Recovery from Caesarean: Physical and Emotional Healing

Recovering From Caesarean: Physical and Emotional Healing
Copyright Samantha Cambray 2009

With around a third of babies currently delivered via caesarean section, many women will experience the recovery from this major operation. Whilst many women may experience little physical discomfort, or have little trouble with the emotional material surrounding having a caesarean, or both, the reality is that recovery from caesarean will pose a big challenge for many of us- at a time when stress and emotions can already be running high.
This article will detail a number of practical measures to assist in recovery from caesarean section, both from a physical sense, and from a deeper, emotional perspective.

Physical Healing
Very soon after delivery, the uterus will begin to contract back down to the original size. This may be experienced as strong menstrual like cramps, and is most severe in the first forty eight hours. The first time you sit and stand after surgery will almost inevitably be very painful. Hunching over can be counterproductive in terms of pain, some women find clasping their hands together behind their back aids proper posture, a relief in pain and more core strength when standing. In any case, each time you stand, it will get a little easier. Walking within 24 hours will help a quicker and more complete recovery
Also normal after caesarean are numbness around the scar (which may last forever); achiness around the site as the nerves and muscles heal; sharp pains from time to time and itchiness . If you are concerned whether what you are experiencing is normal or not, or if you experience fever, chills, heavy bleeding, dizziness or pain that isn’t consistent with your recovery so far, consult your GP.
Infections and reopening of incision, whilst rare, are possible. Infection can be treated with antibiotics and topical medications. Reopening of incision may occur if normal activities are resumed to soon (a good reason to rest up!), or due to faulty suturing. The wound may be resutured, or special dressings used
Many actions may assist in managing pain. Whilst in hospital, utilise the help of midwives and nurses, and try to obtain a private room if at all possible. Rest as much as you can. Take short, slow walks. Avoid fatty foods, carbonated drinks and pain relief that contains codeine. The surgery will slow the digestive tract, and these foods and medications can contribute to more discomfort, gas and constipation. Use a pillow to support your stomach when breastfeeding, or when coughing .
Susun Weed, as leading authority on herbal remedies, says the following herbs may be useful, best taken as an herbal infusion :
 Nettle for increased breast milk and replacement of blood loss
 Oatstraw for improved sleep and strengthening of the nervous system
 Comfrey leaf for assistance in incision healing and prevention of scarring
 Red clover for improved breast milk production and hormonal sanity
 Linden soothes and heals mucus surfaces and incisions
 Raspberry leaf to tonify uterus.
 Aromatic mints - rosemary, lavender, and lemon balm- for digestion.
 Astragalus strengthens immunity, prevents infection.
 Motherwort to ease after-birth pain and prevent post-partum depression.
 Echinacea to increase macrophages; counter bacteria.
 Yarrow against all gram-positive and -negative bacteria.
 Usnea to counter deep infection.
Before you go home, ask someone to ensure the house is surgery-friendly. For example, put healthy snacks and water, a favourite book or magazine, hair brushes, toiletries, nappies and baby items and so on in places where they do not need to be reached or bent over for.
Enlist a support network that can assist with household chores- have a list ready so that people are able to know exactly what it is that would best help. It’s a good idea though, to have boundaries to protect your space with your baby whilst you are babymooning so that you are not disturbed or imposed on during this bonding time by people wanting to “share’ your baby.
There are no hard and fast rules when it comes to resuming normal activities, such as housework and exercise.
Whilst a four to six week figure is often discussed, the most important thing to do is listen to your body. All women will recover at different rates, and similarly, we all have different demands as new mothers. Very few babies will sleep or settle “easily” at this age- and it could be argued that the four to six week mark applies more to a generic stereotype, rather than a person who is suddenly getting little sleep, having to wake often, establish breastfeeding, and undergoing the huge shift in identity and responsibility that comes with having a new baby.
Be gentle, and increase activity gradually. Every mother’s priority should be bonding and getting to know their baby, and nurturing both baby and self. In the case of someone who has undergone caesarean, this is even truer. You deserve it!
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Exercise may be resumed around 6 to 8 weeks after the caesarean , but it is vital to start with light exercise- such as a short stroll- first and work up to your preferred level of exercise over a course of weeks or even months. Guidance from a GP, or perhaps a personal trainer, is vital. Exercise can help alleviate depression if you are feeling down after the delivery, and is obviously important in maintaining health as you nourish both yourself and your little one.
You will need assistance with housework for some time after the surgery (only you will know when your body feels up to it). You may be able to doing light housework, such as folding laundry within a couple of weeks, but it will take much longer to be able to vacuum, lift, move furniture and so on. Work up to the bigger tasks over time, and with caution and gentleness.
Driving will depend both on medical advice and the requirements of your car’s insurer. Ensure any pain medication does not interfere with driving and alertness on the road.
As with vaginal deliveries, a six week abstinence from sex is recommended for those recovering from caesarean section . However, given the new demands on both parents as part of new parenthood, and the potential for emotionality of caesarean delivery, it is unlikely that even after six weeks you will feel like having sex, even if you have the energy. Wait until you feel physically and emotionally ready, talk to your partner about how you feel about sex, and let him or her know you do still find them attractive. Communication is vital. Take the chance to shower each other in attention and affection in other ways (time, energy and baby willing, of course!)
Craniosacral and/or chiropractic therapy can help resolve birth trauma in the infant and help alleviate any physical achiness or discomfort for the little one post birth .

Emotional Healing
In a study of adverse psychological reactions to operative delivery, Fisher (1997) found “operative intervention in first child birth carries significant psychological risks rendering those who experience these procedures vulnerable to a grief reaction or to post traumatic disorder” and “women who experienced caesarean child birth felt significantly worse in the postpartum period than they did in late pregnancy. They reported increased symptoms of depression and irritability and a deterioration in efficiency and clarity of thinking. Anxiety levels had reduced marginally from late pregnancy. Their self-esteem was significantly diminished. "
Ibone Olza, psychiatrist, states: “The birth is much more that the arrival of a child. It is also a crucial moment in the life of many women. Ever since our first menstruation, we have been told about our innate ability to conceive and birth children. That the woman needs to birth by caesarean may give rise to feelings that her body has failed her or even a sense of guilt to not have taken good care of the baby she has been carrying .”
Fisher also states caesarean delivery can cause: "…damage to feminine identity and body image and, because of heightened dependence following surgery, to diminished self-worth. "
A caesarean birth and the implications above can severely affect a woman’s self esteem and identity as a mother at its most vulnerable time. Each woman that undergoes a caesarean needs to be self aware to how having the surgery, however necessary, has affected the way they feel about themselves, and as a mother. This may be explored with solitary reflection, with a trusted and empathic friend, or a counsellor, but will be imperative to making a successful transition from not-mother to mother.
It is common to feel loss after a caesarean. You may be grieving that your birth didn’t turn out the way you had expected or hoped, or that you missed out on the experience of feeling your baby born into the world. You may grieve the loss of important bonding time in the minutes after the birth. You may feel you have lost part of your identity as a woman as you did not birth vaginally like so many others. There are a myriad of things you may feel loss over, and this is completely fine!
Many women at first have trouble understanding that the birth and a healthy baby, whilst happening concurrently, are separate events, and therefore, you will have different feelings about them. Having emotional issues to work through after the delivery does not mean you are not grateful, or do not love your baby. In fact, much of your feelings of disappointment and loss may stem from love of your baby and yourself, and wanting to give both of you the best possible start to your journey together.
The urgency of the reasoning for caesarean can impact on the difficulty recovering emotionally. Any situation that implies a life threat will have an impact , and witnessing or experiencing events that involve actual or threatened death or serious injury is one diagnostic criteria for developing Post Traumatic Stress Disorder . Furthermore, emergency caesarean often involves making decisions or consent in a very short amount of time, and/or affected by a range of drugs and in pain. Decisions made in labour may be regretted afterwards, and the “what ifs?” may play out indefinitely.
Jo Bainbridge, co-founder of CARES SA Inc, states that one reason caesarean has such a high potential for trauma is that it is depersonalising and unlike any other situation we find ourselves in: “In no other situation would women allow themselves to be so 'open' (pardon the pun) to strangers.” We need at some level, to detach ourselves from the experience to get through it, and it can be difficult to integrate such an experience into our self and world view.

You may experience regret, sadness, anger, jealousy, resentment, guilt, fear, grief, inadequacy, disappointment, low self esteem, and a whole range of other emotions after a caesarean. You may find it harder to make decisions, think clearly, inability to respond to things as well as you would usually, unwillingness to be social and fear or avoidance of having more children. This is all normal.
The reasoning behind the emotional and cognitive reaction to caesarean may stem from a lack of involvement in decision making and residual feelings of powerlessness and vulnerability, the separation of mother and child, and the risks involved with major surgery . Caesarean isn’t just a physical occurrence- it can have a myriad of meanings to you, depending on your beliefs, expectations, past experience and values.
However, if you do feel like these emotions are more than you can cope with, or they go on for a long time, or you feel like your ability to function as normal is obstructed (which, at some point, we all do), look for support. Find a counsellor, see your GP, talk to friends who have also been through caesareans, especially those who also feel ambivalent about it. There are some conditions- such as Post Traumatic Stress Disorder, or Post Natal Depression, that can follow an event like a caesarean, and diagnosis and treatment is vital.
Jo Bainbridge states that those most at risk of depression include those who expected a natural birth; had inadequate support during labour, delivery and/or post operatively; had a general anaesthetic or other drugs that impede memory and/or have unpleasant side effects; felt coerced by hospital staff or support people; felt that the delivery was “surgery” rather than the birth of their child; had trouble breastfeeding; were isolated or lacked support once home; and/or felt guilt about their emotional reactions to caesarean
Studies have shown that women undergoing a caesarean are 11% less likely to have a partner or support person with them during delivery; are 37% less likely to see their baby in the first five minutes of life; and are 78% less likely to hold their child immediately after delivery than those who birth vaginally . These occurrences can affect the ease of bonding after birth, a vital task of mother and baby for psychological wellbeing.
Activities that facilitate bonding and secure attachment between you and your baby can assist in your own emotional recovery and finding your identity as a mother. These may include breastfeeding (the ultimate tool in physical and emotional health for you both), keeping your baby in arms, in a sling or otherwise in close proximity, maintaining genital integrity (no circumcision), co-sleeping, immediate comforting to a crying baby and talking and interacting with your baby .
The above will not only help you recover from caesarean, but your baby as well, and help him or her adjust to life outside the womb.
Other ideas for emotional recovery include talking often and in detail with trusted others about the caesarean, writing the baby’s birth story, writing a letter to the hospital or your care providers (whether you send it or not is up to you), and joining online or face to face support groups
There are a wealth of online resources for women recovering caesarean- try searching ‘caesarean recovery’, or specifically, search for the International Caesarean Awareness Network; CaesareanBirth.com, or for an Australian-specific site CARES; Birth Healing; Birthrites or Joyous Birth.
Plenty of rest and being “with” you body by listening to the messages it gives you (much like the way you will learn to ‘listen’ to your baby’s cues); a peaceful surrounding that is supportive of you and your baby’s needs; the ability to talk it through, both with professionals and others who have been through a similar experience; being well informed about the procedure and what happened in your specific case, as well as your future potential childbearing issues; and perhaps most importantly, allowing your emotions to manifest and working through them with love, patience and a willingness to grow, are all components of recovery from caesarean .
Joy Johnson, midwife and lactation consultant, states “In labour [the] woman will eventually reach the point at which her previous labour began to overwhelm her. That is likely to be a very difficult time, and it is essential that she has, by that time, her chosen midwife and other companions with her. There should be no ‘onlookers’, no-one who will distract her from her task. An atmosphere of quietness, with peaceful trusted companions, enables the work of labour to progress. ” Passing through this point will not only have the opportunity to be empowering, but also daunting, as the labour then becomes unchartered territory for the woman. A support person who can ensure the woman is able to labour productively, without unnecessary intervention or interruption, is essential.

No one technique, idea or therapy will help everyone when recovering from caesarean. It’s like birth itself- everyone is different, takes immense energy but will ultimately provide you with gifts. Recovering from caesarean is a time where your intuition will serve you well, and it will give you the opportunity to reconnect with your intuition if this was impeded in birthing. Find techniques and therapies that resonate with you, listen to your feelings, your body and your thoughts. Be gentle, you and your little one will benefit from gentleness.

The post-caesarean state can sadly, be one of confusion and pain for the mother. Hopefully, this article will assist you by giving you some tools to experiment with in your recovery journey. Much love, peace and healing to you, at this significant and intense time.

References available on request, unable to post here due to forum formatting issues.