Image courtesy of and Copyright FOOTPRINTS & RAINBOWS 2014
It doesn’t matter if it was an emergency caesarean or an elective caesarean, it was still a caesarean and a major abdominal surgery and it is essential that you look after yourself properly in the first 6 weeks after a caesarean, and that you look after yourself in general for the first 6 months after your caesarean.
When you’ve had a caesarean it can be hard to remember to take it easy and look after yourself properly – especially if you have older children that you need to look after.
When you had your caesarean the surgeon not only cut through the skin on your lower belly/bikini line horizontally (or possibly he did a vertical incision running up/down your belly instead of horizontally), but he or she also cut through the nerves located in the skin of your belly, either divided your lower abdominal muscles or cut through them (depending on if they were able to be stretched apart enough for the uterus to be pulled through or not), cut through the outer, middle and inner layers (including the muscle layers) of your uterus, cut through numerous blood vessels and nerve pathways, may have cut through some fluid drainage systems, cut through the tissue barriers that separate the various parts of the body (the fascia, and the peritoneum which is cut through twice during the procedure) and then stitched it all back together to make you as close to whole as possible again. The surgeon may have cut your uterus horizontally (transverse incision), or he/she may have cut it vertically (classical incision) or in a “J” or “inverted T” incision if a horizontal incision wasn’t an option at the time.
Major abdominal surgery like a caesarean takes 6 months to become 100% fully healed, and although the incisions themselves will be healed by 6 weeks post partum there is a lot of microscopic repairs that need the rest of those 6 months to be completed. If you had complications with your surgery or developed an infection in the incisions or in your uterus afterwards it can take longer than 6 months – sometimes in rare cases up to 2 years – for it to be completely healed.
During those 6 months there are many ways that you can take care of yourself. Not driving for those first 6 weeks is usually one of the first things that you are told – driving uses the abdominal and core muscles and can put strain on your incisions, you are also not covered by insurance during those first 6 weeks after a caesarean, and if you have an accident while driving during that time your incisions can reopen which can cause some serious complications.
One of the other things you are first told is that you cannot lift anything heavier than your new baby. If you have older children, for example toddlers, who like to be lifted up and held this can be difficult to do, and it is essential that you don’t lift them up in those first 6 weeks as in doing so you run the risk of your incisions reopening or causing further damage.
You need to rest as much as possible and get a good amount of quality sleep. The majority of healing a repair work within the body is done while you are sleeping, and you need quality sleep with at least 2 REM cycles (around 7-8 hours of sleep) every night in order for it to work efficiently. This can be difficult with a new baby who may wake up several times a night for a nappy change and/or a feed, so sleep whenever you can, sleep when baby is sleeping, and don’t stress about the housework, right now you need to focus on you and on healing your body, the housework can wait until later on when your partner (if you have one) is home or until the weekend. If you have older children at home it can be even more difficult to get enough sleep and sleeping when your new baby is asleep can be close to impossible. If you are in that predicament then it is time to ask for help – from family and friends that you trust who can help look after your children for an hour or two each day while you take a much needed nap - or time to send the older kids to day care one or two days a week to give you a break and time to catch up on sleep (and housework if you need to catch up on it as well).
You need to eat a healthy and well balanced diet. Your body stores many of the vitamins and minerals that it needs within it until they are needed. During pregnancy your baby takes nutrients from your body, even when you haven’t had enough of them during your daily food intake (in which case the baby takes them from your internal stores), and by the time your baby has arrived you may be running low on some essential vitamins and minerals like Vitamin D and Iron. If you choose to breastfeed these vitamins and minerals will be going into your breast milk for your baby as well, so it is essential to make sure that you are getting enough from your food (and in the case of Vitamin D, from sunlight. You produce the highest amount from exposure of the areas of skin between your lower ribs and the base of your neck, so wearing a shirt in the sun all the time while it is good for helping to prevent skin cancer it can greatly reduce the amount of Vitamin D that your body produces). Eat healthy foods with lots of carbohydrates, a reasonable amount of natural fat (you need this to help with energy) and protein. During the 6 months that it takes for abdominal surgery to fully heal ensure that you eat an increased amount of protein in your diet. Your uterus is made up of 3 layers of muscles, and the incision from the surgery did cut through part of your uterus. Muscles need protein to grow and to heal, so for those first 6 months after your caesarean make sure you eat more protein than normal to help your uterus heal well and to help reduce your risk of uterine rupture and other complications in any future pregnancies (while the risk of uterine rupture during labour is actually less than 0.5% after 1 caesarean and less than 1% after 3 cesareans it doesn’t only happen during labour, it can happen during pregnancy too, so if you strengthen your uterine muscles now, and continue a high protein diet during your next pregnancy your muscles will be stronger and your risk of rupture will be reduced).
Take care of your emotional health. This side of things can often be forgotten, and good emotional health is just as important as good physical health. If you aren’t emotionally healthy then that will affect the rest of your life and will also affect your baby and any other children you might have. If you experienced a traumatic delivery there are many people and groups who deal with that and can help you, for example in Victoria, Australia, there is now a Maternal Mental Health Service that has a section dealing specifically with Birth Trauma. There may be similar services in other states within Australia, and in other countries around the world.
If you are feeling down or just don’t feel right go and see your family doctor. If they brush off your concerns see someone else, because you may have a mild case of post partum depression (or something else might be going on) and you will need support. If you are having visuals of your child/ren or yourself being hurt (by you or someone else), combined with these feelings and are having dreams that are similar to the visuals as well go and seek help now.
Make time for you! I have mentioned this in several other blog posts, because it is very important and follows on from the above section on your emotional health.
You need to have something special that you do for yourself, without children, and without your partner, that makes you feel good and happy. Whether it’s going out to see a movie or meeting up with your friends, getting your hair done, taking up a hobby, going back to work (if that’s what makes you happy), whatever makes you happy go out and do it.
And don’t feel guilty about doing something for yourself, it makes for a happier mum, and by proxy it makes for happier kids and a happier home. Therefore by doing things for yourself as well you are making your home a much better place to live in.
Lastly, and most importantly, keep an eye on your physical health post caesarean, in particular the scar area for separation of the incision or signs of infection (more redness than is normal, puss, a foul odour, seepage that doesn’t look right etc) and your legs for signs of a blood clot (a bruise that cannot be explained that spreads quickly over a 12 hour period, and/or redness and/or pain and/or a localised area of swelling spreading in a meandering line across and/or up/down your leg). If you notice any of these things go and see your GP right away, if you notice all the symptoms of a blood clot go straight to your local Hospitals Emergency Department to get checked out.
Also keep an eye on your general physical health, if you develop a fever in the first 2 weeks post partum go and see your GP, especially if it is within 5 days of coming home from hospital. If your post partum bleeding suddenly increases and you are going through a maternity pad in an hour or less go straight to the emergency room to get checked out as it could be a sign of a post partum haemorrhage (contrary to most common knowledge in the mummy world haemorrhages can occur right up until your post partum bleeding ends anywhere between 2-10 weeks post partum). If you are having clots larger than the size of a 50 cent piece (or larger than the size of a golf ball) go and get checked out. If your post partum bleeding continues for longer than 10 weeks go and get checked out as well. If you are feeling run down then you may be overdoing things and it is time to slow down and take care of yourself for a while, because you are important and need to be healthy and in good health just as much as your baby is.
As always, feel free to share.
Jenna Edgley
Student Birth Doula
FOOTPRINTS & RAINBOWS
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