Nobody expects to have a cesarean. Even if you’ve had time to prepare (e.g., your cesarean was scheduled, as opposed to occurring on an unplanned basis in labor), and even if you made a conscious effort to read the chapter on cesareans in your birth preparation books, many find the reality of major abdominal surgery hits them like a ton of bricks. Pain, bloating, trouble with bowel movements, medication schedules — it’s not really what anyone thinks about when they think about bringing home their baby.
Included in this post are my best tips for recovery — physical and emotional.
I approach this set of tips as a cesarean mom who is now a birth and postpartum doula. Between my own experience living through a postpartum influenced by surgery, to caring for clients who have experienced cesareans, I care a lot about sharing with new parents the things that can only be learned by living through it. The “I wish I’d known”s that they don’t share with you in hospital discharge instructions, or cesarean birth classes.
Stay ahead of pain by taking your meds as directed. Don’t get behind on this.
Everyone’s experience of pain is different post-cesarean. Some parents recover very well, and are taking nothing but tylenol and motrin by the time they discharge from the hospital. Others absolutely need narcotic pain relief to move and hold their baby comfortably. This depends on a variety of factors, including whether and for how long you labored prior to having your cesarean — often folks who endured both a long, hard labor and then surgery on top of that will have a tougher recovery and feel more pain for longer, because their uterus went through a lot more than someone who was operated on before labor began. These days, hospitals are stingier with giving out narcotic painkillers due to the opioid crisis. You will probably get a sense before you are discharged from the hospital of whether you need narcotic pain relief, or whether IV tylenol is doing it for you. Ideally, you can be sent home with the right type of medication for you. If not, and you find yourself struggling without the right prescription once you are home, contact your provider and advocate for yourself. You can’t care for a baby, or yourself, or recover in pain. Add in any additional stressors like older siblings, a deployed or working spouse, etc. and pain control becomes even more imperative.
Move smart – limit stairs, exertion and lateral movement, and don’t use your abs.
Moving smart is important to keep pain under control and promote optimal physical healing. To start, never use your abs to sit up — instead, roll to the side and push yourself up with your arms. Observe restrictions on lifting, which can strain your incision and be painful. This can be difficult if you have an older child at home who is used to being picked up, but make sure to lovingly explain and enforce this boundary for your own safety and health.
Similarly, try to avoid stairs. If this is not possible, limit yourself to one flight per day. In a two story home, this means when you go downstairs for the day, try not to go back up until the end of the day, when you plan to stay up there. If you know in advance that you will be having surgery to deliver, and have a multi-story home, consider making a temporary bedroom on the main floor before your scheduled delivery date. You can always reintegrate stairs and relocate to the floor with your usual bedroom when you regain some strength.
Take it slow with walks, lifting and other physical activity, and pay attention to how your body feels. If you notice pain or increased vaginal bleeding (lochia), this is a message to slow down.
Try to limit lateral movement while nursing, and in general. Even the most normal movements, like turning to the side or reaching for anything, can be painful when you’ve had abdominal surgery. To this end, keep everything within reach so you don’t have to stretch. You truly don’t realize how much you use your abs until they have been sliced through – you use them for everything! This can be especially challenging when trying to get comfortable feeding your baby — another reason staying ahead of pain by keeping up with meds is critical. Which is a great segway into….
Set up “pods,” commit to a postpartum “cocoon” and camp out there with your baby, skin-t0-skin
This is the crux of my general postpartum advice to everyone regardless of how they deliver, but I feel it is especially important for cesarean parents to promote healing, bonding and pain control. Designate 1-3 areas in your home, the most important being your bed/nightstand area, which you should plan to spend the majority of your time in. Stock each area with essentials: burpcloths, nipple butter, nipple pads for leaking, water, healthy snacks, chargers, books, clean onesies, baby blankets, clean bras and tops for you, etc. Make sure everything is within easy reach to the extent possible, including the baby’s bassinet or other sleep surface. And then when you have returned home, get in bed with your baby and stay there. Create a “cocoon” for yourself, where you only have two jobs: take care of yourself, and feed/hold your baby. Everything else — laundry, dishes, etc. — can be dealt with by someone who is not you, and who didn’t just have a major surgery and a baby.
In our society, we have this cultural image of a “together” new mom who “naturally” ascends to the role of the nurturing, blissful mother without regard to the physical and emotional realities of birth and postpartum. She is dressed, she is happy, she is entertaining visitors and also keeping a clean house while her baby sleeps contently after being fed — always with the mother fully clothed, sitting upright in rocking chair in a beautiful nursery. While some people can pull this off, for most, this narrative is simply not accurate, and is responsible for the emotional and physical torture of many new parents, who may wonder why breastfeeding isn’t going well, why their baby is crying to be held so much, and why they feel so tired and frustrated all the time. They may then assign blame and feelings of inadequacy to themselves, when in reality, operating this way postpartum can sabotage your ability to rest, your milk supply and the chances of a content baby. Choose yourself, choose your baby. Put yourself in a position where it will not be hard to feed your baby when they need it, where you are already in “rest mode” all the time, and where the pressure to do anything else is off.
It is extremely difficult to develop a supply and good breastfeeding relationship, as well as to recover and bond with your baby, when you are “up and about” trying to get things done, with the baby separate from you in a bassinet or device. Commit to a period of “lying in” as a gift to yourself and your new baby. Stay skin-to-skin, which allows taking feedings as they come with less frustration than if you were fully clothed and not already holding or having your baby in arm’s reach. Additionally, have you ever heard the phrase “sleep when the baby sleeps”? Many postpartum parents find this is much easier said than done. Think about it: sleep will be much easier to catch when an opportunity presents itself if you are already in bed. Sleep and rest are so important to your recovery — not to mention mental health. It’s hard to prioritize sleep and rest in a culture where we perceive “staying in bed” and “naps” as lazy, and sleep as for nighttime only. In this context, it’s not surprising that a topless mother splayed out in bed most of the day with her baby snoozing on her chest, and a partner taking care of domestic duties, is unusual. It is important to make an intentional effort in your postpartum planning to counteract cultural expectations and narratives that do not prioritize you or promote your healing. All new parents, but cesarean parents especially, deserve this opportunity.
If you are someone who finds the idea of staying in bed horrifying, ask yourself why this is. Many women, especially professionals, cannot perceive of this as productive, and have harsh internal belief systems that work against the notion of optimal recovery after birth. For example, do you hang your self-worth on your productivity, or on your identity as an organized, capable professional? Do you believe sleeping in late, or laying in bed, are lazy? Were you punished for this type of behavior as a child? If you are one of these individuals, put in the work now to dismantle these deeply ingrained narratives, which unfortunately can predispose you to postpartum depression when inevitably, you will not be able to operate in your traditionally productive fashion after birth, and may beat yourself up for being exhausted and feeling out of control. Give yourself permission to separate from that world, and create a new one, where you are your top priority — where your physical and emotional well being, as well as your ability to bond and care for your child, are paramount and intentionally protected. Make your bed and any other designated “pods” self-sustaining areas of comfort and pampering for yourself. Have things nearby that feel good to you and create an ambiance that helps you want to stay in bed — scented lotions, LED candles, meditative sounds, twinkling lights or a salt rock lamp. Commit to limiting electronic devices so you can be fully present, and with less stimulation, able to sleep when you feel sleepy. This is your refuge and sanctuary. Other people should enter it with respect for what you have been through and what you are doing, and if they are going to enter, they should bring along a cup of hot tea, breakfast in bed, a back rub or a stack of laundry that they folded and are putting away themselves. Visualize and create your version of this. Discuss it with your partner and enlist their help and support in making this a reality. It’s not frivolous — this is how you will recover, and emerge feeling healthy and whole. One day, you will be ready to leave your cocoon behind and venture out more regularly into other parts of the house and external world, because of that initial work and time you put in up-front, caring for yourself.
Eat foods that promote healing, and drink tons of fluid
Diet and fluids are extraordinarily important to cesarean healing. All parents, whether or not they know they will be having a cesarean, should engage in postpartum meal planning to maximize the chances they will have nourishing, healing foods on-hand and easily consumable. Options for this include: setting up meal or grocery delivery; setting up a MealTrain (www.mealtrain.com) for family, friends and coworkers to cook or bring by healthy munchies for you; and hiring a postpartum doula or chef who can prioritize ensuring you are eating a balanced diet with an eye toward recovery.
Starting with food first, Vitamin C (found in oranges, lemons, peppers etc.), collagen (a structural protein found in animal bones and tissue) and zinc (found in meat, pumpkin seeds and more) are all essential for wound healing. Bone broth especially is a postpartum superfood — in particular for cesarean parents — because it is collagen packed. There are also collagen protein powders that can be mixed into fruit smoothies, collagen gummies and more. In addition to fruits and meats, drinking plenty of water and consuming fiber rich foods — i.e. loads of veggies! — are also extremely important (more on that below).
In general, warm, nourishing foods with meat and vegetables like stews and soups are always good. Healthy munchies – fruits, nuts, etc. — can sustain you between meals. Identify recipes in advance that incorporate these things, cook (and freeze or can) meals in advance, and when your fridge/freezer are full, prepare your partner to cook these types of foods for you on a regular basis.
Drink plenty of water. This helps you to feel good, eliminate waste and stay hydrated for breastfeeding.
Show your bowels some love
Did you know that major abdominal surgery can temporarily cause your bowels to shut down? It’s true, but nobody ever tells parents this. One reason is that the anesthetics used for cesarean section make your muscles and organs sluggish, and as a result, bowel function is slow to return. Another is that narcotic painkillers are notoriously associated with constipation. Combine that with dehydration, which is common in sleep deprived new mothers (especially if breastfeeding), as well as weakened pelvic and abdominal muscles and generalized fear of post-birth bowel movements — and it can be a recipe for your insides to become completely bound up. Iron supplements and the iron in prenatal vitamins can sometimes also contribute to inability to move one’s bowels.
Be proactive and intentional about avoiding this. In addition to drinking tons of water (ideally lukewarm, room temperature) eat foods and consume juices that promote easier bowel movements. Examples are vegetables, fruits and other high-fiber foods. Constipation and bowel impaction are serious problems for cesarean parents and straining can be very painful and risky with the incision. Prunes and prune juice are your friend. Milk of magnesia (a laxative) often is recommended on top of the colace (a stool softener) given by the hospital, which is commonly not enough. Magnesium can also help. Gentle abdominal self-massage can help move gas, which can also be painful when trapped and cause bloating. Although you should take it slow and gentle with movement, moving a little bit each day is beneficial. Please speak with your provider if you are unable to have a bowel movement. This is one of the least-known side effects of cesareans that often hits people the hardest. Too many suffer in silence and shame.
Find comfortable nursing positions
Cesarean parents may face extra challenges nursing for a variety of reasons, including but not limited to potential separation from baby in the immediate postpartum period, increased pain, limited movement and grogginess from heavy sedation. If the mother labored before her surgery, she may also be exhausted and need to rest. All of these things make achieving the ideal amount of skin-to-skin and a strong early nursing effort difficult after a cesarean. You may need to actively push your nursing staff and OB providers to allow you immediate and uninterrupted access to your baby if these things are not the norm at your hospital — a lot to ask of someone who has just endured surgery. (Someone whose surgery is planned in advance has an advantage in this regard, because they can arrange for their wishes to be respected ahead of time). Add in the fact that there is a fresh wound on your core, exactly where the weight of your baby would typically lie during nursing, and the barriers can be high.
To head this off, a few suggestions: take a prenatal breastfeeding class with an independent lactation consultant. Commit to achieving a good latch, every time you work on breastfeeding with your baby. Additionally, in the hospital, identify nursing positions that feel good pain-wise, and use them. In particular: I encourage all new parents planning to breastfeed, but especially cesarean parents, to engage in side-lying nursing if comfortable. This gets the baby off your incision, and prevents you from having to constantly be propping yourself up in bed to nurse, which requires using your abs. Many folks credit sidelying nursing with getting them through the first year postpartum.
Early on, sidelying may not be comfortable, as it takes some maneuvering to get in this position, which can be difficult during the period you are still hospitalized, fresh out of surgery and re-learning how to move your body. Additionally, in a cramped hospital bed that is often inclined and stuffed with pillows and linens that nurses are constantly adjusting, sidelying nursing may not be as safe or logistically feasible as in a flat, spacious bed at home where you control the number and location of pillows and linens. Furthermore, many hospital nurses are not familiar with sidelying nursing, and may discourage it.
If sidelying nursing is not easy or accessible to you prior to discharge, use pillows to cushion your incision, lean back and put the baby tummy to tummy with you. Position the baby below your breast with the nipple around his/her nose and upper lip, and latch the baby upward from below. Have a lactation consultant who is experienced supporting cesarean parents on speed-dial that can filter the conflicting and sometimes unhelpful advice you might get from rotating postpartum nurses and hospital lactation consultants. And above all, be gentle with yourself. Practice skin-to-skin as much as you feel able to do in terms of pain and your energy level. Be patient and persistent with nursing, and do not be discouraged — it is a learning process both for you and baby that takes time to master. The hospital is unfortunately not an optimal environment for recovering and learning to nurse, so remember: it will be much better once you are home. By then, your milk will be in and things will look very different.
Be gentle with yourself and surround yourself with support
People who have just had major abdominal surgery, and also been handed a newborn to care for, should ideally not be doing housework or caring for older children once they are home. Additionally, try to have someone who can do everything else for the new baby except feed him or her. You can work up to integrating diapering, clothing and bathing the baby as you begin to feel better. In addition to your partner (if applicable) and any family (if nearby), a postpartum doula is a great option for those with the means and need to help ensure household and childcare tasks are distributed away from the birth parent to protect their space. As discussed above, you should be in bed, resting, nursing and recovering, up only as it feels good to you. Increase activity slowly, a little more each day than the last. If you see increased bleeding (lochia). stop, and take that as a sign to slow down. Wear loose, comfortable clothes (if you even get dressed at all!). To this end, you may wish to invest in some pants wide, soft waistbands, as any friction with your incision site will be uncomfortable for quite a while. When you open your home to visitors, have a list of tasks that they can choose from to help with, and set boundaries and expectations around the amount of time folks can stay, and your priorities/needs, so that you can rest and nurse baby on your schedule without feeling pressure to accommodate or entertain others. Nobody is entitled to you or your baby if you aren’t feeling up for it.
Be on the lookout for complications
Cesarean parents are at higher risk of a number of postpartum complications, including but not limited to different types of internal and external infections, blood clots, and surgical injuries. If you think that something is not right, be proactive about reaching out to your provider, and assertive if you feel you are not being listened to or taken seriously. Unfortunately, medical providers have less economic incentive to see people in person once they are discharged from the hospital postpartum, and as a result, may be prone to dismissing problematic symptoms as “normal”.
Similarly, cesarean parents are at higher risk of experiencing a range of perinatal mood and anxiety disorders. If you think you are suffering from depression, or any other emotional complications, please know that this is extremely common, even if you think you have no reason to be upset. This may be the case even if your cesarean was decided upon in advance, with time to prepare emotionally. Often the true impact of one’s birth experience on mental health does not become apparent until much later, when the dust has settled, and even then, parents may not immediately connect difficulties with adjustment to the birth experience. There are many compassionate perinatal mental health practitioners who dedicate their entire practices to helping people integrate and come to terms with their initiation into parenthood. Help is available, and there is no need to be ashamed. Talk with your provider and your doula, who can recommend someone specializing in this area to assist you in working through your feelings and if necessary, seeking treatment.
In this vein, be choosy who you discuss details of your cesarean decision or experience with, especially if your surgery was unwanted, traumatic or surprising to you. Unfortunately in our culture, having negative feelings about one’s birth experience is not socially acceptable. Often new parents are shamed or dismissed when they try to talk to family or friends about these things. Being told, “a healthy baby is all that matters” is extremely common. This dismissiveness can contribute to the mother feeling unsupported and ultimately withdrawing and developing depression. It is okay and advisable to practice boundaries with individuals who do not feel safe to discuss your true emotions about birth or motherhood with. Instead, save it for your doula, or someone who listens nonjudgmentally and gives you permission to feel however you may feel about your entry into motherhood.