Whether your c-section is planned or it occurs as a last minute decision, recovering from an abdominal delivery will be somewhat different than if you deliver vaginally. Each woman's recovery will be different, depending on her health before pregnancy, her age and any complications that occurred during delivery. But there are some universal bits of wisdom about physical and mental health after delivery that every woman recuperating from a c-section should know.
"Women who have had c-sections are at 10 times the risk for endometritis or uterine infection than are women who have delivered vaginally," said Dr. Kathryn Pruzinsky, associate clinical professor at UC San Diego's Department of Reproductive Medicine. "This problem usually presents within 48 hours of delivery."
Signs of uterine infection include fever, uterine tenderness, foul-smelling vaginal discharge and oozing at the abdominal wound.
To guard against uterine infection, Pruzinsky advises that women avoid putting any pressure on the abdominal wound, and avoid intercourse or putting anything into the vagina for at least six weeks after delivery.
"Most patients don't want to have intercourse any sooner anyway," she said.
Another major difference between vaginal and abdominal deliveries is the abdominal incision that comes with C-section.
"There is more of a pain issue and it is most intense during the first week," Pruzinsky said.
Most women who have C-sections are anxious to know how and when they can return to physical activity and exercising, according to Dr. Silverio Chavez, an obstetrician at Kaiser Permanente in San Diego.
"Thanks to the low transverse incision we do now - we call it the bikini incision - women can return to activity much sooner than they used to," he said. "We get the women up and walking the next day and this helps several things: the return of normal bowel function; preventing blood clots; returning to normal activity; and getting rid of the water weight."
As for more vigorous exercise, Chavez suggests women wait at least six weeks before returning to the gym; four weeks or until the lochia (vaginal discharge) ceases before entering a swimming pool; and four weeks before driving.
"It's important that the incision be fully healed," he said. "And keep in mind that you must build your endurance and you may not have a lot of energy for awhile."
All women who give birth experience a major hormonal shift soon after - namely a sharp drop in estrogen - and depression may set in. The question is how do you distinguish between the normal "postpartum blues" and something more serious?
Duration and intensity, say the experts.
"By six weeks, postpartum depression should be over," Chavez said. "If you still have a hard time dealing with the baby and normal activity by then, it could be more serious. Women who have just delivered are impacted significantly by the drop in estrogen, but you also have to look at what else is happening in their lives."
The risk of postpartum blues in C-section deliveries is not thought to be significantly different from vaginal deliveries, Prusinsky added, "but a slower return to normal activity (because of the abdominal surgery) could increase the anxiety and frustration. Also, if there was a pre-existing depression, this could be precipitated again by postpartum depression."
Other pearls of wisdom offered to C-section moms by both medical experts and women who have been there:
- Don't be afraid to examine your incision so you'll know if there are any changes.
- The staples in your abdomen are usually removed four to seven days after delivery.
- You may have numbness and itching around the incision for some weeks. This is normal. Ask your obstetrician about a topical ointment.
- Don't refuse the offer of family and friends who want to help in those first weeks. Trying to be all things to all people can slow your recovery.
- An elastic belly supporter can make turning and getting up more comfortable. You won't need it long.
- Certain medications for depression and some birth control pills are safe even when breastfeeding.
- Keep the baby off your abdominal incision while breastfeeding.
- Step aerobics are not a wise choice of exercise because of the changes in ligaments after delivery, according to Jennifer Havlin, director of Seattle Birth Fitness and Education.