Cesarean Recovery

With the number of cesarean sections increasing in our country annually, many women do not really understand or know that recovering from a cesarean section is much different from a vaginal delivery. After my first cesarean section I learned this the hard way and wish I had a couple tips on making recovery more bearable.  But we often forget that the recovery after a cesarean birth is not just physical, but it is also emotional for a large portion of cesarean section mothers.

The different types of healing to be considered are in the hospital, long term, when you return home with your new baby, and also things you should be aware of such as when to call your health care provider post cesarean. (I also want to thank ICAN and their Recovering from a Cesarean White Paper in aiding to my post today)

While in the hospital :

• Get as much help as you can from family members, your partner, nurses, and other hospital staff. That is what they are there for and during the hours, and days immediately after your surgery, you will need it even if you do not want it.
• Stay hydrated and eat. You may not want to eat, but working on eating a well balanced and healthy diet, as well as staying hydrated (stay away from sugary drinks such as fruit juice and soda) will help to make you start to feel semi human again.
• If private rooms are available opt for one so someone (family member or friend) can stay with you to help you during this time.
• Use a pillow between your legs, and/or on your side to help sleep to be more comfortable. In the days, and even weeks following your cesarean it will not be easy to get comfortable. This is completely normal.  It took me almost a full 2 months to even get comfortable in my own bed at home after my second c-section.
• Take pain medication that is being offered if you are in pain. With my first child, I was breastfeeding and was overly concerned about any of the medications being transfused though my milk so I opted for over the counter pain medication such as motrin instead. But it certainly made my recovery longer, and made taking care of my son harder. (As ICAN recommends, ask your provider about a stool softener, as narcotic pain medication can cause constipation.)
• Get up and walk around.  It may hurt like hell, but it will help to get you back on your feet sooner rather than later. The longer you wait, the more painful it will get up, and the harder it will be.
• The use of a pillow to protect your stomach while coughing, standing up, nursing or moving around in bed is a smart idea.
• Do not hesitate to ask for a lactation consultant in the hospital. Breastfeeding after a cesarean section is more difficult not just for mom because of her incision, but also for baby. Check out the ICAN white paper on Breastfeeding After a Cesarean.

The first couple days in the hospital may feel like you are dying, I know because I have been there, but in most cases, you will only get better. When you get home, there are some more great tips for healing, although your housework may suffer for the first couple weeks, I am sure no one will mind too much.

When you get home :

• Focus on yourself, and your baby. You just had major surgery and your baby needs you.
• Have your partner help/do the household chores. Laundry, dishes, cooking, or anything else that needs to be done. Don’t worry, you can put off the dusting, cleaning the bathroom, mopping, and all the big chores for a couple weeks, your house won’t be mad at you!
• Do not lift anything that is heavier than your baby for at least 4-6 weeks. Those infant carriers/carseats are tempting to pick up, especially when going to an appointment for you or your baby, but stay away from it. You do not want to hurt yourself, or have an extended recovery.
• Ask others for help. If you have older children it may be helpful for your partner to take some time off from work, or have an available family member come over to help you. During the first weeks after my second cesarean section my toddler not only got the flu, but I was the only person he wanted making it difficult on me because I could not pick him up.
• Take it slow!  Get back into your normal household routine over a long period of time. You do not want to over do it because you will certainly pay for it later on.
• Have access to baby stuff such as diapers, bottles, burp cloths, wipes, or whatever you and your baby need for a couple hours in several places around the house. If your bed is the only place you are comfortable, make sure you can set yourself up to be able to hang out with baby, change diapers, and everything else you need right there.
• Co-Sleep!  Room in with your baby, so when it comes time for midnight feedings, you do not need to get up or go far to take care of your little one.
• If you have school age children, have others help to prepare their lunches, lay out clothes for the next day and anything else that needs to be done. To spend quality time, sit on the couch, or someplace comfortable and assist them with their home work, or read a book. Find ways to spend time other than anything that may put a physical strain on you.
• Considering hiring a post partum doula. They can really be heaven sent in a post cesarean situation!
• Don’t push yourself. If you want to take a shower and get dressed for the day, make that your only goal for the day.
• Pajamas are your best friend. They are comfortable, and help to remind others you are still recovering from major surgery.
• Remember how important it is to continue to remain well hydrated, and eating healthy.

Many do not think of the long term or emotional recovery of a cesarean section. I personally did not even encounter the emotional recovery until my cesarean baby was 3 months old. Be gentle on yourself, you aren’t the first to go through this, but many people around you may treat your feelings like nothing because cesarean sections have become so common. I can’t tell you how the phrase “a healthy baby is all that matters” feels to me still today.  Do not let others discount your feelings on your experience.

For your long term recovery…

• Contact your local ICAN (International Cesarean Awareness Network) chapter. These are women who have been there, and done that and know how you feel and what you are going through. They are an excellent support system internationally and are such a huge blessing for many mothers. I know they were to me!
• Write out a birth story, express your feelings on paper, or on a blog, get it out. Keeping your feelings inside may be harder in the long run.
• Keep your baby as close to you as possible for as long as you can.

If you experience any of the following symtoms or problems, you should contact your care provider immediately.

• Any type of bleeding from your incision.
• Leaking, redness, or any type of fluids coming from your incision.
• If your pain does not decrease over time.
• Symptoms of post partum depression such as anxiety, fear, problems sleeping, depression, or anything else you may equate with something more than just the baby blues.
• Cramping or pain in your arms or legs that will not go away.
• Continuous headaches, migraines, or backaches.

Over all, be gentle on yourself.
You just went through major surgery!

Loyally Devoted to Doctor

I recently read the book The Highly Sensitive Person by Elaine N Aron, Ph.D. In the chapter called Medics, Medication, and Highly Sensitive People, the author states:

“Keep in mind, too, that it is common to feel an attachment to anyone you have been with during an arousing experience, especially if it was a truly painful or emotionally significant ordeal. In the medical realm you hear these sorts of extra feelings when people describe their surgeon or women talk about the person who delivered their child, which is perfectly normal. The solution is simply to know why it happens and compensate for it appropriately.”

In the chapter about relationships, she talks about studies that were done that showed people are far more likely to fall in love under stressful circumstances. She applied this phenomenon to attachment in all relationships, not just romantic relationships. Later when I read the above statement in the medical chapter, so many things started to make sense to me.

Why do women love their maternity care provider, even when they may have done unnecessary procedures on them and not allowed them to make their own choices? Why do many providers use scare tactics? Why do women hold so adamantly to the belief that their provider “saved their life” or “saved their baby” or “was a great doctor” or “really took good care of me”, even when evidence to the contrary is right in front of them? Why do they fail to make important connections, such as that their c-section may have been one of the many unnecessary ones, or that there may not have been a true evidence based need for their induction? Why is childbirth treated like a major emergency with so much fear and anxiety around it? Why aren’t all women who give birth in this system severely traumatized from it, and instead defend and adore their doctors? The answer is simple: the culture of fear that surrounds childbirth actually endears women to their doctors. It cements the relationship between women, their doctors, and the hospitals their doctors practice at. It ensures that the women will keep coming back, and will recommend their providers to all their friends as they speak about them in glowing heroic terms. It is quite brilliant really, providers and hospitals have found the key to running a very successful business, and it has nothing to do with allowing women to make their own choices. They simply have to give the illusion prenatally that the woman can make her own choices for her birth, and then make sure that the actual experience of birth is one filled with fear, anxiety, and of course a healthy baby, and then the narcissistic provider will come out looking like roses to the woman who must endure the “horrors of childbirth”.

Of course, I am not really giving the doctors the benefit of the doubt here. They likely don’t know on a conscious level what they are really doing. They have been trained to act this way, by people who were also trained to act this way, and it is reinforced for them every time a woman profusely thanks her doctor for a job well done, and every time a woman tells her birth horror story where the good doctor makes an appearance as the hero who delivers her baby to her despite all the dangers that presented at the last minute. Both the woman and the doctor seem ignorant of the psychological effects that framing every average birth as a medical emergency creates.

In the statement above, the author states: “it is common to feel an attachment to anyone you have been with during an arousing experience, especially if it was a truly painful or emotionally significant ordeal.” This describes childbirth perfectly. The word “arousing” here is referring to sensory levels. That can mean physically, emotionally, sexually, or any other assault to the senses, good or bad, that can be had. We know childbirth can be described as “arousing” in many ways. It is also inherently “painful” and “emotionally significant”. Even when women use drugs, there is still some level of pain before she took them, and depending on what type of drugs she took, she may still experience pain while she is taking them. So really, all births fit this criteria. Births in a hospital, or at home, or in a birth center all have these same basic elements. It seems women are wired to form an attachment to the people who were with her and helped her through the event. This could be her partner, her doula, her midwife, her doctor, her nurse, or her friend or relative. I think this type of attachment likely had an evolutionary purpose at one time. It would be ideal to attach to an older, wiser woman who assisted with the delivery of babies who would have been there to care for the mom postpartum, and to slowly help her to bond and form an attachment to the baby. This wise woman would then help the mother learn to breastfeed and care for her new infant, while slowly pulling back her own attentions from the situation. This is what we have in homebirth midwives today. How would our ancestors have fared if a man had shown up in the tribe to deliver a baby, and then disappeared immediately afterward? The woman would be left adoring him, yet not having help from him to form an attachment to her infant. Never learning how to breastfeed or other infant care skills. What would have become of humanity? What is becoming of humanity?

Midwives and doulas seem to understand this phenomenon. Doulas usually visit a woman once or twice postpartum and are available if she needs to talk or has questions about the baby, breastfeeding, or the birth. Midwives start seeing a woman more and more as the birth approaches, and then once the baby is born, they start to taper off again, seeing her less and less until she is no longer needed at all. This is a much more natural and appropriate response to caring for a woman during such a pivotal transition in her life. What happens when women see doctors or CNM’s in hospitals though? They are likely seeing a practice, not a specific provider. They will likely not give birth with the same doctor or CNM they saw prenatally. They may never see the same doctor or CNM again after they give birth, or perhaps just once at the six week checkup. How does this affect women emotionally, or in her relationship with her baby, when instead of having a slow winding away from her provider, there is just an abrupt ending to the relationship? Does this interfere with breastfeeding, or affect feelings of trauma related to the birth, or feelings of depression related to her new role as mother? It is ingrained in our psyche to attach to these people who help us through such a major event in our life. How will the people we choose handle this responsibility? Are we choosing someone who will corrupt our experience and force an unnatural attachment to them by creating more anxiety around the experience? Are we choosing someone who will be there for us days, weeks, and months later to answer our questions about the baby or to offer us emotional support? Will the person we choose even be available for the birth, and will we ever see them again afterward?

Now I realize why other women feel the way they do about their provider. I did not attach to my provider, I was instead extremely traumatized by her actions. I still wonder why some women are traumatized, and others fall in love with their providers, given the same set of circumstances. I wonder if it is actually more natural, and thus common, to attach to a provider even when (or perhaps especially when) that provider creates an atmosphere of fear. It makes sense then why so few of us are speaking up about the system and the way women are treated. It makes sense that women are extremely loyal to their providers, even when many aspects of their births were disappointing or upsetting to them. It makes sense that many women are reluctant to accept that there is anything wrong with maternity care. It makes sense why the maternity care system is so hard to change and is met with so much resistance from every side.

What can birth activists do to help women form healthy attachments during this transitional time in her life? It may be tempting to try to convince all women to have a homebirth with a midwife since we know that they are probably the best option for healthy attachments and a healthy weaning away as well, however, if a woman has already formed a strong attachment to a certain provider, it may be more realistic to recommend having a doula. A doula will be there prenatally, for the birth, and postpartum, and therefore can provide much of the physical and emotional support that new moms need and deserve. Some moms may hire a doula, yet keep her same provider that she has formed an attachment to, and others may find that a doula is a stepping stone to having a homebirth the next time. One day I hope that maternity care shifts to being centered around the mother again, and not around the provider and his schedule or routine.

The Infamous Cascade Chart

As someone strongly involved in the birth community, this is probably one of my favorite pictures floating around the internet that I run across every once and a while.? One day when I find out the person who actually put these thoughts and cascade of interventions into a physical chart to view, I am going to kiss them!

I have always loved how it starts with induction, because lets face it, so many women today are starting their labors with some kind of artificial labor stimulant. Whether it be pitocin, or the oh so dangerous cytotec. I can personally say I have been the victim of the cascade myself with my first child. Had I seen this before my pregnancy with him, I would have never opted for the induction. Many do not realize that induction in many cases will fail, almost half of the time according to the most recent figures, and when I quote that, I am quoting Robbie Davis Floyd in a 2008 interview, I believe it was in Pregnant in America but my birth/pregnancy movies and interviews all start to blur together when you watch so many of them. These babies are not ready to be born in many cases, especially when we are seeing these inductions before the “due date” or the 40 week gestation mark. Although we know that “due dates” aren’t much to put stock into, many women and providers use them as some type of eviction date, which history has shown to be a pretty bad idea. No one is going to be pregnant forever and many women left alone will go into labor on their own. Now granted, there are cases that induction is medically necessary and for these special cases, I am completely thankful. Without induction these women would be subjected to cesarean sections instead of labor inductions which could in turn be even more hard on their body, and experience over all.
What we do not understand with the induction of labor is, we are creating unnaturally strong contractions in attempt to simulate something similar to natural labor. As someone who has experienced pitocin labor, and natural labor, I would take a million natural contractions over being on the receiving end of pitocin again. The comparison in my opinion is not even in the same ball park. Another issue with these contractions as most know, is the fact that they are more likely to cause fetal distress on the baby because they are not natural contractions or what normal contractions are supposed to be. So in turn we are putting our children under unnecessary stress. Especially if they are not ready to come and join us in “our world” yet. Again something I learned with my first.
Then we have the provider who comes in and looks at the fetal heart monitoring and says, “Oh No! Your baby is in danger!!” So off to the operating room we go for an “emergency” cesarean which in reality was caused by the pitocin to begin with. You would think by this point there would be a bit of common sense in the Obstetric community to say, ya know, I think we are causing these actions instead of blaming the increasing cesarean rate on “patient choice cesareans” which only make up 3% at most of the incredibly high cesarean rate in our country.

But a cesarean is only one path that this induction cascade can lead to. There are still women out there that will have a vaginal delivery when subjected to a labor induction, but in turn these women have greater risks for other procedures including episiotomies which have all in all been proven to really have little to no benefit to women in the long run. While episiotomy rates are starting to decrease, they are still over used in many communities. For example, here in my state of Connecticut, some hospitals have an over 25% episiotomy rate, when science tells us there really shouldn’t be over 10%. Trying to obtain these numbers are like pulling teeth too FYI!

We also have vaccum extraction. I had never really discussed this or spoken with someone who experienced this until I met my Chiropractor in the summer of 2008. He was discussing with me why Chiropractic care in infants is important, and then he described his own daughters birth, they had applied the vaccum to the top of her head, and while “assisting” her out, they pulled so hard the vaccum literally flew right off of her head. My Chiropractor described it so vividly… “I thought her HEAD popped RIGHT OFF! I was horrified to even look!”? My heart broke for him because no parent should have to go through that kind of fright during the birth of their child!

These all often lead to epidurals, which especially if you are going to have a cesarean section, you will either have this or a spinal block. All types of anesthesia that will have a direct impact on the baby. Although I have experienced women told there will be no effects on their baby at all.
I am sure most know about the “breast crawl” and I can say after watching a baby who’s mother did have an epidural, as opposed to a mom who had a natural birth, there is no comparing the instincts of the baby. While I had epidurals with both of my children, I didn’t have the opportunity to breastfeed then until they were a little over an hour old. My first was almost 2 hours. For more information on epidural effects on babies, click this link!

The last thing I want to touch on is the separation of mother and baby after a cesarean section which is very common. It is pretty uncommon for an newborn to be allowed to stay in the OR with mom, although it does happen sometimes. I can really related to the lack of bonding, breastfeeding problems, and reduced bonding because of this because I deeply experienced this with the births of both of my children. While I bonded, it was not that “instant motherly love” I am sure most feel. It hurts me to this day to know that my bonding was an almost learned bonding because I knew as a mother it was something I needed to do in order to protect my babies.? While most women who have had cesarean sections are not quick to admit this, I think by discussing this and acknowledging that this is a true problem it will only help to improve it for others in the long run. I also noticed that mothers who do experience this may be ashamed or fearful to admit this because it make portray them in a less than perfect light, or maybe others may look down on them because of this, but they should not be ashamed. It happens and there is nothing we can do about it but help other women to not go through what we did!

Be empowered by your birth, no matter how you birth!
If it is a bad experience, help to educate others so they do not go through what you did, so they can avoid the pain or heartache you have dealt with!

A Serious Look at Post-Partum Depression

Post-partum depression hangs a dark cloud over what is otherwise supposed to be a happy, blissful time of unconditional love. Generalizations of tears, insecurities and hopelessness do not grasp the entirety of what PPD can entail.

A licensed professional counselor with a focus on post-partum depression recently gave a presentation to a moms’ group in my area describing symptoms, signs and prevention of PPD.

She shared a checklist that you can view online. She also recommended Post-Partum Survival Guide: It wasn’t supposed to be like this as a good resource for information, but I was unable to find it to purchase online. Surprisingly (or not), post-partum depression is still not widely studied and certainly not clearly understood. Some practitioners, be they doctors, counselors or psychologists, do not recognize PPD as an illness. For yourself or your friends, it is important to make sure that the person whose help you seek shares your philosophies and is compatible with the mom and her family.

Everyone is encouraged, of course, to research for themselves on this topic, and information provided here is not intended for medical advice. If you or someone you know shows signs of PPD, seek help. Sometimes just having someone validate the feelings is all that is needed. Other times, medication might be needed, but that is at the discretion of the doctor and client.

Here are a few suggestions, however, that are easily provided as a friend or that can usually be obtained if you only ask. We were told that these can help with regular depression, too.

Take time for healing
Eat, sleep, exercise
Take breaks
Maintain marital intimacy, dates (does not have to include sex)
Recognize achievements even if it’s just changing the diapers all day
Laugh daily
Express negative feelings
Attend to positive feelings, a gratitude journal might be helpful
Act to change, don’t just talk about it
Let go of self-blame
Get social support
Recharge your batteries
Let go of expectations
Have a loose structure; plan to rest
Allow some crying time; set a timer for 20 minutes if needed, but cut yourself off when the timer goes off
Avoid major life changes, if possible

With up to twenty percent of American women experiencing PPD, it is necessary to be aware, especially for African-American women and women in lower income levels who are more at-risk.

There is also Postpartum Support International that has a toll-free helpline and is working to pass legislation in support for mothers. Please visit their site for more information. An additional good article on PPD is on Scientific American.

Know the resources in your area. Be familiar with the signs and symptoms. Be willing to help a fellow mom. Be willing to ask for help.