after a caesarean section and in some cases even longer. You may need to stay longer if you lost a lot of blood during labor, the baby is not feeling well, an infection in the womb develops, or there are difficulties feeding the baby.
On the same day or the day after your surgery, you will be helped to get up and stand. Movement is important for healing and for your bowels to recover after surgery. Climbing stairs, walking with the stroller, carrying the baby and the baby carrier are not things you need to avoid for healing. However, heavy lifting beyond these examples should be avoided for the first two weeks after a C-section. Listen to your body to know what you can handle.
The operation section
In the vast majority of cases, a thread is used which disappears by itself a few months after the operation. The dressing covering your incision should remain in place for 5 days unless otherwise instructed. You can then remove it yourself and apply surgical tape to protect the scar. If you have narrow strips of tape under the bandage that hold the wound together, you can also put surgical tape over this and leave it in place for another 1-2 weeks, or until it comes off by itself. If the tape is itchy or bothersome, you can remove it earlier. As your scar is fresh, the skin will be red and lack protective pigment. Be sure to cover, avoid strong sun or use high sunscreen on the scar during the first year after your caesarean section.
Coughing, sneezing or laughing may cause pain in the surgical wound itself. Try pressing your hands or, for example, a pillow against the wound for 'support'.
Getting an infection in your wounds is rare thanks to the antibiotics you will receive during your surgery. However, if you have any of the symptoms listed below, you should contact your gynecological emergency department or health center:
- The scar has increased redness around it.
- Increased pain compared to the first days.
- It comes from the scar.
- The area around and on the scar feels warm.
- You get a fever along with any of the above symptoms.
Bleeding from the vagina
Everyone bleeds from the vagina after childbirth. This is called discharge and comes from the wound left by the placenta after it has detached from the uterine wall. The discharge starts as a heavy period, then becomes more brownish and finally lighter before it stops. During the 4-6 weeks that bleeding is common, the smell and consistency of the bleeding may also vary.
After giving birth, your uterus is particularly sensitive and susceptible to bacteria, which increases the risk of infection. An infection of the uterus is treated with antibiotics and in some cases the woman may need to be hospitalized to receive antibiotics in a drip directly into the bloodstream. As you are particularly susceptible to infection during this time, you should avoid bathing (showering with the bandage is fine and it does not need to be changed afterwards), avoid using vaginal protection (tampons or menstrual cups) and remember to use a condom during sex. However, you should avoid sexual intercourse while you have fresh bleeding.
If you are worried, you can seek care via a health center or a midwife's office. However, go to an emergency room or a gynecological emergency room (except in the first week when you contact your obstetric clinic) if one or more of the statements apply to your condition:
- You are bleeding more than you did in the first 24 hours after giving birth.
- There are many or large clots of blood coming from the vagina.
- You have a fever above 38.5 and pain in your lower abdomen. It feels sore when you press on your uterus.
- Your rejection will be very smelly.
- You are tired and have a headache along with any of the symptoms above.
Afterbirth
Soon after the baby is out, the uterus will start the job of contracting again. This is called afterbirth and can be painful. If you are a preemie, you are more likely to experience strong, painful afterpains. They are usually felt more during breastfeeding, but the pain usually subsides after 3-4 days as the uterus contracts. It may be worth testing whether a heating pad or tens device relieves and taking Alvedon and Ipren if necessary.
Breastfeeding and milk production
If you want to breastfeed your baby, it is good to be prepared that it may be a bumpy road before breastfeeding works well, regardless of whether you gave birth vaginally or by caesarean section. After surgery, it can be difficult for a woman to hold her baby by herself and milk production may lag slightly. This certainly does not mean that you will not be able to breastfeed if you have had a caesarean section, just that it may take a little longer for the process to start.
Let the baby suckle often and have as much skin-to-skin time with the baby as you can. It is normal to breastfeed a lot in the first few days before the mature milk flows. 8-12 times/day and more is common and may come as a shock to the tired new mother.
When the mature milk runs out between days 3-5, you may get something called milk stasis, your breasts become hard and you may feel a little sick. Here's the best thing you can do to breastfeed on, ideally on baby's cues. If your breasts feel very tense and you need to relieve the pressure in your breasts between feedings, you can take a warm shower while gently massaging your breasts. You can also try using something called Cotterman's hand grip, where you place your fingertips around the nipple and press for a few minutes. This simply causes the milk and tissue fluid to be pushed backwards, softening the nipple and areola and making it easier for the baby to get a good grip on the breast.
Sore and tender nipples are also very common. For sore nipples, you can air them, lubricate them with breast milk and use special creams available at the pharmacy.
If you need support and advice on breastfeeding in the first week after giving birth, you can always call your maternity ward. Dare to ask for help from friends, family and health professionals. As with everything else when it comes to a newborn, no one expects you to know everything from day one. In a way, both you and your baby are new to this world.
Read more about breastfeeding in our breastfeeding category HERE.
You can also prepare for labor by starting to hand-stimulate your breasts at the end of your pregnancy. Don't worry if you don't get any milk out when you hand-feed. Simply stimulating the breasts promotes the production of colostrum, which can facilitate the start of breastfeeding.
Sleep deprivation
Once the birth is over and all you want to do is sleep, a new chapter begins with night wakings and days that blend into one. Talk to your partner, if you have one, about how you can best take care of your home, each other and your baby in the early days. Take the opportunity to sleep for a while during the day when the baby is sleeping so that you are more prepared for a night with an unclear number of hours of sleep. If you are breastfeeding, it is difficult to share responsibilities at night, but perhaps your partner can relieve you between breastfeeding sessions. There are many ways to comfort a baby besides the breast and it can be good for the partner to find their own tricks early on.
Sleep is essential for everyone, so if you're feeling extra sensitive, unfocused and stressed, it could well be the lack of sleep that's haunting you. A tip for all parents out there is to take all the rest you can get. Whether it's a 10-minute power nap on the couch in the middle of the day or having a friend or relative come over and carry the baby around for a while so you can cook in silence. People often want to help and feel needed, but sometimes you have to reach out and ask for it yourself.
Fallout
A prolapse is when the uterus sinks into the vagina, or organs around the vagina bulge into the vaginal wall. This is due to a weakened pelvic floor. The development of some form of prolapse is more common after a vaginal birth compared to a caesarean section. However, it does occur, but you may not always be bothered by it and therefore do not need to seek medical attention. For others, it can cause a feeling of heaviness, chafing or problems emptying the bladder and bowel.
There are a number of things you can do to avoid the risk and to alleviate the symptoms of prolapse. These include doing squatting exercises regularly to train your pelvic floor muscles, avoiding heavy lifting, and if you need to lift heavy weights, remember to squeeze your pelvic floor muscles. It is important to always go to the bathroom immediately if you feel the need to poop. Also remember to eat fiber-rich foods and drink plenty of fluids to give your gut the best possible conditions.
If you are bothered by a bulge in your vaginal opening, frequent need to pee even though you have just been to the toilet, inability to empty your bowels properly, leakage of stool or unrecognizable bleeding, it is important that you contact a health centre or gynaecological clinic. There is good help available!
Urinary tract infection
After a caesarean section, it is more common to get a urinary tract infection than otherwise. The most common cause of the infection is the urethral catheter that is placed in everyone who has an incision. Sweating when you urinate and having to urinate frequently are two common symptoms. Urinary tract infections usually go away on their own, but if the symptoms become severe, you should contact a health center to see if antibiotics are needed. Drink plenty of water/fluids if you experience urgency and run to the toilet frequently. This may make the UTI go away on its own.
Baby blues and postpartum depression
The three-day cry or baby blues is something many new mothers have experienced. The hormones and transition can cause feelings of sadness and anxiety to take over. Some don't feel this at all, while others feel a deep sense of sadness and unhappiness. It can be helpful to remind yourself that this is very common and always passes. The so-called "baby bubble" is in many cases far from perfect, cozy and peaceful all the time. The reality for many women is that life is a rollercoaster of emotions in the early days with a newborn.
However, if you feel strong feelings of depression, cry a lot and find it difficult to bond with your baby, you may be suffering from postnatal depression. Don't be afraid to talk to your potential partner, a friend, a family member or your health visitor. If the feeling of depression hasn't passed after about two weeks and you find it difficult to get up and face the day in the morning, it's time to seek help. Through your childcare center, you may be offered contact with a psychologist or doctor if needed.
Peeing and pooping after childbirth
It is said that three things shall function after a woman has given birth. Peeing, pooping and having sex. Not right at the beginning of course, but it is important to remember that these three things are basic needs and if they do not work, we will be affected in one way or another.
After the catheter is removed, you can try to pee yourself. The spinal anesthesia given to you during a caesarean section may impair your ability to pee, but it is important to try to pee as soon as you feel the need. Remember to drink plenty of water and eat high-fiber foods to avoid constipation after childbirth. The pelvic floor is weakened even after a caesarean section, and small or large amounts of urine may leak out when straining. If this continues to be a problem, it is important to bring it up at your follow-up appointment with the midwife. Unless your doctor or midwife tells you otherwise, you can start practicing squatting exercises immediately after giving birth.
Split abdominal muscles
Diastasis Recti, or abdominal muscle separation, is something you may have heard of before. During pregnancy, all the layers of abdominal muscles stretch and become weakened. This is to make room for the growing uterus. After giving birth, these eventually find their way back together, but in some cases the connective tissue between the muscles remains stretched and the distance between the muscles becomes too large. Signs that you have split abdominal muscles may be that your stomach bulges outwards, your abdominal muscles feel weaker, you have problems with your pelvic floor and lumbar spine, problems with urinary incontinence, etc.
It is not dangerous, but it is important to be aware of the condition so that you train your muscles properly. Consult a midwife or physiotherapist for an exercise program to strengthen the pelvic floor, oblique abdominal muscles and back. In some severe cases, surgery is needed to fully recover.
There is no pregnancy or birth that is exactly like any other. The same goes for the journey towards feeling recovered. Be kind to yourself and let the internal and external healing process take its time.
