C-Section Queries

[Boggler]

Im due to have dc2 by elcs (transverse baby) on Thursday! I've never had any major surgery and I'm obviously nervous about the post delivery recovery but I've got a great dh and family nearby so I think things should be ok. What I want to know though is the differences I'll experience compared to a vb birt that I had with dc1 for instance:

1. I bf dc1 straight away but I've heard that after a c section it takes longer for the milk to come in, is this true? How long does it take?
2. I've heard that the bleeding after the birth is much worse after a c section true or false? If true how bad is it likely to be?
3. I know that I won't nw able to drive for 6 weeks, but how long will it take til I can walk/ stand etc without being in agony?
4. Any advice to make things easier?

Many thanks x

Having surgery for anything is a scary experience. Ill try to answer based on my experience but please don't take that as norm.

1. my milk didn't seem to come straight away, but as dd had already had a dextrose jab due to drop in sugar levels and had swallowed a load of junk she wasn't too interested in feeding in any way. I seem to remember having my milk in quite quickly though.
2. I bled throughout my labour but only for about a fortnight after emcs. I don't know if the fact I'd lost a lot of blood prior meant a shorter bleed than some or not.
3. it's best to try and get active as soon as possible, as horrific as that seems. With dd in NICU I was up and about the morning after so I'd be able to walk to NICU to see her. I'd say I was mainly pain free within a few days, and definitely by a week though some things will twinge at you.
4. other than trying to get active as soon as, I don't know. Maybe don't rush to leave hospital, those remote control beds are a godsend for the first few days!

Good luck with it all

One word - lactulose! You will not be able to poo post surgery. (people dont tell ypu this!) This stuff is a godsend. Don't bother faffing about with fibrogel, it doesn't work, skip straight to this stuff and you will be 'relieved' in no time!

I had an EMCS with DC1 and vaginal delivery with DC2.

Both times I had no problems breastfeeding. You can do skin to skin straight after your section (assuming you haven't been knocked out) and just start feeding. First you will have colostrum and milk will come in after 2 or 3 days - same as with a vaginal delivery.

I do remember lots of blush gushing out with my cesarean, more so than with my vaginal delivery. But in the end I recovered from my section within a week and from the vaginal (forceps) delivery it took more than a month...

you should get up a few hours after the section, the midwives will let you know... this is actually better for the recovery.. don't remember the reason now though..

i stopped using painkillers after a few days and have never been in agony with the section. (well, try not to cough or sneeze!)

do dead sea salt baths once your midwives says it's ok to bath and take arnica tablets..

you'll be fine!

Good luck on Thursday - FWIW, I had an 'em'CS with DS2 and it was fine (emergency, as in 'not scheduled', but there were hours between decision and actual surgery, so no panic).

1. Milk does not as such take longer to come in after CS, but can be affected by how quickly your baby gets to the breast and how much time baby gets at the breast. Drugs can make a difference too, however if you are going to have a spinal anaesthetic your baby should be fine. I'd try and avoid morphine/pethidine injection before they are born if you can.

Ask to hold your baby as soon is practicale, do lots of skin to skin couddles and allow free access to the breast from the start. You'll need help with positioning, so do keep asking for it (I had lovely MWs who kept popping their heads round to see if we needed anything, but I know other new post-op mums who were left to it...)

1. Bleeding after the birth tends to be less after CS, because you can be certain that all of the placenta/membranes have been manually removed, so nice 'clean' uterus left behind [wind].

BFing can help your uterus to contract and reduce the immediate post-op gush.

1. You are not allowed to drive until you can perform an emergency stop. There is no law that states 6 weeks. You have to able to turn your head and stomp hard on the breaks. Being able to jump off a step is a good test for that .

Some car insurance companies have their own rules, but none of these have anything to do with the law or what would be medically recommended. FWIW I drove after about 3 weeks or so.

Enjoy those first few newborn cuddles and sniff the baby's head for me!

My milk took 2/3 days to come in after my emcs. I was up before i left HDU! It really wasn't so bad that way, i walked down the corrode that night when i moved rooms, just me and my 'handbag' lol.

Second lactulose (and glycerine suppostitories in case you don't get the lactulose quick enough). They definitely gave me a bit of a clean out while they were in but i can't remember much about the bleeding and have nothing to compare really. Take lots and lots of fullsize maternity pads with you, they used them to dress my wound, as well as fort the obvious. Lots of big, cheap black pants, you don't want anything resting on or near that wound. The drive home wasn't nice a week later with that bloody seatbelt!!!;

1. No problem pooing here - much less than after vaginal deliveries!

I do not get on well with strong painkillers (morphine and the likes make me itch). You may be offered a Volterol (Diclofenac) suppository whilst in theatre or the anaethetis who'll the spinal mention it when they consent you. IMO, go for it: you don't feel it and the painrelief is great without the need for laxatives. Paracetamol is fine. Cocodamol/solpadol and the likes are full of codeine, again make me itch and certainly cause constipation.

1. Chocolate bar of you choice for after delivery . You will have been fasted beforehand (just in case they suddenly need to put you to sleep) and you'll be ravenous. IMO child birth without postnatal Snickers should be outlawed!! Although the toast and tea are not bad either, but my DH nicked them...

Oh gawd, yes, I had cheap M+S full knickers a size bigger than my usual that came right up to my waist. They were jolly comfortable, but you could've lauched a ship with them as sails. Glamourous, not.

I've had 2 sections and breastfed each time without problems. Bleeding afterwards wasn't especially heavy.
I was fine to drive after 4 weeks, and moving around after. Just take it slowly, you will shuffle around for a while and make sure you don't lift anything heavy or reach up. My first section was elective for breech and I would choose this option every time (if I was to have more DCs!).
Loads of luck.

No problems pooing here either, but absolutely yes to the big pants! (I still wear mine).

Lucozade sport or similar for when they let you drink, not the fizzy ones, the flat ones. Really felt like they helped. Also straws for when you need a drink, much, much easier!

dear boggler,

1. elective CS definitely increase the time for your milk to come in. normal births will take 3-4 days, sometimes you will need to add on 1-2 days when you have a caesarean, but more so during an elective. The reason being is that labour (so if you have normal birth or emergency caesarean in labour) tells the breasts that the baby will be coming soon. if you have an elective caesarean your body has no idea what is about to happen as it hasn't laboured, so it takes a couple of days to catch up with the milk.
2. Bleeding will be slightly more with a caesarean but not a lot more. Most bleeding comes from your placental site, which you have regardless of which type of birth you have. people who have caesareans might just have a little bit more because of the scar, but this will be very minimial.
3. Driving all depends on your car insurance company, some will just say when you can safely and comfortably do an emergency stop, so check your policy.
4. do take your pain killers in first few days, even if you are not in pain. it is a lot harder to become pain free when you are already in pain than it is just to top up levels if you take them frequently. try to use opiates such as codeine as a last resort especially if you are breastfeeding. there is a very very extremely rare gene out there that causes people to convert codeine to morphine in extremely high doses and this gene can be passed on to the baby and as codeine passes htrough the breast milk, the baby can convert it to dangerous levels. again this is very rare, but it is something we were told about on our postnatal ward to be aware of. if you are taking codeine, make sure it is the one you stop first. paracetamol and ibuprofen or other anti-inflammatories are safe for breastfeeding. try to mobilise as early as you can, the quicker you are up and about, the easier recovery is. make sure you are eating a good diet with lots of fibre and drinking lots to keep your stools soft as you can be a little constipated after a caesarean and especially if you are taking codeine. breastfeeding on your side is a good option if you are too sore to have baby on your tummy in the first few days :)

good luck with your CS
Emma - midwife

Thanks everyone for the information, I don't feel quite so unprepared now. Can you buy lactolose? Or do you need a prescription? I'll stock up.

If you are having a PLANNED CS you should bear in mind that it is generally a much easier, calmer procedure than an EMCS, for a start.

There is no physiological reason why Bf should be harder after a planned CS than a simple VB. The drugs used for anaesthesia (spinal or epidural) are MUCH less likely to have any effect on your baby than other anaesthesia as they don't cross the placenta. The one drug you really want to avoid in terms of successful bf is pethidine. it is an opiate which makes babies sleepy after birth and harder for them to latch on and bf.

If you have a 'shivery' reaction to the anaesthesia, or throw up, obvs that will make holding and feeding your baby a bit harder immediately afterwards, but those effects if you are unlucky enough to get them shouldn't last long.

Bear in mind that women who have EMCS's tend to have gone through labour beforehand, sometimes a long labour and are generally knackered and have other drugs in their system before they get as far as a CS.

There is no reason why you would bleed more after a CS (who is giving you this info, btw? They sound quite alarmist!). My consultant told me I was likely to have a lighter bleed but it might go on for a bit longer. I'm not sure why this would be true, but I bled medium to light for about 4 weeks.

The 6 weeks driving 'ban' is largely a myth. Check with your insurers but usually you can drive as soon as you feel you are ready. (When I rang my insurers to check I was allowed to drive, they were baffled - they pointed out that people have surgery for various things all the time! and there's no 'ban' on when they can drive, it's up to individuals to be sensible. If you feel no pain and are strong enough to do an emergency stop then you should be fine. Obviously you can leave it for as long as you like if you have support).

My best tips for CS recovery are:- peppermint oil capsules in case you get trapped wind - a large refillable water bottle with a sports type cap so you can keep a lot of water to hand and drink while you are breastfeeding! and get a big V shaped cushion to prop you up afterwards. John Lewis do a fab one.

Keep on top of your painkillers and you should be fine. I had my stitches out on day 5 and felt pretty good by then - just the kind of 'soreness' you get if you do a lot of sit ups. I had to be careful getting the buggy up and down kerbs, making sure I didn't lift it, but that wasn't too hard.

Good luck - I am sure you will be totally fine, esp if you have family support to fetch and carry for you.

does this help

Sorry, but elective caesarian does not 'definitely increase the time for your milk to come in'.

milk production is triggered by the placenta being removed. This happens during a planned C section.

As I have said above, there are a few reasons why Bf might be hard initially for a mother after a planned CS - but your breasts will receive the 'message' they need when the placenta is removed.

Like I said - avoid the pethidine. MWs tend to use it a lot, probably because it is a cheap and easy say of administering a painkiller. It can make babies very sleepy and slow to BF.

I didn't know that having a CS DEFINITELY increased the time it took for milk to come in? I had an EMCS without labouring at all (failed sweep at 37w, two failed pessaries at 38w, non-engaged footling breech baby which was undetected by any of my medical team, waters broken by med team after midwife failed, followed by footling presentation and feotal distress) on the Wednesday and my milk came in sometime between Friday and Saturday (I don't know for sure when as it came in almost imperceptibly, with no pain whatsoever, it was only when, on the reluctant advice of a very mis-informed midwife (I'm not saying all are, but this one was a nightmare) that I began expressing milk to 'top-up' babies feeds on the Saturday that it became apparent my milk was definitely in lol.

So if it was slow to come in, when would it have come in with a natural birth?

I know the plural of anecdote is not evidence, and that is my own personal experience, but saying that it will definitely take longer is mis-information, plain and simple. For the record, I have successfully and almost effortlessly BF'd my DD to 21m (and now she loves colostrum!) following my EMCS, and I fully expect to BF DC2 in the same manner, whereas my sister who had two spontaneous labours and relatively easy births was unable to establish BFing with either, despite excellent support it just didn't happen for her. To continue to perpetuate myths about BFing and CSs is disingenous and undermines the efforts of those who are trying so hard to combat such prejudices. (rant over, as you all were, lol)

Anita, indeed.

The amount of time it takes for your milk to come isn't determined by CS or VB although EITHER birth being stressful can make it harder - more info here from kellymom - kellymom.com/ages/newborn/newborn-concerns/c-section/

I think it is sensible to let women having a CS know any genuine reasons why Bf might be harder initially - some women might need to work out the comfiest nursing position for them, for example. It is worth pointing out that this is also true if you have had bad tearing or an episiotomy with a VB (I have quite a few friends who struggled with BF because of these reasons, and they got much less help and support than I did with a CS, which doesn't seem fair).

But so much info around CS's AND breastfeeding is poorly informed guff. Obviouysly there are variations and exceptions, but milk usually comes in in 2-3 days, it is not longer for a CS unless there are complicating factors (lots of opiate painkillers during a long labour for a EMCS, or baby being taken to NICU straight after birth). 'midwifeEmma' is simply not accurate when she says you can expect milk to take over a week to come in after a planned CS.

FWIW, i Bf'd my DS exclusively after our planned CS. He was healthy, so was I, there was never any need to feed formula.

my tips would be - get skin to skin as soon as you can and keep the baby there with you. I didn't do this in theatre, but you really aren't there very long. As soon as I was in recovery, I stuffed him down the front of my gown, cuddled him, rubbed some colostrum on his lips and he started to root. So I brushed his lip with my nipple and he latched on and that was that. (obvs there is a lot of luck with BF - anyone can have problems but we were lucky enough not to)

Be aware that after a CS you will be stiff and find it hard to move around in the bed, certainly for the first couple of days (actually, wriggling around a bed trying to reach things is harder than standing up and walking, IME). So just keep the baby with you as much as possible and don't let well meaning MWs put the baby in a crib etc where you won't be able to get them yourself. Sure, you can ask someone, but on a busy ward they might not come. And in any case, the more contact the baby has with you early on, the better for BF-ing.

Good luck OP!

Well I had a semi elective cs 10 days ago (was meant to have an elcs today but dd2 decided she didn't fancy sticking to the plan and I started having contractions), and I had an emcs 4 years ago. Both times I bf straight away, I had skin to skin in theatre then bf in recovery. My milk came in on day 3, and I successfully bf dd1 until she self weaned at 11 months and dd2 is feeding well so far.

My bleeding has stopped now, and after a few days it wasn't that heavy. I am surprised it's stopped already, in fact I keep expecting it to restart!

With dd1 it took me days to poo , this time I took some fybogel which got things going.

I was sent home after 30 hours with volterol and paracetamol, which wasn't enough, I sent dh out for co codamol which I took regularly for a few days but I think I last took anything on Thursday.

I was out of bed within 12 hours. A week on I was pretty much able to walk as normal. My scar is itchy now rather than sore.

I intend to drive by 4 weeks as I'm going a bit stir crazy!

Good luck

i should add that when i said definitely increases the time for breast milk to come in, this is just physiologically as oestrogen levels (which block oxytocin and prolactin - hence why you can not use combined oral contraception with breastfeeding) decrease at the end of pregnancy even when the placenta is inside. and these hormones play a part of a role in the start of labour. removing the placenta obviously removes these hormones so this will be the biggest factor in breatsfeedign starting. however oestrogen levels will be lower in a woman who has laboured at term say, compared to a woman having an elective CS at 38-39 weeks, so there are higher levels to clear out of the system, hence sometimes a 1-2 day delay.

having skin to skin ASAP and lots in the first few days and BF on demand and expressing if you wish will decrease the time for your milk to come in.

this is advice i have given to moms i look after in my 6 years in midwifery. some women's milk won't be affected, but i'd say a lot of women do have to wait longer in my experience. but your baby will be fine on your colostrum alone until the milk comes in.

Emma