The first 24 hours after caesarean

Caesarean section is now very common in New Zealand – read about the first 24 hours after Caesarean section and pick up tips to speed your recovery.

Before you read about recovery after a c-section, you may want to check out Caesarean in detail to learn more about what happens during the procedure.

Caesarean sections today

In 1984 the caesarean section rate in New Zealand was just 9.6%. By 2014 this had increased to 25% of all births in that year. And the actual figure could be even higher. The caesarean section rate at Auckland hospital was almost 35%.

Some of these are planned in advance, this is called elective; some are unplanned and are carries out as an emergency during labour. For more information about this operation and what to expect, please follow the links in the articles listed below.

All women who have a Caesarean section have undergone major abdominal surgery and as a result have to expect a recovery period while their body heals, strengthens and gradually returns to normal. The majority of childbearing women are strong and healthy and therefore heal remarkably quickly, but it is important to acknowledge the healing process and the resources that your body needs to do this successfully – whilst also caring for a new baby and possibly a toddler or two!

Recovery area following a Caesarean

Most women have a Caesarean under a spinal or epidural anaesthetic and are therefore awake during the entire operation. When the operation is complete they are totally conscious and able to be cared for in the theatre recovery area with their baby and support person present. Different hospitals around New Zealand follow different procedures at this time, depending upon their resources, but the norm would be for mother and baby to stay together whenever possible, so that breastfeeding can be initiated without delay. At this time you will be nursed by theatre staff, but you may also have your own Lead Maternity Carer present or a hospital midwife, whose role will be to assist you to feed your baby.

Here is a bit about what to expect –

Mums

Pain relief after Caesarean

You may have an infusion of pain relief. Some units use ‘Patient Controlled Analgesia’ which, as its name suggests, allows you to control how much of the pain killer you receive. As your anaesthetic wears off you will become more and more aware of a bruised, painful feeling in your abdomen. It is advisable to have pain relief sooner, rather than later, or the pain may become harder to control. If you have ‘been to sleep’ under general anaesthetic you may feel groggy at this time also.

If there are no contra-indications, such as asthma or allergies, you may also have had a diclofenac (voltarin) suppository inserted into your rectum in theatre, which will also reduce swelling and provide background pain relief for 8-12 hours.

There is no reason for women to suffer pain after an operation. Your recovery will be impeded by pain and complications from reduced mobility may occur.You will have an intravenous drip in one or both arms, ensuring that you are well hydrated and possibly an infusion of syntocinon to keep your uterus well contracted after the operation.

Other things to expect in the first 24 hours after a Caesarean section

  • It is not uncommon for women feel nauseous at this time. Anti emetic drugs will ease the nausea and vomiting and will be given to you if required.
  • The theatre nurse will be closely monitoring your blood pressure and pulse.
  • Your abdominal wound will be checked frequently. Usually this is along your bikini line and is around 10cm long. It will be covered by a dry dressing.
  • Occasionally women have a drain next to the wound, if there is a risk of fluid collecting within the wound.
  • As you will be unable to get up to pass urine you will have a urinary catheter, which is a thin plastic tube inserted into your bladder, through the urethra next to your vaginal opening. This is attached to a bag which collects your urine. It usually stays in for around 24 hours.
  • Your vaginal blood loss will be like a heavy period at this time and the theatre staff will also check that this is normal.

Baby care after a Caesarean

In the midst of all of this is your new baby, who will usually be very alert after the birth and keen to have the first feed.

Immediately after the birth your baby may have been checked over by a midwife or paediatrician. This is routine after a Caesarean in some units.

Usually your baby will be wrapped and passed to mum or dad for the period after the birth while your wound is being stitched up. Operating theatres can be cold and if mum is not feeling well it can be difficult to keep baby skin to skin and warm in mum’s arms.

When the operation is complete you will be taken to a recovery area and at this time you will be assisted to hold your baby and initiate breastfeeding. As babies have an alert period after the birth it is important to feed baby at this time. Follow the links below to learn more about baby’s first breastfeed.

The best way to initiate breastfeeding is by placing baby ‘skin to skin’ on your abdomen or beside you and allowing natural rooting and sucking reflexes to occur. Once staff are satisfied that your initial recovery is satisfactory and that you are comfortable and pain free, then an unhurried time for you and baby to feed will occur.

The midwife will also be observing your baby’s colour, alertness and responsiveness at this time, but this should not interfere with your breastfeed.

The postnatal ward – the first 24 hours

Most women stay in hospital on average 3 nights after a Caesarean section. That has greatly reduced over the last few years as previously women would have stayed in hospital for a week or more.

Once you are ‘stable’ (your blood pressure and pulse are normal, you are pain free and the wound is not bleeding) you and your baby will be transferred to the ward together. This is usually after a couple of hours. If there are any concerns about the baby, for example if your baby was premature, then the baby may go to the neonatal care unit, to be cared for by specialist nurses and doctors.

In most units in New Zealand ‘rooming in’ is practised – the mother and baby are not separated night or day. On the first day you will only be able to move around the bed and you may also require assistance to do this. Staff will lift your baby and assist you to hold your baby while you feed. But as your anaesthetic wears off you will quickly regain your mobility and by the second day most women are up for a shower and lifting their baby from the cot when they need to feed.

A lot of women have a constant infusion of pain relief, which is patient controlled. In some units oral pain relief or regular injections may be offered. It is vital to remain pain free in these early days, or you will be less inclined to move around, which can lead to severe complications:

  • Deep vein thrombosis can occur, where a clot forms in your blood vessel in your leg, due to sluggish blood flow.
  • Chest infections are another complication of poor mobility.

Some women require additional medication, for example:

  • Antibiotics if they have an infection or are perceived to be at high risk
  • Anti emetic drugs if they are nauseated
  • Drugs related to an existing medical condition, such as raised blood pressure.

Usually whilst you are in hospital the ward staff will administer you medication. If it is still required when you go home, they will obtain a script with instructions for you.

It is vital to eat and drink well in the early days after a Caesarean section. Initially you will be offered a light diet and once you are eating and drinking normally (usually by the end of day 1 or the start of day 2) your drip will be removed.

Normally women do not move their bowels for a few days after childbirth. Meanwhile ensure you eat lots of fruit and fibre and most importantly that you drink a lot of water. Constipation is pretty miserable, especially whilst you still feel bruised and sore, so let your midwife know if you have not moved your bowels by the third day. The hospital will provide food, but you can also supplement this with additional fresh fruit and snacks.

The first 24 hours after a Caesarean section are vital to the healing process, which continues in the days, weeks and months to come. For information on recovery from here, check out Caesarean section – the first few days and Recovering at home after a caesarean.

Baby’s First Breastfeed provides information on the importance of the early breastfeed and how to facilitate baby’s first feed. You may also want to check out vaginal birth after a caesarean section (VBAC).

Paula Skelton

Paula Skelton is a qualified NZ nurse and midwife, a midwifery & childbirth educator and the mum of three lovely girls.

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