Coping at home after a caesarean

Of course, everyone’s recovery experience is different and it depends on a lot of factors:

  • The amount of help at home
  • How much you listen to your body and take recovery at your body’s pace rather than any other arbitrary schedule
  • How active your other children are
  • How your birth went on the day
  • How you are managing with breastfeeding, or not
  • How baby (and you) are sleeping

Any one of these can, at times, throw a bit of a spanner in the works. Something that felt manageable yesterday, can, after a sleepless night, feel insurmountable.

For example: carrying your baby upstairs may feel daunting today simply because you went up and down stairs too many times yesterday, when (after a day of taking it a bit easier) tomorrow you will be fine again.

The good news is, there are lots of things you can do to assist your recovery but perhaps the most significant is to listen to your body!

A slight twinge should be viewed as an indicator to change how you are doing something or indeed refrain from doing it (or do it more slowly). And remember  the regime of pain medication may well be masking some of the warning signs, so treat any twinge as a signal to slow down.

However, before you go into hospital, there are a few things you can do which can radically improve your recovery chances:

  • Get everything on one level e.g. the changing area (with all relevant supplies) on the same floor as the one you are going to spend most of the day on (at least for the first few weeks). Perhaps ask your partner to replenish the stash before they head off for the day, in the early days it is important you limit the number of times you go up and down stairs
  • Enlist the help of others, perhaps have a rota for family and friends who can pop in to lend a hand. It is worth spelling out ahead of time that if they visit, they are coming to help, (and that is not mean just cuddling the baby), they are not there to be waited on by you. It is even ok to go and have a nap while they watch baby for you
  • Organise car sharing for the activities older children may be still participating in. You should not drive for 6 weeks (insurance can be invalidated by abdominal surgery), so you are going to need someone else to take your other children to swimming lessons or football practise. Planning this ahead of time when you can still do your share of carpooling takes away any pressure or guilt you might feel
  • Manage the expectations of your older children before your birth – with toddlers, start them climbing onto your lap rather than picking them up, give them simple jobs to ‘help mummy’ before the baby arrives to reduce the chances of any resentment being associated with baby
  • If you have pre-schoolers at home after the birth, plan more sedentary activities ahead of time. For example investing in play dough, puzzles, colouring books and sedentary games, and start visiting your local charity shops weekly prior to birth to stock up and don’t bring it all out at once, stagger the new things)
  • Above all, ask for help

Personally speaking, I found recovery after my second baby easier than the first time round. Second time round, I didn’t fret about getting off the pain medication as fast as possible, I knew how to get out of bed without hurting myself. I had my ‘baby station’ set up and my toddler loved ‘helping’ (though I didn’t sell it to her as helping – she thought she was playing games seeing how many things she could fit in her trolley – the muslin, the remote, the telephone, the baby wipes, when all I actually might need was the baby wipes).

A bit of planning ahead can make things so much easier.

Why do women fear a caesarean birth?

From the contact I have had with mums-to-be over the years, it is safe to say there are many different reasons why women fear caesarean birth. For many it stems from an overall fear of the unknown – both the surgery itself and the possible outcome. But then there are those women whose fear is based on previous experiences – experiences which may be birth related, but which could also derive from other surgical and hospital experiences. While still others experience fear because of the stories they have heard friends tell or clips they have seen in the media.

Researchers have often documented birth dissatisfaction as higher in women who have given birth by caesarean than those who deliver vaginally. ‘Loss of control’ being long established as a significant factor in the poor satisfaction ratings associated with unplanned caesareans in particular. A study in 2016 attempted to quantify this a bit more.

The top 4 reasons given by the women in the study were:

  • Poor communication – not so much in terms of what they were told, but rather the extent to which they felt listened to by those caring for them
  • Fear of the operating room
  • Distrust of the medical team – again relating to not being listened to and feeling something was being ‘done to them’ without due consideration
  • Loss of control

In this study, many women expressed the wish that they had been given more information about caesarean birth, both its likelihood and the procedure, prior to giving birth.

The study recommended for any birth, proceeding towards a caesarean delivery, a ‘collaborative plan’ should be negotiated and that such a plan must involve discussion beyond the relaying of the medical facts. Failure to do so would increase the likelihood of all the fears highlighted above.

‘Informed consent’ is a formal procedure, one which is carried out in all caesareans, unless the mother is unconscious and a caesarean deemed time critical. However, this study revealed that the process of ‘informed consent’ was all too often a formality where the mother was simply expected to agree, without time allocated for a more ‘robust exchange’.

What this all points towards is the importance of antenatal education in providing a rounded and balanced approach to modes of birth, where caesarean birth are given as much time and respect as vaginal birth, where myths and fears can be openly addressed. Being informed well before the event that a caesarean might be a possibility, what will happen and how means women can participate in their birth and this could go a long way to reducing the feeling of loss of control and fear so often unnecessarily tied up with caesarean birth.

Does antenatal education set women up to fail?

Sit any group of women down to talk about caesareans and you will hear all sorts of alarming ‘facts’. Common ones are:

  • You will have to have a caesarean if your baby is breech
  • You cannot pick up your baby or drive for 6 weeks
  • Bonding with your baby will be severely affected
  • Once you have had a caesarean, your next birth will have to be a caesarean too
  • the list goes on and on

What is really alarming about these facts’ is not one of them need be true.

Hard as it may be to hear, antenatal education often does little to disabuse women of these misconceptions. Rather, it can perpetuate the idea that this important procedure is a last resort best avoided.

In reality, in addition to being lifesaving in an emergency context, caesareans have significant benefits in certain pre-labour situations where attempting a vaginal delivery carries greater risk for mother or baby. Add to these, those women who view a caesarean as preferable because of the unbearable fear and uncertainty they associate with vaginal birth (tokophobia) and there are a lot of women who can benefit from planning a caesarean delivery.

Unfortunately, many women still understand so little about caesareans it will perhaps be no surprise to hear some find their caesarean experience so traumatic they go on to develop post-traumatic stress disorder (PTSD). And those who do want (or need) to plan a caesarean are left totally unaware of the opportunities for making their birth feel special and personal.

Nearly one in three women in the UK will have a caesarean, with unplanned caesareans accounting for two thirds of these.[ii] They are a possible outcome of even the most straightforward pregnancy yet are barely touched on in many antenatal classes.

This reluctance to talk positively about caesareans has forced them to the periphery of antenatal education. Books and classes can be biased in favour of vaginal delivery making it impossible for women to have open, rational discussions with those responsible for their care. Most remain unaware of the huge benefits of preparing for the possibility of caesarean birth, either planned or emergency.

Helen Walsh, author of Go to Sleep,[iii] said of her antenatal classes:

“They did not prepare me for a caesarean outcome and perhaps more importantly, the implications of such an outcome. Had I known more I would have opted for an elective caesarean and I would not have endured such a traumatic birth experience [breech baby] which I firmly believe contributed if not triggered my descent into postnatal depression.”

It is well known that a woman’s preconceptions can affect her labour[iv] and realistic expectations are significant in determining both how she ultimately perceives her birth[v] [vi] [vii] and how she approaches her recovery.[viii] Yet women are still unable to get access to the information they need in order to develop a flexible approach to birth. All too often the risks of vaginal birth are downplayed while caesareans are portrayed as an intervention to avoid wherever possible, with those planning a caesarean labelled selfish or ‘too posh to push’. This systematic bias (intentional or otherwise) leaves women in the dark about what they face.

The likelihood of needing intervention (epidural, instruments, induction or caesarean) during vaginal birth is made light of, but actually effects a significant number of women – over half of UK women will experience some form of intervention[ix] yet many remain poorly equipped to negotiate their way through the experience.

The feelings of distress and loss of control that can become associated with such a birth can have a significant impact both physically and emotionally on mum and baby.[x] [xi] Women need to know more about their options so they can assess the risks for themselves. While some would prefer to leave things in the hands of their carers, many more would prefer to play an active role in decision-making. [xii] To achieve this they need realistic information about the experience they face. Women need to know the implications of the decisions they might be tempted to make, and they need to know their rights in this regard. In the case of caesareans: knowing how to prepare for the procedure; being aware of the opportunities open to them during surgery; learning alternative positions for breastfeeding and ways to improve recovery can all radically improve the experience for many women, even if the caesarean was not their original preference.

Fortunately, in the UK at least, the National Institute of Clinical Excellence (NICE) are addressing the issue of antenatal education, in relation to caesarean birth.[xiii] They agree:

“It is important that women are presented with evidence based information in order that they are able to make an informed decision…For all women requesting a caesarean, if after discussion and offer of support a vaginal birth is still not an acceptable option, offer a planned caesarean.”

This was a huge step forward back in 2011. Unfortunately, the reality is that the extent to which this guidance is followed is still very much in the hands of the individuals providing the care – their personal opinions (as well as hospital policy), consequently perspectives can vary widely.

The toxic combination of out of date or inadequate information and biased advice means women will continue to face their birth with huge gaps in their knowledge. Failing to inform women properly contributes significantly to the mismatch between their birth expectations and birth experience exposing many to unnecessary levels of trauma.

[ii] J. Thomas, S. Paranjothy and Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit. National sentinel caesarean section audit report. (London: RCOG Press, 2001)

[iii] H Walsh ‘Go to sleep’ (Canongate Books Ltd, 2011 ISBN:978-0857860057)

[iv] K. Hofberg, M. R. Ward, ‘Fear Of Pregnancy And Childbirth’ Postgraduate Medical Journal, 79 (2003) 505-510

[v] J. Lally, M. Murtagh, S. Macphail et al, ‘More in Hope Than Expectation: A Systematic Review of Women’s Expectations and Experience of Pain Relief in Labour’ BMC Medicine, (2008) 6:7doi:10.1186/1741-7015-6-7

[vi] C. Oblasser, The Faceless Caesarean (BoD, 2009)

[vii] C. Francome, W. Savage, H. Churchill et al, Caesarean Birth in Britain: A Book for Health Professionals and Parents (London, Middlesex University Press, 1993)

[viii] L East, Caesarean Birth: A positive approach to preparation and recovery, (Tiskimo 2011  ISBN: 978-0-9568480-0-0)

[ix] NHS, Latest Maternity Statistics Show How the Pattern of Giving Birth in England is Changing, (NHS Information Centre, 2008)

[x] J. Lally, M. Murtagh, S. Macphail et al, ‘More in Hope Than Expectation: A Systematic Review of Women’s Expectations and Experience of Pain Relief in Labour’ BMC Medicine, (2008) 6:7doi:10.1186/1741-7015-6-7

[xi] L East, Caesarean Birth: A positive approach to preparation and recovery, (Tiskimo 2011 –  ISBN: 978-0-9568480-0-0)

[xii] K.L. Ingold, author of ‘A phenomenological exploration of women’s experiences of giving birth in Leeds and discussion within the context of NHS maternity policy’ (Masters dissertation in Public Health, University of Leeds Academic Unit of Public Health, 2011)

[xiii] National Collaborating Centre for Women’s and Children’s Health, Caesarean Section Guideline, Draft (Commissioned by National Institute of Clinical Excellence, RCOG, 2011)

When is a caesarean really necessary?

Which of the following circumstances necessitate a caesarean delivery over attempting a vaginal delivery?

  1. The baby is in the breech position – presenting bottom down rather than head down
  2. Mum is carrying twins – both twins are presenting head down
  3. Mum has HIV – with a viral load of less than 400 copies per ml
  4. Mum has had a caesarean previously
  5. Mum’s labour is failing to progress
  6. The baby is in the transverse position – lying across mum’s body

Scroll down to see…

Only No. 6. and even then, only after attempts to manipulate baby into a head down (or breech) position have not worked.

In all other instances, a caesarean may well be recommended, but it is not required.

That said, it is worth listening to the fine detail of why a caesarean may be being recommended. For example, over the last few decades the number of breech babies delivered vaginally at home has significantly decreased, so if your baby is breach and you are planning a home birth and your midwifery team are recommending a hospital birth, this could be because they feel less experienced in home breech births. Investigating the possibility of an experienced, independent midwife may mean this is still possible, or moving the birth to a birthing centre within your local hospital may help move towards a birth plan which supports both parties.

Similarly, twins do not have to be delivered vaginally, but where one twin is lying in a more complex position i.e. not head down, then a caesarean may be preferrable to mitigate against situations where cords become entangled or prolapse as the first twin is delivered.

At the end of the day, it is about being informed and checking you have all the facts. If you are at all unsure that the advice you are being given is the whole picture, it is your right (in the UK at least) to ask for a second opinion.

Sort the fact from the fiction

There are many myths about caesarean birth, and the popular press often perpetuate these to achieve sensational headlines.

It can also be the case that as women talk to each about birth experiences, incomplete or inaccurate information can be inadvertently passed on. One person’s negative experience can so easily paint this important procedure in a terrible, light.

It is so incredibly important to check information, ask questions and challenge responses before making a decision about the way in which you prefer to give birth. Taking on board second-hand information without questioning it, means some women face birth knowing next to nothing about caesarean birth. As a result they risk missing out on opportunities to make their experience a positive one.

  • Did you know, putting your gown on backwards means you can try holding baby skin-to-skin during surgery?
  • Did you know a breech position does not mean you must automatically have a caesarean delivery?

Caesarean Birth: A positive approach to preparation and recovery blows the myths out of the water. It also dedicates entire chapters to the preparation for and recovery from caesarean birth. There are even whole appendices on the risks and benefits of both vaginal and caesarean birth to help in your decisionmaking. All data has been reviewed by a team of midwives and obstetricians and we are confident the information is accurate and reflects the latest research.