Episode 12: Recovery from your caesarean
Listen now to the Pregnancy and Childbirth podcast with Dr Greg
Episode 12 Content and Overview
In episode 12 of the Pregnancy and Childbirth podcast, Dr Greg Jenkins, obstetrician and gynaecologist, discusses the recovery process after a caesarean section.
The recovery process is important because it allows you to heal physically and emotionally after your caesarean. It is also an opportunity for you to learn about your own body and how to care for yourself following surgery. The recovery process will vary from woman to woman, but there are a few things that are common to most women, and these will be covered in this episode.
Listen in as Dr Jenkins discusses pain relief options, the healing process, guidelines for discharge from the hospital, dressing your wound, what activities you can and should do as you recover and more. Whether this is your first or second caesarean, you will find this podcast informative and helpful as you navigate the road to recovery. So, tune in now for all the information and advice you need to make your recovery as smooth and easy as possible.
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Transcription
00:00:00
Hi I'm Greg Jenkins. Welcome to my pregnancy and childbirth podcast. Today we're going to talk about recovery after your caesarean. This topic was suggested by the partner of one of my patients. If you have any suggestions for podcast topics, please let me know.
00:00:18
There are two types of caesarean. There's the caesarean that's performed during labour, where there was a plan to aim for a vaginal birth but something happened during the course of labour to change direction and move towards a caesarean. The second type of caesarean is where there was always the intention to carry out a caesarean.
00:00:36
Now the recovery for both of these and the post caesarean care is very similar for both. Really, the only difference is that if you laboured for some time before you had a cesarean, there may be a little bit more recovery needed in the first couple of days as you will be recovering from the labour as well as recovering from the caesarean itself.
00:00:57
We'll start by talking about what to expect immediately at the end of your cesarean. So you'll usually have either a spinal or epidural type of anesthetic, in some instances they might leave an epidural catheter in your back and give you some anesthetic down the epidural immediately following your caesarean.
00:01:17
Some will give you some medication, some long acting medication through the epidural or the spinal to help with your pain relief for the 1st 12 hours or so after the caesarean and on other occasions you might have a drip with a push button that'll give you small amounts of pain relief as you need it.
00:01:35
Whichever approach it is, the anaesthetist will ensure that you have some good quality pain relief to get you through the 1st 12 hours or so after your caesarean. The same thing would apply if you had a general anesthetic or a go to sleep anesthetic for caesarean. So you have some good quality pain relief.
00:01:55
You'll also have an intravenous drip, and drip will stay there usually until the following day, and that enables you to have some intravenous fluid, you might need some extra antibiotics and that just helps to keep you well hydrated and keep you well during your post operative recovery.
00:02:15
You'll have a catheter in your bladder. It's important that your bladder is able to be emptied following caesarean and you might not be able to do that yourself. So the catheter will usually stay there until the following day.
00:02:28
In terms of the skin closure from your caesarean, we'd usually use the dissolving stitches in the skin so it would be unusual to have a stitch which required removal so they'll usually be a dissolving skin stitch, and then there'll be a waterproof dressing over the top of the skin stitch and I would usually use a clear dressing so that we can see the wound quite clearly through the dressing.
00:02:52
If the caesarean is fairly straightforward and there were no other complicating factors, it'll usually be ok for you to have something light to eat and something to drink, within the first few hours after your caesarean. And this is actually a good thing to do because it helps to speed up your recovery.
00:03:10
Now, there may be occasions where this is not advisable, in which case we'll be sure to let you know that's the case. Generally, on the first day of your caesarean, we wouldn't expect you to be getting up out of bed. This is generally a rest day where you'll be resting in bed.
00:03:25
The exception might be if you had your caesarean very early in the morning, in which case we might have you sitting out of bed by later in the day, but usually you'd expect on the day of your caesarean, pretty much a day where you're going to be resting in bed.
00:03:37
The midwives will give you lots of assistance with caring for your baby, and if you're breastfeeding, assisting with breastfeeding, and all of those kind of things. And usually your partner is, very much encourage your partner to be involved in all of these activities as well.
00:03:54
So we managed to get through the day of your caesarean and the night following, and hopefully this has been a fairly comfortable time with plenty of pain relief, lots of time spent cuddling your baby and helping to get the breastfeeding started, if that's what you're wishing to do.
00:04:10
So the following day we plan to get you up and about. So generally speaking the catheter will be removed first thing in the morning and at some time during the day, preferably the morning time, the midwife will help you to get out of bed and get showered, and most women find this is a nice experience and makes them feel a lot fresher and a lot more back to normal, being able to have some breakfast in the morning and get up and have a shower and not be connected to a catheter anymore.
00:04:38
We'd usually be able to cap off your intravenous drip so that you're not connected to a drip now, and if everything goes well during the day, then you're intravenous drip would usually removed from your hand or your arm that day as well. Making some changes to your pain relief today, so any pain relief that you had through either your epidural or through the drip would now be removed and we'd be relying on tablet form of pain relief going forward now.
00:05:07
And most commonly this would be a combination of three tablets that you're given regularly. So one of these would be paracetamol, which is Panadol, and then usually another drug, which is what we call an anti-inflammatory drug. So the two most common ones would be things like Nurofen or Voltaren.
00:05:25
We'll give these in quite a good dose regularly, generally 3 times per day. That of course assumes that you're not allergic to either of these medications, in which case we find other alternatives. And the third regular type of drug you have to manage the pain relief in these early days is a slow release, stronger pain relief style medication. It's a little bit like Endone nor Oxycodone, and it's a slow release form which causes less side effects, which means you only have to take it twice a day and gives you a nice long lasting pain relief across the day.
00:06:01
So they'd be the regular pain relief medications that you get. Now on top of these there would usually be some pain relief that you would ask for if you need some extra pain relief. But most women will have a bit of extra pain relief in the first couple of days, and this would most commonly be a medication like oxycodone or endone, which you can have as an extra if you need it.
00:06:25
So on the first day after your caesarean, you're mostly going to spend the day in your room unless of course your baby is in the nursery, in which case you'd usually wheelchair up to the nursery to visit your baby. So, day one, mostly in your room sitting out of bed, spending some time in bed and gently mobilizing back and forth to the bathroom as you need to. And that's about all you need to be doing on the 1st day after your caesarean. On the second day, we continue the same plan in terms of your pain relief medication, but on the second day, you'd be doing a little bit more moving around, so spending more time out of bed, more time walking around and able to venture out into the ward to walk around the ward a little bit, and it's important on Day 2 to venture out of your room and it's good for your well-being generally to expand your horizons beyond your hospital room so some little walks around the ward with some assistance is a good way to help your recovery progress.
00:07:26
There's plenty of evidence that women who take lots of pain relief and mobilize actively early in their recovery make a faster recovery than women who spend a lot of time sitting in a chair or sitting in bed and not taking pain relief and experiencing more pain. So take plenty of pain relief and gently progress your mobilization over the first couple of days after your caesarean and this will lead to a better recovery.
00:07:55
Timing of discharge is going to vary from hospital to hospital and you may want to be somebody who's discharged from hospital quite early, and it's certainly possible to go home on day two or day three after your caesarean if everything is going smoothly and you're feeling confident. Most women will stay a little bit longer than that. Now what you'll need in terms of pain relief once you get home will depend on how soon after your caesarean you go home.
00:08:20
Now the main stay your pain relief once you go home will be things like Pandadol and Nurofen or Voltaren, and you should take these regularly in quite good doses and your doctor or midwife will explain to you the sort of dosing you can be looking at once you go home and you should take these medications regularly for as long as you need to, and then gradually reduce them once you feel you're not needing them anymore.
00:08:44
Now if you discharged early, you might need some stronger pain relief to go home with, in which case we might give you a prescription or a small supply of of the medication we mentioned earlier, you've got oxycodone or endone. Now this is a very strong pain relief tablet. It will help with your pain relief in the first few days after you're home, if you need it.
00:09:06
We do need to be careful with this medication because it's extremely addictive and the longer you're taking it for the harder it's going to be to stop. So if we do give you some endone or some oxycodone, it's the same drug, to take home, we generally only give you a very small supply and we wouldn't expect you to require any more than the supply that you've been given.
00:09:30
In terms of the dressing, so as I mentioned earlier, there's a clear waterproof dressing covering your wound. Now this can actually stay on for several weeks, and some women find the dressing is quite comfortable. It provides an extra layer on top of the wound so their underwear doesn't rub around the sensitive skin on the incision. So there's a degree of flexibility or personal preference whether you would prefer the midwives to take the dressing off before you go home, or whether you prefer to leave the dressing on.
00:10:01
It's a clear dressing so you can see the incision quite clearly underneath and see how everything is healing. So if you prefer to leave the dressing intact, it's generally something we would talk about as your discharge approaches, and I've had someone leave the dressing intact for six weeks and we take it off when they come back for their six week checkup.
00:10:21
It is important to be aware of constipation after caesarean section. It is quite common to have some difficulty opening your bowels in the first week or two after the caesarean. So it's a good idea to have something that you could take at home in a form of a laxative to help your bowels along. Now, most laxatives are completely safe during breastfeeding, if you are breastfeeding, so make sure that you talk to your doctor or midwife about what you might want to take as a laxative if you're having difficulty with your bowels after you leave hospital.
00:10:54
In terms of activity, you should be pretty much fine to do most normal day-to-day things once you're discharged from hospital. People worry about maybe lifting their other children or going up and down stairs or just doing gentle day-to-day activities. Now, generally those things are all going to be fine. The caesarean section incision is inherently quite a strong, incision just because of where it's placed on the abdomen and the type of incision that it is.
00:11:25
It's very unlikely that you're going to do anything that will really disrupt the healing process. So the advice we generally give is that if something feels comfortable, it's ok to do. And if you go to do something and it's painful around the area of the incision, then you're probably not quite ready to do that yet. And we'd certainly suggest that any heavy or strenuous activity or strenuous exercise, for example, should be delayed until at least after six weeks.
00:11:55
In terms of driving, there aren't any clear guidelines around when you should drive after a caesarean, but a common sense approach suggests that when you can stomp your foot on the brake really hard, then you will be safe to drive. And most women will reach this point by about three weeks after your caesarean. So what I'd suggest is that you sit in a straight back chair and stamp your right foot on the ground really hard. And when you can do that without doubling over and discomfort, then you'll know that you're ready to be able to drive. And as I say, that's generally at about 3 weeks.
00:12:37
So what do you need to look out for after your caesarean? You should keep an eye on how the incision is healing. If it becomes red and swollen and increasingly painful, this could be the indicator that you might be developing a wound infection. This is not especially common. If it's going to occur, it occurs most commonly within about the first two weeks after the caesarean. And it might mean that you need some antibiotics.
00:13:04
If this happens then you should get in touch with your doctor or midwife or your general practitioner to get them to have a look at the incision and see whether antibiotics are needed. Now because you've had a catheter in your caesarean, there's a possibility of developing a bladder infection, and if this happens you might experience a lot of frequency, so needed to go to the bathroom to empty your bladder very frequently, and you might experience burning or stinging when you're passing water. And if this is the case, again you should seek advice from your pregnancy care provider so that you can have a urine test performed and you might need some antibiotics.
00:13:41
Now, very occasionally we see women who develop a fever or an infection in the uterus after caesarean. This can happen after normal birth as well, but it's a little bit more common after caesarean. And again, it commonly happens around the 7 to 14 days after the caesarean. And if this happens you'd be likely to develop fever and lower abdominal pain. So you might feel hot and sweaty, you might have a raised temperature and feel a bit unwell with pains in your lower abdomen, your lower tummy.
00:14:13
And if this is the case, again, you should seek a review by a pregnancy care provider or your GP, as you might need some antibiotics. Generally we'd book in a six week check up for you to come along at six weeks and see how your recovery from your caesarean, your recovery from childbirth is going and how you're coping with motherhood. And we'd have a careful look at the caesarean incision and make sure that everything is healing nicely and talk about family planning and all those other things that we do at the six week check up.
00:14:45
So this is very general advice about caesarean section recovery and what would apply to most women who had a caesarean. There will be specific circumstances that may be particular to you, in which case your obstetrician or midwife will explain those to you before your discharge, so if there are special things you need to be looking out for, then you're well aware of those things. Don't be shy to ask all of the questions you have in the time leading up to discharge so there's an opportunity for all of those questions to be answered for you.
00:15:18
I hope this has been a helpful discussion around the things to expect following recovery from caesarean section, and as I mentioned earlier, if you have any suggestions regarding topics for future podcasts, please let me know. Bye for now.
