This guest blog post is by Ashley Derderian Sousa RN, BSN a labor, delivery, and postpartum RN, lactation consultant, & mama. Keep scrolling if you want to learn everything you need to know about cesarean births.
As a labor, delivery, and postpartum nurse I know the definition of a cesarean birth is a surgical procedure which allows for delivery of your baby through an incision in your abdomen and uterus. However, as a mama who has sat in that bed laboring, uncomfortable, having racing thoughts full of the unknowns – I know how it feels and for some of you it is so much more than that.
I am going to be talking strictly about cesarean births today, but if you’re looking to find out everything you need to know about pregnancy, labor, birth, and postpartum – join me in my Childbirth 101 class!
For some of you your cesarean birth is planned – some prefer it that way, while others may have a medical condition that warrants this to be the safest route of delivery. Some mamas may have an unplanned cesarean – after months of hoping and preparing, and hours or days of laboring perhaps you end up in that operating room. In rare cases, some mamas may experience an emergency cesarean. Each of these may leave you with relief and happiness while others may experience disappointment, trauma, or endless questions. I am here to remind you – however YOU feel about YOUR birth is valid.
As your labor, delivery, and postpartum nurse I want you to know that I am proud of you – regardless of how you deliver! While your birth may or may not have been exactly what you had dreamed of – know that your nurses are going to be there to support you, teach you to care for yourself and your baby, and listen if you need to process your birth. I am also here to tell you that while yes your birth may not have been what you pictured or perhaps it was really hard – know that when that baby is placed on your chest so much of what has occurred over the last hours and days will melt away.
In this post, I’m going to talk a little bit about what your cesarean birth may look like but also dive into some recovery tips and tricks and must-have cesarean birth items.
In the United States – about 31.7% of mamas will have a cesarean birth, however worldwide cesarean deliveries occur in about 39.5% of births. The most common type of cesarean is a non-emergency cesarean, followed by a planned cesarean, with the rarest being an emergency unplanned cesarean. Cesarean births occur for a variety of different reasons which I’ll discuss below.
You might have a scheduled or planned cesarean around 39 weeks if:
- Baby is transverse or breech
- Baby is projected to be large
- You have had a prior uterine surgery
- There are multiple babies
- There is a safety issue with the placental location
- There are active herpes lesions or high HIV viral loads
You may have a non-emergency unplanned cesarean if:
- You didn’t dilate past a certain stage
- Baby is not moving down the birth canal
- Baby is showing signs of distress
You may have an emergency cesarean if:
- Baby has major heart rate rise or drop
- Umbilical cord prolapse
- Placental abruption
- Uterine rupture
In an emergency situation – our goal is to get you and your baby into the operating room as quickly as possible and safely deliver the baby. There may not be much time for us to stop and explain what is going on, which can be very frightening. There also may not be much time for us to prepare. As I said this is very rare – my goal is to educate you not to scare you!
However, in the case of a planned cesarean or an unplanned and non-emergent cesarean section, we will have time to pause, discuss options, process, and prepare! Typically preparing for a cesarean birth looks like this: discussing options with your provider, cleaning the abdomen to help prevent infection, placing an intravenous catheter if you don’t already have, shaving the top portion of your pubic hair if applicable, signing consents, reviewing medical history with care providers, anesthesia consultation, etc.
You may walk down to the operating room or be wheeled down in your bed depending on the situation. Typically if you’ve been laboring you may have an epidural and oftentimes they are able to give medication through the existing epidural, and in that case you won’t be able to walk. If you’ve never seen an operating room – you can expect it to be bright, cold, and full of staff who are there to help ensure your comfort and safety as well as your baby’s safety. Shortly after arriving in the OR, you will have anesthesia which can either be given through your epidural catheter or a spinal anesthetic will be given by an anesthesiologist. This typically takes about 10-20 minutes and then you will be laid down on the operating room table, a drape will be hung, we will ensure you are numb from the waist down, and we will call your birth support person into the room (typically they hang out outside the room while we get you settled, however, every birthplace is different.) Your anesthesiologist and birth support person is likely positioned at the head of the bed so you are able to see them and communicate with them throughout your birth.
Common complaints at the start of the procedure are that the operating room table tends to be narrow and quite hard which can be uncomfortable, spinal anesthesia can affect your diaphragm and make you feel like you can’t breathe (don’t worry someone is monitoring your vitals,) nausea, vomiting, or dizziness from anesthesia, and sometimes an overwhelming feeling of anxiety or emotions as a whole.
Next, your care providers will start the procedure in which they will go through seven (yes seven) layers of skin, muscle, tissues, and uterus before they go to your bag of water or amniotic sack, which they safely rupture and prepare to birth your baby (try and tell me that woman aren’t total bada$$ warriors!!) Once they start to pull your baby out you won’t feel pain but perhaps you may feel pulling, pressure, or tugging. Then the moment you have been waiting for – you get to meet your beautiful baby!
It is likely your baby will go to a warmer in the operating room to be assessed by a pediatric provider and then once all is stable- will likely be placed skin to skin with you if this is something you feel up for trying.
Over the next 30 minutes or so your providers will surgically repair and suture the layers of muscle, tissue, and skin back together. Once that baby is on your chest – you likely won’t even be thinking about that! Lastly, your provider will likely cover your incision with a surgical dressing, which will stay on for about 24 hours after the procedure and can be removed with the help of your nurses. Most birthplaces recommend waiting about 24 hours after birth to shower as well. You will likely have a urinary catheter in place until about 8-14 hours after your delivery as well, and possibly longer if there are indications.
Now you have officially entered the postpartum period also known as the fourth trimester. Many mamas don’t realize that after your birth you enter a different trimester which is a trimester full of healing, growth, change, and adapting. I would be lying if I said the fourth trimester was easy, and for some mamas, this may be the hardest part of their “pregnancy” and that’s ok! Be patient with yourself, your new baby, your new body, and your new life. Again, my goal is to educate you, support you, and empower you through every stage of motherhood.
Those mamas who have experienced a cesarean birth state that the pain experienced in the first 2–5 days after birth can be quite uncomfortable. I recommend keeping up with your pain medication and trying to move as soon as possible. While it may sound crazy, slow and gentle movement may actually help you recover quicker. Some mamas don’t realize that you will likely bleed for about 6 weeks after the birth of your baby regardless of whether you deliver vaginally or have a cesarean birth. I recommend being prepared for this before delivering by stocking up on different size pads, comfortable underwear, and loose-fitting clothing (more on that later.)
Let talk a bit more about what recovery will look like! The first few days your bleeding will be heavy and bright red, kind of like a heavy period! You may also pass some blood clots – however if you saturate a pad an hour or pass any clots larger than a golf ball you should contact your healthcare provider immediately. After a few days the bleeding will progress to a brownish-red and will be less heavy and within a couple weeks will progress to yellow-white discharge which make require a panty liner. If at any time you are concerned about your bleeding – please make a phone call! When you are able, I recommend getting up and moving around – even if that means sitting on the edge of your bed, but PLEASE don’t do this without asking for help! This will help reduce pain, swelling, and even gas. Use a pillow or blanket as a brace against your incision when you get up as this can help decrease discomfort and pain. You will find your care providers extra excited when you start farting after surgery as it means your GI system has “woken back up” after surgery. You may find that because of this it takes a few hours or even days to feel hungry, however I recommend trying to eat ice chips or crackers if you’re feeling nauseous as sometimes its helpful to have something in your belly, but don’t force it! When you are able to get up, remove your dressing, and shower – please don’t be afraid to look, however you might be! This is totally normal and if it takes you some time to look at it that’s ok too. Your care providers can be super helpful in answering questions and helping you care for your incision. Please be mindful if you notice bleeding, redness, swelling, pus, fever, or the incision looks like it is opening – you should report this to your providers immediately. Other fears after a cesarean: peeing and pooping! Movement, plenty of water, fiber, and stool softeners will help all of the above! Try not to strain when passing urine or stool as this can put strain on your incision and if you’re having trouble doing either – this is another thing to mention to your providers.
Other postoperative red flags include:
- Foul smelling vaginal discharge
- Excessive pain
- Fever, aches, chills
- Burning or stinging when urinating
- Abdomen is tender to the touch
- Pain or swelling in legs, feet, arms, hands, face
- Dizziness, blurry vision, headache
- Sadness, rage, anxiety that doesn’t improve or worsens over time
- Anything else that just doesn’t feel right!
Now that we’re gotten all the not so fun stuff out of the way…
Without further ado – here are my top cesarean birth tips!
1.) Be kind to yourself and patient with yourself. I am going to start by saying that first and foremost be kind to yourself and remind yourself of the powerful and wonderful things you have just accomplished – YOU JUST GREW AND BIRTHED A BABY! Repeat these affirmations:
- “I appreciate my incredible and magical body and all that it is capable of”
- “Birth rarely goes as planned and I am strong enough to adapt”
- “It’s ok to be both equal parts excited and fearful”
2.) Accept help. This starts in the hospital and extends through your entire postpartum period.
3.) Get up and move and keep moving throughout your recovery – no matter how hard it is! This will help with swelling and relieve gas pains (which sometime extend as far as your shoulders.)
4.) Stay on top of pain medications meaning take them as ordered around the clock and continue them after discharge as needed.
5.) Drink water and take your stool softeners so that constipation doesn’t become an issue.
6.) Care for your incision by keeping it clean and dry. You don’t necessarily have to clean the incision site itself but allow warm soapy water to wash over the area and pat it dry. Some mamas will actually use a hair dryer on a warm setting to dry the area and place a telfa dressing over it to help keep it dry.
7.) Keep a pillow or blanket nearby to use as binder when coughing, sneezing, laughing, or getting up as counter pressure can decrease discomfort.
8.) Roll on your side slowly to get in and out of bed.
9.) Prioritize caring for yourself and allow yourself to get enough rest, eat a well-balanced diet, and drink adequate amounts of fluid.
10.) Know that each day will get better and it’s ok to emotionally process your birth – whether you feel great about it or not so lovely about it
Must-have post cesarean birth items for the mamas by the mamas!
Comfy high waisted undies possibly compression underwear (some mamas even invest in disposable diapers and swear by them!)
Loose fitting clothing that will fit up and over the incision instead of directly on the site
Abdominal binders can be helpful as they help mamas feel relief from pain and discomfort
Some studies have shown that chewing sugar free gum in the hours that follow surgery can help speed up movement of the GI system and help you pass gas and poop sooner!
Protective mattress cover can be great to place on top of mattress so in case you leak blood or experience postpartum sweats it will protect the mattress itself
Set up a breastfeeding and changing station for yourself and baby on each level of living that way you’re not up and down the stairs several times a day
A changing station for myself? Say what!? Many mamas don’t realize that whether you deliver vaginally or have a cesarean birth you will bleed for about 6 weeks after delivery, and it will slowly improve over time. Having pads of all different sizes at home will allow you to wear what you feel you need depending on how your bleeding looks each day
When I took a survey of other helpful items – a lot of moms said something to help them grab things if they drop them, such as this handy little tool! Something else they mentioned that can be helpful after a cesarean birth was a step stool to help them get into and out of bed.
No matter how you deliver your baby – you are amazing! Give yourself time and patience as you adjust to your new role as mama and recover from your birth, and know it won’t happen overnight. If you are looking for guidance on how to navigate not only your birth, but the postpartum recovery process please feel free to book a postpartum support consultation with me!
To learn everything you need to know about pregnancy, labor, birth, and postpartum – please join me in taking my Childbirth 101 class! Code ASHLEY20 will get you 20% off!
More from Ashley:
Top 10 Breastfeeding Tips For New Mamas
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