As April, Cesarean Awareness Month, comes to a close, I wanted to discuss what happens during a cesarean birth and what the recovery process looks like.

 

Cesarean Awareness Month was started by the International Cesarean Awareness Network (ICAN) to raise awareness about the number of women who give birth by cesarean section each year. Currently, approximately 1 in 3 women will give birth via cesarean.

 

Some cesareans are planned during a woman’s pregnancy for reasons such as fetal positioning or placenta previa, amongst various other reasons.

 

Sometimes women choose to have a cesarean. For many of these women it is because they have had a previous cesarean and are choosing have another, while for others they choose to give birth at a location that does not offer women a trial of labor after cesarean (TOLAC) and therefore must have a repeat cesarean section.

 

For some women, particularly women with a history of abuse, a vaginal birth could be traumatic, so it isn’t uncommon for these women to discuss the option of an elective cesarean with her healthcare provider.

 

Many women who have given birth by cesarean section, however, were not planning a surgical delivery. A cesarean may become necessary during labor for reasons such as fetal distress, failure to progress, cephalopelvic disproportion (the baby’s head is too big for the mother’s pelvis),  placental abruption, a uterine rupture or cord prolapse.

 

Typically, the woman will be awake during the cesarean delivery, and will be allowed to have her partner, and depending on hospital policy, sometimes a second support person, such as a doula,  in the operating room with her. Prior to the cesarean an IV will be started and a urinary catheter will be placed.

 

A small, horizontal incision is usually started along the bikini line above the pubic bone.  Despite the numbing medication, many women report they were able to feel some tugging, though not painful, during the delivery. It is also common for women to feel nauseated during the procedure. Once the incision has been started the baby is usually delivered within a matter of minutes.

 

Sometimes the baby will be able to be placed on the mother’s chest and in some instances mothers who are planning to breastfeed are able to attempt the initial breastfeeding session in the operating room.

 

In situations where the baby needs a little more attention hospital staff may take the baby to a warming station for assessments or medical assistance. In cases where the baby needs immediate medical care, he or she may be taken to a neonatal intensive care unit (NICU).

 

Once the baby has been delivered and the incision has been closed the mother will be moved to a postoperative room for observation. The mother’s legs will still be numb from the medication and it is not uncommon for the woman to feel shaky or itchy from the pain medication used during the procedure.

 

Following the cesarean surgery a nurse will massage the uterus to help it shrink to it’s pre-pregnancy size. Sometime within the first 24 hours of delivery the nurse will probably encourage the new mother to get out of bed and walk around a little bit. This has been shown to help speed up the physical recovery process as well as help prevent blood clots. The urinary catheter will also be removed. Most of the pain medication used during the cesarean will have worn off. It is common for women to utilize narcotic pain relief for several days.

 

Women who give birth by cesarean section as well as vaginally, will experience vaginal bleeding, called lochia, after delivery. The birthing facility should provide the new mother with some sanitary pads and will give her information about how much blood is normal and when there is cause for concern.

 

Women who have uncomplicated cesarean deliveries typically remain in the hospital for 3 to 4 days, which is on average one day longer than women who deliver vaginally.

 

A cesarean section is major abdominal surgery.The incision may be tender for several weeks. Recovering from a surgical birth while also caring for a newborn is no walk in the park. It can take weeks for the muscles to heal. In fact, many doctors recommend women wait at least 6 weeks before driving a car and that they do not lift anything heavier than their baby for the first few weeks. It is also advised that women avoid stairs as much as possible. Because the physical recovery can take a few weeks, it might be a good idea for women to line up help, from either a friend, family member or even a postpartum doula, to help with tasks around the house as well as caring for older children.

 

Emotional recovery from a cesarean section can look different for each woman. Some women adjust quickly and are happy about their birthing experience.

 

Some women experience feelings of anger, guilt, sadness, or disappointment. For some women, a cesarean birth is traumatic. Many new mothers, who deliver vaginally or by cesarean alike, experience baby blues or postpartum depression.

 

All of these feelings are common and should not be ignored. Some women find comfort in talking to other women via support groups, while other women may choose to discuss their feelings with a mental healthcare provider, their primary healthcare provider, or their OB-GYN or midwife. It is perfectly acceptable for women to feel however they want to feel about their birth experience. Being sad about the way one’s baby came into the world does not make someone a bad mother or mean they love their baby any less.

 

A healthcare provider’s job is to determine what is the safest way for a baby to enter the world, while taking into account risks for both the mother and baby. Whether planned or not, many women find comfort in having conversations with their healthcare provider about what to expect during the procedure and knowing they have chosen a skilled surgeon to perform a surgery that is typically safe for women and their babies.