Tag: Recovery

If you’ve ever given birth or know a person who has (that makes all of us), you likely know someone who has had a cesarean section — also called a C-section.

C-sections — which involve abdominal surgery to deliver a baby through an incision in your uterus — are very common. In fact, about 30 percent of all births in the U.S. happen via C-section, according to Cleveland Clinic.

Though common, C-sections are a major surgery (they are performed in most cases when giving birth vaginally isn’t possible or safe for you or your baby). And like any serious surgery, the recovery process can be taxing on your body.

Here, experts share what symptoms you might expect to have after a C-section, whether your surgery was planned or due to an unforeseen complication.

Though every person’s post-surgery experience varies, here are some of the most common symptoms you may encounter after a C-section.

A C-section can slow your bowels. “There are three main reasons for this,” says Stephanie Hack, MD, FACOG, a board-certified obstetrician and gynecologist and founder of Lady Parts Doctor.

“First, the bowels are slightly ‌stunned‌ after a C-section,” Dr. Hack says. During the surgery, your intestines go through a lot — they are manually manipulated and moved out of the way to get to your uterus, she adds.

“Second, some of the medicines you take have a bowel-slowing effect,” she says.

This includes the anesthesia used during a C-section as well as the pain medications (sometimes narcotics) that you may take after surgery, says Marcy Crouch, PT, DPT, a pelvic floor physical therapist and co-host of the ‌No Mama Left Behind‌ podcast.

“Lastly, you’re often asked not to eat for a certain period before and after your C-section,” Dr. Hack says. “This decreases the amount of food in your intestines, and thus may increase the time before you have another bowel movement.”

A lack of food — and fluids — can also dehydrate you, which contributes to constipation. Breast or chestfeeding can amplify constipation, too, Crouch says. That’s because a lot of the water you drink goes to making milk (instead of to your bowel).

After a C-section, the general recommendation is to avoid lifting “anything heavier than your baby for the first six to eight weeks,” according to Mount Sinai. Lifting heavy objects can hinder the healing process.

During a C-section, your doctor has to cut through many tissue layers in your abdomen to get to your uterus. “Putting too much pressure on these layers before they are fully healed can lead them to reopen, causing you pain and injury,” Dr. Hack says.

Most people have pain at their incision site after a C-section, Crouch says. You may feel it any time you activate your abdominal area, or even when you least expect it (like when you laugh, cough or sneeze).

Remember, you’ve just undergone a major surgery that involved cutting through many layers of tissue. Feeling sore is normal.

Your incision site will likely feel tender for three weeks or longer, but thankfully, any intense pain should go away after about three days post-surgery, per Mount Sinai.

For some, “scar sensitivity and [scar] pain can hang around for years,” Crouch says.

In general, pregnancy puts you at a greater risk for blood clots. “This is due to changes that happen with your clotting factors in the prenatal and postpartum states,” Dr. Hack says.

Your increased risk could also be due to the pressure put on the veins in your pelvis and legs from your growing uterus, according to UT Southwestern Medical Center. This pressure slows the return of blood, leading to a greater likelihood of clots.

Specifically, a C-section itself doubles your risk for a blood clot in your legs, pelvic organs or lungs, per Centers for Disease Control and Prevention (CDC).

This is partly “because you are typically not as active while you rest and recover,” Dr. Hack says. When you don’t move a lot, your blood flow gets sluggish, making blood pool in certain places and possibly form clots.

Signs of a blood clot in your arm or leg may include the following, per the CDC:

• Swelling
• Pain or tenderness not caused by injury
• Skin that is warm to the touch
• Redness or discoloration of the skin

Signs of a blood clot in your lung may include the following, per the CDC:

• Difficulty breathing
• Chest pain that worsens with a deep breath or cough
• Coughing up blood
• Faster than normal or irregular heartbeat

If you feel any of these symptoms, get immediate medical attention as blood clots can become dangerous and potentially life-threatening.

“C-sections can temporarily weaken your core for two reasons,” Crouch says. “One is the pregnancy itself, which has stretched your abdominal muscles for nine months,” she says.

“Another is this is a major [abdominal] surgery,” Crouch says. The nature of the procedure further weakens your core. “In order to reach your uterus, your abdominal muscles are separated at the midline, and in some cases, cut,” Dr. Hack says.

Plus the incision goes through many layers of tissue, Crouch adds. No wonder your core feels unstable while in the recovery process.

If you didn’t deliver vaginally, you might be surprised to learn that you’ll still get vaginal bleeding after birth. Called lochia, this bloody discharge also has cervical mucus and some uterine lining, according to the Cleveland Clinic.

This is a normal part of your body’s postpartum healing process. “After any birth, the uterus must heal,” Dr. Hack says. And it does this by shedding any uterine tissue and materials related to pregnancy.

At first, lochia will look dark or bright red, then fade to a pinkish brown color until gradually turning to a yellowish-white, per the Cleveland Clinic.

“It can be surprising to a lot of C-section parents that they get pelvic floor issues like pain with sex, leaking pee, constipation, pelvic pain or prolapse [i.e., when a pelvic organ slips down from its normal position and bulges into the vagina],” Crouch says.

“But C-sections aren’t protective of pelvic floor problems,” she adds.

In fact, pelvic floor issues often happen way before surgery does. Indeed, your pelvic floor — the muscles that sit at the bottom of the pelvis — endure a lot of strain while carrying the weight of your baby during pregnancy.

“Postpartum pelvic floor issues are usually a result of the collective load and changes your body accumulates through nine months of pregnancy,” says Molly Scheumann, PT, DPT, a pelvic floor physical therapist at The Down There Doc.

Also, as we’ve learned, C-sections can affect your core strength and stability. Thing is, “your abdominal muscles work very closely with your pelvic floor muscles to regulate the pressure in your abdomen,” Scheumann adds.

When one or both of these muscle groups are weakened or “don’t work well together, abdominal pressure can be thrown off,” she says. And this can cause multiple pelvic floor-related symptoms, like leaking urine, pain or prolapse.

Scarring from your C-section can also affect your pelvic floor function. That’s because scar tissue isn’t as strong or flexible as the original tissue it replaced, Dr. Hack says.

After a C-section (especially if it was unplanned or due to an emergency), you might need to focus on rest and recovery and not begin breast or chestfeeding right away.

“These delays can affect the development of an adequate milk supply,” Dr. Hack says.

Abdominal pain from your incision can also make it feel challenging to breast or chestfeed comfortably.

What’s more, the epidural you received before surgery could also affect nursing. Anecdotally, some parents say that epidurals affect their baby’s latch after birth, while others say it doesn’t. Clinical data is also conflicting about whether or not epidurals have an effect on your infant’s latch after birth, per a February 2021 review in the ‌Journal of Clinical Anesthesia‌.

Fortunately, these side effects seem to be temporary. Epidurals don’t impair babies’ development or ability to breastfeed in the long term, per the American Academy of Pediatrics (AAP).

As if pregnancy-related back pain wasn’t hard enough, back discomfort might stick around after delivery, too.

Changes in posture are partly to blame for back pain, Crouch says. Dr. Hack agrees: “Your center of balance has changed, and your muscles must readjust as your body returns to its pre-pregnant state.”

The bones and ligaments in your pelvis must also shift back, which may lead to back pain and discomfort as well, according to the Cleveland Clinic.

Plus, lifting or feeding your baby present more posture and pain challenges, Crouch says. For example, you may slouch, slump or crane your neck while breast or chestfeeding, to achieve a position that’s most comfortable for your baby. Combined, these can all add up to sore back muscles.

“The low back also works closely with your abdominal wall and pelvic floor,” Scheumann says. After a C-section, both of these muscle groups can be weakened, putting strain on your low back.

And “your back might feel a little cranky from the anesthesia” you had during surgery, Crouch says. Indeed, epidurals can cause temporary tenderness or back pain, per the Cleveland Clinic.

Depending on the reason for your C-section, you may be at a higher risk for needing another in future pregnancies.

For example, if you needed a C-section because you stopped dilating, you’re more likely to go through the same thing in another pregnancy over some who has not, Dr. Hack says.

Plus, if you’ve already had C-sections (usually two), your doctor will typically recommend you go that route again for safety reasons, she adds. That’s because a vaginal birth after caesarean (or, VBAC) has some serious risks such as a uterine rupture.

“Numbness, tingling or altered sensation around your incision site are common symptoms of nerve damage following a C-section,” Scheumann says.

There are several reasons why C-sections can damage nerves:

• ‌Direct trauma to nerves‌: “Direct trauma to nerves
  during the incision or handling of tissues can lead to nerve injury,” Scheumann says.
• ‌Indirect trauma to nerves‌: “The surgical procedure involves an incision through layers
  of tissue, including skin, fat and muscle, which may inadvertently affect
  nerves in your abdominal area,” Scheumann
  says.
• ‌Compression or traction on nerves‌: If there’s excessive scar formation, compression or traction on the nerves (like a nerve getting pulled into the suture line, for example), it can result in damage, Scheumann says.

The recovery from a C-section is a marathon, not a sprint, Crouch says. While everyone is different, here’s a general timeline for the recovery process:

‌Two to three weeks post-surgery‌: “Your superficial incision, usually low and where your pubic hair is, usually seals up within a few weeks,” Crouch says.

‌Six to eight weeks post-surgery‌: “While you may look down at your incision after two to three weeks and see that it has healed, that’s only a superficial view,” Dr. Hack says. “The tissue underneath is going through a complex process of healing that will take several more weeks to heal,” she says. On average, tissue healing takes between six to eight weeks.

‌Eight weeks to a year post-surgery‌: “Just because the wound is healed doesn’t mean it’s recovered or that you’ll feel “normal” after six or eight weeks,” Crouch says. “The internal healing, where your body has to knit together muscles, tissues and basically reconstruct its inner landscape, takes much longer,” she says.

Every body works on its own timeline, but it’s estimated full recovery after a C-section can take nine months up to a year, Crouch says.

And keep in mind, healing may be even slower if you’ve had a previous C-section. “While not the case for everyone, recovery can be more difficult after each subsequent C-section,” Dr. Hack says.

Ultimately, giving birth by C-section is extremely common and sometimes necessary for parents.

While many of the above symptoms are a normal part of the C-section recovery process, others could mean something more serious is going on.

If you’re unsure whether a symptom is normal or not, call your ob-gyn or midwife. And call them immediately if you have any of the following symptoms, per the Cleveland Clinic:

• Red or swollen incision
• Pus or leaking discharge from the
  incision
• Fever or worsening pain
• Heavy bleeding
• Severe pelvic pain and cramping