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After Caesar

Tips for women who have to undergo Caesarean sections – how to have a positive delivery and care for yourself after surgery.

IN my years of practice, I have had many pregnant women walk through my doors, with different opinions on the method of their delivery. Some women are adamant about having vaginal deliveries, while others may prefer to go straight for a Caesarean section.

In reality, the choice of method ultimately depends on the woman’s body and the baby. As doctors, we know that nature has given babies a way out through vaginal delivery, but some circumstances may call for a surgical method instead. In one of my earlier articles for this column, I had written about the pros and cons of a C-section, and when it may be medically necessary. In this article, I will provide some tips for women who have to undergo C-sections – how to have a positive delivery and care for yourself after surgery.

When a C-section is needed

A C-section is when the baby is delivered through an incision in the mother’s abdomen and uterus. Sometimes your obstetrician will advise you to have a C-section in advance, due to certain pre-existing conditions that you may have or that you developed during pregnancy, including genital herpes, gestational diabetes, or multiple births. At other times, you may go into labour wanting a natural delivery, but certain complications, like breech positions or foetal distress, require you to have a C-section instead.

Some of my patients are totally against C-sections because they have heard horror stories about the dangers of, and recovery from, the surgery. You are right to feel cautious about undergoing a C-section, as it is a major surgical procedure and carries risks. However, your obstetrician would not recommend a C-section unless he or she felt that it was absolutely necessary. Under these circumstances, the benefits of a C-section would outweigh the risks, potentially saving your life and that of your baby’s.

Post-op care

If you do need to undergo a C-section, you should take great care of yourself after the operation, so that you heal and recover quickly, and are able to enjoy being a mother!

Here are some tips for what to expect, and how to care for yourself, after the surgery:

  • Start getting up and going to the bathroom within the first 24 hours after surgery. This will help you heal faster and get you used to moving around with your wound. When you first try to get up, move slowly and have someone with you because you may feel dizzy or short of breath.
  • Take slow strolls around the hospital, or sit in a rocking chair. This will help to speed up healing and help with gas after abdominal surgery.
  • If you find it painful to urinate after the catheter is removed, ask the doctor or nurse to suggest solutions that will ease the pain.
  • Pain is to be expected after the surgery. Ask your doctor for advice about painkillers, but if you are breastfeeding, discuss the possible side effects and safety issues for your baby. If you want to avoid medications, ask your doctor about any drug-free alternatives.
  • Don’t be alarmed when you experience heavy bleeding. This is due to your uterus shrinking down to its pre-pregnancy size, so you will have a heavy flow of bright red blood for up to six weeks post-surgery. Use extra-absorbent menstrual pads or special post-delivery pads, not tampons. The colour of the bleeding will change over time to pale pink or dark red, and then eventually to a yellowish or light colour.
  • When you are back at home, avoid housework, strenuous activities and heavy lifting. Do not lift anything heavier than your baby. If you start bleeding more, that will give you an idea that you are doing too much.
  • Make sure that the baby changing station and feeding supplies are near you, so that you don’t have to move around too much.
  • Drink plenty of fluids to prevent constipation, and eat nutritious meals to restore your energy and promote healing. Keep an eye out for fever or pain that doesn’t go away, as that could be a sign that your wound is infected.
  • Talk to your doctor about family planning, and when is an appropriate time to try and conceive again. Your body needs time to heal after this pregnancy and delivery.

There are a lot of old wives’ tales about what you should or should not do after a Caesarean. Some of these are based on sound medical advice. For instance, do not have sexual intercourse or do exercise until your doctor says it’s safe. Do not take baths, only showers, until your wound is healed and you are no longer experiencing vaginal bleeding.

Avoid going to public pools, hot tubs, spas and saunas until your doctor advises otherwise. Going up and down the stairs repeatedly may not be good for your wound, so avoid movement like that for several months.

What to watch out for

Your healing is of paramount importance after surgery. Look out for signs that you may be suffering from post-op infection or are not healing well.

If you experience any of the following, call your doctor immediately:

● Fever of more than 38 degrees Celsius

● Severe headache that begins after birth and does not let up in intensity

● Sudden onset of pain, tenderness and burning in the abdominal area

● Foul-smelling vaginal discharge

● Sudden pain in the wound area, including discharge of pus

● Pain in one area of the leg, which is swollen and red

● Burning sensation when you urinate, or blood in the urine

● Rash or hives on the skin

● Extremely heavy bleeding that soaks a maxi pad in one hour, or bleeding large clots

● Sore, red and painful area on the breasts, may be accompanied by flu-like symptoms

● Feeling anxious, panicky or depressed

Emotional care

Some women may feel quite upset after a Caesarean section, either because they had really wanted to have a normal delivery or because it was an emergency operation to overcome a critical situation. Such distress is normal, and women need support and understanding to get through this. Do not be afraid to talk about your feelings to someone, either to family or a trusted friend. Describe how you felt throughout the birth process, so that you can deal with any negative feelings you may have.

If you have problems breastfeeding, talk to a lactation consultant through your hospital or the support groups – there are many groups in Malaysia who are available to give advice online. Do not be ashamed to ask for help from family, relatives or friends to take care of you or the household. You may feel overwhelmed that simple tasks leave you feeling drained, so don’t try pushing yourself.

Most importantly, spend time every day to hold your baby and bond with him or her. All the pain will be worth it when you look into your baby’s eyes.

The Star Newspaper, Sunday, 23 January 2011