C-Section 411

I’ve heard a lot of myths about c-sections. Almost all of them are wrong. As someone who had a c-section, I had to do a lot of mental work to “forgive” myself for the lies these myths perpetrate. Before we really get into what you need and what you don’t for c-section recovery, let’s talk about what C-Sections are, what they aren’t, and why you shouldn’t be afraid of them.

Quick disclaimer before we begin: I am not a doctor. I am a mom who has given birth via emergency c-section and a researcher. I was not prepared for my c-section, my hope is this will prepare you in case you wind up having one.

What a C-Section is…

A c-section is an invasive surgery where a baby is removed from the mother’s body. Most c-sections are emergency procedures, but all c-sections are medically necessary. Approximately one-third of births in the US are c-sections.

Women at high risk for a c-section meet one of the following criteria: they are carrying multiples, have a pre-existing chronic condition (like hypertension or diabetes), are having a difficult pregnancy, or are carrying a particularly large or ill-positioned child. Before c-sections, the maternal and baby mortality rate was over 50% higher than it is today (I won’t go into graphic detail as to why this is, just know if you need one, get one).

What a C-Section isn’t…

A C-section is NOT:

• The easy way out, they often have a longer recovery time than vaginal births and cause pain for far longer than vaginal birth.
• A faster recovery time. Vaginal births offer full recovery times at around 6-8 weeks; c-sections could take over a year to fully recover from.
• A better version of labor. C-sections are an invasive surgery with potentially severe consequences. Your body is designed for labor and delivery, it is not designed for a c-section.
• Something only lazy people get. Listen, there is no version of parenting that is lazy. It is all work.
• A bad choice. Doing what it takes for you or your child to survive is not a bad choice.

If you are getting a C-section, it is because you need one. Without the C-section it is likely you, the baby, or both of you could die. C-sections are a necessary procedure you should be prepared for before entering labor.

Before the C-Section

A c-section is an emergency procedure, so every woman should be prepared to have one. I don’t care if you have had 4 successful vaginal births or if this is your first time, you still could wind up with a c-section. The following applies to everyone.

Update your paperwork.

Update your beneficiaries and make sure you have a current will. Listen, birth is very much a life or death ordeal. You do not want to be worrying if your family will be financially okay if something happens to you while going through labor. If you have not done this yet, stop reading and go do it. Then come back and read the rest.

Call your insurance and get the following information:

• How long is the covered hospital stay for a regular vaginal birth (generally about 1-2 days), a vaginal birth with complications (generally 2-3 days), and a c-section (generally around 4 days)?
• Ask about any steps you need to take to ensure everything is fully covered. Do you need to get your birth pre-approved?
• Which hospitals are in-network?
• How do you get a breast pump?

You are going to want to take advantage of everything you can, and you will want to stay in the hospital as long as you are able after birth (you may have to fight for this).

Gather Recovery Items

If you are planning on having a vaginal birth, you should still gather all the items you need for that type of recovery. Additionally, Get a pack of c-section underwear. Buy it close to the delivery date and keep it in the package. If you have a c-section your birth partner or SO will have time to run them through the wash before you need them.

C-section underwear are typically an item you need to order online. You will probably not have enough time to order them if you have a c-section, so get a package just in case.

Prepare Mentally

If you are having complications and your doctors think an early delivery is likely, schedule a talk with your NICU. After your c-section, you may not be able to hold your baby for a couple of days depending on your condition.

You (mom!) have to authorize the NICU to let anyone including the father hold the baby. Get baby visitation figured out with the NICU before you suddenly have your c-section. Otherwise, there might be days when your baby doesn’t get physical contact.

Take some time to understand that your birth plan is a guide, not law. Things change when giving birth. You might want to have a natural birth and then wind up needing Pitocin.

In the birthing room, your team will do everything they can to follow the birth plan, but be open to suggestions. Every single one of the amendments they want to make is to help keep you alive and help keep you from needing surgery. Things can change on a dime. You will be in much better shape mentally if you understand that the birth plan is just a wish list and not what is actually going to happen.

Be sure to have a conversation with your birth partner about what you want to happen if things go off plan. Do they want to cut the cord if they can (they will probably see your innards if they choose to)? Should they stay with you or go with the baby if you are separated? Do they want to stay in the room if they are allowed?

Finally, get a therapist for both you and your spouse. Birth is traumatic and marks a huge change in your lifestyle and relationship dynamic. Both men and women can get postpartum depression. Having someone you already work with lowers your risk and releases everyone involved from the stigma of asking for help for depression.

During

There are a few typical ways a c-section goes down (think of them like danger levels): planned, unplanned before things get bad, and people are about to die.

Planned C-Section

C-sections are usually planned if you are having multiples or suffer from a condition where labor would be too dangerous. They are scheduled well ahead of time and you and your doctor have planned the day to a T.

Usually, in a planned c-section, your birth partner can accompany you and potentially cut the cord and you are fully conscious having received an epidural. Typical post-birth things like holding your baby are very much on the table for a planned c-section. Following your doctor’s advice here will decrease the risk of ancillary damage that might need to be repaired and help decrease your overall recovery time.

Unplanned C-Section

The next level is an unplanned c-section before things get dire. In this situation, you have begun labor and something is going wrong. Maybe your blood pressure is too high, or the baby is positioned incorrectly. Either way, while the c-section was unplanned you have time to have a discussion about options with the doctor and nurses. They will be able to guide you and you will know what is happening before it happens.

While this is not what you wanted, they will do everything they can to reduce your stress and make these changes easy. If the doctor is suggesting a c-section might be necessary, this is where you are at. Keep an open mind and ask any questions you need to. You will likely be able to have an epidural and still hold your baby. Your birth partner may be able to remain in the room.

Remember, in this case, you are having a c-section to avoid other, worse, complications.

Emergency C-Section

The final level happens when you, the baby, or both are in imminent risk of death. The nurses go quiet. Their faces drop all pretense of expression. They look like soldiers about to descend into battle. A flurry of activity happens quite suddenly around you. Machines are pulled, you are wheeled to a room, the only sound is a nurse running ahead of you to announce what OR room is open and there are nurses on your bed prepping you for surgery.

When you descend to this level of danger, there is no pretense of consent. These people are going to save your life and your child’s life regardless of what you want, and they have no time to consider what you might want. You will likely be placed under a general anesthetic.

From the moment the nurses make this decision until your baby is safely out is typically less than 3 minutes (mine was 2 minutes 15 seconds).

In this situation, the only thing you can do is go to your happy place. You will wake up and your baby will be fine. Any resistance at this stage could cost your life or your baby’s life. Your birth partner will not be allowed in the room. You should have a conversation with your birth partner if they should remain with you or the baby in this case. Keep in mind, they may not be able to stay with you until you are out of recovery.

If you find yourself in the third situation, take comfort in the fact that these people are trained to safeguard your life and the life of your baby. They have reached a point where doing that means revoking any pretense of consent, but in return, you will soon hold that precious baby that you will be around to raise.

In any scenario where the surgery is not planned, it is important that your birth partner call the insurance and pre-approve (simultaneously approve) your surgery. Getting the surgery pre-approved, even if it is an emergency, can keep you from getting a surprise bill.

Recovery- The first 6 weeks

After your c-section, it is going to feel like your insides are all out of sorts. When you stand it will feel like your intestines are falling out, when you laugh it will feel like you are being gutted. There is no comfortable position to sleep in (how you were sleeping before the baby was born is going to be the least uncomfortable position), and your body feels like it has been hit with a truck. If you were put under a general anesthetic, you will have a hard time staying awake.

All of that is normal. After all, the doctors did just remove a good portion of your insides to access your uterus and remove the baby before shoving everything back in. You just had major surgery, lower your expectations for how you should be feeling.

Where our vaginal birth sisters can be up and walking the same day as they gave birth, you are not going anywhere for a while. It could be a day before your catheter comes out, and two or three days before you can manage the walk to the nursery unaided.

Don’t expect to do stairs or go to the bathroom alone before 4 days (which is a big reason to stay in the hospital your entire allotted stay). Depending on your healing speed, at 4 days you could have the stitches removed before going home. Otherwise, you will be back at the doctor’s office in about a week.

Ice packs and pressure are your friends in those first few days. The hospital will probably provide you with a girdle or “belt” if you ask. Don’t use the girdle all the time, it is meant to give you temporary relief. The less you wear it the faster it will stop feeling like your insides are falling out when you stand. This sensation should start to abate around 4 days after the birth, and fully dissipate within two weeks depending on how much you wear the girdle.

You will also receive a peri bottle (portable douche), the standard mesh underwear and pads, and this magic piece of cloth that always feels cool to cover your incision site. You probably won’t be bleeding all that much. If you aren’t, save the pads as your next period is likely to be a doozie. Any pads you don’t use are great for lining training potties in a couple of years.

Around day 3 you are going to want a shower and some real underwear. This is where that package of c-section underwear really shines. They have just a little compression, not as much as the girdle, but enough to make that feeling of your insides falling out bearable. Most also feature a pocket at incision height for a hot or cold pack. That pocket is glorious, not only for this initial healing period, but also for period cramps later. You will only really need that c-section underwear for a month or two until your scar stops feeling hypersensitive. But in that month, they are the number one thing you want.

The Effects on Your Body

When you give birth vaginally, you can more or less see what needs to heal. The placenta left behind an open sore about the size of a dinner plate, but otherwise all your damage is close to the surface.

That is not so for a c-section. In a c-section you not only have the damage caused by the detaching placenta, you also have an actual incision that goes through the uterine wall. This internal incision will be held together with internal, dissolvable, stitches. Any harsh contraction of the uterus could cause those stitches to tear, so it is vital you avoid any form of hanky panky until that 6-week mark. A tear in your uterine wall is a huge complication you don’t want to deal with.

Since your uterine wall now has scar tissue, you may now face restrictions in the number of future pregnancies it is safe for you to have. Talk to your doctor about whether you can have a VBAC (vaginal birth after cesarian) and if it is safe for you to carry another child. Also ask the doctor when it is safe for you to drive.

A Note on Mental Health

In that first week after giving birth you should also really contact a psychologist if you haven’t already. Our bodies are not meant to give birth in this way, and doing so really messes with our hormone chemistry. Your body is still trying to support your child in the womb, while at the same time providing milk for the child that is out. It is very confusing on the hormone level and drastically increases the risk of postpartum depression, especially if you and the baby are separated after birth (you can’t live with the baby in the NICU).

Even if you don’t get postpartum depression, you will still need to process the emotions and everything else surrounding the birth. Seriously, get a therapist and meet with them once a week.

You will have a 6-week checkup, mostly to make sure the incision is healing properly. Insist on an internal exam. Because you had major surgery, it is possible you were given antibiotics or were exposed to other diseases in the hospital (I came home with pneumonia and a yeast infection). The internal check will help make sure you don’t have an infection of any kind which could delay your sexual recovery.

Long Term Recovery

After your first 6 weeks, when they give you the go-ahead to start resuming life, you are not actually healed. That go-ahead just means you no longer risk tearing an incision. Your journey back to health is just beginning.

A vaginal recovery typically takes between 6-8 weeks before you start feeling normal. For a c-section, it could be much longer. Many women who have had c-sections report recovery times closer to the 8 months to a year time-frame. At 6 weeks you might not be strong enough to resume a work-out routine. You will still be exhausted, and your scar and stomach area may still be uncomfortable.

At 6 weeks you may even still be sleeping with your pregnancy pillow to keep your insides from feeling like they are slowly stretching out (its a weird feeling). It could be over a year before you can even attempt a sit-up or a plank. I highly recommend using an app like 8fit to get back into shape. Don’t pay for premium, but start on the lowest setting and go from there. My daughter is almost two and I am just now able to do a sit-up. Before she was born I did over 100 sit-ups a day.

Sex could also take longer. Check out my postpartum sex tips article for more.
Basically, just take it easy. It is going to be a while before you are actually feeling okay.

To read about postpartum care for a vaginal birth, click here. Leave a comment below if you have any questions or anything to add!

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