Recovery after a Cesarean Birth

If you have had a cesarean birth, this information can help you with your recovery.

Medicines

The amount of pain medicine you will need is very individual. Some women need more narcotic medicine than others. Generally, you will continue to take the same pain medicines you were using in the hospital. This typically includes ibuprofen and a supplemental narcotic. Do not take ibuprofen if you are allergic to it. Ibuprofen works best when taken regularly every 4 to 6 hours.

Some women find it helpful to alternate taking ibuprofen with their narcotic medicine. Narcotic medicines cause constipation, so only take what you need. To prevent constipation, take the laxative (Senna) and stool softener (Docusate, DOSS) from the medication kit you were given in the hospital. If your provider ordered iron for you, wait to begin taking it until you have had one to two normal bowel movements.

Incision

Unless you've been given different instructions by your provider, you should follow these guidelines in caring for your incision.

Your doctor used dissolvable stitches, dissolvable staples, or tape strips to close your incision, and covered it with a dressing. At home, you will need to keep the area clean and dry, change the dressing if needed, and watch for signs of infection.

Care for your incision:

• Do not get the incision wet for the first 48 hours.
• No tub bathing for seven days.
• Your incision should be covered by a clean and dry dressing for five to seven days.
• You may shower after 48 hours. Your nurse will tell you if the dressing you have is not waterproof and needs to be changed after showering.

After five to seven days, remove the dressing. You may notice a rust colored stain on your skin. This is normal and is caused by the antiseptic in the dressing and will wash away over time.

How to change the dressing:

• Wash your hands with soap and water.
• Be sure your skin is clean and dry.
• Gently remove the old dressing.
• Open the package for the clean, new dressing and remove backing. Place center of dressing over your incision and rub the edges to make adhesive stick. Remove white paper edging from outside of dressing.

Signs of Infection

Call your provider if you have any of the following:

• Redness or hardening of the surrounding area
• Area around the incision is hot to touch
• Temperature of 100.4° F or greater
• Increasing or unusual pain
• Excessive bleeding or discharge that has soaked through the dressing
• Yellow or green discharge

Caring for Stitches or Dissolvable Staples

Some drainage from the incision can be expected for the first few days after surgery. If the discharge does not decrease after a few days, becomes bright red with blood, or contains pus, contact your provider.

Stitches or staples normally cause some redness and swelling where the stitch enters the skin. Bruising and a small lump may also form. You may have mild irritation, soreness, itching, tingling, or numbness. These are normal and no cause for concern.

Gas Pain

Surgery and narcotics slow digestion. This can cause abdominal gas and bloating that is often painful.

Gas pain can be relieved by:

• Walking about in your home several times a day.
• Drinking warm peppermint tea or warm water.
• Avoiding very cold beverages and carbonated beverages.
• Taking the recommended amount of ibuprofen for pain. This limits the amount of narcotics you need.
• Placing a warm pack on your abdomen.

Diet and Constipation

Frequent small meals are often better tolerated following surgery and will also help with your milk production.

Focus on including high fiber foods to help prevent constipation, and drink plenty of fluids including water and juice. Foods that are iron rich will help to rebuild your blood.

If your provider prescribed iron because your blood count is low, wait to begin taking it until you have had one to two normal bowel movements. Continue taking the bowel medicine from your SAM kit. You may also use Milk of Magnesia that you can buy over the counter. This works overnight.

Activity and Exercises

For the first two weeks, your activity level should be minimal. Eat, sleep, feed, and care for your baby and yourself. Do not lift anything heavier than your baby and limit stair climbing as much as possible. Do not do housework or shopping.

You can start driving when you are no longer taking narcotic medicines and you are moving easily without pain. This is so you can respond to a driving emergency and hit the brake without hesitation.

Take walks based on your energy level to help your recovery and boost mood and self-image. The gentle exercises that follow can be started within the first few days as you feel able. Don't start rigorous abdominal exercises until at least four to six weeks postpartum.

Deep breathing
Purpose: Prevent the lungs from becoming congested, which can happen when confined to bed.

1. As soon as you are able, take 2 to 3 deep breaths. Take the air in slowly and fill the lungs.
2. Relax to let out the air.
3. Repeat every half hour while awake for the first 24 hours.

Shoulder circling
Purpose: Relieve stiffness in the neck and shoulder region that can result from being in one position for a long time.

1. Sit upright and stretch the top of your head upwards.
2. Rotate shoulders 20 times in both directions, making circles as large as possible.
3. Relax when finished.
4. Repeat 20 circles each way every hour. Do this exercise when you feel tension in your neck and shoulders.

Prolonged expiration
Purpose: Combine deep breathing with gentle activity of the abdominal muscles.

1. Lie with knees bent up. This exercise can also be done in a sitting or standing position.
2. Take a deep breath.
3. Let the air out and at the same time, suck your tummy in towards your backbone. Continue until you have no air left in your lungs and hold for a slow count of five.
4. Relax.

This exercise can be done throughout the day (two or three times every hour). There will be a pulling sensation on the incision but doing this exercise will not cause any harm.

Posture correction
Purpose: Avoid hunching or bending that may lead to backache. You may hunch over as you walk because of the tension and discomfort in the incision area. Try to be in an upright posture when standing.

Gentle stretch
Purpose: Increase flexibility of the incision area.

1. Starting position: Stand upright against a wall.
2. Raise both arms slowly and gently above your head with both hands as high as you can until you feel a stretch in your abdomen. Then go a little further.
3. Hold for a count of five.
4. Relax.
5. Repeat 5 to 10 times every day.