Expectation and planning for your caesarean section is vitally important in assisting with recovery. Caesarean section is regarded as major surgery and a six-week recovery time is recommended. The following are recommendations for assisting with your recovery.
Discuss your procedure with your gynaecologist regarding the actual Caesarean section, date, admission times, what happens in theatre, recovery and on transfer back to the ward. The anaesthetist discusses the spinal and post-op pain management before you go to the theatre. This will alleviate much of your stress, giving you time to mentally prepare yourself.
The pain aspect: In reality, preparing yourself mentally for post-op pain is easier said than done. From personal experience, I found the expectation of pain played a major role in how I coped with the pain thereafter.
Our aim as your doctors is to minimise your pain as far as possible and to prevent break-through pain.
Pain management begins before your caesarean section commences. An anti-inflammatory suppository is administered beforehand.
Spinal anaesthesia is by far the anaesthetic of choice and reduces pain sensation during the Caesarean section. You may experience a dull tugging sensation during the procedure.
IMMEDIATE POSTOPERATIVE PAIN MANAGEMENT:
The effects of the spinal may last up to 2-4 hours post-op.
A pain pump (PCA – patient-controlled anaesthesia) is usually prescribed and self-administered at a duration of 8 minutes by the patient with minimal risk and is maintained for a 24-hour period. Intravenous (IV) and/or a combination of oral medications are prescribed 6 hourly to maintain pain relief.
Anti-inflammatories, either IV or suppositories, are prescribed 12-hourly.
DAY 1 POST C/SECTION:
Patients are weaned off IV medication. Oral medication and suppositories will now be administered, provided you are coping well.
Physiotherapy – begins on day 1 to assist with mobilisation on and off the bed, techniques to reduce additional strain on the abdominal wall and the incision. Moms should be comfortable when breastfeeding. Good posture is important. A breastfeeding pillow or support may help significantly. Physiotherapists may assist moms who experience pain during breastfeeding.
In my practice, I have an Orthotist who provides post-natal support belts which are fitted on day one post-operatively. These are for short-term use and have significantly reduced pain for my patients, especially within the first two weeks after the caesarean section.
DISCHARGE FROM HOSPITAL:
Most patients are discharged after 3-4 days.
Pain medication will be prescribed for a further 2 weeks. You may wean medication in the second week if you are coping well.
Oral analgesics are dosed 6-hourly. They may cause constipation so ensure adequate fluid, the use of Movicol/alternative sachets may be necessary.
Anti-inflammatories are used 12-hourly.
Discuss wound care with your doctor
The duration of pain for most patients significantly reduces after two weeks.
Adequate rest is also necessary for healing. Try to rest when your baby is asleep.
DO’S & DON’TS POST CAESAREAN SECTION
- Correct dosage of pain medication for a duration of 2 weeks
- Weaning of analgesia may commence in the second week if pain is being managed well
- Reduces risk of deep vein thrombosis, short walks in and around your home
- Adequate fluid intake & good nutrition
- Assists with breastfeeding
- Prevents constipation
- Adequate wound care
- Support your wound if you cough/sneeze
- Most sutures dissolve and would not require removal (Discuss with your doctor)
- Breastfeeding in a comfortable position
- Do not lift heavy objects
- You need only carry your baby
- Assistance at baby’s bath time with the filling of the bath, etc.
- Avoid going up and down too often, limit to once daily within the first week
- Your body will give you an indication if you are overexerting yourself
- Avoid strenuous exercises
- It is advisable not to drive you for at least the first 4 weeks (major surgery has medico-legal implications)
Contact your doctor if you experience any of the following symptoms:
- Fever post-operatively
- Foul-smelling vaginal discharge
- Engorgement of the breast, accompanied by fever
- Redness, excessive swelling or pus over your caesarean section wound
- Difficulty in breathing
- Excessive swelling of the legs and calf pain
- Any symptoms of postpartum blues/depression
Recovery is significantly improved with adequate rest. Over-exerting your body may delay your wound healing and prolong your pain. This is a wonderful time to be bonding with your newborn, so be gentle on yourself. Your body has undergone immense change and requires time to heal.
by Dr Casandra Pillay Obstetrician & Gynaecologist
Life Fourways Hospital