New Mothers Guide After C-Section Delivery or Cesarean Delivery Includes The Following:
C-section refers to a cesarean section delivery for child birth or delivery. It is an operative procedure whereby the fetuses after the end of 28 weeks are delivered through an incision on the abdominal and the uterine walls. The first operation performed on a patient is referred to as a primary cesarean section. When the operation is performed in subsequent pregnancies, it is called repeat cesarean section.
What Happens After C-Section Delivery or Cesarean Delivery? (Day 0)
In the First 24 Hours or Day Zero
- The new mother is put under observation for the first 6 to 8 hours and this is important.
- Periodic check up of the pulse, BP, the amount of vaginal bleeding and the behavior of the uterus (in low transverse incision) of the new mother is done and recorded.
- Fluid: Sodium chloride (0.9%) or Ringer’s lactate drip is continued until at least 2.0–2.5 L of the solutions is infused.
- Blood transfusion is helpful in anemic mothers for a speedy post-operative recovery.
- Blood transfusion is required if the blood loss is more than average during the operation (average blood loss in cesarean section is approximately 0.5–1.0 L).
- Oxytocics: Injection oxytocin 5 units IM or IV (slow) or Methergine 0.2 mg IM is given and may be repeated.
- Prophylactic antibiotics (cephalosporins, metronidazole), for all cesarean delivery is given in 2–4 doses. The therapeutic antibiotic is given when indicated.
- An analgesic, that is, pain relieving medications in the form of pethidine hydrochloride 75–100 mg is administered and may have to be repeated.
- Ambulation: The new mother can sit on the bed or even get out of bed to evacuate the bladder, provided her general condition permits. She is encouraged to move her legs and ankles and to breathe deeply to minimize leg vein thrombosis and pulmonary embolism.
- Baby is put to the breast for feeding after 3–4 hours when the mother is stable and relieved of pain.
What Happens in Day 1 After C-Section Delivery or Cesarean Delivery Day?
Oral feeding in the form of plain or electrolyte water or raw tea may be given. Active bowel sounds are observed by the end of the day.
Day 2: A light solid diet of the new mother’s choice is given. Bowel care: 3–4 teaspoons of lactulose is given at bed time if the bowels do not move spontaneously.
Day 5 or Day 6: The abdominal skin stitches of the new mother are to be removed on the D-5 or D-6.
When is the New Mother Discharged After C-Section Delivery or Cesarean Delivery?
The new mother is discharged on the day following the removal of the stitches if she is fit. Usual advice like those following vaginal delivery is given. Depending on postoperative recovery and availability of care at home, the new mother may be discharged as early as the 3rd to as late as 7th postoperative days.
Signs of Complications A New Mother Should Look Out For After A C-Section Delivery or Cesarean Delivery:
Post caesarian section, a new mother has to look for the following signs and symptoms in her body. If any of these occur, they are suggestive of any underlying pathology, disease or complication that might be caused due to a cesarean section. So, the new mother has to look for the following signs to avoid any complications, these include:
Postpartum Hemorrhage after C-Section: The blood loss in cesarean section is more often underestimated. It is mostly related to uterine atony (loss of tone of the uterus tone), however, but blood coagulation disorders may rarely occur.
Shock after C-Section: While most often it is related to the blood loss, it may occur when the operation is done following prolonged labor without correcting pre-existing dehydration and ketoacidosis.
Breast Changes after C-Section: These are generally related to breastfeeding difficulties, which include breast engorgement, mastitis that refers to swelling of breast or retraction of nipple or baby is not able to take the feed properly, so if any of the factors are present it should be reported to the doctor immediately.
Anesthetic Hazards after C-Section: These are mostly associated with emergency operations. The hazards are related to aspiration of the gastric contents.
Hypotension & Spinal Headache Infections after C-Section: The common sites are uterus (endometritis), urinary tract, abdominal wound, peritoneal cavity (peritonitis) and lungs. Septic pelvic thrombophlebitis may be associated with endometritis. Risk factors for infection are prolonged duration of labor and that of rupture of membranes, repeated number of vaginal examinations. Prophylactic antibiotics reduce the risk significantly.
Intestinal Obstruction after C-Section: The obstruction may be mechanical due to adhesions or bands, or paralytic ileus following peritonitis.
Deep Vein Thrombosis & Thromboembolic Disorders after C-Section: These are more likely to occur following cesarean section than vaginal delivery. Septic thrombophlebitis is also a known complication
Wound Complications after C-Section: Abdominal wound sepsis is quite common. The complications, which are detected on the removal of the skin stitches, include pus and discharge. In case you observe any of these, immediately report to your doctor.
Breast Feeding Guidance To A New Mother After C-Section Delivery or Cesarean Delivery:
The mother is told to start breast feeding as soon as possible after C-Section Delivery or Cesarean Section. The benefits of breastfeeding are:
Ideal Food for the Baby: Breast milk is an ideal food for easy digestion and low osmotic load.
Carbohydrates: Mainly lactose, stimulates growth of intestinal flora, produces organic acids needed for synthesis of vitamin B in the baby.
Fat: Smaller fat globules present in the breast milk, which are better emulsified and digested.
Protein: Breast milk is rich in last albumin and lactoglobulin, less in casein.
Minerals: Breast milk has low osmotic load (K+, Ca2+, Na+, Cl–), so less burden on the kidneys of the baby.
Breast Milk Gives Protection against infection and deficiency states:
- Vitamin D promotes bone growth, protects the baby against rickets.
- Leukocytes, Lacto peroxidase prevents growth of infective agents.
- Lysozyme, lactoferrin, interferon protect against infection.
- Long-chain omega-3 fatty acids are essential for neurological development of the baby.
- Immunoglobulin’s IgA (secretory), IgM, IgG protect against infection.
- Supply of nutrients and vitamins.
Positioning of Baby During Breastfeeding
Positioning of Baby plays an important role and the new mother should be taught about the proper position of the baby during feeding, which is as follows:
The mother and the baby should be in a comfortable position. Feeding in the sitting position, the mother should hold the baby in an inclined upright position on her lap; the baby’s head should be on her forearm on the same side close to her breast with the neck of the baby slightly extended. A good attachment means the infant’s mouth is wide open and the chin touches the mother’s breast. The mother should guide the nipple and areola into the baby’s mouth for effective milk transfer. The milk transfer to the infant begins with a good latch on and by a peristaltic action of the tip of the tongue to the base.
The proper position for milk transfer is chest to chest contact of the infant and mother. The infant’s ear, shoulder and hip are in one line. Baby sucks the areola (lactiferous sinuses) and the nipple holding the tongue and the palate. Feeding in lateral position following cesarean delivery or with painful perineum is carried out by placing the baby along with her side of the trunk and the arm.
A healthy mother while breastfeeding will produce about 500–900 ml breast milk per day. This will give her baby about 75 kcal/dL. This requires additional 750 kcal/day for the mother. This amount is either to be supplemented through her diet or is made up from her body stores.
Diet & Supplements for a New Mother After C-Section or Cesarean Delivery
A new mother after a c-section should be guided about proper diet regimes to be followed and nutritional intake should be increased that includes:
- Multivitamins tablets.
- Iron tablets and calcium tablets.
- Roughage and high fiber diet.
- Fresh juices.
- Pulses etc.
Postnatal Care for a New Mother After C-Section Delivery or Cesarean Delivery
Postnatal care includes a systematic examination of the new mother and the baby and appropriate advice given to the mother during the postpartum period. The first postnatal examination is done and the advice is given on discharge of the patient from the hospital. The second routine postnatal care is conducted at the end of 6th week postpartum.
General Advices to the New Mother:
Rest. The patient is advised bed rest for 1-2 days, then from the 3rd day is allowed to walk so as to let the stitch line heal properly.
Postpartum Exercises. After a few days if the patient is in sound health then she is allowed to do her usual duties. Postpartum exercises may be continued for another 4–6 weeks.
Vaccination. Vaccination for MMR, Hep B for the baby needs to be done by the parents.
Monitoring. Evaluation of the progress of the baby periodically should be done and the mother should also be asked to continue breast feeding at least for 6 months.
Family Planning. Family planning counseling and guidance is given to the patient for proper child spacing.
Management of Ailments. Additional investigation and appropriate therapy are given according to the abnormalities detected during the check up of the new mother.
Counseling. Some new mothers may need psychological support also.
Irregular Vaginal Bleeding After C-Section or Cesarean Delivery. It is not uncommon to encounter irregular or at times, heavy bleeding after 4–6 weeks following an uneventful period after cesarean delivery. This is usually the first period especially in not lactating women and simple assurance is enough. Persistence of bleeding dating back from childbirth is likely due to retained bits of the conceptus and usually, requires ultrasound examination followed by dilatation and curettage operation.
Leucorrhea After C-Section or Cesarean Delivery. Profuse white discharge might be due to ill health, vaginitis, cervicitis or subinvolution. Improvement of the new mother’s general health and specific therapy cures this condition.
Cervical Ectopy After C-Section or Cesarean Delivery. Cervical ectopy (erosion) met during this period without any symptom should not be treated surgically. Hormone-induced ectopy during pregnancy takes a longer time (about 12 weeks) to regress. Thus, asymptomatic ectopy should be examined again after 6 weeks and if it still persists, cauterization is to be considered.
Backache After C-Section or Cesarean Delivery. It is mostly due to sacroiliac or lumbar sacral strain. A backache over the sacrum is likely due to pelvic pathology, but if it is over the lumbar region, it might be due to an orthopedic condition and is often relieved by physiotherapy. Retroversion of uterus seldom produces a backache. If associated with a return of uterus to its normal place with symptoms, a pessary is inserted after correcting the position and is to be kept about 2 months.
Uterine Prolapse After C-Section or Cesarean Delivery. A slight degree of uterine descent with cystocele, stress incontinence and relaxed perineum are the common findings at this stage. These can be cured by effective pelvic floor exercises. However, if the uterine prolapsed is marked, then effective surgery should be done after 3 months.
Urinary & Anal Incontinence After C-Section or Cesarean Delivery. The mother is examined for any sphincter injury.
- Perineal strengthening exercises are advised to the patient.
- Women with persistent symptoms after 6 months need special investigations and surgical treatment.
- American College of Obstetricians and Gynecologists (ACOG). (2020). Cesarean Birth (C-Section). https://www.acog.org/womens-health/faqs/cesarean-birth-c-section
- National Institute of Child Health and Human Development (NICHD). (2021). What are the risks of cesarean delivery? https://www.nichd.nih.gov/health/topics/cesarean/conditioninfo/risk
- Mayo Clinic. (2021). Cesarean Section. https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655
- World Health Organization (WHO). (2015). WHO Statement on Cesarean Section Rates. https://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_eng.pdf
- MedlinePlus. (2021). Cesarean Section. https://medlineplus.gov/cesareansection.html
- Centers for Disease Control and Prevention (CDC). (2021). C-Section (Cesarean Section). https://www.cdc.gov/nchs/fastats/delivery.htm