C Section questions...Hormones? Painkillers for the recovery?

[postitnotes]

I'll be having an ELCS for my second baby in February and I'd like to know what other people's experiences were for their sections.

a) Hormonal rush afterwards. My sister has just had a natural delivery and mentioned the powerful hormones that have kicked in afterwards. They're making her feel amazing. When I had my first baby by CS I can't really remember this kind of feeling. I definitely bonded with her and got immediate skin to skin etc, but I just wondered if you're having a baby via surgery rather than it happening naturally do you still get this kick of hormones?

b) Painkillers once you are home... I am a massive wimp, and took ages to recover last time. I got sent home with paracetamol and ibuprofen after 3 days last time and I felt like I might as well have eaten smarties instead for any painkilling they did. Can you get anything stronger for the aftermath? I was too scared to move last time because of the pain, although I was then getting told off by the nurses who predicted imminent thrombosis. I felt that if I had effective pain relief, I would feel more confident to moving a bit more and that would help with the healing (I mean just going to the loo etc, not doing star jumps). I'm also not sure that there is consistency in what painkillers are allowed if you're breastfeeding, but would quite like to be fore-armed with knowledge about what i could ask for. Did your painkillers work? Or do you have a high pain threshold anyway?

[LikeSilver]

a) not sure of the science and personally it's hard to say as I had an EMCS so haven't experienced natural delivery. While staying in hospital I definitely had a huge adrenalin rush (considering I had been in labour for three days and by all rights should have felt bloody exhausted) but crashed big time when I got home.

b) I was sent home with cocodamol and ibuprofen and I managed fine with this but I do have a reasonably high pain threshold. The most painful but for me was the drive home with the seatbelt over my scar, I was nearly in tears with that but otherwise I felt better than I was expecting to. Is it something you could discuss with your consultant beforehand and explain how difficult you found recovery last time?

[mrsnec]

Hi Op, can't help you with the first question because I have nothing to compare it too. I had complications after my emcs which meant it was 8 hours before I could see dd but no bonding problems at all.

Painkiller wise, Diclofenac injections for the first two days worked for a while once they kicked in. I was given something for thrombosis too. Other than that just offered paracetamol but didn't really need it that often once I was home. My back hurt more from the spinal than the wound did which I didn't expect.

[DIYandEatCake]

I've had an elcs and a straightforward vbac and I must say I did feel great after the vbac compared to the cs. I'm not sure about the hormones, I think for me after the cs my body (and mind!) was kind of in shock and then the drugs blurred everything too I think. Perhaps if I was doing it for the second time it might feel different, I'm sure part of the shock was just the whole becoming a parent thing.
I had oramorph for the first day which was amazing (though may have contributed to the dazed and foggy feeling) and then ibuprofen/paracetamol like you, so I can't advise on other painkillers I'm afraid. All the best with it x

[EmbarrassedPossessed]

As far as I'm aware, the main hormonal changes are triggered by the placenta being delivered which happens via either method of delivery. That's what triggers the contraction of the uterus and the start of breast milk production.

I would have thought that there could be some endorphins/adrenalin/exhaustion reaction to enduring labour and a vaginal delivery that might result in the feeling of a high that you wouldn't get with a planned c-section. I don't think that this is necessary to feeling amazing post birth.

I had an EMCS so it's not quite the same, and I was unwell afterwards so didn't see my baby for a day or so. This didn't prevent me "bonding" with him.

Pain relief - I had diclofenac tablets which were good, and another one that I can't remember. I found it important to stick to the schedule of pain management using a combination of painkillers to keep on top of the pain.

[WhyOWhyWouldYou]

You won't have the adrenaline rush but you do get the oxytocin (love hormone). Oxytocin in c section initially comes from synthetic hormone injection during the c section, I believe the placenta also causes hormonal changes (its certainly what 'tells' your body to produce milk) and finally skin to skin also releases oxytocin.

The main difference between you and your sister was probably just a natural one that would have happened regardless of each of your modes of delivery, with the adrenaline rush possibly giving your sister a bit more of a high.

[DoggyDaycare]

I think there is a difference in the hormones- eg it is usual after a cs for the milk supply to come in a day later than a vb because those hormones are triggered more slowly. I think it is just one of those things about a cs....it is different to a vb and has different advantages and disadvantages but is not better or worse.. not sure what motives your sister has in pointing out how her choice is making her feel better though.

I took paracetamol and ibuprofen afterwards and was OK, but they also offered me codeine every few hours that I could have taken if I needed it and sent me home with some just in case, so they obviously thought this was the next stage in pain relief and OK for breastfeeding.

[FeelingIrie]

Agree with other PPs re the high, I definitely had one after my planned section, I would try to put what your sister has said to the back of your mind and not worry about it at all. You can over think that kind of think IMO.

Re drugs, I don't remember feeling much pain at all post section, and I'm no tough cookie, I think I was given liquid morphine pretty regularly alongside painkillers for the first few days as I had to stay in a week. I do remember feeling a bit scared to sit up though, esp in the mornings after I had been in bed a while, thank goodness for those electric beds!

Good luck OP, wishing you a lovely, calm, positive experience.

[PrincessTheresaofLiechtenstein]

"I think there is a difference in the hormones- eg it is usual after a cs for the milk supply to come in a day later than a vb because those hormones are triggered more slowly"

I don't think there is evidence for that, as it is the removal of the placenta that starts that process, and then the process changes to supply/ demand led. It is quite likely that a mother recovering from a CS has a little less skin to skin time overall and is dealing with more pain in the first few days, and it is possibly that recovery that interferes with frequent, demand led feeds - all this could possibly mean that bf is slightly trickier to establish. It is by no means a given though - many women establish feeding just fine after a CS.

it is possible that it is the spinal and painkillers given for the surgery that accounts for the fact that you may have not felt a rush of good feelings as the baby was born, but actually many mothers who have a completely intervention free birth don't feel anything like that either..Different for everyone.

On the issue of painkillers after, I wouldn't have thought paracetamol and ibuprofen would be enough in the first few days - as others have said, I would have expected something stronger. Most painkillers are ok for bf.

[WhyOWhyWouldYou]

"I think there is a difference in the hormones- eg it is usual after a cs for the milk supply to come in a day later than a vb because those hormones are triggered more slowly. "

I looked into this a lot as I'm down for elcs and its something I'd heard that worried me. Its a myth, an elcs won't cause that. The placenta being delivered by any method 'tells' your body it is necessary to produce milk. However traumatic birth whether cs or vaginal can influence it, as can limited contact with baby due to mother or baby being seriously ill. So those hormones don't differ

[WhyOWhyWouldYou]

Sorry posted too soon

....between non traumatic vaginal and cs.

[RedToothBrush]

I had diclofenac and paracetomol in hospital, and that just about was enough if I kept on top of the pain relief. (They were rushed off feet and it did get forgotten though, so ask if you don't get given it automatically was the advice of one of the midwives. She made it clear not to be a martyr with it)

I could have had morphine if I had needed it though but I didn't really want to do this.

I was sent home with two weeks supply of diclofenac after two days. I'm generally not good with pain. I didn't find it easy but it was manageable if I made sure I took the doses o ntime as prescribed.

Btw if you were likely to have 'imminent thrombosis' I would have thought they would have been giving you injections to prevent that. The fact they didn't probably says more. My community midwife was actually pleased to see me in bed at home a couple of days later, rather than up and about and overdoing it.

[postitnotes]

Thanks for the responses, everyone. I've got my next appointment at the end of December so I'm going to discuss the painkillers then and hopefully get something down in my notes so I don't end up feeling like I'm having to battle with the nurses to get them to listen to me.

RedToothBrush Yes, I did think they were intent on scaring me out of the bed. In fact, they always seemed diametrically opposed to whatever I wanted - eg I wanted to stay 3 nights, they wanted me out sooner (despite the bfing co-ordinator wanting me to stay as bfing wasn't going well); I asked for Oramorph, they said to wait until the paracetamol had kicked in (!); I asked whether I could take some codeine home, they said I couldn't if I was bfing; I was too scared to get out of bed, they told me I would get thrombosis...

[RedToothBrush]

I think that codeine is a no-no if you are breast feeding, so that sounds right. And yeah I bet they wanted you out as they needed the bed plus its better for their statistics if you only stay 2 nights. They wanted you to be getting out of bed, as if you don't they can't discharge you...

I think I probably should have stayed 3 nights because of the pain and problems I was having breast feeding, but I don't think I could have coped with the lack of sleep and the constant interruptions for another 24 hours. I think the peace and quiet at home made up for the lack of professional care at home. However I could only do that with support from DH.

[postitnotes]

Codeine seems to be debatable - someone upthread was sent home with cocodamol, and one of the doctors who came to see me said it was fine. But the nurse didn't think so.

I was lucky wrt my bed though - I asked if there was a room free and got moved after just a few hours on the ward, and my husband stayed with me pretty much the whole time - I would probably have been keener to leave sooner if I hadn't had that nice quiet room and he'd not stayed overnight. Just needed to be less of a wimp!

[RedToothBrush]

postitnotes, I BELIEVE (but could be wrong) that the latest advice is not to use codeine if breast feeding. I think its pretty recent and not everywhere is implementing it from what I've seen on MN (though that could be because posters gave birth a couple of years ago).

[rallytog1]

I wasn't allowed to have codeine in the hospital when I was trying to bf - but a doctor whispered to be that I'd be fine to have it once I was home.

Tramadol is a great painkiller that is fine if you're bf and may be worth asking for if you don't think other painkillers are cutting it. I had diclofenac and may as well have been taking smarties for all the good it did!

[Tricycletops]

Was your previous section an emergency? I ask because while mine was technically an emergency I wasn't in labour, and I seemed to have much less pain afterwards than friends who'd been in labour for a long time first - so you might find it better this time. I think I was just given paracetamol and ibuprofen home with me but there might have been some diclofenac as well.

[CommanderShepard]

I had a rush, followed by a massive crash and birth trauma - bear in mind though that I was induced due to pre-eclampsia and ended up with an EMCS.

Pain relief-wise I had diclofenac and paracetamol. I also had Fragmin anti-coagulant injections and was in a trial for self-administering them; they were fine. Came in useful when I was in hospital last year for gallbladder surgery; I had to have them again and the nurses were agog that I was happy to do them myself - I was told that I have nerves of steel and they couldn't have self-administered in my position and clearly I was some sort of badass superhuman

[CommanderShepard]

That reminds me - I found out during my gallbladder stay that if I have Oramorph I need Cyclizine too or I'll throw it all back up. I'd be a rubbish smackhead. It's worth considering if you find co-codamol or codeine makes you hurl too (as it does me)

[BikeRunSki]

A - yes with dS (Emcs with spinal block), no with dd (crash CS under GA)

B - sent home with enough paracetamol to sink a ship both times, but could have had Tramodol. Not sure what this is, but think its stronger.