Pregnancy
Instructions
Care in Hospital after Surgery
What pain relief will I get and for how long?
You will always be given pain relief during and after the surgery. Whilst you may feel some discomfort you should never be in pain. All the drugs prescribed are safe for mothers and safe for breastfeeding. The drugs prescribed are usually a variable combination of:
- Paracetemol
- Diclofenac (“Voltaren”) or another kind of Non-steroidal anti-inflammatory drug
- Narcotics (e.g. pethidine, morphine, oxycodone)
- Tramadol (“Tramal”)
Different anaesthetists have different regimes for pain relief but most revolve around a small number of drugs that are preferred for breastfeeding mothers. The regime will also be tailored to you individually depending on different factors such as known drug allergies, the type, duration or difficulty of surgery etc. Most women who experience significant pain post caesarean section find they have tried to avoid too much pain relief, then the pain can come on quite suddenly and be more difficult to get back into control
My general rule of thumb is that after caesarean section you will need regular and stronger pain relief for the first week, regular but milder pain relief in the second week and only occasional pain relief in the third week post surgery. Of course, there are large individual variations between women. Never feel that you should not take pain relief and always be reassured that you can discuss any concerns with me or the anaesthetist.
Will I be attached to anything after surgery?
Yes, you will have an intravenous line and an indwelling urinary catheter for about 24 hours. These are usually removed the following morning, unless your caesarean has been done late at night or overnight in which case they will usually be removed the following morning. Sometimes I will insert a wound drain to allow any excess blood or fluid to be drained from the wound to avoid infection. This is also usually removed the following day. It is uncomfortable but not painful to remove, however it is a good idea to have some pain relief about half an hour before the midwife removes the drain.
What other drugs may be given?
You may have antibiotics administered during surgery, and occasionally afterwards
If your blood group is Rhesus Negative you may receive another injection of “anti-D” as you had during pregnancy
What about the risk of Deep Vein Thrombosis?
Pregnant women and any person who has had surgery is at increased risk of a deep vein thrombosis. Obviously women having caesarean sections are, therefore, at increased risk. Some individuals may also have other risk factors, such as a previous DVT or a genetic mutation, that increases the risk even further. In nearly all cases I will prescribe a daily injection of a blood thinning agent such as ‘Clexane” for the days after surgery until discharge from hospital. Those women at even higher risk may need to take Clexane for 6 weeks after surgery.
When can I eat after surgery?
I will usually leave instructions that you can suck on ice for the first 4 hours, then you may drink fluids. Light diet can start about 8 hours after the operation, but this may vary in individual circumstances.
When will I be able to go to the toilet after surgery?
Usually the urinary catheter will be in place until the next morning. After it is removed you will need to go to the toilet to pass urine on your own. As you will be sore and unsteady on your feet due to surgery and pain killers, it is wise to have some assistance getting to the toilet in the first day or so.
Most women will not open their bowels for 2-3 days after childbirth, whether by vaginal delivery or caesarean section. Constipation can be made worse by some forms of pain killers and by lack of mobility. If you have not opened your bowels by day 2 or 3 it is advisable to try some additional fibre agents or a laxative such as “Lactulose”. In more stubborn cases a small enema (a suppository capsule eg Glycine or 5mls of fluid “Microlax”) can be used to get things going.
Will I bleed and for how long?
Most women will bleed for 4-6 weeks after birth. This is the same, whether you have had a vaginal birth or caesarean. The bleeding can be quite erratic – sometimes dark and old, sometimes bright. An occasional clot can be passed as part of the normal process but contact me if the clots are bigger than the size of golf balls. The bleeding should not be very heavy after discharge from hospital. If the bleeding becomes very heavy then you should contact me.
What will happen with breastfeeding?
Your milk will ‘come in’ as it would if you had a vaginal delivery. The trigger for milk production is the rapid drop in hormones after the placenta is delivered from the uterus. It does not matter whether the placenta is delivered at a vaginal birth or removed at a caesarean. In both cases the colostrum will be produced initially and the milk will come in about three days later.
After Discharge from hospital
What pain relief can I take after I go home?
On discharge from hospital you will be supplied with pain relief tablets. This should be enough to keep you comfortable for 1-2 weeks. If you require another prescription, or the tablets are not strong enough to keep you comfortable, then contact my office.
How do I care for my caesarean wound after I go home?
Even within 48 hours of the surgery your wound is already very strong.
- In most cases I will put in a DISSOLVING suture (usually a very pale clear suture) that is TRIMMED at the skin level on the day you go home. The suture underneath the skin will simply dissolve over a couple of weeks.
- In some cases I will put in a NON-DISSOLVING suture (usually a blue or black colour) and this should be REMOVED before you leave hospital. I always write clear instructions to nursing staff on my operation report so there should be no confusion about what kind of suture you have.
Sometimes there will be some dressing strips across the wound when you are discharged. These can be peeled off a few days after you go home. The wound can be left exposed without a dressing by 1-2 weeks. I usually will place the incision quite low (for the best cosmetic result) but the disadvantage of this is that usually the incision is in the pubic hair area. This can lead to ingrown hairs along the wound that can become red and inflamed. This can be avoided by gently washing the wound with mild soapy water and using a synthetic loofah or mit to very gently exfoliate the area.
What should I be concerned about after I go home?
Things to be concerned about include:
- Severe pain not covered by the analgesia you have been prescribed
- A very red and inflamed wound, especially if the surrounding skin is becoming increasingly red and angry
- An area of the wound opening up (usually a small open area will heal up again but you should let me know anyway)
- Heavy vaginal bleeding and / or offensive smelling vaginal discharge
- A fever above 38 degrees Celsius. This may suggest mastitis, a wound infection or urine infection. Call me or your GP for further advice.
- Being unable to pass urine for many hours despite desperately needing to go (a warm bath can help – just try passing urine in the bath) or not being able to open your bowels for more than 3 days.
- Weakness in your lower limbs (especially if associated with difficulty passing urine)
Who do I call if I am concerned about something?
Generally you should contact my office on 9417 1156 or you can call delivery suite after hours. If the matter is more urgent and cannot wait until 9am then page me on 9387 1000 and leave a message. I will call you back as soon as possible (usually within 15 minutes). If the matter is very urgent then call 000 for ambulance attendance.
What kinds of activities can I do after a caesarean?
By the time you are discharged you should be able to :
- Walk around comfortably and push a pram. You will probably only be able to walk for short periods (15-20 minutes before having a short rest)
- Care for your baby
- Go out for a coffee
- Walk to the local park
- Go out for a meal (with the baby – don’t leave it in the restaurant – remember you are new to this!)
- Visit friends.
You can swim once your bleeding has completely settled (usually 4-6 weeks)
You can jog or run after about 6 weeks (sometimes longer) but you will be surprisingly exhausted very quickly.
You can start gentle floor exercises (including gentle abdominal work) at about 6 weeks (but not full sit-ups for about 8-12 weeks)
Be guided by your physical condition. If it hurts then rest.
When can I drive?
There is no specific time that must pass before you can drive. Having surgery, including a caesarean section, is considered a temporary impairment to driving. Two specific things govern if you are safe to drive:
- You are NOT on any medication that could make you drowsy (e.g. panadeine, panadeine forte, tramadol or endone) Panadol or voltaren will not affect your conscious state so you can drive while taking these medications.
- You can slam your foot on the car brake in an emergency without flinching in pain. You must be able to avoid an accident by braking hard if necessary. You can test this by stamping your foot hard on the ground and see if it causes any significant pain – if it does then you are not ready to drive.
Most women can drive safely by 3-4 weeks after a caesarean. I do, however, STRONGLY recommend that you contact your insurance company to ensure that you will be covered by your policy in the event of an accident. If they require written certification of your fitness to drive then contact my office.
What can I carry?
You should not carry anything much heavier than your newborn baby for about 4 weeks. This includes other children, baskets of washing or bags of groceries. If you need a baby bath filled and moved get someone else to do it. Doing any of these things can sometimes be impossible to avoid (eg having to catch a falling toddler!) You are very unlikely to actually do any harm to yourself but you will pay the price in terms of being much more sore for 2-3 days.
When can I have sex again?
You can resume sexual intercourse when you have stopped bleeding vaginally. Until then having intercourse can increase the risk of uterine infection. Remember you may ovulate (and fall pregnant again) even when you are breastfeeding. Full breastfeeding will usually delay ovulation (and hence your periods) for about 6-8 months but this is not a very reliable form of contraception. Of course, when you can have sex again and when you will be interested can be two separate things!
I will discuss contraception at your postnatal visit.
Remember:
- If you are not breastfeeding at all or significantly supplementing breastfeeding with formula then could ovulate as early as 4-6 weeks after birth. Therefore I would recommend using condoms until your check up.
- If you are completely formula feeding then you can recommence the pill (talk to me about this).
- If you are fully breastfeeding then it is still recommended that you use condoms or start the ‘minipill’ (a progesterone only form of contraceptive pill that is safe for breastfed babies). If you are interested in a longer term form of contraception I will discuss this at the postnatal visit.
Do I come back for a postnatal check up?
I will usually see you for a postnatal check up at about 6-8 weeks after the birth. Obviously there are individual circumstances to consider and I may wish to see you sooner (I will arrange this if I think it is necessary). In the meantime please just call my office if you have any issues and we can sort things out as soon as possible.