Caesarean Section: Post surgery care and management

Coker couldn’t be happier. Finally, he had become the father of a baby boy. The first child was a girl and as an only son, he craved so much to have an heir. The delivery was via Caesarean Section (CS) and the doctors already announced the arrival of his baby boy but were silent on the condition of the mother. Though excited, he was a bit nervous and feared for the safety of his wife who just had a baby via CS. Her first child was via vaginal birth but it wasn’t the same with the second birth.

Sadly, a bereaved Coker had to return home to his toddler daughter with a newly born in his arms as his wife passed away due to complications. While more Nigerian women are opting for C-section, as a choice of delivery due to different reasons, according to a survey by the News Agency of Nigeria (NAN) conducted recently, the surgery comes with risks, experts say.

Dr Ijarotimi Omotade, a Senior Lecturer in the Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, in a report by NAN, said “the rate of increase of CS worldwide remains a cause for concern considering the risks associated with the procedure.”

According to her, the risks include but are not limited to maternal death, bleeding, dangerous clot formation in blood vessels, infection and anaesthetic complications.

She said as beneficial as CS is, there are risks involved with it just like other surgical operations.

The expert maintained that the procedure should only be done when medically indicated.

According to Omotade, some indications for CS  include when the passage (pelvis) is too narrow for the passenger (fetus), when the placenta or tumour is blocking the passage  and  when the womb (uterus) is in danger of a rupture.

Omotade, however, said apart from the cited indications, many mothers in the country now willingly demand for CS, hoping to escape the excruciating pains of labour.

“Mothers are now also requesting caesarean section because they want to preserve the tone of the perineum and vagina.

“Mothers,  who want their babies delivered on a particular day like their birthdays, husband’s birthday, wedding anniversary, special occasions like New Year  day, Christmas or other religious occasions are not left out of social factors,’’ she said.

So, if mothers would willingly demand for CS, there is a need to understand the risks and post operative management measure that should be taken, experts admonish.

 

Care after a C-Section

The days following the birth a baby also known as the postpartum period, can be one of the most challenging times for mothers and families. This period can be even more challenging for mothers who have had a cesarean delivery.

After any delivery, a mother needs to allow her body to rest and heal. Ideally, this means little to no housework and no running after other little ones.

The maternal mortality rate is highest in the postpartum period, so special consideration needs to be given to the care of the mother. Mothers need a support team prior to the birth of their children to help during this time.

The support team can include family, church members and new mother support groups.

 

Physical Care after a Cesarean Section:

Before leaving the hospital:

• Mothers are encouraged to get up and try to go the bathroom within the first 24 hours after surgery. This will help start the healing process, experts say and will make them get used to moving around the incision. However, mothers are advised to move slowly because they might experience dizziness or shortness of breath.
• Urinating after the catheter is removed can sometimes be painful, experts say. It is advisable to ask the nurse or attendant to suggest ways to make it easier.
• If staples were used for the incision they will most likely be removed before a mother leaves the hospital.
• It is important for mothers to talk with the health care provider about dealing with pain after the surgery. If medication is something that may be required, it is important to get a prescription and information about the side effects for both mother and baby, if breastfeeding.
• The uterus will begin the “involution” process which is the shrinking of the uterus to its pre-pregnancy size. So, there will be experiences of heavy bleeding of bright red blood which is called lochia and this may continue for up to 6 weeks. A mother will require to have extra-absorbent menstrual pads which the hospital should provide after delivery. Experts advise that mothers do not use tampons during this time.
• Gentle strolls around the hospital or rocking in a chair can help speed the recovery and help with gas that can develop after abdominal surgery, experts say.

 

After Going Home:

• Experts say that activity level should be kept low until a mother’s health care provider suggests an increase of activity. It is important that lifting anything heavier than the baby be avoided as well as tedious house works.
• The lochia bleeding will change over time and can increase with activity and position changes. Lochia will change over time to pale pink or a dark red color, and then eventually to a yellowish or light color.
• It is important that mothers make certain that they are getting plenty of fluids to keep them hydrated and eat healthy meals to restore your their energy and prevent constipation.
• Mothers must be alert to any fever or pain, which can both be signs of infection, experts say.

 

Things to avoid:

• Sexual intercourse until the doctor confirms that it is safe
• The use of tampons or douche
• Taking baths until the incision is healed and the mother is no longer bleeding
• Public pools and hot tubs
• Lifting anything heavier than the baby
• Repeatedly using stairs
• Exercise, at least until the doctor gives permission

 

Reasons to call your doctor immediately:

• Fever of over 38 degree Celsuis
• Severe headache that begins right after birth and does not let up in intensity
• Sudden onset of pain in the abdominal area, such as tenderness to touch or burning sensation
• Foul odor from vaginal discharge
• Sudden onset of pain in the incision area that can include a pus discharge
• Swollen, red, painful area in the leg
• Burning urination or blood in the urine
• Appearance of rash or hives
• Extremely heavy bleeding that soaks a maxi pad within an hour, or the passing of large clots
• Sore, red, painful area on the breasts that may be accompanied by flu-like symptoms
• Feelings of anxiety, panic, and/or depression

 

Things a C-Section mum must avoid

• Hold on to your sneezes. If you can think about the tricks, your mom taught you to control the involuntary act of sneezing, apply them now. You shouldn’t cough.
• Laughter is not the best medicine now. Not when your stitches are raw. Suppress your laughter! Be content with a half chuckle.
• Your pillow becomes your best friend now. Every little motion will require you to use a pillow to support your belly. Don’t forget the bumpy ride from the hospital back home when every little bump will remind you of the wound on your belly.
• Don’t eat stuff that makes you gassy. Being gassy could worsen the pain.
• Now, this also means that you shouldn’t eat anything that will constipate you. Remember how tough it was for you to poop the first time after the C-section? Exerting too much pressure may loosen the stitches.
• Don’t climb stairs. Use elevators. If your building hasn’t one, consider sedentary life for few weeks even if it meant you set up a mini house of your own in your very room.
• Don’t look too closely at your sagging belly.
• Don’t ever think of looking at the incision under that floppy belly.
• If you want to check how far the incision has healed, ask your partner or husband to check it for you.
• Don’t be in a rush to get back to normal life. There are layers of incisions that may tear with sudden jerks.

Additional information from the American College of Obstetricians and Gynecologists