Friday, 27 May 2011

Caesarean Recovery: Fastest Way To Recover From a Caesarean

Tried and True

After three of my own I wanted to share with you the experience based information that I have leaned about recovering after a caesarean. After my first terrible recovery and upon finding out that I would require another, I thought there has to be a better way. So I began investigating the biggest mistakes that women make (and learned that I had made them all) and why some women recover so much faster than others. It's not fair!

Need a little encouragement? Three weeks after my first caesarean, I was walking through the shops, stooped forwards taking little baby steps. One week after my third caesaren, I was driving my own car to the shops - not recommended and probably illegal, but you see my point. When you are in that amount of pain, the last thing you want is to stay in that amount of pain for a moment longer than you have to.

Before we go on, you need to understand that this info is based on personal experience and you need to discuss your recovery with your nurses and healthcare providers.

My number one piece of advice is to ask your Doctor and each shift of nurses what you can do to speed your recovery. Ask everyone you come across - they will all have different idea's, all based on different experience and by doing so, you will get the whole picture.

Sabotaging Your Recovery
(and what you should be doing instead)

PAIN RELIEF - This may seem obvious but many women try to be martyrs. Some are scared that they will become addicted to the medications when really, you aren't on them long enough to develop a habit. Most hospitals provide morphine or pethidine for the first few days then encourage slow weaning. 

Other women have a bad reaction to the morphine/pethidine that is prescribed - like any medication, it does have a long list of side effects from life endangering allergic reactions to the more common problems like constipation. 

If these drugs don't sit well with you for whatever reasons, there are dozens of alternatives. Most commonly, an epidural can be left in place for the first 48 hours post-op. Some will require you to call the nurse for a top up, others are self administered. No matter what you are offered, make sure you use it! 

Pain is an enormous hindrance to recovery - if you are in pain, you will be scared to move at the risk of more pain. By failing to move, you are putting yourself at risk of blood clots, slowing your recovery and making it harder on yourself than it really has to be. Mobility is a vital key to recovering from your caesarean and you should do all you can to prevent pain from standing in the way of moving.

You may wonder what on earth has Paracetamol have to do with a caesarean and how can it possibly help? Take it anyway. All of these drugs interact together and work in different ways to give you maximum coverage. Like it or not, from a managerial perspective hospitals are a business, they have budgets, they don't like to waste money, they want people to recover and be discharged as early as possible. If Paracetamol didn't work, it wouldn't be offered to every patient post-op.  

 Did you know? When treating any pain you should always begin with mild treatments like Paracetamol or Ibuprofen then build your way up to the stronger medications like Codeine then Morphine. After your recovery, work in
the opposite direction by omitting the strongest painkillers first then until you are left with only the mildest forms of pain relief.

You can discuss your options with your nurses, some will prefer that you ask when you need pain relief, others suggest that you stay ahead of the pain and take it as often as prescribed. I fall in the latter group. If you explain your reasons (that you want to stay ahead of your  pain so that you can become mobile sooner rather than later) and ask for a little note to be made on your med's chart, most hospitals are willing to oblige especially if the note was made by your Doctor.

Many hospitals have a "Pain Patrol" team of Doctor's who visit after your surgery if not every day. These are the people who check that you were adequately covered during your surgery and afterwards. These are also the people who have a brilliant understanding of all of your options so if you are struggling with your reaction  to morphine, they can provide you with alternatives. Be sure to pick their brains - learn your options and discuss a schedule.

EARLY MOBILITY - This is possibly the most important thing you will learn today so listen carefully. The longer you postpone movement, the longer your recovery will take. I have heard of women who have been forced out of bed within hours of their caesarean (because of their epidural headaches) so it is possible.

This sort of exercise should be done
early (day 2) and done often. 
Your nurse will actually have a bit of schedule for you to follow. Day one - bed rest. Day two, catheter comes out, shower, toilet. Day three - Take the epidural out. Encourage a more active role in caring for baby, (bathing, changing etc) Get mum walking further and so on. 

However, this schedule is based on the average woman - the way you cope with and feel pain is nothing like the way I dealt with or felt it nor is it like the next woman's way of coping with it. 

So what's the solution? You have to tune into your body and push it to the point of near pain...and just a little bit further. If you stay ahead of your pain (with your medication) you will feel more tenderness and awkwardness rather than real "OMG I can't move" pain. Don't get me wrong - on a scale of 1-10 many women say that day 2 post-caesarean is about a 12. You will hurt but if you manage the pain properly it should have a minimal effect on your movement as long as you move slowly

The longer you stay inactive the higher the risk of developing blood clots. And have you ever broken a bone? Remember how funny your limb felt when you finally got the cast off? It takes a long time to recover normal movement after that, doesn't it? After a caesarean there's a lot of lying still.

You can avoid that feeling by moving your toes and feet as soon as you can feel them again after surgery and as often as you remember. Try rotating your feet and stretching your ankles. Wiggle your toes. Take as deeper breath as you can comfortably muster (good for several reasons). The next morning, your nurse is going to come for you and she is going to get you in the shower - like it or not. If you haven't wiggled your toes since before your spinal anesthetic then you are going to have trouble with this. If you have been wiggling your feet and trying to move your knees in bed, then you are going to be fine - sore, dizzy, a little scared but fine.

PHYSIO - Physio also begins on day two. The trick here is to do it slowly and accurately. As an example, one exercise involves lying flat, legs bent with your feet flat on the bed and slowly rocking your knees one way then the other. You can do this the day after your caesarean. They recommend you do this a few times a day. Do it more. Do it as often as you remember.
Gently try lifting your bum off the bed and rearrange yourself slightly (day two)
Breastfeeding is awkward because it means rolling onto your side. It seems impossible the first time but know that hundreds of women have been before you and haven't fallen apart at the seems - pardon the pun. Support yourself with pillows and flex your legs. When you're lying in bed, try lifting your bum off the bed to straighten yourself out and lie flat again.

Focus on your technique as you do your physio, there's no point doing it if you're not going to do it properly. Never mind about how long it takes or how far  you can bend, cocentrate on recovering a normal sense of movement.

Tune into your body, take it slowly and (here's the secret again) push your self to the point where it starts being a little painful and (very slowly) just a little bit farther. Each time you do this, that point of pain will be a little further and you can push yourself a little more.

This is what gave me the confidence (or the sheer stupidity) to get behind the wheel after only eight days. The first time around, I was barely able to get in and out of bed by myself after eight days!
Post Caesarean exercise doesn't have to be strenuous.
Concentrate on technique and recovering normal movement

As for exercise itself (in the traditional meaning of the word) you should wait six to eight weeks before checking with your Doctor if you are ready to hit the gym again. There are some rules you will have to follow and a very important (case by case) "walk before you run" conversation that I'm not qualified to give.

REST - Despite everything I have just told you...


Rest is critical to your recovery. You are under strict instructions to avoid lifting anything over 3kg (or heavier than your baby) for the following six weeks. This is not a suggestion, it's an order. 

Think about this, you actually have a legitimate medical excuse (and they don't come by everyday) to use and abuse every offer of help for the next six weeks. That means you can send hubby shopping for groceries, you can get your neighbour to wash your toilet or straighten out your bathroom and you have a real reason to totally ignore the dishes and neglect the vacuuming! How great is that?

If however you have older children, you will find this instruction downright frustrating - what with prams, nappy bags, baskets full of laundry and all the other mommy jobs, you will also find it downright impossible
One word made me stop and take stock of myself - hernia. Yes, it's hard but now is the time to think outside the square. Do you really have to pick up the two year old? Or can he sit on your knee and have a cuddle? 
Is there a passerby you could ask to lift the pram in or out of the car? Can you call on your older child be your best helper and carry (drag) the nappy bag into the house?

Pushing yourself to fast to far will hinder your recovery and be the undoing of all your hard work.

Did you know? When you are exercising it is actually during the rest period between rep's that your body is burning calories and building muscles. Rest is the vital stage that is often overlooked.

OVERCOMING FEAR - Fear is one of the biggest causes of a slow recovery - it interferes with you motivation to recover. It will comfort you to talk with one of your nice nurses (because there always seems to be one that has very little patience or sympathy for you) about your specific fears. I think most womens biggest concern is tearing the wound open again. As long as you move slowly this isn't a problem - you can feel the point where it begins to hurt and you stop, it's that easy. 

Of course you do hear the horror stories but you rarely hear about the other accompanying conditions or circumstances. You never hear about the infections they also had at the time or the fact that they were on one medication or another that doesn't apply to you. I also have an unconfirmed sneaking suspicion that some of these stories are aided further along the grapevine by well meaning nurses trying to get overactive mothers to sow down and take care of themselves - would love to hear your thoughts.

Many women also fear getting pregnant again because traditionally, if you had one caesarean you could kiss goodbye to the idea of ever having another vaginal birth. Would it comfort you to know that thousands of VBAC (Vaginal Birth After Caesarean) babies are born every year. To find out if you will be eligible for VBAC you will need to discuss the subject with your OB. 

The vast majority of caesarean's are brought about because of one off circumstances (breech babies, fetal distress, labour not progressing normally) and providing those circumstances don't present in the next pregnancy there is no reason you can't have a trial of labour followed by a VBAC.

I sincerely wish you a speedy recovery after your caesarean. Be sure to add your tips and experiences below, I always love hearing about them. Good luck!!

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