Caesarean Birth: Expectations, Preparation & Recovery
Are you prepared?
With one third of babies being born via caesarean, isn’t it about time we started preparing women better for their baby’s abdominal birth? Even if you’re not planning a caesarean, it’s worth reading 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. Do you know what to expect? How long recovery can take? How to massage your scar? Knowing these things can make a big difference to your experience. Our Founder, Miriam Greaves and The Motherhood Movements, Jo Diplock, share their invaluable tips and advice.
With my experience of an emergency caesarean and, with Jo having had two caesarean sections herself, we hope that, through this article, we are able to provide knowledge from a first-hand point of view of what to expect, how to prepare and how best to recover afterwards.
WHAT TO EXPECT
If your caesarean is planned, you will go into hospital early on the day of the operation or the night before. You will be asked not to eat or drink after a certain time so that your stomach is empty at the time of the operation. You will usually be given a time for your operation but it may be delayed by emergency cases. It can be helpful to plan how you and your birth partner might spend the time. Below are some ideas:
Relaxation scripts (you can download or have read to you) visualisations and massage techniques (Parent Tribe’s Positive Caesarean course can teach you these)
Reassuring yourself and baby with positive affirmations/statements (contact Parent Tribe for a FREE copy of these)
Listening to music. Make a playlist before you go into hospital to help you relax.
Watching 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 here.
Playing board games
Using essential oils to help you relax and feel uplifted
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 have choices. See below).
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 wear theatre clothes.
The area where your scar will be, usually above the pubic hair, will be shaved. The skin is swabbed with antiseptic, which may be bright orange.
You will need a catheter (a thin plastic tube), inserted into your bladder to keep it empty. If you are having spinal or epidural anaesthetic, the catheter can usually be inserted after the anaesthetic starts to work.
Your midwife may fit you with stockings that can feel tight and warm. They help to avoid DVT (deep vein thrombosis) or blood clots
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 blood back to the heart, and helps to prevent a fall in blood pressure.
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.
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 theatre. There could be as many as 16 people in cases of multiple birth or if the baby is believed to be high risk. There are likely to be fewer than six.
An anaesthetist nurse
A theatre/running nurse
HOW LONG DOES IT TAKE?
For a first caesarean, it can take as little as 5 – 10 minutes for baby to be born, although the whole operation 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.
It is expected that you will spend at least one night in hospital (if on an enhanced recovery plan) and possibly a little longer dependent 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, 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 Ibruprofen and paracetamol to stronger pain medication, if required.
You will be allowed to leave 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.
HOW TO PREPARE FOR A CAESAREAN/ ABDOMINAL BIRTH
If you have enough notice then help prepare yourself for the demands of the surgery on your body by following these steps;
Get your mind in a really positive place so that you look forward to your baby’s birth. The Positive Caesarean course 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, 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 hospital. This will not only help you on the day, but will also have a huge benefit on your mental health post-surgery. Feeling in control and understanding your choices is a key element to a positive birth.
Teach your elder children, should you have any, how to get themselves in and out of the car seat/bath/toilet/anything else that involves lifting them.
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.
Whether you’re planning for an caesarean or not, it is always worth writing a caesarean birth ‘plan’ (or ‘proposal’ as we like to call it!). If you’re not planning for one, you never know what might happen on the day and, should you have your wishes written down, it can make such a differences to your birth experience to know that they were listened to and carried out. Things you might like to think about":
An atmosphere of peace and calm
Mother’s choice of music to be played in theatre
Drop the drape or use a clear drape so mother can see her baby being born
All IV straps on non-dominant hand so that mother can hold baby easily
If all is well with baby, immediate skin-to-skin.
Perform all newborn tests on mother’s chest, if possible
Weighing and measuring of baby to take place after the first feed.
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 6 weeks - check with your 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. Perhaps consider whether you need additional help or support for them also and what this might look like.
Pack your hospital bag accordingly. 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. So pack things that are easy to put on and 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, fibre and staying well hydrated will help.
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 ignored the points above and 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.
Be kind to yourself - you've just given birth and you need to rest. Enjoy your newborn bubble.
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 epidermal layers. 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 as being able to touch and move your scar is important for long term function and health.
HOW TO MASSAGE YOUR 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 prescription being one of 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 “natural” birth 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 I, 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.