GUIDE TO: Caesarean Births - What to Expect, How to Prepare & Recover
Are you prepared for a caesarean section?
With one in three babies born via a caesarean section, we’re on a mission to better prepare you for an abdominal birth. Even if you’re not planning a c-section, read on! You never know how your baby’s birth may go on the day, and being informed is a key element to a positive birth experience. Parent Tribe Founder, Miriam and Jo Diplock from The Motherhood Movements, are going to take you through the key questions many people have:
- What exactly is a caesarean?
- What can I expect on the day?
- Who will be in the room?
- How long will it actually take?
- How can I prepare in the months, weeks and days before (if a caesarean is planned)?
- How can I supercharge my recovery?
- How should I massage my scar (and own it!)?
With my own experience of an emergency caesarean and with Jo’s two c-sections, rest assured that this post is very much based on our first-hand experiences, as well as our professional experiences in our roles as a Hypnobirthing Teacher (Miriam) and Pre and Post Natal Specialist (Jo). In short, we’ve got this covered for you!
WHAT EXACTLY IS A CAESAREAN SECTION?
A caesarean section, also called a c-section or abdominal birth, is an operation to deliver your baby through an incision of the abdomen and uterus.
You might have a planned c-section for medical or other reasons, or you may be advised to have an emergency c-section if your medical team believe your baby’s life or yours is in danger or there are other medical complications.
You might choose to have a ‘gentle caesarean’, which involves you and your partner being able to see your baby enter the world and them being placed on your chest for skin-to-skin contact immediately. The baby may be very gently encouraged out but is largely left to ‘wriggle’ out through the incision. Check out this short birth video to see it happen - it’s pretty incredible!
WHAT SHOULD I EXPECT BEFORE & DURING A CAESAREAN?
WHEN: If your caesarean is planned, you will go into the hospital early on the day of the operation or the night before.
EATING: You’ll be asked not to eat or drink for six to eight hours before the operation.
SCHEDULE: You will usually be given a time for your operation but it may be delayed by emergency cases, so do bear this in mind. It can be helpful to plan how you and your birth partner might spend the time. Here are some ideas:
Relaxation scripts (you can download MP3s or have your partner read them to you) visualisations and massage techniques (our Positive Caesarean course can teach you these)
Reassure yourself and your baby with positive affirmations/statements
Listen to music. Make a playlist before you go into the hospital to help you relax
Watch a funny film. It’s always a good idea to get your happy hormone, oxytocin, flowing!
Watch/read positive caesarean birth stories - you can find lots on our blog
Playing board games
Using essential oils to help you relax and feel uplifted. Contact us for more information on the best oils for birth
INFORMED CONSENT: You will be asked to sign a consent form. Always make sure you understand what will be happening to you and your baby and ensure that you've gone through your caesarean birth plan (yes, you do have choices during a caesarean! More on that below).
WHAT YOU’LL WEAR: You will change into a hospital gown which will be open at the back. You may be wheeled into theatre or you may walk. Your birth partner will also wear some very fetching theatre clothes!
PREPARING THE SKIN: The area where your scar will be, usually above the pubic hair, will be shaved. Lots of women want to know whether they should wax/shave before their caesarean. Rest assured that the staff won’t be looking so you really shouldn’t feel embarrassed or worried about how ‘prepared’ you are down there! It’s more about personal choice here, so do whatever you feel comfortable doing.
The skin is swabbed with antiseptic liquid, which may be bright orange.
INSERTING A CATHETER: You will need a catheter (a thin plastic tube), inserted into your bladder to keep it empty. You’ll be less mobile for a while and, therefore, unable to go to the toilet. It also helps ensure the bladder isn’t injured during the operation. If you are having spinal or epidural anaesthetic, the catheter can usually be inserted after the anaesthetic starts to work.
SURGICAL STOCKING: Your midwife may fit you with stockings that can feel tight and warm. They help to avoid DVT (deep vein thrombosis) or blood clots
WHY IS THE BED TILTED? The operating table is tilted or wedged to the left. This relieves the pressure of the uterus on the vena cava, the major blood vessel taking the blood back to the heart, and helps to prevent a fall in blood pressure.
A CANNULA IN YOUR HAND: An intravenous (IV) drip feeds fluid into a vein, usually on the back of the hand or arm. This helps to maintain blood pressure and can be used if you need drugs during the operation.
MONITORING: Electrodes are attached to your chest to monitor your heart rate and you may have a finger pulse monitor.
WHO WILL BE THERE?
You might be surprised at how crowded it can feel in the theatre! There are likely to be fewer than six in most cases. There could be as many as 16 people in cases of multiple births or if the baby is believed to be high risk. You will have:
An anaesthetist nurse
A theatre/running nurse
HOW LONG DOES A CAESAREAN TAKE?
Your baby will be with you in no time! For a first caesarean, it can take as little as five–10 minutes for your baby to be born. The whole operation, including the preparation and closing the incision, can take up to an hour or more. If it is a second or subsequent caesarean, it can take longer due to the presence of scar tissue from previous operations.
WHAT TO EXPECT AFTER A CAESAREAN BIRTH
It is expected that you will spend at least one night in the hospital (if on an enhanced recovery plan) and possibly a little longer depending on how the surgery and your recovery goes. This is to give enough time for any post-surgical issues to arise, for your general well-being to be managed, and for your legs to have their feeling return to them so your catheter can be removed.
You will be given pain relief following the procedure, which can range from ibuprofen and paracetamol to stronger pain medication if required.
You can leave the hospital once the midwives and doctors have checked that you are able to pass urine following the catheter removal and are generally well and ready to leave with your baby.
Remember, although caesareans are common, it is still major abdominal surgery! Try not to rush home before you are truly ready.
OUR TIPS ON PREPARING FOR A CAESAREAN
If you have enough notice then follow our top tips to help you prepare yourself for the demands of the surgery on your body.
Get your mind in a really positive place so that you look forward to your baby’s birth. Our Positive Caesarean Class will teach you tools and techniques to shift your mindset so that you feel calm and confident about the process. By using relaxation scripts, MP3s and positive caesarean birth affirmations and much more, you’ll be amazed by how effective these tools be.
Understand what will happen to you on the day. Knowledge is power and once you have that knowledge you will feel so much more relaxed, calm and in control when you go to the hospital. This will not only help you on the day, it will also be a huge benefit on your mental health post-surgery. Feeling in control and understanding your choices is a key element to a positive birth.
If you already have children (and depending on their age), try teaching them how to get themselves, how to get in and out of the car seat/bath/toilet/anything else that involves lifting them. The more they can help you, the better!
Exercise for strength in your upper body and legs to assist you when you have a weaker core. Follow The Motherhood Movement for lots of tips on this.
Immerse yourself in positive caesarean birth videos and stories. You can find lots here.
Prepare healthy meals and build up a good supply of freezer supplies for the early days when you may not feel up to cooking. Nutrition is one of the major components for scar tissue healing so include things that provide support for collagen repair (protein/vitamin e and c, to mention a few, and hydration). Here are some great meal ideas to prepare and freeze
Think about arrangements for children/pets/driving (you are able to drive when you can perform an emergency stop following surgery - or from six weeks. Check with your health visitor and insurance company to see your policy and how this effects you prior to having a newborn.
Consider whether the people closest to you might also need some more support. If your partner is now taking on the role of two adults whilst you recover, then talk to them about what support they migh tneed. Perhaps consider whether you need additional help or support for them also and what this might look like.
Pack your hospital bag. You may wish to have a back up bag left in the car should you need to stay longer than anticipated.
Consider your clothing for post birth. Even bending to put on a pair of pants can feel particularly tricky. Pack things that are easy to put on and, if you area breastfeeding, you can feed in (if you plan to breastfeed, having a caesarean section should not affect this with the right support).
Eat as healthily as you can. If you have ever experienced having a bowel movement postpartum you will know that this can potentially be an event all of it's own! Post surgery, as your internals have been moved and handled, you may experience trapped wind and constipation making this event a bigger one so to speak. Eating a diet that's rich in colour and fibre, and staying well hydrated will help.
WHAT TO INCLUDE IN A CAESAREAN BIRTH PLAN / BIRTH PROPOSAL
Whether you’re planning for a caesarean or not, it is always worth writing a caesarean birth plan, or birth proposal as we like to call it!). You never know what might happen on the day and, should you have your wishes written down, it can make such a difference to your birth experience to know that you were listened to and your preference carried out.
Here are a few suggestions. Think of it as a Pic ‘n Mix and add your own to make it personal to you.
An atmosphere of peace and calm
My choice of music to be played in the theatre
Drop the drape or use a clear drape so I can see my baby being born
All IV straps on non-dominant hand so that I can hold my baby easily
If all is well with baby, immediate skin-to-skin
Perform all newborn tests on my chest, if possible
Weighing and measuring of my baby to take place after the first feed
Keep up the daily relaxation practice and positive affirmations. As the day draws closer it's only natural to feel nervous about the unexpected. Stay calm and remind yourself of the process.
Keep up the healthy diet - hydration really is key!
Stretch and move your body. Pay attention to your ribs, hips and chest. The tighter these muscles are, the more pull on your scarring you'll have.
Get up as soon as you can post surgery. This will ease a lot of your symptoms and get your bowels moving too, easing any trapped wind. You can also drink peppermint tea to ease these after effects. When you get up, try to keep both legs together and stand up on two feet (avoiding twisting through the torso). You will likely want to hunch over a little to protect the scar site to begin with.
Make the most of the hospital beds that are adjustable to sit you up and lie you down again. If you don't have the luxury of this at home, try sleeping on an incline for the first few days.
Likewise, be mindful of doing movements that mean you bend backwards. For example, washing your hair is best done with your head down not your head back.
Lift nothing heavier than your baby and the biggest piece of advice would be DO LESS. Move little and often but however "okish" you feel after three days, now is not the time to begin doing the washing or carrying your toddler. The less you do, the faster you will recover.
Understand that every day you should feel better (unless you've had a set back) so no matter what, tomorrow is a new, brighter day.
Stay on top of your pain medication. Don't wait until you feel pain to take it or try to skip it altogether early. Keep a log of your medication so you do not forget when you last took it.
Big pants are your friend, along with any waistline that sits above your scar! Now is not the time for those under the bump maternity jeans. They may feel stretchy beforehand but the scar is often very sensitive and the slightest rubbing may irritate it.
Allow water and soap from the shower to run over the scar. Do not rub too hard. Allow the sticky residue from the plaster to come off.
Avoid baths until you can comfortably sit back up and down again and your scar has healed.
Always contact your health care team if your pain gets worse, your scar smells bad, starts bleeding, leaking liquid of any kind or if you feel unwell.
Our best advice is: be kind to yourself - you've just given birth and you need to rest. Enjoy your newborn bubble.
PELVIC FLOOR: Treat your pelvic floor as if you've birthed any other way. The pressure that pregnancy places on the body means that you will still need to provide flexibility and strength to the pelvic floor. In some cases, you may find that, as the abdominals have been compromised, the pelvic floor takes on a larger role and needs more relaxation as well as strength. Focus on the inhale and the exhale on your pelvic floor exercises. To find an example of a good pelvic floor exercise pop across to Jo’s 7 day core rehab programme.
SCAR MASSAGE: It takes up to two years for any cut or graze to heal through all the layers of your skin. During this time, adhesions can form around the scar site. These adhesions can, at best, give a lack of function to the core and, at worst, bind organs together. Once your scar has healed it's time to begin your scar massage. For some women, particularly those who had an unplanned surgery, this can feel emotively overwhelming. If you find yourself in that situation prior to the massage, it's worth seeking some assistance for any potential birth trauma you've not uncovered because being able to touch and move your scar is important for long term function and health.
HOW TO MASSAGE YOUR CAESAREAN SCAR
Follow this video for an explanation of self massage or seek out your local women's health physiotherapist (we love The Mummy MOT) or other qualified scar tissue massage therapist for them to assist you instead.
Move your body and address your imbalances. The feeling of moving slightly hunched over for you might take longer than ideal and this can lead to over-tight and stretched muscles. For example, if you hunch forwards you may find this leads you to having back pain that otherwise may not be associated to your caesarean. Equally, if your pelvic floor is a little too ‘on’ following the compromise of the abdominals, you may feel the lower back flares a bit too much.
Focus on your exercise being aimed at strength and posture not based just around weight loss or shape change. It's paramount for long term health following a caesarean that you keep on top of your movements.
Certain exercises that can be helpful for moving and loading the fascia around the hips include the Pilates 1 Leg Circle and Pelvic Clocks.
Glute strength can help to assist flexibility and strength to the pelvic floor so keeping on top of that can also help long term. A good example exercise for this would be the fire hydrant.
Long term, you want your scar to feel soft, pale and not have numbness or pain to it. Should you find that it feels tight, indented, painful or like cheese-wire it may need a little bit of work.
There’s no reason why having a caesarean birth can’t be the most beautiful day of your life. We live in a culture of fear around birth where vaginal births are considered by some to be “natural” births and a caesareans, therefore, are not. We’d like to reframe this for you. When my son, Thomas, was born via emergency caesarean, many people said to me “oh well, better luck next time”, “I’m so sorry you had a caesarean”. No wonder women feel like they’ve failed some how! But you know what? That day, I was the bravest I’d ever been in my life. It took great courage and trust. My son’s birth was the the most natural way for him to come into the world. My son wouldn’t have survived a vaginal birth so, for him and me, his abdominal birth was natural and beautiful…and life saving. And I certainly won’t be apologising for that any time soon! Remember ladies, we are all super heroes and we deserve to own our births and feel proud.
If you are planning to have a caesarean birth, our Positive Caesarean Class is perfect. This two-hour private session is designed to help you and your birth partner look forward to your cesarean as a positive birth experience. You’ll learn:
Breathing techniques for a calm pregnancy, birth, feeding and beyond
Deep relaxation, including the use of visualisations
How your birth partner can support you and play an active part in the birth of your baby
What options are available for your caesarean birth and how you can incorporate this into your birth preferences/plan
How to release fears and negative thoughts you might have about caesareans and develop and maintain a positive mindset for pregnancy and birth
How to prepare so that the first few days and weeks of parenthood following a caesarean are positive, relaxed and calm.