Care and advice after a caesarean section Information for women and birth partners

Your wellbeing will be assessed through:

• regular monitoring of your blood pressure, pulse and temperature

• how well you are able to drink and eat

• how well you are able to move around (if you have any pain and discomfort)

Once your baby has been born and an initial assessment of their wellbeing has been completed, you will be encouraged to hold and cuddle them against your skin. This type of skin to skin contact helps to regulate baby’s temperature, heart rate and breathing, and if you choose, encourages breastfeeding. Usually you will start skin to skin contact in theatre, but if this isn’t possible for any reason you will be encouraged to hold your baby against your skin in the recovery area.

Your partner can enjoy skin to skin contact as well.

Feeding your baby within the first hour after birth is also recommended and your midwife will be able to help youfind a comfortable position. If you are breastfeeding, consider lying on your side or holding your baby under your arm, to avoid placing undue pressure on your abdomen (tummy). You will be offered support to feed and care for your baby, however, if you need further assistance please discuss your requirements with your midwife.

You will be given fluid directly into your veins via a plastic cannula (a small plastic tube that sits in your vein) to ensure you remain hydrated until you feel able to drinkfluids normally. This is usually for the first few hours although the exact length of time will depend upon your wellbeing. Your cannula will be removed when you are drinking normally. This is usually before you transfer to the postnatal ward.

You will be encouraged to eat a light snack such as a sandwich or toast when you feel hungry. However, if you experienced complications during your caesarean section you may be advised to wait until you have been reviewed by your obstetrician (specialist doctor) and normal bowel function has been confirmed.

Following your caesarean section, you will be offered:

• regular pain relieving tablets (paracetamol and ibuprofen)

• pain relieving suppositories in your rectum (backpassage) if appropriate.

There are other types of pain relief available in addition to these, depending on your individual needs and circumstances.

If you experience pain please let the midwife or recovery staff nurse looking after you know, as additional pain relief can be offered if you need it. This will help you to remain mobile and care for your baby, as well as reduce the likelihood of you experiencing breakthrough pain. Breakthrough pain is the term used to describe recurrent pain or pain that occurs before your next dose of pain relief medicine is due. All the pain relief you are offered will be safe to use while breastfeeding. However, if you require oral morphine on a regular basis it is important to observe your baby for excessive drowsiness. Please discuss this with your midwife.

It is normal for women to lose lochia (a combination of mucous, tissue and blood) after birth until the womb renews its lining. Following your caesarean you will be given a drug called Oxytocin (a synthetic version of the naturally occurring hormone oxytocin) through your cannula into a vein. This will encourage your uterus (womb) to contract, helping it to shrink back to its normal size and reducing your blood loss. However, you mayfind that your lochia appears to increase when youfirst stand up. There is more information about blood loss in the section ‘Blood loss – what to expect after the birth of your baby’.

You will have a small plastic tube passed into the opening where your urine comes out (urethra) before your operation. This stays in place until you are able to walk to the toilet again, and drains your urine into a bag that will be hanging at your bedside. Your urinary catheter will remain in place for a minimum of 12 hours after your caesarean section. The exact time will depend upon your individual wellbeing. Once your urinary catheter is removed, you will be encouraged to drink plenty offluids. When you pass urine you will be asked if you had normal sensation (feeling) at the time. You will also be asked to measure the amount of urine you passed during yourfirst two visits to the toilet. This will allow your midwife to assess your bladder function. Your midwife will also be able to give you information about pelvicfloor exercises which are important after having a baby.

Your wound will be covered with a dressing following the operation and your Midwife or Doctor will advise you regarding the length of time this should stay in place for after your caesarean section.

Stitches stop any bleeding from the wound and join the skin and muscle together. The thread used is dissolvable so they do not have to be removed. The stitches start to dissolve after about ten days and have usually completely disappeared after six weeks.

When you are advised to remove your dressing, it is best to do this after having a shower as it will be easier to remove if it’s wet. You can take care of your wound by having a bath or shower every day, gently patting your wound dry with a clean towel. A shower is advisable to begin with because it is easier for you to get in and out.

You are advised to wear loose, comfortable clothing and cotton underwear, and keep the wound clean and dry.

Please discuss care of your wound and infection prevention with your midwife.

Please let your midwife or GP know if:

• your wound becomes hot, swollen, weepy, smelly or very painful
• you develop a temperature and flu-like symptoms.

• your wound starts to open

If any of these occur you may be developing an infection and need treatment with antibiotics. Staff seeing you at home or in clinic after your discharge home will review your wound if you have any concerns.

The numbness from the anaesthetic will take a few hours to wear off completely. You will be encouraged and helped to get up as soon as possible, however, you should only get out of bed for the first time when your midwife or a maternity support worker is with you. You will be encouraged to walk round the ward, and once your catheter is removed walk out to the toilet. This not only aids your recovery but helps to reduce the risk of blood clots forming in your veins (DVT).

Blood normally flows quickly and uninterrupted through our veins. Sometimes however, clots can form that either reduce the blood flow or stop it completely. A deep vein thrombosis (DVT) is a blood clot in a vein, usually in the leg or pelvis, and its most common cause is immobility (not moving around enough, for example after surgery). A pulmonary embolism (PE) can occur if part of the blood clot breaks off and travels to the lung. In severe cases, PE can cause collapse and may prove to be fatal.

To help reduce the risk of developing blood clots in your legs after your caesarean section it is important for you to continue wearing your surgical stockings for at least seven days. They are to be worn day and night with a maximum 30 minute break each day. You may also receive a daily injection of medicine to thin your blood.

It is important that you are aware of the symptoms of DVT and PE so that you know when to seek medical advice if you are concerned.

Symptoms of a blood clot (DVT)

• pain in the calf or thigh associated with swelling of the limb - this may be worse when the foot is bending upwards towards the knee
• heat or redness particularly in the back of the leg, below the knee
• you mayfind it difficult to put weight on the affected leg
• difficulty in breathing or shortness of breath
• coughing up blood-stained sputum (a thick fluid produced in the lungs)
• chest pain that is often worse when breathing in
• collapse

DVT usually affects one leg.

Symptoms of pulmonary embolus (PE)

If you have any of these symptoms while in hospital please inform your midwife. If you have been discharged home and have any of the symptoms of DVT (see above) please call 111 or if you have any symptoms of PE (see list above) then please call 999.

The length of your hospital stay and most suitable location for you to continue your recovery will be discussed with you. You will have the opportunity to ask any questions you may have.

Going home

You will be given a postnatal pack which includes:

• a summary of your notes and information for the midwives or maternity support workers that visit you at home or see you in clinic. Your GP and health visitor will also receive a copy.

• information on what to expect over the forthcoming days in terms of your health, and that of your baby is available in other tabs within the Healthier Together App or website.
• Local contact telephone numbers, including numbers for local breastfeeding support groups, if required.

Your midwife will discuss your pain relief and any other medication you are to take home. You will be asked to con firm the address and contact details for your postnatal visits.

Please ensure that whoever is taking you home brings your baby’s car seat to the ward, as you are unable to take your baby home in a car without one. It is a legal requirement in a private car to have a car seat but currently not in a taxi. You are strongly advised to use a car seat for every journey to protect your baby.

Support at home

Arrangements will be made for you to receive a contact from a midwife on yourfirst day at home; unfortunately we cannot guarantee a time for this. You may also receive a visit.

The midwife or maternity support worker usually visits you two or three times during yourfirst ten days at home, or you may be offered clinic appointments depending on your individual needs. Your care is then continued by your health visitor after approximately the first 10-14 days.

Breastfeeding support

Breast feeding support is offered in other tabs within the Healthier Together App or Website.

For details of local breastfeeding support groups please visit your local hospital website or ask the Midwife who discharges you from hospital.

Pain relief

You are advised to ensure you have paracetamol and ibuprofen at home to use for pain relief once you leave hospital. Your midwife will discuss the frequency and dose with you before you go home.

Headaches

A headache can often be the result of tiredness or a lack of sleep. If this does not clear after using pain relief (such as paracetamol and ibuprofen) or if you feel the headache is severe or is associated with other symptoms (such as drowsiness or nausea) please phone your local postnatal helpline, your GP or 111.

Lifting

You are advised not to lift anything for six weeks. You may begin light housework and lifting after this, but avoid heavy lifting for three months.

The exception to this is lifting your baby. If you already have older children or toddlers at home you will need to ask for extra assistance from family and friends to begin with because toddlers are too heavy to lift (although they can have plenty of cuddles for reassurance). If you are shopping, try to carry equal loads in each hand, not one heavy bag. It is worth remembering that car seats and prams can be quite heavy, so remember to ask for help when you require it.

You can always phone to speak to a midwife if you have any concerns, or would like some advice.

Rest

Try to rest for at least one hour every afternoon. You will need someone to help you at home for at least two weeks. Where possible, make arrangements with family and friends who may be able to assist with daily household tasks.

What to eat

It is important to eat properly. Try to eat three meals a day, containing plenty of protein such as meat, cheese, nuts and milk. This will help your body with the healing process. Also include fibre such as fruit, bran and vegetables to prevent constipation, as this will cause strain on your abdominal (tummy) muscles.

Driving

You may start driving when you feel comfortable, although you should check with your insurance company that you are covered to drive following major surgery. Before you start and before you put the keys in the ignition, try putting your foot on the brake while the car is stationary, as if you were doing an emergency stop. If this is painful you should wait a few more days and try again. Try to start with short journeys as you may become tired quickly.

Activities

A midwife will discuss postnatal exercises with you either in hospital or at home. We recommend that you continue with these once back home.

Gentle sports such as swimming can be started when your wound is healed. It is not advisable to undertake energetic exercise such as aerobics until you feel comfortable. If you would like further advice or more information you can contact your midwife or GP or refer to the ‘Shape up after pregnancy’ tab in Healthier Together.

Postnatal follow-up appointment

It is important that you attend your postnatal follow-up appointment six weeks after the birth of your baby. This enables your doctor to check that everything is healing well and that there are no problems. This appointment is usually with your GP, but you may be asked to come back to the hospital if there were complications that need to be discussed with the obstetrician. If you are thinking of going back to work, this is a good opportunity to discuss it with your doctor.

Sex

You can return to having sex/ sexual intercourse when you feel comfortable. It will not damage your wound, but some positions may feel uncomfortable. Contraception is important because fertility can return quickly. Your midwife or doctor can discuss your future contraceptive needs with you.

Future pregnancies

It is advisable to leave a 12 month gap between pregnancies. This enables your body to recover from your caesarean and reduces your risk of scar separation during a future pregnancy and/or labour. Scar separation affects 2 in every 1,000 women who have had one previous caesarean section. You are advised to discuss the recommendations for your care in a future pregnancy with your midwife or GP before you conceive again.

Your caesarean section may also put you at increased risk of the placenta growing in the wrong place on the wall of your womb in a future pregnancy. This could lead to difficulties at the time of delivery or excessive bleeding. These are uncommon complications affecting between 4 and 8 women in 1,000. Although having one caesarean section increases the likelihood of you having subsequent caesarean sections, 75% of women (3 in 4) with one previous caesarean have a subsequent vaginal birth (NICE 2007). You are therefore advised to discuss the implications of your caesarean section with your midwife or obstetrician.

There are support groups which give friendly, practical advice to women who have experienced a caesarean section, and for those women hoping to have a vaginal birth having previously had a caesarean (known as VBAC for short). Ask your midwife for more information.

Useful links

• NHS Choices
• www.vbac.com