Recovering from a cesarean delivery:

How will I feel after a cesarean delivery?

Like any new mother, you'll probably feel both euphoric about and overwhelmed by the new person in your arms. But you'll also be recovering from major abdominal surgery while dealing with typical postpartum issues such as engorged breasts, mood swings, and vaginal discharge.

C-section patients typically stay just three or four days in the hospital before going home. But your recovery will be measured in weeks, not days, so once home you'll need help taking care of yourself and your new baby. What's more, if you have other children, they may be feeling needy after you've been away from them for a few days, to say nothing of the fact that you're returning home with a new baby! Plan to get all the help you can.

What will I get for postpartum pain relief?

If you have an epidural or spinal for your c-section, your anesthesiologist may add morphine, which can provide excellent postpartum pain relief for up to 24 hours without the grogginess that you get from systemic narcotics. Some anesthesiologists leave the epidural in for 12 to 24 hours after surgery so you can get more medication through it if needed.

Once your regional analgesia is no longer providing adequate pain relief, you'll be given systemic pain medication, usually pills containing a narcotic and possibly acetaminophen. It may help to take ibuprofen, too. You'll also be given a stool softener to counteract the constipating effect of the narcotic.

If you have general anesthesia for your surgery or you don't get a dose of morphine through your spinal or epidural afterward, you'll be given systemic narcotics for immediate postpartum pain relief. You'll either get a shot of pain medication every three to four hours or you'll use a system called "patient-controlled analgesia": You push a button when you're feeling discomfort that delivers medication through your IV. A machine controls the doses so you don't get more than what's safe.

In any case, don't be shy about asking your nurse for more medication if you're uncomfortable. You don't need to suffer in silence, and the longer you wait to ask for the medication you need, the harder it is to control pain in the end.

If the medication that's been ordered for you isn't covering your pain, let your nurse know. If the nurse can't help you, ask to see an obstetrician or anesthesiologist. The more comfortable you are, the easier it'll be to breastfeed your baby and to get moving again.

What's recovery like during the first few days?

You may feel groggy and possibly nauseated right after surgery. Nausea can last up to 48 hours, but your caregiver can give you medication to minimize your discomfort. Many moms also feel itchy all over, particularly those who received narcotics in their epidural or spinal. If this happens to you, let your caregiver know so she can give you medication to relieve the itchiness.

If you plan to breastfeed, you can start in the recovery room right after surgery. Ask the nurse to show you how to nurse in the side-lying position or using the football hold, so there won't be pressure on your incision.

Breastfeeding can be challenging in the days after a c-section because of the pain from a healing incision. Ask to see a lactation consultant as soon as possible to help you position your baby comfortably so you don't end up with sore nipples. If the hospital doesn't have a lactation consultant, ask for the nurse who's the resident expert.

You may feel numbness and soreness at the incision site, and the scar will be slightly raised, puffy, and darker than your natural skin tone.
Your doctor will come by daily to see how you're doing and check that the wound is healing properly.

Anything that puts pressure on the abdominal area will probably be painful at first, but you'll feel a bit better day-by-day. Be sure to use your hands or a pillow to support your incision when you cough, sneeze, or laugh.

Your nurse will come by every few hours at first to check on you and help you. She'll take your vital signs, feel your belly to make sure your uterus is firm, and assess the amount of vaginal bleeding. Like any woman who just delivered a baby, you'll have a vaginal discharge called lochia, which consists of blood and sloughed-off tissue from the lining of your uterus. For the first three or four days, it will be bright red.

Your nurse will also instruct you on how to cough or do breathing exercises to expand your lungs and clear them of any accumulated fluid, which is particularly important if you've had general anesthesia. This will reduce the risk of pneumonia.
If everything's okay, your nurse will remove your IV and urinary catheter, usually within 12 hours of surgery, and you'll likely be able to start eating bland, mild foods if you feel like it.

You might have some gas pain and bloating during the first two days. Gas tends to build up because the intestines are sluggish after surgery.
Getting up and moving around will help your digestive system get going again.

If you're in great discomfort, the nurse may give you some over-the-counter medication that contains simethicone, a substance that allows gas bubbles to come together more easily, making the gas easier to expel. Simethicone is safe to take while breastfeeding.
You may be encouraged to get out of bed the day of surgery and certainly by the next day. (Do not, however, attempt to get up by yourself.

The nurse should be at your side the first time.) In the meantime, get the blood going in your legs by wiggling your feet, rotating your ankles, and moving and stretching your legs.

Just walking to the bathroom may seem impossible at first, but moving around is important for your recovery. It will help your circulation and make it much less likely that you'll develop blood clots. What's more, it will make your bowels less sluggish, which will help you feel a whole lot more comfortable sooner.
It's also important to get to the bathroom to urinate regularly. A full bladder makes it harder for the uterus to stay contracted and increases pressure on the wound.

By the second day, you should be taking a couple of short walks with help from your partner or a nurse. Try to take your walks a short time after you've taken pain medication, when you're likely to feel more comfortable.

In three to four days, your doctor will probably remove your sutures or staples. This takes just minutes, and you may feel a small pinch but no pain. After that, if all's well, you'll be sent home.

What's recovery like after I leave the hospital?

Expect to need help – and lots of it – once you get home. If nobody offers, ask for support from your partner, parents, in-laws, and friends.
If you're worried that you may not have enough support, hire paid help if you can afford it.

You'll likely be given a prescription for more painkillers and a stool softener before you leave the hospital. You may need prescription painkillers for up to a week after surgery, gradually transitioning to over-the-counter pain relievers. (If you're breastfeeding, don't take aspirin or drugs containing acetylsalicylic acid.)

Drink plenty of fluids to help you avoid constipation. Your incision will likely feel better day-by-day, quite noticeably so after several days, though it may continue to be tender for several weeks.

Call your caregiver if you have signs of an infection, including:

* warmth, redness, or swelling at the incision site
* oozing from the incision site; worsening or sudden onset of pain
* any fever (even if your incision looks fine)

Your vaginal bleeding and discharge should be diminishing, though it may last up to six weeks. It should gradually turn from bright red to pink and then yellow-white. If menstrual-type bleeding continues past the first four days after delivery or comes back after slowing, call your healthcare provider.

For more information on warning signs of a medical problem in the weeks after delivery, see our article on when to call your practitioner.

How active should I expect to be?

While it's essential to get plenty of rest once you're home, you also need to get up and walk around regularly. Walking promotes healing and helps prevent complications such as blood clots. But don't overdo it.

Start slowly and increase your activity gradually. Since you're recovering from major abdominal surgery, your belly will feel sore for some time. Take it easy and avoid heavy household work or lifting anything heavier than your baby for eight weeks.

In six to eight weeks, you'll be able to start exercising moderately – but wait until your caregiver gives you the go-ahead. It may be several months before you're back to your former fit self. You'll be able to resume sexual intercourse in about six weeks if you're feeling comfortable enough, with your caregiver's okay.

What will my scar be like?

At first, the scar will be slightly raised, puffy, and darker than the rest of your skin, but it'll start to shrink significantly within six weeks of surgery.

A c-section incision is only 4 to 6 inches long and about 1/8 inch wide. As the incision site continues to heal, your scar will more closely match your skin color and will narrow to about 1/16 inch wide. It might be itchy while it's healing.

C-section scars are usually very low on the abdomen. A low-lying scar will eventually be hidden by your pubic hair, probably way below the waistband of your underwear or bikini bottom.

Emotionally speaking, what should I expect?

Moms have a wide range of emotions after a c-section, so it's hard to predict how an individual will feel. You might feel disappointed if you had your heart set on a vaginal birth. Or you might not care about how you gave birth, particularly if you had complications and were worried about your baby's well-being.

Some women who end up in surgery after a long, drawn-out labor feel a sense of relief, while others are upset that they ended up with a c-section after doing all that work. And others have mixed emotions.

Some moms say they feel cheated out of a vaginal delivery, especially if they took childbirth classes and fantasized about the "ideal birth."
Others say they feel as if they're somehow less of a woman because they needed a c-section.

All of these feelings are common and may be difficult to resolve. If you feel this way, it may take some time to reconcile the reality of your birth experience with what you'd imagined during your pregnancy.

It might help to know that many women find their baby's birth, whether vaginal or c-section, very different from what they expected. If you have nagging doubts about whether the surgery was really necessary, talk to your practitioner about it and ask her to review the decision with you.

Remember that you're also likely to have the range of emotions common to most mothers during the postpartum period, regardless of how they gave birth. Postpartum blues are common, whether you had a c-section or a vaginal birth. If you're feeling really blue, seek help. You may be suffering from postpartum depression.

Finally, you may be frustrated if it seems to be taking you a long time to recover. Remember that just healing from the surgery is likely to take a significant amount of time and energy. Add to that all the postpartum changes your body is going through – along with your new round-the-clock parenting responsibilities – and you're bound to be in less-than-top condition for a while.Try to cut yourself some slack and be patient. In time, you'll be feeling better and enjoying life with your new baby.

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